Are you nervous about getting a tooth drilled?
If so, you’re not alone. A majority of us have some form of anxiety about going to a dental visit.
In an extensive world-wide study, 61% people say they suffer from dental fear. The main reasons for this phobia are:
- the expectation of significant pain,
- the smell of nauseating chemicals,
- the high-pitched sound of the drill,
- the discomfort from keeping their mouth open, and
- the financial burden of paying for dental services.
Another study shows that 19% of patients have significant dental anxiety; this rate is double (38%) for female respondents. In addition, 8% of patients miss or cancel dental appointments because of their fear. (Source: Journal of Dental Hygiene)
Responding to Patient Fears
Many practitioners are responding to this global trend in dental phobia by providing accommodations that relieve patient fears.
We respond to fears in one of four ways: Fight, Flight, Freeze, or the most effective one: Face.
But although a quiet and relaxing atmosphere in a dental office is a good start, this is not enough for individuals who suffer from extreme anxiety, developmental disability, autism, and other non-verbal or neurological challenges.
Patients with an extreme sensitivity are less likely to see their dentist at all, and they may have never had have a positive experience during a visit. Highly sensitive patients may wait several years before getting proper care. Unfortunately, extreme fear and avoidance of dental care eventually results in tooth loss, gum disease, and many other terrible health conditions.
Patients who are vulnerable are at highest risk of abuse, deprivation, and fraud. Anyone who knowingly takes advantage of someone who is in a vulnerable state is doing a disservice to society. Read more about how Multi-Level Marketing companies influence people: 11 Ways Multi-Level Marketing is Like a Cult.
Every medical practitioner should strive to design positive a and tolerable experience for every patient. This can only happen when the owner and their team consider all the possible ways to see a visit from the patient’s point of view.
You can read more about this concept in What Happened When I Became an “Employee For a Day.”
Here are some ways providers can ease their patients’ level of stress (especially those who have high anxiety and sensitivity)—before, during, and after a dental visit.
Before Starting the Procedure
- Minimize the wait time before a visit
- If a delay is necessary, provide options for the patient to move around, take a walk, or occupy themselves to reduce anxiety
- Talk to the patient with a calm tone and plenty of patience
- Only speak while within the patient’s visual field (not behind or beside)
- Explain everything that will happen beforehand
- Allow a family member or friend in the room during the visit to ask questions, provide comfort, and take notes
- Let the patient see, hear, touch, and examine instruments before they are used
- Give the patient time to ask any questions before starting
- Agree to use a communication app if the patient has one
- Use fun distractions to calm the patient (jokes, selfies, toys)
- Don’t tease a patient for poor oral hygiene or other problems
- Use a “First and Then” visual and provide a specific reward (“First, I’m going to use this tool to scrape your tooth starting on the top right side. Then, you can sit up and play a trivia game.”)
- Offer noise-canceling headphones, earbuds, or earplugs
- Offer background noise options (loud hum, white noise, music)
- Offer a heavy vest or warm blanket
- Offer sunglasses
- Use a sand timer for a visual reference of how long the procedure will take
- Dim the overhead light, use a blue filter, or switch to a pen light
- Have a TV with videos playing for a distraction during the procedure
- Review non-verbal communication signals, and review how the patient can give or receive instructions
- Discuss the option for nitrous oxide or anti-anxiety meds the day before a visit
- Be aware that local anesthetics may not work if the patient has Ehlers-Danos Syndrome (EDS) — which has also been linked to fibromyalgia, autism, auditory processing disorders, and a variety of other conditions.
- Be aware that conditions like Ehlers-Danos Syndrome can affect nerve branch positioning, which could result in accidentally under-numbing or drilling a nerve
- Be aware that the patient can hear your conversation even with headphones on
- Understand that poor hygiene could be due to a genetic disorder, poor executive functioning, strong gag reflex or extreme teeth sensitivity… and not necessarily from irresponsibility
- Speak to the patient directly and give facts with total honesty
- Instead of promising “this won’t hurt” or “it will be quick,” say “this might hurt because of X, but I’m going to try to avoid it by using Y; and if that doesn’t work we’ll try Z.”
- Don’t shame the patient for poor oral hygiene or an aversion to unpleasant sensory experiences (such as flossing)
- Don’t make changes after the procedure starts without letting the patient know their options
During the Procedure
- Don’t ask the patient questions while your hands or instruments are in their mouth
- Stop “small talk” with the patient if it makes the patient uncomfortable
- Limit your chatting with staff; it can be distracting and overly stimulating
- Avoid excessively touching the patient, especially if they seem sensitive
- Give the patient options for everything: flavor of toothpaste, flavor of prophylactic material, color of toothbrush, the order of tasks, etc.
- Use warm water instead of cold if the patient has sensitive teeth
- Make sure the exam or procedure is not rushed or pressured
- Check the patient’s comfort level and take frequent breaks
- Remind the patient frequently that they can signal if something is too loud or uncomfortable
- Agree to stop immediately when the patient signals to stop
- If there is any discomfort or pain, allow the patient to use non-harmful self-stimulation to calm down
- Allow the patient the option to sit up whenever they want
- Review all steps that will happen during the procedure (including tools used, pressure, pulling on lips, flossing) and allow the give them the option to adjust or stop at any time
- Respect the patient’s need to skip certain tasks (such as flossing or polishing); use alternative methods like gauze or scalers to reduce sensory overload
- Alert the patient before using a high-pitched instrument like a drill
- Complete the procedure as quickly and efficiently as possible
- If a procedure needs to be stopped and rescheduled, take notes on what was completed so the next visit can happen seamlessly
After the Procedure
- Explain what was done and any followup that is needed
- Give the patient written instructions
- Follow up with a text or phone call the next day to ask how they are doing
- Send a quarterly postcard or note to tell them you appreciate them choosing your practice
Effective dental practitioners are able to demonstrate to patients that their concerns are valid, and that they have a choice in how services happen to them.
If you want to read more about responding to pain as a business owners, check out:
Interested in hearing how you can reverse a toxic workplace? Find out more here.
Grace LaConte is a business consultant, writer, workplace equity strategist, and the founder of LaConte Consulting. Her risk management tools are used around the globe, and she has successfully reversed toxic work environments for clients in the healthcare and non-profit fields. Grace specializes in lactation law compliance & policy development, reducing staff turnover after maternity leave, and creating a participatory work culture.