The patient sat in the chair shivering before we had even started. Her arms were crossed tightly and her body was rigid, visibly trembling. We had not picked up a single instrument. Nothing painful had happened. Yet a quiet room and a gentle tone had done little to ease her fear. Someone said what dental professionals often say in that moment: “Relax.” She could not.

Working chairside, I have learned that “just relax” is almost never said unkindly. It comes from a genuine desire to reassure the patient and reduce the tension in the room. We want the patient to know that what is about to happen may not be as frightening as they imagine.

But the instruction itself gives a frightened patient very little to work with.

Relaxation is not something every patient can switch on simply because we ask them to. That morning, this patient did not feel safe yet. Years earlier, she had undergone a painful childhood extraction that she still remembered. I know that because I asked her.

What happens when we ask

I sat beside her and asked what was worrying her most. She told me about her previous dental experience. She remembered pain she had not expected and the feeling that she had no way to stop what was happening. Her behavior in the chair began to make more sense. Instead of assuming that reassurance alone would settle her, we now understood something about the experience behind her fear. She did not simply need to be told that everything would be fine. She needed to know that this appointment did not have to feel like the one she remembered.

Two patients may appear equally frightened for different reasons. One may be anticipating pain because of a previous experience, while another may be worried because they do not understand what is about to happen. Asking what is worrying the patient helps the dental team respond to the concern in front of them.

Giving the patient a way to stop

Before treatment began, the dental team agreed on a hand signal with the patient. If she raised her hand at any point, we would stop. She could take a moment, ask a question, or indicate that she needed a break before we continued. During the procedure, she raised her hand once. We stopped.

After a few seconds, she indicated that she was ready, and treatment continued.

It was a small but important moment. We had told her she could ask us to stop, and when she tested that promise, it worked. Because she had described a previous experience in which she felt unable to stop what was happening, responding immediately to her signal showed that this appointment could be different.

A stop signal is simple, but its value depends on what happens after it is established. If we tell a patient that they can signal for a pause, we must also respond when they use it. Ignoring the signal could undermine the trust it was intended to build.

A study involving 60 patients experiencing dental anxiety found a greater reduction in reported anxiety among those who used an electronic patient-dentist communication system during root canal treatment than among those who received routine care.¹ Although a hand signal is much simpler, the underlying principle is similar: the patient has a way to communicate when speaking is difficult.

The dental assistant’s opportunity to notice

Not every patient needs the same response. One may need more information, another may need quiet, and someone else may find a brief conversation helpful. The important part is paying attention. Dental assistants may be well positioned to notice these differences because of the time we spend beside patients before, during, and after treatment. We may notice someone becoming unusually quiet, asking the same question again or tensing as treatment approaches.

A brief conversation before treatment can create an opportunity for the patient to mention something they may not have volunteered otherwise. Checking in at appropriate points during the appointment can also remind the patient that communication has not stopped simply because treatment has begun. We do not have to diagnose the reason for the anxiety. We can notice the change, listen to the patient, and communicate relevant concerns to the clinician.

What can we offer instead?

There is nothing inherently dismissive about asking a patient to relax. The intention is usually to reassure them. The problem is that the words alone may not address what that particular patient needs.

For the woman in our chair, understanding the experience behind her fear helped the dental team respond more appropriately. The hand signal then gave her a practical way to communicate during treatment. Another patient may need a different response.

The woman who arrived shivering completed her treatment and booked another appointment before she left. I cannot attribute that outcome to one sentence or one technique. What changed was that the dental team understood what frightened the patient and responded with something more useful than a request to relax. Before asking, “How do we get this patient to relax?” it may be more useful to ask, “What is making this patient afraid?”

More about dental anxiety: Airway resistance and dental anxiety: What dental hygienists need to know

Reference

1. Singh H, Meshram GK, Warhadpande MM, Kapoor P. Effect of “perceived control” in management of anxious patients undergoing endodontic therapy by use of an electronic communication system. J Conserv Dent. 2012;15(1):51-55. doi:10.4103/0972-0707.92607