Being scared of the dentist is a common reason as to why people avoid going to the dentist. Dental anxiety or dental phobia is an everyday occurrence for dentists to deal with as not only does it not allow the dentist to check the patient and do their job, but it is an unpleasant feeling for a patient. This equally makes it stressful for the dentist as they are trying to take measures in making sure your teeth are in the greatest shape and health.
It is no surprise that most dentists do not enjoy treating patients who are very scared of the dentist.
At our practice, we are geared in fully dealing with patients who have dental anxiety or dental phobias. We see patients who are scared of the dentist on a daily basis and we have an almost 100% success rate in reducing their fear of dentists.
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Fear of the dentist becomes a vicious circle because patients will avoid seeing the dentist until a problem occurs. When a dental emergency does occur, they are already excessively nervous and usually, the procedures that are needed for them to be taken out of pain, are quite involved and not the most pleasant for the patient or the dentist.
The patient in an emergency will see the first dentist that they can get an appointment with, and who may not be the best equipped to deal with nervous patients. These patients are often “squeezed” in an already full appointment diary so coupled with the fact that the dentist is already rushed, is a perfect scenario to push the nervous patient over the steep edge of nerves and panic. The nervous patient then has another bad experience which reinforces all their previous beliefs about dentistry. They then avoid seeing the dentist again until the next emergency episode strikes. Quite often, they will say to the dentist, “ Just pull the damn tooth out,” rather than trying to have it saved.
Being scared of the dentist is a broad spectrum from having mild anxiety to having a severe phobia of the dentist. Patients who have a severe phobia of the dentist have been known to carry out their own extractions in a desperate attempt to avoid dentists. This usually subjects into more problems for the patient in the long run.
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Patients who are scared of the dentist usually have worse oral hygiene, more gum disease and more tooth infections than patients to attend regularly Without Fear. This is where we would like to make a change. Even before a patient has set foot inside our dental practice, we use techniques on the phone which reduce dental fears.
The first appointment is absolutely crucial and quite often it is the non-verbal clues from the patient that gives us a good indication as to the problem that the patient faces in having dental treatment.
Management of dental anxiety or dental phobia can fall into two broad categories
The first category involves around psychotherapeutic treatment which includes behavioural management and cognitive orientation change. Cognitive therapy revolves around restructuring negative thoughts.
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Pharmacological techniques is the second category and can be broken down into oral sedation, sedation and general anaesthetic. At our practice, we are so successful in the management of dental anxiety that we hardly ever need to use the pharmacological techniques.
Behavioural techniques to manage dental anxiety
There are many behavioural techniques for patients who are scared of the dentist and a skilled dentist will use more than one combination that suits each patient individually.
These techniques include:
- Muscle relaxation
- Breathing techniques
- Guided imagery
- Positive reinforcement
What is dental anxiety?
Dental anxiety is the unpleasant emotional state around visiting a dentist before the actual event of doing a checkup or anything else has actually taken place.
Although some anxiety is normal before visiting a dentist, it is the excessive anxiety which puts the patient into a disadvantageous emotional state. Hence known as dental anxiety. As a result, the night before a dental appointment, they will be turning in their sleep and going through in their mind all sorts of unpleasant images and events even though the dental appointment has not even yet taken place.
Dental phobia is an unrealistic fear of dental treatment. Therefore if a patient has a phobia of blood, they will have images in their mind that their mouth will bleed so much that it will not stop.
The problem with treating patients with dental anxiety or phobia is that they have an increased sensitivity to pain. In fact, they perceive pain even when nothing has even taken place.
What is the cause of dental anxiety?
Fear of the dentist can be due to childhood trauma or previous bad experiences. It may even be related to seeing a family member having an unpleasant dental experience or being told about this verbally. Media could also be a contributory factor such as seeing a film or reading about an unpleasant dental appointment.
For patients who have had a bad experience, they will usually remember the sights, the sounds and the smells and can often visualise it in their heads. The visualisation or thoughts that causes dental anxiety can be divided into 4 main groups:
- Specific stimuli
- General stimuli
- Distrust of dental personnel
- Thinking about catastrophic events
Treatment and management of nervous dental patients.
All new patients at the practice receive a questionnaire to fill in. Part of this questionnaire includes questions on the level of dental anxiety. During a new patient examination, the initial interaction of the dentist with a patient also reveals levels of dental anxiety that a patient may have. We try to ask open-ended questions in order to ascertain more precisely any problems. Quite often it is the non-verbal clues that give us the best idea of the level of dental anxiety that a patient may have.
Examples of non-verbal clues are as follows in this list.
- A patient in an anxious state will be more twitchy and hyperactive than what they normally are. They will tend to walk or talk faster and appear to be in a hurry or can’t keep still.
- Patients become more irritated if they have to wait past their normal appointment time by even the few minutes.
- Patients become panicky and blush when you speak to them and often will become tongue-tied or keep nodding with no or hardly any verbal communication.
- There is no good eye contact and their sentences will tend to be confusing and will often stumble over simple words.
- Often their body language.
