Anxious or Phobic Dental Patients



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The Role of the Dental Staff


T

he dental staff can incorporate many skills into their standard procedure that will reduce anxiety in patients.



Scheduling. Make appointments in realistic increments so as not to keep patients waiting too long. Easy, non-invasive treatment should be scheduled for initial visits (oral examination, x-rays, home care instructions, treatment plan presentation). The patient should become familiar with the sights and sounds of the dental equipment during a low stress procedure such as prophylaxis or x-rays. If it has been a long time since the last prophylaxis, the procedure might be better accomplished in two short appointments rather than one long session. Gross removal of calculus along with one week of warm saline rinses and correct brushing technique may begin tissue healing for a more comfortable subgingival and fine scaling. The patient should be informed of the treatment plan before it is started so they can be prepared for multiple visits.

First Meeting. The dentist should interview the patient personally. Try to conduct the first session in a quiet, comfortable, confidence building room such as the doctor's private office. The interview's main purpose is to acquire information, "How can we help you?" The first contact between patient and dentist can create non-painful associations, build rapport, and increase the patient's confidence. The dentist should listen carefully to everything the patient has to say in an unhurried and nonjudgmental way. The dentist should convey understanding about not only the facts presented in the interview but also the way the patient feels about treatment in general.

Compassion. Help the patient to feel welcome. The receptionist and auxiliaries can provide encouragement and positive feedback to the patient about their progress. Friendly interaction with the dental assistant before treatment can "break the ice." Give the patient a reassuring and non-threatening touch on the shoulder or hand. Touch can convey warmth, security, and competence as well as caring. Always keep eye contact when speaking to the patient. Listen to what they say and use non-critical dialogue. Always use compassion when dealing with patients and show how much you care.

Interactive Communication. Assure the patient that you will do your best not to hurt them. Just the simple statement that you will do your best to not cause pain and that you will stop at the first sign of discomfort will reassure the patient and increase their trust. Be sure to follow through with this promise and stop at the first sign of discomfort.

Use previously successful coping skills. It may also be helpful to question the patient about their previous experiences and methods of coping. It can often be helpful to use previously established techniques to deter fear and anxiety in dental a situation.

Clearly state your expectations for the visit. Set goals with clearly defined objectives for the patient's treatment. The patient (especially if a child) should know exactly what is expected of them and the consequences of inappropriate behavior before the start of treatment. Simple explanations such as "When you are quiet and sit still you will be done faster and will feel better" can be very effective.

Signals. Set up a signal for communication. If the patient is given a signal to use (such as raising their hand) to stop treatment, they feel more in control of their situation. Use a tell-show-do method of describing the feelings to expect and explain how long the procedure will take. Let the patient ask questions before the procedure.

Ask the patient what they would prefer. Sometimes the patient themselves may have ideas of how the treatment may be more comfortably accomplished. Just asking them what they think and giving them time to respond will show a sense of caring and concern.



Ambiance. The office atmosphere can be very conducive to either tension or relaxation depending on many factors. The receptionist can relay a relaxed feeling to the patient when they first arrive. Soothing music and a visual distraction such as a fish tank is often helpful. A non-hurried, caring attitude from the staff and a professional, relaxed working relationship between dentist and assistant can influence the patient's emotional state. Always remember to save all criticism or concern among the dental staff for a time when you can meet privately.

Hand-Outs. Have copies of journal articles and other information regarding dental fear and phobia readily available in the waiting room. Simple, understandable articles can be studied at a later date, and just the availability of such materials will convey the concern of the dentist.

Praise. Give the patient positive comments about at least one aspect of their dentition or their coping skills at the end of each session. This will build confidence for the next appointment and the patient leaves feeling good. It is also helpful to give the patient praise throughout the appointment, particularly if the procedure takes more time than expected.

Music. Stereo headphones with soothing music, books on tape, or relaxation exercises can be a mental distraction as well as partially blocking out the noises of the drill.

Guidance into Relaxation. Teach the patient how to relax. If you currently know stress reduction exercises that work for you, explain them to the patient. Other behavioral techniques are covered later in this course.

Last Resort. If needed, pharmacological aids such as sedatives or nitrous oxide can be provided, but should be kept to a minimum because they do not help overcome the root of the patient's anxiety.
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