Dealing with phobic patients

A dentist must have good clinical skills but equally as important is how they can deal with nervous patients. Patients who are phobic have poorer oral health and we know that oral health has a significant impact on the quality of life, appearance, and self-esteem of a person. 

  1. Firstly, identify these patients. The dentist must have a calm, uninterrupted conversation with the patient and try to identify which of the dental situations gives rise to fear and anxiety questionnaires are available for assessing anxious and phobic patients such as MDAS (Modified Dental Anxiety Scale) This scale includes a series of five questions to be presented to the participants and they are asked to rate the level of anxiety they would feel if they were in a particular dental situation.Identifying anxious individuals can enable the dentist to anticipate patient’s behaviour and be better equipped with measures to help alleviate patient’s anxiety.
  2. The dental surgery ambience must be pleasant, having soft aromas and relaxing with soothing music.
  3. The staff such as receptionists, dental nurses, should be positive and caring
  4. The dentist should be friendly, sensitive, and sympathetic. 
  5. The dentist should use behaviour modification techniques. The strategies could involve relaxation along with guided imagery and adjuvant use of physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signalling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modelling.
  6. Clinical techniques must be of a high standard such as giving a painless local anaesthetic. 
  7. In more severe cases or where the above has not worked, a dentist can use pharmacological management by the use of sedation and general anaesthesia,

Behaviour modification techniques for dental phobia in more detail

  1. Anxiety produces certain physical symptoms such as excessively being fidgety, sweating, shallow rapid breathing and heart pounding. Relaxation exercises with guided imagery are where patients are taught to develop a mental image of a pleasant, calming experience that consciously guides their attention to achieve relaxation of their muscles and optimal breathing thereby reducing anxiety. However, it takes time to practice and become good at it.
  2.  Distraction is a very good technique of diverting the patient’s attention by listening to their favourite music. It also eliminates the sounds of dental surgery instruments.
  3. Giving the patient a chance to feel that they are in control of the treatment procedure. It involves signalling to the dentist or dental nurse to stop the procedure; this increases the patients’ sense of control and trust in the dentist. A signal can be as simple as a raised hand to tell the dental nurse or dentist practitioner that one would like to stop the procedure. 
  4. Tell-show-do is a behaviour-shaping technique that reduces uncertainty and increases predictability for a specific dental procedure. This technique is used for both child and adult patients and starts off with verbal explanations of procedures in phrases appropriate to the patient (tell); demonstrations for the patient of the procedure away from their mouth such as a plastic model (show) and then completion of the procedure (do). Tell-show-do is effective because the patient already knows what to expect hence reducing the anxiety and the fear.
  5. Positive reinforcement is an effective technique to reward desired behaviours and thus encourages the recurrence of those behaviours. Reinforcers include being positive in your voice and words, active modulation, an active smiling facial expression, verbal praise, and an NLP technique using appropriate physical demonstrations called anchoring.
  6. Desensitization is a very effective technique. Treatment is carried out in stages starting off with something easy that is easy for the patient. Once they feel comfortable with that, you move onto the next stage and so on. Any procedure is possible with this method.