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Dental Anxiety

Feb. 1, 2005
Reverse the negative neurochemistry that causes -

Reverse the negative neurochemistry that causes …

"It’s not you I dislike - it’s just being here."

How many times have our patients told us this? As dental practitioners, we know this could be a difficult patient.

The dental office can create some stressful situations. Some practices even specialize in treating anxious patients. With the economy, traffic, and threat of terrorism, it’s important to know what we can control, what we can influence, and what is out of our ability to manage.

Learning the tools of stress management is not only good for the office, but can have dramatic benefits for one’s personal life as well. A less stressful office can make an appointment more comfortable for both patients and staff.

For many people, anxiety is common. Effects can range from minimal to disastrous. The brain releases neurochemicals in reaction to stressors, and this leads to anxiety. It is so common in the dental profession that it negatively impacts the whole experience for many patients.

The brain’s hypothalamus gland is responsible for maintaining homeostasis, our internal stability. It is incredibly sensitive to the psychological and spiritual state of our bodies. When fear is perceived, the hypothalamus - which transfers thought into chemistry - goes into action. It does this by secreting the hormone Cortisol Releasing Factor, or CRF, which causes 20 other hormones and neurotransmitters to be released in the body. These hormones affect just about every organ system in the body. CRF stimulates the release of hormones like epinephrine (adrenaline), norepinephrine (catecolamines), and cortisol (hydrocortisone). The fight-or-flight reaction occurs when a real or perceived danger is imminent. This leads to a series of reactions in the blood vessels such as muscle contractions, which give the energy to fight or flight. However, when the enemy is within - such as dental fear - people enter the resistance stage. When this occurs often, diseases such as hypertension, stroke, coronary artery disease, or immunosuppression can occur.

As concerned dental professionals, we should be aware of our patients’ obvious signs of anxiety. These can be sweating, changes in body posture, avoidance of eye contact, or agitation. When you shake the patient’s hand, feel for sweaty hands, cold hands, firmness of grip, or lack of concentration. The patient’s medical and dental history may reveal stress and anxiety, which may include medical treatment and medications, previous negative dental experiences, or infrequent visits to the dentist. The way you deal with this situation will impact the success of treatment, the professional-patient relationship, and the ability of the patient to accept your treatment recommendations.

Most people don’t realize they have control over neurochemicals released by their brains. However, numerous studies show that we do. As professionals, we can use the appropriate tools to reverse the effects of negative neurochemicals. Remember, stress can lead to anxiety, which results in neurochemical changes.

Following these procedures may be critical in detecting and assisting anxious patients. Recognize signs and symptoms of stress and anxiety before a situation calls for crisis intervention. Failing to recognize a difficult patient may compromise the patient-professional relationship. Calm patients are more likely to cooperate, accept extensive treatment, and return for regular visits. An anxious mind is a closed mind, while a calm mind is open to trust and suggestions.

Stress reduction in the dental setting is important for improving your practice and your personal life. Embracing these techniques will change your attitude and help you enjoy life and your chosen profession.

6 Ways to Decrease Stress

Send pre-initial visit packets to patients before they visit your office. These packets should calm patients with reassuring and welcoming materials. Packets should also contain information about your office philosophy and goals for patients’ well-being.

Manage patients’ senses. Upon entering your office, patients could be soothed with aromatic smells, pleasant sights, and relaxing sounds.

Friendly, engaging office staff can greet patients and welcome them to the practice.

Before treatment, a sensitive, attentive practitioner may use a technique called “anchoring,” a physical technique from Neuro Linguistic Programming, or NLP. This incorporates the five senses by inducing a positive release of endorphin and serotonin - the hormones that counteract negative effects of catecolamines and cortisol - and produces euphoria and a sense of well-being. The technique sends the chemicals along the same pathways where previously ingrained, negative images and chemicals had prevailed. It’s similar to Pavlov’s conditioning response in dogs. With training, it can be accomplished within 10 to 15 minutes in the dental office. During each visit, the patient may be taken quickly back to calm relaxation by “ringing his bell.”

Researchers have developed innovative verbal strategies professionals may use to change the state of being in their own nervous system, as well as those of their patients. Language can reduce anxiety. Each word can call up a stored neurological representation, similar to a file name in a computer. The same words can have different meanings to different patients. This depends on the content of their “file,” and each person’s content is determined by events in their lives. As dental practitioners, we want to carefully choose our words to promote a calm, healthy state of being. Now that we know the power of words, let’s examine how a question can be one of the most powerful patterns of language.

Questions are essential to:

- redirect a person’s focus

- create new options

- make arguments discussions

- clarify what a person wants.

Learning to ask the correct questions complements the “anchoring” technique.

Compartmentalization is a technique especially appropriate for dental professionals, who tend to micromanage their surroundings.

Imagine an 8-by-8 wall. Imbedded into this wall is a series of 2-by-2 drawers. Each drawer is labeled and represents personal anxieties such as wife, husband, IRS, front tire that’s low, office overhead, handling a difficult patient, mother, the war in Iraq, etc.

Imagine putting these troublesome topics in the appropriate drawers and slamming them shut. Imagine slamming them, hearing the sound, feeling the shuddering wall, and seeing them tightly closed. Now you can open up any drawer, take out the problem anytime, and deal with it.

If you’re working on a patient and your mind is trying to deal with the IRS and prep a clean margin, you’re doing a disservice to the problem and the patient. Put the IRS in its drawer and direct your full attention to the patient. You will both be happy, and patients might refer others to your practice.

Compartmentalization helps you focus your energies on one problem at a time. You won’t avoid problems, but manage them more efficiently.

Any time your mind starts to juggle many problems at once, open a drawer, throw the extra problem into it, and slam it shut. Your anxiety level will decrease when you focus on one thing at a time. Try it. It works.

Ronny Charin, RDH, BS
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Mrs. Charin specializes in advanced periodontal therapy and anxiety reduction. She is an adjunct clinical instructor at Nova Southeastern University College of Dental Medicine. Reach her at (954) 473-1526 or [email protected].

Dennis Price, LMT, AS
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Price became a certified NLP (neuro-linguistic programming practitioner) in 1989 and has been a trainer with Anthony Robbins’ Life Mastery University for 12 years. He has a private practice in Fort Lauderdale, Fla. Reach him at [email protected].