Strategies for hygienists who treat patients with dental anxiety or phobia
by Ellen Byrd, CRDH
As dental professionals, we know many people have at least some degree of anxiety about visiting the dentist. But for a patient with a dental phobia, a dental visit can be a completely terrifying experience. The price of dental phobia is extremely high! It can cost our patients the loss of their teeth, a loss of self-esteem, or reduced quality of life for many years. They often suffer with embarrassment over how their smile looks, the inability to eat well and discomfort or pain.
What are some things that dental professionals can do to help patients overcome debilitating dental fears or phobias in order to get the care they so desperately need?
It can be very helpful if we can try to decipher the severity of our patient’s dental fear or phobia, handling it accordingly. In the case of severe dental anxiety, or a dental phobia, there has probably been a complete avoidance of the dentist—often for years! On the other hand, other patients will usually go to their appointments; however, they may not sleep the night before or may even feel sick before or during their dental appointment. They can often feel tense and may have a lower threshold for pain or suffer from muscle tension or headaches in the dental chair.
Those with dental anxiety or phobia report the main triggers as: pain, a feeling of helplessness and loss of control, embarrassment, or negative past experiences as the cause for their fear of the dental office.
Pain—Some patients have had a previous dental experience that may have been uncomfortable, had trouble getting numb, or have very sensitive teeth or gums. We have many pain control techniques, analgesics, and anesthetics available these days and proper selection is key.
• Before and during the appointment: Patients can take over-the-counter analgesics such as Extra Strength Tylenol or Motrin prior to their appointment when appropriate. During the appointment, we can select the appropriate clinical products based on the type of procedure, length of procedure, as well as our patients’ individual needs and preferences. This may include local anesthetic and topical rinses, liquids, sprays, subgingival gels, or tooth desensitizing agents. Sedation dentistry can provide a calming experience for patients who have experienced high levels of anxiety related to dental treatment. Some dentists are highly trained or certified in IV conscious sedation or sometimes offer oral sedation.
• After the appointment: Having a post-appointment care plan is very important and reassuring to patients even after the appointment. Warm saltwater rinses, over-the-counter or prescription pain medications are available to assist in a person’s recovery after the procedure. Having post-appointment care information in writing as well as given verbally is also helpful.
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A seasoned hygienist once said it is important to “meet our patients where they are.” This is especially important in the case of patients with dental phobias or anxiety.
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Helplessness or loss of control—In the dental chair, a patient has to stay still, they cannot see what's going on, or they may constantly anticipate discomfort or pain. For some patients, a clear explanation of what procedures will be done, what to expect, and how to indicate if they need the operator to stop or give them a rest can help immensely.
Panic, Trouble breathing or gag reflex: Not being able to breathe properly can certainly trigger their sense of a loss of control. Patients with larger chests or even more obstructive airways (large tongues, narrower throat openings) may have a harder time breathing when fully reclined or reclined suddenly.
As dental professionals, it may be important to recline patients for our own comfort or ergonomic reasons. However, some patients feel uncomfortable when the chair is reclined too far or too quickly. Reclining a patient gradually, asking for their input as we do so, standing or adjusting our position when possible while working, or coming to a comfortable compromise with the anxious patient may be helpful.
A heightened gag reflex in the anxious or those who are anxious because of their gag reflex may also feel more comfortable holding the suction themselves when applicable (during a dental hygiene visit). Reminding a patient to breathe through their nose, frequent suction breaks, letting them swallow or relax their tongue, or the power to request a break when needed. It is also helpful to be aware of those who may have sinus issues or colds that may also need extra help or breaks in order to assist their breathing.
Embarrassment—We may be used to it, but the level of physical closeness during dental treatment can make some people anxious and uncomfortable. Some people may be very ashamed of how their teeth look and may be afraid they'll be judged or ridiculed. It is imperative to be reassuring to these patients by respecting their space, approaching them gently and respectfully, and by being encouraging rather than judgmental. This is especially important in cases of extreme neglect where a dental phobia has played a role.
Negative past experiences —Many patients have had pain or discomfort during a previous dental procedure (often in childhood) are likely to be more anxious. To help these patients overcome fear based on past experience, it is good to encourage them to share their feelings, concerns and fears so we can help them overcome their fears. It is good to let them know how far dentistry has come in recent years. Comfort choices can also be offered to these patients including headphones, music, blanket, a relaxed environment, distraction, mental imaging, sleep mask, breathing techniques, a bite block, etc.
A seasoned hygienist once said it is important to “meet our patients where they are.” This is especially important in the case of patients with dental phobias or anxiety. Using insight and experience, we can decipher their level of dental anxiety or phobia, and tailor our treatment for the anxious patient—before, during, and after treatment. It is our goal to establish a relationship and level of trust to overcome or at least cope effectively these fears, get the care they need, and achieve their oral health care goals.
Ellen Byrd, CRDH, resides and works in a periodontal practice in Clearwater, Florida, as a dental hygienist, transcriptionist, social media manager and part-time blogger. She has worked in the dental field as a clinical and administrative assistant in both a general or periodontal practice since 1997.
