Nearly 19% of the US population is thought to struggle with moderate to high levels of dental anxiety.[i] Unfortunately, this condition that can lead to avoiding dental treatment for long periods of time, resulting in more significant treatment being required when they eventually do make an appointment.[ii] A good chairside manner is, of course, a great help, but there are some other specific steps that may assist you with anxious patients.
People tend to fear the unknown, and it can leave their imagination running wild. By carefully and clearly explaining your treatment plan to the patient, their understanding will improve, and their anxiety can be reduced. Please note that it is important to avoid making the patient feel guilty for being anxious, as this can intensify patient anxiety.[iii] Instead, encourage questions to help prompt patients to speak up.
Dental anxiety can stem from many different causes and patients may be triggered by several different stimuli. There are many different sensations that can cause distress for certain patients, such as activation of their gag reflex or feeling that they will inhale fluid.
For some, hemophobia, or blood phobia, rather than a specific dental phobia is the primary problem when it comes to treatment.[iv] In these cases, try to minimize the amount of blood that is visual to the patient. Everyone is different, therefore discovering which triggers may affect your patients is essential to alleviating the stressors of the appointment.
Music or even a familiar voice can be very therapeutic. Offering the opportunity for a patient to bring their own music can help them relax as well. Some may prefer podcasts or audiobooks, so let them know those are options too—though the intermittent sound may be less effective at masking the sounds of dental surgery. The act of letting the patient choose their own music selection gives a sense of empowerment, as patients can sometimes feel powerless during treatment. In addition, the small act can allow them to focus on something else while you’re performing any necessary treatment.
Providing a distraction is the key. Similar to music, having a television for patients to watch can be an effective distraction as well.
With any anxiety, waiting can intensify fear and worry due to the person having idle time and becoming preoccupied with their concerns.[v] In this case, you may want to recommend an early appointment or suggest the patient arrive very shortly before it. This may not always be feasible but reducing the amount of wait time for the patient may help mitigate their anxiety. Sitting in a waiting room can also lead to the patient imagining distressing images and scenarios if they can hear noises, such as drilling tools. As a resolution, suggest the patient wear headphones as they wait to help filter out any noises.
Treating those with severe dental anxiety
The overwhelming fear of dentistry is called Odontophobia and is recognized as a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). When a patient is unable to manage their feelings of dental anxiety, they may be receptive to seeking psychological help. Cognitive behavioral therapy is highly regarded as a treatment for those dealing with phobias.[vi] This treatment option isn’t a quick fix, so making this recommendation long before significant dental interventions is optimal.
For exceptionally nervous patients, sedating or referring them to a sedation clinic may be an option for treatment.
In some circumstances, better-tolerated treatment options may be available. One example of this would be the use of an intraoral scanner instead of conventional impression taking material. While conventional impressions have their advantages, your patient may have anxiety about choking over dental material or the unpleasant taste it presents.
Intraoral scanners will enable you to carry out scans in considerably less time than conventional impression taking.[vii] It spares your patient the discomfort of dental impression material and keeps the appointment as brief and unobtrusive as possible.
Dental fear exists on a spectrum. For many, it is manageable with a little help and consideration; for others, it may require more significant efforts. By understanding your patients’ psychological needs and having modern tools that cause the least amount of stress, you will be better equipped to help your patients. By reducing the amount of dental fear in patients, you will begin to see regular attendance and can administer preventive treatment earlier on.
[i] White, A., Giblin, L., Hill K., Boyd,L. The prevalence of dental anxiety in dental practice settings. JDH: Journal of Dental Hygiene. 2017; 91 (1) 30-34. Available at https://jdh.adha.org/content/91/1/30 Accessed September 10, 2018.
[ii] Armfield J., Stewart J., Spencer A. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health. 2007; 7(1): e1. Available at https://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-7-1 Accessed July 12, 2018.
[iii] Hmud R., Walsh L. Dental anxiety: causes, complications and management approaches. International Dentistry SA. 2007; 9(5): 6-14. Available at http://www.moderndentistrymedia.com/sept_oct2007/hmud.pdf Accessed July 12, 2018.
[iv] Van Houtem C., Aartman I., Boomsma D., Ligthart L., Visscher C., Jongh A. Is dental phobia a blood-injection-injury phobia? Depression and Anxiety. 2014; 31(12): 1-9. Available at https://www.researchgate.net/publication/255986684_Is_dental_phobia_a_blood-injection-injury_phobia Accessed July 12, 2018.
[v] Biddiss E., McPherson A., Knibbe T. The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces. Anesthesia & Analgesia. 2014; 119(2): 433-448. Available at https://www.researchgate.net/publication/263294228_The_Effectiveness_of_Interventions_Aimed_at_Reducing_Anxiety_in_Health_Care_Waiting_Spaces Accessed July 12, 2018.
[vi] Appukuttan D. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, Cosmetic and Investigational. 2016; 8: 35-50. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790493/ Accessed July 12, 2018.
[vii] Patzelt S. The time efficiency of intraoral scanners an in vitro comparative study. The Journal of the American Dental Association. 2014; 145(6): 542-551. Available at https://jada.ada.org/article/S0002-8177(14)60113-6/pdf Accessed July 5, 2018.