Chinwe Akuonu talks dental anxiety and how dental teams can reassure and comfort nervous patients.
Dental anxiety can be described as a learned response of tension, discomfort, or apprehension towards dentistry.
Contrary to popular belief, it is quite a common condition, and according to the 2009 UK Adult Dental Health Survey, about 48% of adults admitted being dentally anxious. That’s almost 1 in 2 people scared of the dentist. And bear in mind that children are not included in those figures.
As a result of the high prevalence of nervous patients, we dental professionals acknowledge the problem and are expected to possess the skills to help reassure individuals and help them overcome this problem. Without us, it risks being underestimated, or in some cases overmedicated, hence leading to dental phobic disorders and, subsequently, to a dental vicious cycle.
A dental vicious cycle is indeed exactly what we try to avoid. It entails the following behaviour: total avoidance of seeing the dentist, which further leads to neglect of oral health, and finally to what we call ‘symptom-driven’ treatment. This means that patients only seek help when they are already in pain. They then associate this back to the dentist, who is seen as the cause of the problem, rather than the solution.
Just like every other issue in life, in other to find a solution, we need to know the cause.
Dental anxiety may be caused by the fear of pain or not being in control, the feeling of numbness, previous negative/traumatic experiences, horror stories from family members or friends, the media portraying dentists as scary, fear of judgment and embarrassment, and interestingly, according to recent research, the high cost of treatment could also possibly contribute to dental anxiety.
Management of dental anxiety
The two main methods available to help with the management of nervous patients include a behavioural management technique and a pharmacological approach. The previous is usually the first line of treatment and sufficient with majority of anxious individuals. While the latter comes into action when the first method fails.
The first step in deciding what kind of reassurance to provide includes the patient assessment with the modified dental anxiety scale (mDAS), which assigns an anxiety score to each patient.
Once the assessment is done, different behavioural management techniques can then kick in. It’s all about the teamwork between the dental team and the patient.
Different techniques
- Excellent communication skills are required to build rapport with the patient. It is important to speak slowly and always use positive terminology
- Ensure that verbal and non-verbal communication are always coherent, allow patients to ask questions, adopt the tell-show-do technique. This means that you explain the procedure in layman terms. You visually show them what you’ll be doing and gain consent prior to commencing
- Use stop signals, so that the patient is in total control of the situation. They can raise their hands at any stage if they need the dentist to stop the procedure
- Ensure that the environment is well organised and decluttered. I also tend to wear friendly scrubs because it reassures both children and adults. Nice calm music in the background also helps or patients can wear their headphones if they prefer.
- Prefer reinforcement helps boost patient’s confidence levels
- Use desensitisation and acclimatisation techniques which consist in gradually exposing the patient to different procedures one step at a time
- Adopt pain free techniques for delivering local anaesthetic (use numbing gels) or ‘The Wand’. This slowly administers the LA in a slow computerised manner, alternative to traditional syringes, and less threatening to patients
- Acupuncture can also be utilised.
Prevention better than cure
If the above-mentioned methods fail, then the next step is that of conscious sedation which may involve the use of a mask to help administer nitrous oxide and oxygen. This option is excellent for the management of children. Otherwise, the other alternative is that of intravenous sedation which requires the use of a stronger medication called midazolam, usually administered through the veins.
During these procedures, patients are still conscious.
Seeing that there are many methods available to dental professionals to help manage nervous patients, if you are anxious, please do see your dentist and rest assured they can help you. Prevention is always better than cure.
You can also visit www.dentalfearcentral.org for more information.
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