Dear Barry – I have several patients who become incredibly nervous at the mere mention of an injection. I feel I’ve tried everything but to no avail. What’s your secret to success?

When looking after a patient with dental anxiety, there are a number of techniques and approaches that can be used to help them become as relaxed and comfortable as possible. Every patient needs to be assessed individually and the approach tailored according to their responsiveness to what is going on around them.

Anxiety rules?

At this juncture, it’s probably worth defining what anxiety is, as it helps to understand how to quell it in our patients.

In essence, anxiety is a fear of something that hasn’t happened but a worry about something that might. So, for example, a fear of an injection or needle is not fear of the needle itself; it is a fear of what they think might happen. They might be imagining the sensation of sharpness or pain, or something going wrong, a resultant injury, etc.

The theory of neuro-linguistic programming (NLP) breaks this down even further, suggesting that anxiety is generated as result of a combination of internal representations, a feeling/emotional state and body posture/breathing:

  • An internal representation or thought is a picture, sound and/or internal voice of a bad event
  • This may remind them of, perhaps, an experience in the past (a memory) or of something that they fear happening that hasn’t happened yet (a construction)
  • When coupled with a negative body posture such as the shoulders being down and forward, the head down slightly and/or shallow breathing, this can influence or create a negative emotion in the body – resulting in the feeling of anxiety.

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Practical steps

So, when a patient has a ‘fear’ of needles, talking to them about something that makes them happy, something that changes the thoughts in their mind, for example, the last holiday they went on, can have a significant, positive impact on any feelings of anxiety.

Whilst the patient is in a more ‘happy place’, this is the time to explain what needs to be done, using optimistic language and phrases that create positive images in their minds.

Embedded commands are also useful; an embedded command is an NLP term for ‘planting’ a thought (state, process, or experience) within the mind of another person beneath their conscious awareness.

For example, I might say: ‘So, Mr Patient, the most important thing today is that you feel completely comfortable whilst I look after you. Everything I do will be gentle and if there is anything that isn’t completely comfortable, all you need to do is raise a finger or your hand, and I will stop what I am doing. This is so that I can find out what I need to do to make sure you remain relaxed and comfortable. How does that sound?’

Assuming this sounds good to the patient, I might continue: ‘Great. So, I am going to gently rub in some bubble gum-flavoured numbing gel into you gum for a minute…’

I would then run through my ‘comfortable injection technique’, which results in the patient having an injection that is easy, effortless and comfortable.

The ultimate aim is to have patients leave with a new sense of wellbeing about attending the dentist. This is achievable by using the techniques mentioned in this article – and others beyond the scope here – throughout the whole patient journey.

By being attentive, listening to our patients and building rapport, the priceless, added value of anxiety-free treatment is achievable.