Anxious or Phobic Dental Patients



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The Dental Fears Control Program


Dr. Robert F. Kroeger of the University of Kentucky's Dental Fears Treatment Clinic developed a program that includes a step-by-step process that uses relaxation techniques to calm patients determined to have dental fear and anxiety. When used prior to treatment but after the initial treatment planning, this study has been shown to be 90% effective in helping patients reduce their dental anxiety.

At the first appointment, the patient completes various emotional evaluation questionnaires. Once the questionnaires are complete, the assistant interviews the patient to pinpoint the exact reason for their fears. This process provides a catharsis for the patient and begins the fear reduction process.

Once the fears are determined, the patient watches a video that demonstrates: the dentist's statement of treatment philosophy, the dentist interviewing a fearful patient, a gentle injection after use of topical anesthetic, patient wearing stereo headphones with a relaxation CD, the patient using the hand control signal to interrupt treatment, the dentist completing a routine operative procedure like a filling, and the dentist's exit interview. The video demonstrates a model of correct responses to the dental setting and the successful completion of a dental procedure without undue stress and discomfort.

After the video the patient is taught two relaxation exercises: progressive relaxation and imagery.



The progressive relaxation exercise involves alternately tensing then relaxing each major muscle in his or her body thus reducing overall muscle tension. The patient is instructed to pace their breathing during these exercises at intervals of five seconds (take a deep breath, hold it for five seconds, let it out at a rate of five seconds, hold five seconds, breathe in five seconds).

The guided imagery exercise involves imagining a relaxing scene in a pleasant place. The patient is instructed to tell himself or herself a story about the place and to imagine as many details as possible involving sights, smells, sounds, and feelings. The patient is instructed to practice these exercises one hour daily over the following week.

During the second appointment, the assistant again interviews the patient and the patient completes the same questionnaires. If the patient has worked on progressive relaxation and imagery, by the second appointment the patient is much less fearful and gives lower ratings on the questionnaires. Once the interview and questionnaires are complete, the patient is instructed to relax for ten minutes and once again watches the modeling video.

After the video is complete, the assistant uses a method called systematic desensitization. The assistant reads a description of a dental scene (such as taking x-rays) and the patient is instructed to imagine the scene for ten seconds then practice a relaxation exercise until the fear reaction disappears. Then another, more stressful scene is described and the patient is again instructed to relax. The patient is eventually conditioned to relax when confronted with all fear producing dental scenarios. If, following the sessions, the dentist determines that the patient is still too anxious for treatment other options should be considered. The Dentist may prescribe oral premedication or give an outside referral to a mental health professional or a dental fear treatment clinic.

An excellent resource for further study into this technique can be found in Dr. Kroeger's books. "Managing the Apprehensive Dental Patient" is written from the clinician's standpoint. "How to Overcome Fear of Dentistry" is written directly to the patient using nontechnical terminology and includes the questionnaires used to pinpoint the cause of fear.


Deep Breathing


Sometimes all it takes for the patient to calm down is a few deep breaths. In addition to Dr. Kroeger’s exercises, encourage the patient to breathe deeply from the abdominal area. Ten to twenty deep, slow breaths give the patient more time to think about the fact that they are in good hands and that the treatment is for their benefit.

Another type of deep breathing is alternate nostril breathing. Instruct the patient to block off one nostril and breathe in deeply for five seconds. Then, block off the other nostril and breathe out for five seconds. The patient should repeat this ten times then switch nostrils. According to Harvey and Marilyn Diamond in “Fit for Life II” this will balance the right and left sides of the brain and lead to a greater sense of tranquility and harmony.

Modeling


Inappropriate expectations can lead to inappropriate reactions. Demonstration of appropriate behavior through videos (as mentioned as part of Dr. Kroeger's plan) is an excellent method of patient education.

An ideal modeling tape should include:

  • Proper response to an injection (using a gentle technique with topical anesthetic).

  • Dentist explaining the procedure including the sounds and feelings associated with it.

  • Patient raising his or her hand for a rest stop.

  • Proper response to discomfort.

  • Successful completion of the dental procedure with dentist praising cooperative behavior.
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