Generalized Anxiety Disorder

By: Dana Arenas

Dental Hygiene III
Kirkwood Community College

Generalized anxiety disorder (GAD) is a psychological disorder. It is characterized by

excessive or disproportionate anxiety about many parts of life such as; work, relationships, and
finances. GAD is diagnosed by extreme worrying for 6 months or more. Everyone has some
stress or anxiety but for people with GAD it often controls their life. People with GAD cannot
relax, may startle easily, and have difficulty concentrating. Other problems include difficulty
falling asleep or staying asleep. Physical symptoms can include; fatigue, headaches, muscle
tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea,
lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.
Patients may have one or two of these physical symptoms or all. Symptoms vary from person to
person.
It was not until the 1980s that anxiety disorders were recognized by the American
Psychiatric Association. Generalized anxiety disorder is a progressive disorder that typically
begins during teenage years or young adulthood and gets progressively worse. The average age a
patient is diagnosed is 31. Symptoms can come and go and stress usually makes the symptoms
worse. People with mild GAD can live normal lives but if they have severe anxiety ordinary
daily tasks can be extremely difficult. Generalized anxiety disorder affects about 3% of
Americans age 18 and older and affects twice as many women as men. GAD can run in families
but scientists are unsure why, it is unknown if GAD is passed on by genetics or if it is more of a
learned behavioral disorder. For many people GAD may be a life-long problem but that is not
always the case. For some, there may be a time in life that is more stressful and the disorder may
only be for that period in life. There are ways to help prevent GAD such as exercising, eating a
balanced diet, and not consuming coffee. Alcohol abuse can also make this disorder worse.

There are different treatments for generalized anxiety disorder. There are many different
medications categorized as anti-anxiety or anti-depressants that are successful in treating this
disorder. Medications are often trial and error based. Patients may have to try several different
medications before finding one that works for best for them. Patients often describe feeling
normal after starting medication regimen because they are able to live without the incessant
worrying. As with any medication there are many possible side effects. Benzodiazepines, one
type of anti-anxiety medications, have common side effects such as; drowsiness, slurred speech,
confusion, depression, dizziness, impaired thinking, memory loss, nausea, and blurred vision.
Antidepressant medications often used for anxiety also have common side effects such as;
nausea, nervousness, headaches, sleepiness, and weight gain. Unfortunately, antidepressants can
actually have the opposite and a huge risk of taking antidepressants is the suicidal thoughts.
Patients should contact their physician immediately with if there are any suicidal thoughts.
Psychotherapy is another possible treatment. Some doctors may want the patient to try this
therapy first before treating with medications. During psychotherapy (counseling) the emotional
response to stress is discussed and the therapist help with strategies to deal with the symptoms.
There is also cognitive-behavioral therapy used to treat GAD. This therapy is used to help the
patient change their way of thinking and therefore lesson the symptoms of the disorder. All of
these treatments can be successful but a combination of treatments may be the best course of
action. There is no cure for generalized anxiety disorder. The goal is to reduce the symptoms
enough so the patient can function in normal daily activities.
Generalized anxiety disorder does not directly have an effect on the oral cavity. People with
GAD do not have specific problems with oral home care. However, certain medications taken to
relieve anxiety may cause oral problems such as xerostomia. Not all patients on anxiety

medications will have xerostomia but that side effect usually does not bother the patient much
and the benefit of taking the medication greatly outweighs this side effect. A greater dental
concern for patients with GAD is just getting to the dental clinic. Many people without GAD
have anxiety with seeing the dentist so this can be a bigger problem for someone that has daily
anxiety issues. A dental clinic should be prepared to see people with GAD and dental anxiety in
general. The staff should be welcoming and the dental hygienist should discuss with the patient
how they are feeling. The dental staff should also be aware of physical signs of anxiety such as
sweating, nausea, hyperventilation, etc. Getting to know your patients is one of the best things
that can be done to help a patient with GAD during the dental appointment. If the patient has
increased anxiety due to the fear of pain during the dental visit the dentist or dental hygienist can
offer some form of anesthesia. Having patients use non-verbal cues such as raising a hand during
treatment may help them feel more in control and possibly lessen anxiety. A longer appointment
time may be necessary because a patient with extreme anxiety should not be rushed through an
appointment. Taking breaks during treatment so the patient can calm down may also be effective.
Distractions such as movies, music, or even talking to the patient about something other than
dental work can help calm the patient and lessen anxiety. There are many techniques that can be
used in the dental office that can help patients with GAD get through their appointments.
Generalized anxiety disorder can be a serious debilitating problem. GAD can happen to
anyone at any point in life. There are several treatment options to help with the symptoms of
GAD but there is no cure. Anxiety can pose a serious problem with patients keeping their dental
appointments but fortunately there are many ways dental staff can help patients cope with
anxiety.

WORKS CITED
Dimensions of Dental Hygiene. June 2005;3(6):40-41.
Generalized Anxiety Disorder (GAD). (n.d.). Retrieved June 27, 2015, from
http://www.nimh.nih.gov/health/topics/generalized-anxiety-disorder-gad/index.shtml
Wilkins, E., & Wyche, C. (2013). The patient with a psychiatric disorder. In Clinical practice of
the dental hygienist (11th ed., pp. 959-961).