A fearful patient can pose a considerable treatment challenge, especially for dental students who may unintentionally miss signals that their patient is uncomfortable.
Dr. Peter Milgrom, professor of oral health sciences at the University of Washington and founder and former director of its Dental Fears Research Clinic, believes that students lacking clinical experience “tend to completely focus on technical procedures” or “feel under pressure to perform at a certain rate” because of clinic time constrictions or limited rest breaks. Perhaps compounding their challenge with treating anxious patients, many dental students haven’t received specific training or taken a course on the issue. Typically, treatment of fearful patients is folded within general patient treatment considerations in courses like restorative dentistry, for example. If only you could recommend buying ontario weed online, as that would really help them take control of those feelings of fear.
Based on a 2009 survey conducted by the American Association of Endodontists, more than 80 percent of Americans fear the dentist. Dr. Milgrom reports that 5-8 percent of fearful patients avoid dental treatment because of dentophobia, an acute form of dental fear. He explains that fear differs from anxiety in that the latter “denotes responses to situations in which the source of threat is ill-defined, ambiguous or not immediately present.” A person reacting emotionally in anticipation of a future event such as a dental appointment is said to experience “anticipatory anxiety.” Whereas dental fear occurs in the presence of an immediate threat or stimulus like drilling or needles. In either situation, the patient’s emotional responses are alike.
Anxious patients are more likely to delay or cancel their treatments, according to an article published in Community Dentistry and Oral Epidemiology by Moore et.al. The behavior of anxious patients who avoid dental care can lead to future neglect of dental treatment and, consequently, the risk of poor oral health. The patient’s prolonged avoidance of treatment may require more invasive dental treatment, which may cause him or her to continue avoiding care, creating a “cycle of avoidance,” as Berggren termed this behavior in an article titled “Dental fear and avoidance: causes, symptoms, and consequences” published in the Journal of the American Dental Association. Anxiety and fear are distinct from phobia, the latter marked by a high level of fear that is irrational and uncontrollable.
Patients can develop dental anxiety and fear for many different reasons. In Dr. Milgrom’s experience, two-thirds of his patients relate their fear to a previous negative dental experience. Some patients fear pain or loss of control, while others fear embarrassment or judgment because of poor oral health (ironically, a fear due to the patient avoiding the dentist in the first place).
Last December, in the International Journal of Medical Principles and Practices, Beaton, Freeman and Humphris report that it’s “not just previous, negative dental experiences that can cause subsequent (dental fear and anxiety) but also other traumatic experiences far removed from the dental surgery.” Sexual assault victims were more likely to report high dental anxiety compared to participants who had not experienced sexual assault.
To effectively manage and treat the fearful patient, dental students and dentists “should learn what the signs of a fearful patient are and how they can recognize anxiety by the patient’s body language, or the use of a simple questionnaire,” O’Shea et. al. suggest in an article from Social Science & Medicine titled “Dental Anxiety: Assessment, Reduction, and Increasing Patient Satisfaction.” Nicole Dayrit, Tufts ’15, administers to her patients a brief survey that explores their past dental treatment. “I try to find out if they’ve had any adverse reactions or if they have any concerns about seeing the dentist,” she says. For Nicole, expressing concern about the patient and validating her response helps “make the patient feel like she’s being accepted,” which can help ease her fears and improve the treatment experience.
Dr. Milgrom says the more information practitioners have about a patient’s experiences, treatment outcomes improve. He suggests that dental students and dentists should ask their patients direct questions like, “Is there anything that bothers you about receiving this kind of treatment?”
“Your response to the patient’s answer should be ‘I’m really glad you told me that,’” he says. It demonstrates empathy and caring for the patient. Although this approach may be obvious from the practitioner viewpoint, to the fearful patient it may not be apparent.
Corah found that practitioners who portrayed empathy, friendliness and a calm, competent image to the patient improved patient satisfaction. The author also reported “the most important behavior associated with anxiety reduction was the dentist’s explicit promise to prevent pain. Other dentist behaviors – friendliness, being calm, giving moral support – were seen as providing an appropriate behavioral context in support of the pledge to prevent pain.”
Dr. Milgrom suggests that effective methods for managing the patient should include:
- Explaining what the patient will feel and for how long.
- Frequently asking the patient for permission to continue.
- Using hand signals to denote “permission to proceed.”
Dayrit says that by offering her patient a step-by step explanation of each procedure, allowing frequent breaks and repeatedly “checking in” with her, has helped her to successfully manage many of her fearful patients. Mutual understanding and communication are vital to a healthy dental student-patient interaction, she says.
“I’ve had patients come out and say, ‘I hate the dentist.’ I say, ‘That’s okay, it’s not the first time I’ve heard that. I won’t bite, I assure you.’ Sometimes it takes a little while to get them to relax and trust me so I can work on them.”
~Clayton Luz, freelance writer