In a recent survey of consumers, by Yougov on behalf of Denplan (Denplan/Yougov survey, 2012), respondents mentioned the word ‘pain’ 555 times more than the word ‘preventive’ when asked for their immediate reaction to the word ‘dentist’. However far we may think we have come in patient care over the years, it seems that some patients just can’t see beyond the idea that the dentist is only there to hurt them.
While it isn’t a particularly flattering assessment, for some dentists this image simply comes with the territory. For others, the quest to put patients at their ease can become something of a science in itself. As many as 30% of the UK population are afraid of going to the dentist (Denplan/Yougov survey, 2013), and a proportion of these are extremely anxious or even phobic. How an individual dentist deals with such fears and what measures a practice takes as a whole to help patients overcome them can be a reflection of their overall approach to patient care.
Reasons to be fearful
There are many reasons for patients’ anxiety such as worry about being hurt, concern about the unknown, a terror of needles or the sound of the drill, or a deep-rooted fear caused by a bad experience as a child. Some of these can, of course, be alleviated quite simply through empathy and awareness, but sometimes a bit more action is required.
If you know you have a number of anxious patients, it’s worth taking a walk through their patient journey in your practice to see what, for an anxious person, could appear frightening or intimidating; think carefully about the language you use, how you might distract them, and ensure that the whole practice team is trained to recognise patients’ fears and act appropriately.
There are a lot of misconceptions about hypnosis, largely due to stage shows where people volunteer to take part in the name of entertainment. The predominant school of thought is that hypnosis is a way to access a person’s subconscious mind directly. It can be very effective in helping patients to relax and this can bring huge relief to nervous patients as well as making the treatment session easier for the nurse and the dentist.
Hypnosis is widely available through specialist practitioners but is now becoming an increasingly popular therapy offered in dental practices. There are many different degrees of therapy, ranging from simple distraction or visualisation techniques through to deeper hypnotic procedures. Its main uses in dentistry are the reduction of anxiety and fear in conjunction with relaxation, the control of pain, obtaining cooperation from the patient, the control of salivation and bleeding and various elements of oral surgery (Roberts, 2006).
The decision to pursue specialist qualifications and training that could help anxious patients in your practice can depend very much on available finances and time. However, there is no doubt that a practice that shows such commitment to its patients’ comfort and wellbeing as well as their oral health will reap the rewards of a loyal and appreciative patient base. Some payment plan specialists also offer training courses specifically on hypnotherapy and dealing with nervous patients, designed to explore ways for staff to build patients’ confidence and help them overcome their fears. You can also visit The Hypnotherapy Association’s website at www.thehypnotherapyassociation.co.uk or contact the British Society of Clinical and Academic Hypnosis via www.bsmdh.org.
Denplan dentist, Alison Foster, and her colleagues at Redmires Dental Care in Sheffield, share a dedication to providing a gentle, considerate and unhurried approach to patient care. It’s a philosophy that’s clearly displayed throughout the practice, from its reassuring website to the smiley, empathetic practice team and relaxing environment.
A few years ago, Alison spotted an advertisement for a course in acupuncture devised specifically for dentists. At the time, she didn’t ‘believe’ in the therapy so she enquired about it purely out of curiosity; as it turned out, she discovered that it wasn’t a matter of faith at all, it simply ‘works’, though she acknowledges that she doesn’t fully know why.
This ancient far eastern therapy is often regarded with scepticism by those more used to western medicine. However, as well as its use in relieving tension and stress, the technique has proven to be particularly successful in patients with a prominent gag reflex, which may previously have prevented examination, let alone treatment (Rosted et al, 2006). Deciding whether to use acupuncture depends on clinical findings, a patient’s willingness, their suitability and the estimated likely effectiveness of the therapy (Thayer, 2007).
Alison specialises in treating the most nervous patients with a number of techniques. She explained: ‘When a patient is clearly anxious, you first need to establish exactly what they’re anxious about. The key is to give them time and space to tell you what the problem is in their own way. Many of them are acutely embarrassed by their fear and you need to gain their trust so that they don’t feel rushed into something they’re uncomfortable with. It’s also important to remember that the way a person behaves when they’re anxious can be completely out of character – they may come across as rude, grumpy or aggressive when normally they are none of those things – so you do need to cut them some slack.’
Alison recently treated one burly Yorkshireman who had been unable to attend a dental appointment for many years due to his inability to control the gag reflex. As well as taking plenty of time to explain what she would do, sitting him at a more upright angle and allowing plenty of breaks to spit or swallow, Alison offered him acupuncture, which involved the positioning of a needle at a specific point in the chin to stimulate the nervous system.
The patient was able to be treated very successfully and was genuinely delighted to have finally overcome a seemingly insurmountable obstacle. You can find out more about acupuncture at www.medicalacupuncture.co.uk and The British Dental Acupuncture Society provides a two-day course limited to acupuncture that is directly applicable to dentistry.
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