By: Dr Alex Park*
“No offence, but the dentist scares me…” is an introduction that I would commonly get when seeing a toothache patient. It was a hard concept to grasp. However, as time passes and more the patients I saw, I understood why. Here is a little story on my journey to shed a shell on anxious spectrum patients.
I almost saw everything: introverted to extroverted personalities, death stares, screaming, shivering, quivering, and even an occasional sarcasm. As a result, reading facial expressions seemed to become second nature. These myriads of lists mentioned are just a typical way of coping with patient anxiety. For some people, it is hard to break their ice, but the majority of them, there is a story to tell. From young to old, anxiety discriminates no-one.
For a young patient who has never been to a clinic of any sort, they are usually compliant. But once they had an encounter with anything medically unusual, crying becomes a normal reflex. Maybe they had a traumatic experience, such as needles, or this is their way of experiencing “white coat syndrome”. To proceed, I assess their behaviour and determine whether treatment could go ahead. If the procedure is not of an urgent nature, desensitisation appointment may be advisable (Wolpe 1954). How does this work? Young patients come and experience the dental chair. We do not force; we just let them get the feel. There is no hard and fast rule; it takes time. Trust is an important issue to overcome. Once that has been surmounted, you are one step ahead in winning their loyalty. Regardless of what the appointment is, having a positive surrounding with a comforting tone of voice while talking to the patients can help. Also, showing them what instruments will be used can also put them at ease. My common example? A mirror is a popular choice. Nevertheless, if the children are not co-operative, then referral to the Paediatric Dentist is advisable. They have tips and tricks to manage the children comfortably.
Adult patients are similar but, active listening plays a key role. Majority of them that come in for palliative treatments have not seen a dentist since their childhood (Armfield, Stewart & Spencer 2007). That could range up to 40 years. Some of the reasons could be medical, financial, and even due to past experiences. It is quite interesting, because this is very common amongst the baby-boomers. If there is any time for little banters, they would mention, in the past, how they have never used to get needles during fillings, or even worse; they were tied down while getting a tooth taken out. Like our children patients, showing them what you are doing and carefully explaining things play a huge role. It takes time, to manage patients with in-built anxiety. Like an onion, you remove the layers one at a time. Time is of vital essence and a significant investment!
My simple yet effective ways to deshell anxious patients are as shown below (Appukuttan 2016)#:
- Working with the dental staff as a team – Briefing the dental receptionist and dental assistants beforehand and how to better manage has been significantly helpful.
- Asking the patient – They might already be petrified coming to the dentist. Just having awareness shows that you care.
- Active listening – There might be a critical story that could help you crack open the sealed bottle. Things to look out for: mental health, attention deficit disorder, autism spectrum disorder, special needs patients, history of trauma, and family influence.
- Show-tell-do – Explaining, feeling, and even touching the instruments to convince the patients that it is not as scary as it looks can help. However, it is important to be appropriate. Don’t show them needles or scalpels or sharp drills.
- Positive surrounding – Gentle music, gentle media, and gentle tone of voice can ease their senses. If patients prefer their aromatherapy or even their own music, that can make a huge improvement.
- If it leads to pharmacological intervention, nitrous oxide can help reduce that edge bit. However, it is not for everyone. This could be assessed with a consultation with your friendly dentist.
Time and care are needed for these patients. They are vulnerable from the start, and helping to build trust is paramount. Sometimes, you win some, and sometimes you lose some. Please, do not take into heart. However, having an optimistic and open-minded outlook and doing what is best for the patient at heart is the way to go.
*Dr Alex Park is a dentist at the Dentist WA Canning Vale and Ranford Road Dental Centre. He is also a researcher at the International Research Collaborative – Oral Health and Equity (IRCOHE.net).Any questions can be addressed to alex@ircohe.net. This piece has been mediated by Associate Professor Estie Kruger at IRCOHE.net.
Reading…
Appukuttan, DP 2016, ‘Strategies to manage patients with dental anxiety and dental phobia: literature review’, Clin Cosmet Investig Dent, vol. 8, pp. 35-50.
Armfield, JM, Stewart, JF & Spencer, AJ 2007, ‘The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear’, BMC Oral Health, vol. 7, p. 1.
Wolpe, J 1954, ‘Reciprocal inhibition as the main basis of psychotherapeutic effects’, AMA Arch Neurol Psychiatry, vol. 72, no. 2, pp. 205-26.