Two patients cried in my chair last week, which made me think about how often dental professionals must deal with patient anxiety, apprehension, or personal issues. I often feel ill-equipped to handle these situations and am left wondering if I could have done more to comfort and calm someone.
Dental anxiety or fear affects approximately 36% of the population, with 12% suffering from extreme dental fear.1 Let’s examine the most common types of dental fear and how we can help patients overcome them.
Fear of dental pain
Fear of pain is a very common reason for avoiding the dentist. This usually stems from an early unpleasant or painful dental experience, or from bad dental stories someone heard. Ask patients how long it’s been since they’ve been to the dentist. Patients with anxiety may avoid the dentist for years. Explain that thanks to the many advances in dentistry, most of today's procedures are considerably less painful or even pain-free. Tell patients about all the pain management options available in your practice.
Fear of injections
Some people are terrified of needles, especially when one is inserted in their mouth. For these patients, pass the syringe behind them and ask them to close their eyes while you administer the anesthetic. Dry the area well and let the topical anesthetic sit on the tissue long enough to make sure they’ll feel as little as possible when the needle is inserted. As a distraction, give them a task such as wiggling each toe independently.
Fear of anesthesia side effects
Some people fear the potential side effects of anesthesia, such as dizziness, feeling faint, or nausea. Others don't like the numbness or "fat lip" associated with local anesthetics. Clearly communicate what areas of the mouth will be numb and for how long. Recommend that patients eat before their appointment so they don’t have to eat while numb. If anesthesia is not necessary, offer to skip it or opt for topical numbing agents.
Feelings of helplessness
It's common for people to feel helpless while sitting in a dental chair with their mouth wide open and unable to see what’s going on. To help ease their fear, explain what’s happening at every stage of the procedure. Allow anxious patients to hold the saliva suction, giving them control over when they expectorate. Let them decide when work begins by saying, “Let me know when you’re ready.” Another helpful strategy is to establish a signal the patient can use when they want the dentist or hygienist to immediately stop.
Embarrassment and loss of personal space
Many people feel uncomfortable about the closeness of the dentist or hygienist to their face. Others may feel self-conscious about their teeth or possible mouth odor. Assure patients that their teeth are no different from those of many other patients you see. While loss of personal space is inevitable during a dental procedure, distractions such as headphones with calming music, TV with engaging programming, fidget toys, and dark sunglasses can help take their mind off the situation.
Fear of blood
Some people have a fear of blood, called hemophobia. They feel panicky about the possibility or presence of even minor bleeding that can occur during a dental procedure. Rinse and suction more frequently and allow the patient to sit up to rinse or spit if they taste blood. Use gauze to soak up blood as quickly as possible.
Fear of choking
People may worry about gagging or choking when their mouth is numb. They may worry about not being able to breathe or swallow. That fear is increased with the use of a dental dam. Encourage them to breathe through their nose. Tell them they can signal you to stop any time they need a break. Skip the dental dam and/or bite block if possible and avoid placing gauze on their tongue.
Fear of dental office noise
Some people fear the noise made by drills and dental instruments. Offer headphones or ear plugs or encourage patients to bring their own. Turn up the volume on the TV or close the operatory door to drown out noises from other areas.
Fear of dental smells
Some people may be anxious about the smells during a dental procedure. One solution is to use pleasant ambient odors via air fresheners in the office. There are alternative approaches, such as aromatherapy, where the essential oils of aromatic plants are used to produce positive physiological or pharmacological effects.
Fear of change
What if someone doesn’t like the way they look after a procedure? With simulation software, you can show the patient exactly what their smile will look like after the procedure. Address any questions or concerns in detail.
Finally, schedule patients with dental anxiety in the morning because afternoon appointments give them more time to worry and serve to increase their anxiety. That same logic is used when patients arrive at the office—the team should seat them as quickly as possible to avoid them fretting in the waiting room.
Caring and communication are crucial when dealing with anxious dental patients. When speaking to them, normalize anxious feelings and avoid negative phrasing. They should be encouraged to ask questions, and they should be kept informed throughout the dental procedure. Armed with these tips, your next interaction with an anxious patient will be less stressful for both of you.
Reference
1. Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Prac. 2014;23(4):295–301. doi:10.1159/000357223
