Needle Phobia Management — ORE Part 1 MCQ

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ModerateBehavioural Sciences & EthicsNeedle Phobia ManagementORE Part 1

A medically fit adult with severe needle phobia requires several restorations. They refuse conventional local-anaesthetic injections but wish to proceed with treatment. Which approach is most appropriate?

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Correct answer: A — Use topical anaesthetic and a computer-controlled delivery system, with intranasal sedation if needed

Explanation lettering: E = shown as D · D = shown as E

A is correct. Management should be proportionate and should address the barrier to local anaesthesia while maintaining effective analgesia. Topical anaesthetic and a computer-controlled local-anaesthetic delivery device can reduce discomfort associated with injection; SDCEP describes The Wand as delivering solution at a constant slow rate. If anxiety prevents acceptance of local anaesthesia, appropriately delivered intranasal sedation may reduce fear and facilitate subsequent local anaesthesia. General anaesthesia is not first-line solely for needle phobia in a medically fit adult; referral may be considered only after assessment when less invasive measures are unsuitable or unsuccessful. Treatment without adequate analgesia is unacceptable. Hypnosis and acupuncture may be adjuncts for anxiety or pain coping in selected patients, but neither is a reliable sole analgesic for multiple restorations.

Reference: Scottish Dental Clinical Effectiveness Programme (SDCEP), Conscious Sedation in Dentistry, 2025: https://www.sdcep.org.uk/media/iegenn4c/sdcep-conscious-sedation-guidance.pdf