Last Updated on May 5, 2023 by Dr Gustavo Assatourians DDS
Ways to relax a patient
For many patients, finding a good dentist means knowing that he/she will be comforting and a good communicator. The relationship of a patient with his/her dentist and the dental team is like any other: it benefits from open and honest communication. When talking to patients, it is beneficial to normalize feelings of anxiety and avoid negative statements. Additionally, patients should be encouraged to ask questions and be kept informed throughout the dental procedure.
The advantages of good communication
Fears can be substantially reduced with good dentist-patient communication. To this end, the dentist will follow these guidelines:
- Ask the patient if he is well and if something is worrying them. They might need to ask questions. Showing empathy is a good way to reassure a patient.
- Always maintain a friendly and professional attitude.
- Inform the patient of all the steps of the procedure and answer any questions that arise. It can be useful to use drawings or photographs to explain it.
- Do not underestimate the patient’s fears. It is advisable to face them as normal.
- Whenever possible, offer breaks and alternatives in treatments or examinations. Indicate how the patient can notify the practitioner when he needs to stop the procedure by means of a signal, such as raising his hand. This will help lessen the loss of control that many people find particularly distressing.
Prevent avoidance and mental flight (preventing the patient from coming to the appointment):
- Ensure the continuity of appointments
- Serve the patient as soon as possible without making them wait.
- Most likely, the patient, depending upon the degree of the phobia, does not want to do the procedure. Understand this and address it.
- Schedule a short consultation, but long enough to reduce discomfort and desensitize the situation.
- Allow the patient to experience the procedure as pleasantly as possible.
- Ensure they leave with the best possible memory.
Detect what kind of Stimuli are likely to cause patient phobia and manage it. Together, seek a more comfortable solution.
The most common factors that develop dental anxiety among patients are:
|
Psychological factors |
Physical or Environmental Factors |
|
Fear of pain, blood, or injury |
Inadequate treat;ment design and explanation |
|
Past traumatic dental experiences, particularly in childhood |
Professional uniforms |
|
The influence of relatives or other people with dental anxiety that condition the current experience |
Instruments |
|
Psychological characteristics of the patient |
Negative attitude of the professional team. |
Table 1. Factors causing dental anxiety (taken and adapted from Hmud and Walsh, (2009) and Bartolomé, Torres, Méndez and Almenara (2019))
|
TYPE OF ANXIETY |
DEGREE OF ANXIETY |
ATTITUDE OF THE PATIENT IN THE CONSULTATION |
|
adaptive |
mild or low |
The patient remains calm despite the anxiety. The dentist only has a slight difficulty in carrying out the initial examination, diagnosis, or recommended treatment. |
|
High average |
moderate |
Suspicious attitude and psychomotor agitation on the part of the patient. The dental staff will observe signs and symptoms of psycho-functional deterioration, which makes diagnosis difficult and forces a change of routine. |
|
Disabling or blocking |
Severe / High |
The patient shows intense fear. The signs and symptoms prevent the examination, diagnosis, or dental treatment from being carried out, forcing the suspension of the appointment. |
Table 2. Types of anxiety. (Taken and adapted from Mediavilla (2013) and Amaíz y Flores (2016)
Although it may not be possible to completely avoid stress in our life, it can be managed by following a few simple and specific steps.
With certain conditions, such as immunosuppressed patients, various approaches may be possible, such as establishing hemodynamic equilibrium. It happens by encouraging the patient to be awake and active as much as is bearable with the goal of regulating mood and physical well-being.
A temperate office with a calm environment – having among other things a diffuser with essential oils – relieves stress. Warm lighting, perhaps a few plants, and a Himalayan salt lamp encourage a positive patient response.
Additional ways to establish a peaceful office environment include avoiding harsh, sterile lighting in favor of natural light; playing soft, engaging music; walls adorned with pleasant posters and pictures. A dental office can have plenty of natural sunlight if there are windows throughout.
The tell-show-do technique is very effective. The “telling” part involves verbal explanations of the general procedure as well as the associated steps along the way. The “show” part includes the visual, auditory, olfactory, and tactile aspects of the procedure. The “do” part is the completion of the dental procedure. It is used as a roadmap to guide the patient’s attitude and alleviate fear.roadmap. Verbally checking on the patient before, during, and after the dental procedure is a great way to establish a sensitive and empathetic relationship so the patient will not fear returning to the dental chair.