- In the waiting room, they are easy to spot as they will be rapidly looking through books and magazines without actually reading them and are constantly fidgeting. They will also frequently look at the time and become easily emotional or aggressive due to all the excess adrenaline running through their blood supply. A significant proportion will have had alcohol to calm their nerves.
The dental environment
The dental environment is extremely important when treating nervous patients. Our website is full of non-invasive dental images and our receptionists are specially trained when speaking to nervous patients on the telephone. As mentioned before, the first contact is extremely important so we try to make each time count.
The reception and waiting area are calming and don’t have bright lights and loud sounds.
There are plenty of magazines and books and the sounds from the clinical rooms are muted reducing any ideas that patients might have adding onto their tension.
Our dentists always run on time and you will also notice that the non-clinical areas have a pleasant aromatherapy smell of essential oils.
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Communication and rapport
All our dentists have special training in how to manage nervous patients. Good dentist-patient relationship is absolutely vital and we take the time with good listening skills to build a long-term relationship with our patients. We encourage patients to ask questions even when they have left the surgery regardless if it is a common question or a genuine concern.
All the dentists use excellent non-verbal skills such as maintaining adequate Eye To Eye Contact, talking to the patient in the same language and not wearing clinical masks and gloves and quotes during the initial interview.
Psychotherapeutic techniques for treating nervous patients.
1. Relaxation techniques can have a massive impact on reducing dental anxiety. Relaxation techniques make you physically relaxed because the body cannot be physically relaxed and tense at the same time. Relaxation techniques can be dentist directed or the patient can practice these techniques themselves with our excellent resources to accomplish this.
2. The practise of proper breathing must not be underestimated in reducing dental anxiety. Patients who are scared of the dentist will often have shallow breathing and the breathing will not be diaphragmatic. Diaphragmatic breathing is deeper breathing further down in the chest and has been known and shown to be beneficial in reducing anxiety levels.
3. Guided imagery techniques have an important role in treating nervous patients. This works on the principle that you can override an unpleasant image in your mind with a pleasant image which will then have an effect on your physical chemistry.
4. We often use hypnotherapy for patients who have dental fears. Hypnotherapy uses suggestions which then lead to the desired response. Hypnotherapy works well with certain patients.
5. Acupuncture can also be used to reduce dental fears. Acupuncture needles are used at various points called acupuncture points such as the ear lobe. This can be remarkably quick and effective.
6. For certain dental phobias and dental anxiety, we use distraction techniques. General distraction techniques are asking patients to bring their favourite music to listen to and using video glasses to watch whilst in the dental chair. Distraction is a good method for patients who gag when having dental impressions taken. The distraction can be in the form of lifting their leg from the chair so that they are more focused on this and less focused on trying to be sick when having impressions done. Another technique which is extremely good is putting a small amount of salt on the patient’s tongue and this also has a distracting effect from having the impression material placed in your mouth.
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7. We also give patients control by asking them always to raise their hand if at any time they want us to stop. Just the comfort from knowing that the dentist will stop is enough to reduce anxiety sufficiently.
8. The tell show and do technique also known as TSD works well with certain procedures. if a patient is nervous about having their teeth polished, we initially tell them what we are going to be doing, then we actually show them the polishing brush and even have the brush on their fingernails so they can feel it. Finally, the brush is introduced into their mouth and on their teeth in gradual phases.
9. Desensitisation is an underused technique that dentists two don’t use often. Desensitization involves breaking down any treatment into smaller manageable steps. The steps increase in stimulus up to the desired level.
10. We always use positive reinforcement. As the saying goes, ignore the negatives but just concentrate on the positives. There’s nothing worse with a patient telling you that they had a bad experience in the past and the dentist was telling them off.
11. Cognitive therapy can work well with patients who have extremely deep-seated dental anxiety and dental phobia. It is also known as CBT and in CBT, a challenge is made to your feelings. Once your feelings changed then your physical state will also change accordingly.
Painless dental treatment techniques.
Finally, we come down to the actual dental treatment itself. Most dental treatments involve having a local anaesthetic and there are certain ways in which any discomfort from local anaesthetic is minimised or totally eliminated. Nearly all of our patients will say that they didn’t even know that their tooth had been numbed up until afterwards. This is a combination of a gentle manner but also using the help of topical anaesthetic also known as “numbing up cream” prior to having a tooth numbed up. We also use a technique called the intraligamentary technique which has been proven successful with nervous patients. It also has the advantage that your whole mouth doesn’t feel numb for hours afterwards.
All dental surgeries are equipped really well to deal with nervous patients. when cleaning, we use the gentlest ultrasonic scalers and drills that are almost silent. We use newer techniques such as air abrasion and lasers in addition.
Finally, as already stated above, we hardly ever need to use sedation or general anaesthetic because we achieve such good results without them. In addition, we noticed that patients who in the past have had sedation or general anaesthetic, become used to having these and it can be a problem to wean them off.
In conclusion, being nervous of the dentist is absolutely normal and there are many patients from all walks of life who suffer dental anxiety but we have an almost 100% success rate if you are scared of the dentist.