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Are you anxious about your anxious patients?

Dec. 5, 2022
All DPs have had their share of patients with dental anxiety. Your ability to show empathy and communicate well will directly determine your success in treating these patients. Here are some helpful tips.

It can be difficult treating patients with dentophobia, but we all have the power to help these anxious individuals with compassion and care. In doing so, hopefully we can change their perspective and help them overcome at least some of their fears!

It’s Monday morning, and you are exhausted. Still, you pull yourself up by your loupe straps and arrive at the office with Starbucks in hand. I’m going to crush this day! you hesitantly say to yourself as you pull up the schedule and scan through your workday. There it is. The very first patient after lunch. The one who needs nitrous and topical, needs to sit up and rinse out constantly, and can’t even look at your Cavitron. It’s Mr. or Mrs. Dentophobe.

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We’ve all been there, haven’t we? We see the patient’s name, read the notes from the previous visit, and dread what’s to come. Why do we feel such apprehension toward patients who have dental anxiety? Why are we anxious over our anxious dental patients?

Dentophobia is a condition in which an individual is genuinely fearful or anxious regarding dental treatment. Dental anxiety can come from a multitude of origins—perhaps a traumatic experience, a vicarious development during childhood from a family member’s experience, feeling lack of control in that specific environment, or simply a lack of education surrounding dental treatment.1,2 So, how do we manage our own attitudes toward these patients?

Examine your mindset

Many anxious and dentophobic patients are acutely aware of their surroundings and how they are treated by each staff member they encounter. Chances are, they’re in a fight-or-flight mode on some level. Our attitude toward these patients could potentially be perceived as soon as we open the reception room door and call them in.

Understanding dentophobia is crucial in treating these patients, young and old, with compassion and empathy. Isn’t it our goal as dental health-care professionals to treat our patients to the best of our ability to preserve their oral health and, more importantly, their overall health? Unfortunately, some people are absolutely terrified of stepping foot inside a dental office. Can we try to remind ourselves that they are stepping outside their comfort zones because they know they need the treatment? We need to remember that they are coming to us for help; they don’t need judgment, guilt-tripping, or scolding. So, what exactly are our fearful patients feeling and thinking?

Patient psychology

One source says that as much as 36% of the population has dental anxiety, while 12% suffer from extreme dental phobia leading to avoidance of treatment.3 Much of this anxiety and fear can be attributed to anticipatory fear of the unknown and what’s to come.

Another study focused on how patients recalled their pain during dental treatment compared to their anticipated and experienced pain. It was found that there was a closer association between remembered and expected pain, compared to remembered versus experienced pain.3 In other words, the patient remembers the pain as being worse than it actually was.

No doubt, this can be detrimental to anxious dental patients who need treatment, especially since dental treatment generally gets more painful and more expensive the longer treatment is postponed. Patients are then forced to visit a dentist for therapy, which can often exacerbate their fear and lead to future avoidance of treatment.1

This demonstrates how important it is to stress to new parents that they bring their babies, toddlers, and children into the dental office as early as possible while there are no major problems to deal with. The more positive experiences a child has, particularly with preventive treatment, the less chance there will be of them developing dental anxiety. Identifying patients with dental phobia early on can significantly aid in treating them effectively and positively affect their quality of life in the future. One of the most important questions is, how do we treat our anxious patients with compassion, empathy, and kindness?

Tips on treating anxious children and adults

Do your utmost to treat anxious dental patients with empathy. I often try to think of the patient as one of my close family members. This should hopefully tug on your heartstrings a little to treat that patient even more gently and kindly. If it’s a new patient to the practice or a patient you haven’t treated before, take a few minutes at the beginning of the appointment to ascertain their fears and concerns. This can go a long way in forming and maintaining a trusting bond with your patients.

Use good eye contact and active listening (e.g., head nods, short replies and/or questions to demonstrate that you’re listening, brief and light physical contact). The tell-show-do technique helps calm and ground patients of all ages. We’re familiar with this technique in pediatrics, but it can also benefit patients with autism spectrum disorder or those with learning disabilities.

If a patient struggles with not being in control, encourage them to hold the saliva ejector and use it when they need to and instruct them to raise a hand if they need a break. In severely phobic patients, using the counting method can be beneficial so they have a clear time frame to focus on while a certain instrument is being used or procedure is being completed.

You can encourage patients to bring earbuds or headphones to their appointment so they can listen to calming music or a podcast (quietly, of course, so they can still respond to you). And even just physically moving slower during a procedure can help keep a patient calm. A rushed clinician is a clumsy and forgetful clinician! Patients pick up on that hurried and stressful energy. You could even try turning out the lights or using aromatherapy (all with the patient’s permission).

One clinical trial engaging 20 healthy participants “assessed autonomic parameters such as blood pressure, heart rate, respiratory rate, and skin temperature to determine the arousal level of the autonomic nervous system.4 The results revealed that lavender oil caused significant decreases of blood pressure, heart rate, and skin temperature, which indicated a decrease of autonomic arousal.” Speaking with your doctor about using aromatherapy in your practice could be an inexpensive, easily obtainable, and simple way to reduce anxiety in your patients.

Treatment is never one-size-fits-all. But treating anxious patients in a way that allows them to feel calm, grounded, and in control is directly determined by your ability to communicate and empathize. I hope these tips make you less anxious too!

Editor’s note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.

References

  1. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35-50. doi:10.2147/CCIDE.S63626
  2. Heidari E, Newton JT, Banerjee A. Minimum intervention oral healthcare for people with dental phobia: a patient management pathway. Br Dent J. 2020;229(7):417-424. doi:10.1038/s41415-020-2178-2
  3. Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295-301. doi:10.1159/000357223
  4. Sayorwan W, Siripornpanich V, Piriyapunyaporn T, Hongratanaworakit T, Kotchabhakdi N, Ruangrungsi N. The effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity. J Med Assoc Thai. 2012;95(4):598-606.