Learn about good verbal and non-verbal communication:
- Do not display signs of boredom, annoyance, expected upcoming pain, whispers, or looks as a team.
- Do not leave the patient alone! (and not just physically).
- Be in constant communication with the patient and aware of their well-being.
- Be assertive: “it would be good…”, “it is convenient…”, “I would…”, “it would be good for you to…”, “it is usually better to…”, etc.
Give information to the patient during the treatment
Provide adequate information about what is going to happen and what might bother the patient in a calm manner. Do not stress how long it will take, or anything negative, etc. If the patient still does not accept the treatment, it will not be done. If anxiety occurs no matter what you do, familiarize them with the dental environment: the instruments you are using, etc. Talk about why they are there and what they are going to feel. “Knowing” allows them (and you) to control the situation and relax.
Example: when we take out the suction cannula, we explain that it does not cause any discomfort and is just used to suck up water.
Distraction is a useful and quick technique
Reassure the nervous patient with words and gestures, such as a smile or a timely joke. Laughing produces an immediate feeling of well-being, making it a powerful remedy against stress and anxiety.
Example: when the patient is tense and you have been working on his mouth for a while, simply ask “How are you? Are you still alive?” The patient will smile and calm down a bit.Talk to them about topics of interest – about their children, work, leisure activity, sports and hobbies etc.
Reassure the nervous patient with breathing and relaxation techniques
Teach the patient to open their mouth without tensing because this will produce unnecessary jaw pain that destroys the positive nature of the dental intervention. Stop for a moment so the patient can relax their shoulders, neck, and forehead.
Example: “breathe deeply and through your nose; imagine your lungs filling like air balloons and deflating as you expel the air – and with it the tension.”
It is important to provide the patient with a way to communicate without moving their heads, as they cannot speak.
Knowing can communicate in some way and that whenever they want can stop, provides some degree of control for the patient and, therefore, relaxation.
Example: “if you want me to stop or you wish to say something just raise your left hand.”
It is very important for the patient to feel they are in good hands, and the dentist conveys they know what they are doing.
Ensure that the patient enters the consultation room alone, especially when about to undergo a complex treatment.
Self-instruction technique: encourage the patient to mentally repeat phrases that will calm him down.
Undoubtedly, technical advances in dentistry now allow for more precise and less painful interventions, shorter procedures, and greater control by both the dentist and patient.Tools such as painless anesthesia can be of great help in certain cases. Even things as simple as a less noisy drill will help calm the patient and reduce their fears.
Sedation dentistry
Another option for the anxious patient is conscious sedation. Nitrous oxide sedation can be used in certain cases. Through the controlled administration of oxygen and nitrous oxide by inhalation, this procedure allows for an intervention in total tranquility.This type of sedation is also completely safe and effective in the hands of a properly- trained dentist. Undoubtedly, it is a good ally to take into account when panic arises.
Fear of the dentist in children
According to studies, up to 30% of children are afraid of visiting the dentist. Whether due to the fear of the unknown or being controlled by other people (including their own parents, consciously or unconsciously), many children experience anxiety in dental situations. However, treating child patients appropriately is a great opportunity to produce adults with good oral health and without fear of the dentist.
As with other patients, it is important to create a relaxed and pleasant atmosphere during the consultation and to explain the procedure in a simple way. Drawings or photographs can be great allies, making the child participate in the dental work and allowing them to better understand their own body.
Consultations with children are also a good opportunity to instill good dental hygiene habits. Offering a small gift related to dentistry can contribute to their motivation and, incidentally, make them smile.
Among other things, patients who come to our office find it stressful to carry out therapy from beginning to end, either due to a lack of habit or inexperience. This makes us great participants in their self-awareness and education as regards oral health. To this end, providing care and using the most modern means at our disposal for the management and support of stressful circumstances constitutes the main management protocol for a promising treatment.
If you have any questions about this or other topics, contact us at Channel Island Family Dental, as well as on our Facebook page. At Channel Island Family Dental, we are always attentive to your needs to make a timely diagnosis. In addition, our dentists in Oxnard, Santa Paula, Newbury Park Ventura, and Port Hueneme will guide you to the best treatment to give you back your best smile.
