title: Needle phobia: etiology, adverse consequences, and patient management.
abstract: Needle phobia has profound health, dental, societal, and legal implications, and severe psychological, social, and physiologic consequences. There is genetic evidence for the physiologic response to needle puncture, and a significant familial psychological component, showing evidence of inheritance. Needle phobia is also a learned behavior. The dental practitioner must recognize patients with needle phobia before the administration of local anesthetics to identify patients who are potentially reactive and to prevent untoward sequelae. Needle phobia is highly associated with avoidance behavior, and the dentist must exhibit compassion and respect. To avoid bradycardia, hypotension, unconsciousness, convulsions, and possibly asystole, oral premedication with benzodiazepines or other antianxiety agents must be considered for patients who are needle phobic. Management of needle phobiaeinduced syncope includes perioperative monitoring, oxygen administration, positioning, atropine, and vasopressors.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA 15261, USA. chs120@pitt.edu
authors.forename: Chester J
authors.initials: CJ
authors.lastname: Sokolowski
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Giovannitti
authors.forename: Sean G
authors.initials: SG
authors.lastname: Boynes
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy; D016854:Dental Anxiety / Q000209:etiology* / Q000517:prevention & control; D003887:Desensitization, Psychologic; D004562:Electrocardiography; D004569:Electroencephalography; D006801:Humans; D009339:Needles / Q000009:adverse effects*; D010698:Phobic Disorders / Q000150:complications / Q000209:etiology* / Q000235:genetics / Q000517:prevention & control; D011229:Preanesthetic Medication; D019462:Syncope, Vasovagal / Q000209:etiology* / Q000517:prevention & control; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000779:Anesthetics, Local; D014151:Anti-Anxiety Agents; D014662:Vasoconstrictor Agents