HOW DO WE ADDRESS DENTAL PHOBIA OF OUR PATIENTS?
Have you experienced having a hard time treating your patient due to phobia? Do you have patients feeling uneasy, anxious, jittery, keeps on trying to move and attempts to delay so much of your time in treating them? These are the common signs of dental phobia. Dental Phobia or Odontophobia is commonly described by patients as anxiety before visiting a dentist or before their dental appointment.
Dental phobia can arise due to multiple reasons, such as previous negative or bad experience, especially in childhood traumatic experience, exposure to frightening portrayals of dentists in the media and lack of understanding of what the procedure is. These anxieties are also provoked by sensory triggers from sights of needles and handpiece burs, sounds of drilling, the smell of medicine and tooth during preparation, the taste of medicaments such as etchant and also sensations of high-frequency vibrations during procedures.
Dental Phobia plays a major obstacle in providing dental care. It obstructs us to perform simple task of diagnosis, oral prophylaxis, simple tooth restoration and other dental procedures. This may lead the patients into problematic and irreversible situations. Thus, on this post, we will discuss, how we, as dentists, be able to address them properly with empathy and concern.
The lack of communication is a common problem during treatment of patients which causes fear and anxiety. The use of jargons and medical euphemism confuses the patients. If the patient do not understand what is going to happen, or the dentist was not able to explain thoroughly the procedure that the patient can clearly understand, the patient may end up feeling wronged or unjust.
Building rapport is important to build the trust of the patient. This eases the mind of the patient and educates our patients the importance of dental health to them. This can be done by "Tell, Show, Do" technique wherein it can explain the situations and procedures in a simpler manner. The “tell” part of the technique involves verbal explanations of the overall procedure as well as associated steps along the way. The “show” includes demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure. The “do” part of the technique is the completion of the dental procedure without deviating from the roadmap laid out in “tell” and “show.” Taking time to empathized and listen to patients voice out there fears can make them feel welcome and at ease.
There are certain medications that can help relieve anxiety before and during dental appointment such as propofol, diazepams and more. Conscious Sedation with nitrous oxide and oxygen can help reduce anxiety during dental procedures. Other option can be a sedative through IV as this offers longer sedation and will not wear off easily versus inhalation sedation. The last resort is usually GA because of the risk connected to it.
PROPER SCHEDULE AND AMBIANCE
Scheduling and office ambiance can play significant roles in reducing dental anxiety. From the waiting room to the chair, anxiety can take a toll on patients. In some cases, the ambience can worsen a patient’s mental state.
Scheduling patients with dental anxiety early in the morning rather than afternoon appointments lessens their time to worry and anxiety.
Regardless of wait time, a patient with dental anxiety will still be unsure as he or she enters the office. Therefore, ambiance plays a significant role on this wherein a calm and inviting office environment can help reverse anxiousness such brought about by the effect of the sound of a drill or the smell of eugenol.
Smell is the sense most tied to memory, and since a previous negative dental experience is one of the strongest predictors of dental anxiety, masking strong smells within a dental office is recommended for patients with dental anxiety.
Here are the additional ways to establish a calming office environment:
➢ Avoidance of harsh, sterile lighting in favor of natural light.
➢ Playing soft and engaging music.
➢ Walls adorned with relaxing posters and pictures.
➢ Waiting room tables with a plethora of reading options.
➢ Closed doors to help mask smells and sounds.
➢ Offering patients food and/or beverages.
DENTAL HAND SIGNALS
Dental Hand Signs can help both the patient and dentist to communicate with each other during the treatment process. As the patient is sitting with mouth opened, communication is limited. Hand signs can help in conveying problem while working with procedure.
PSYCHO THERAPEUTIC MANAGEMENT
Deep relaxation or diaphragmatic breathing is the most important and fundamental way of helping patients to relax physically. This teaches them to do proper breathing techniques because diaphragmatic breathing is a relaxed form of breathing. The use of the diaphragm for breathing reduces tension in the chest and provides more oxygen for the body per breath. The technique can be done as follows:
➢ Tell your patient to sit up straight.
➢ His/her head should be upright not hanging forward or tilted back.
➢ Rest one hand of your patient to his/her chest and the other hand to his/her abdomen.
➢ Instruct your patient to blow out all the air in his/her lungs until it feels empty.
➢ Ask the patient to begin to breathe in. Inhaling must be done evenly. Count your breathing until you feel exactly full, to help you get a measured and even breath
➢ Exhale evenly. Count the breath out of his/her body without any sudden release.
➢ Exhale longer than he/she inhales.
Hypnosis (from the Greek hypnos [sleep]), although criticized and questioned has been done both in medicine and dentistry. The term “hypnosis” denotes an interaction between the “hypnotist” and single person or more called the “subject/s”. In this interaction, the hypnotist attempts to influence the subjects’ perceptions, feelings, thinking, and behavior by asking them to concentrate on ideas and images that may evoke the intended effects. The verbal communications that the hypnotist uses to achieve these effects are termed “suggestions”. Suggestions differ from everyday kinds of instructions wherein a “successful” response is experienced by the subject doing something involuntary and without much effort. They can be used to induce relaxation, as an adjunct to inhalation sedation, to alleviate pain, anxiety, and stress, in reducing problems with excessive gag reflex. This technique can be learned by us to do with our patients who have dental phobia or we can hire someone by appointment to go to our clinic if there's a patient that may require this.
Acupuncture is a technique, wherein the body is treated by inserting needles at various points on the body, known as acupuncture points. It has been reported that acupuncture is effective in treating dental problems such as anxiety, temporomandibular dysfunction syndrome, pain, and Sjögren’s syndrome. It is a simple, inexpensive treatment modality that requires special training before it can be incorporated into practice. We can suggests this to our patients to deal with their condition and assists them to be free from this fear.
Distraction is a useful technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure. This enables decreased perception of unpleasantness and averting negative or avoidance behavior. Giving the patient a short break during a stressful procedure can be an effective use of distraction prior to considering more advanced behavior-guidance techniques. Several technological options are available for both visual and auditory distraction, such as background music, television sets, computer games, and 2-D and 3-D video glasses for watching movies.
Dental phobias is harmful to patients as well as to us, dental professionals, as this affects the quality of care given. On these cases, the dental team should help the patient to address this kind of problem. By easing the patient’s anxiety through communication, the patient would feel at ease and we can gain our patient’s trust. Putting anxious patients in control of the time, such as allowing them to dictate start and stop times, can help relax their mental state. Physical relaxation is part of the equation as well, breathing techniques, pleasant aromas, distraction through television and calming background music. These all can play a great role in relaxing our patients and calming their nerves. The mental health of our patients is very important to address, thus, as we perform our dental treatments we should also find, learn and implement effective ways to help our patients to address their dental anxiety that will enable us in return to successfully move forward to our actual dental treatment.
Dr. Bryan Anduiza - Writer
Dr. Mary Jean Villanueva - Editor