Combatting Dental Patient Anxiety: A Survival Guide
Anxiety while sitting in the dentist’s chair is a pretty common phenomenon — recent studies show that 5.5% of all patients report being ‘very afraid or terrified’ of their dental visits. A further 9.8% were ‘somewhat afraid’. Dental anxiety varies widely based on the criteria used to measure it and the population studied, but it’s common enough that you need to remain mindful of it when you’re attempting to build patient relationships and improve patient retention in your own dental practice. Generally speaking, the worldwide estimates of dental anxiety range from about 4% to over 20%. It’s clear that dental anxiety is present for the majority of patients to some degree — and as such, should be considered by your treatment team.
First, let’s explore..
What Is Anxiety?
Anxiety is our body’s natural physiological and emotional response to stressful (see ‘life threatening’) situations. It’s an adaptive and advantageous response when it allows us to be vigilant and ensure that we accomplish our goals — things like completing a speech, performing endodontic treatment, etc. are all examples of where anxiety can actually be beneficial to us. However, it can be disabling and even crippling when it’s excessive and not directed in the appropriate direction. It reaches the status of ‘disorder’ when there’s functional impairment. Anxiety disorders can be classified in a number of different types of diagnoses, but this is out of the dentist’s scope of practice to diagnose or treat properly.
The majority of anxiety disorders have common features and do respond well to behavioral management with medical intervention and support when needed. The management techniques we explain today will be discussed in the context that you’re familiar with — the dental office.
Anxiety disorders can range from mild to severe and operate on a spectrum — what is true for one is not true for the many in this case. This ranges from generalized anxiety — the central theme is excessive anxiety and worry.
Dental anxiety has a number of names it is known under- dental phobia, odontophobia, dentophobia, or dental fear in medical and dental literature. Patients experience fear and arousal from a real, specific stimuli, but anxiety is often thought of as anticipatory. Either way, patient response is similar in both situations.
The Root Causes of Dental Anxiety
Negative experiences with prior dental visits is a strong predictor of dental anxiety. People who have painful, embarrassing, or scary dental experiences are over 22 times more likely to have anxiety about visiting the dentist. Extreme helplessness and a lack of control during visits, combined with a lack of understanding from the dentist correlates with dental anxiety. Any sort of experience with extreme pain after dental work is one of the most prevalent stressful life experiences of modern life and this can trigger psychological trauma as well as a persistent fear of the dentist.
Dental anxiety can be extremely problematic to your dental practice. Anxious patients can present as avoidant, resulting in missed or cancelled appointments and it’s important to keep this in mind when working with patients to keep them coming into your office. Anxiety can manifest as irritation and uncooperativeness and if not appropriately addressed and identified, can spur a negative reaction by office staff and further validating the patient’s anxiety as self-fulfilling. Patients who endure a higher level of anxiety tend to have a greater pain response than patients who don’t experience dental anxiety. This can, in turn, increase anxiety among your treatment staff and increase the potential of making a mistake. It’s important that dentists make it a goal to alleviate anxiety to make treatment occur successfully, but also to reduce risk for further dental anxiety as well as reducing avoidant behavior.
Ask your patients questions to guide treatment. Slightly frightened patients may not exhibit outward signs of being anxious, but extra reassurance will improve the patient’s experience immensely. Moderately frightened patients may need to take a break occasionally, while severely frightened patients may be avoidant or struggle coping with treatment.
To expedite screening for anxiety, use single question methods — the SDFQ or Milgrom’s is easily incorporated into the pre-exam dental questionnaires filled out by patients. If patients screen as anxious, a more comprehensive approach to assessment is needed to help staff understand the patient’s presenting anxiety issues.
Managing Dental Anxiety in the Office
Anxious patients are likely to worry that the dentist will attempt to trick them, not take their fear seriously, or recommend unnecessary, painful work. Remember that loss of control, embarrassment, and lack of understanding are associated with dental anxiety, it’s important to use strategies that combat these issues. Empathy and understanding is incredibly important to establishing a positive patient/dentist relationship. Take the time to inquire and listen to your patient’s fears — it’s productive because it sets the tone that you are interested in understanding the patient’s anxiety. Praise is effective in battling anxiety — especially when the patient challenges their fears. Avoid using phrases like ‘there’s nothing to be afraid of’…you don’t want to minimize patient fears. Normalizing anxiety is supportive — say things like ‘this is really common with a lot of my patients.’
Managing communication strategy is also important. Use positive sentence structure — things like ‘you may feel a twinge’ is more honest and effective than ‘you will not feel pain’. Don’t use words like hurt, shot, needle, etc. Anxious patients appreciate clear, honest, straightforward communication.
When you give your patients some control, they will feel much less fearful. Creating a signal system with patients so that they can signal to you that they need a break is calming and centering. It’s important to honor that communication and keep from making promises you cannot fulfill — don’t say things like the procedure will not take long. Distraction techniques work well as well.
