Dental anxiety – building the perfect dental practice

patient with dental anxietyDental anxiety affects around half of UK adults. Trishala Lakhani explains how she would build a practice perfectly catered to anxious patients.

Dental anxiety is one of the most common reasons people avoid visiting the dentist in the UK. According to AnxietyUK.org: ‘Almost half of UK adults have a fear of the dentist’. The Oral Health Foundation ranks visiting the dentist first for making people nervous – even before spiders and heights!

This has a detrimental impact – it allows patients to enter a vicious cycle of delaying necessary treatment and subsequently presenting with pain/infection and inevitably undergoing symptom-driven treatment, which amplifies dental anxiety further.

Additionally, the level of oral hygiene in patients would naturally be of a lower standard than those who regularly visit the dentist.

Research over the past decade shows links between poor oral hygiene and heart disease, uncontrolled diabetes, dementia and problems during pregnancy. Hence dental anxiety poses serious health implications.

Dental anxiety

There are several techniques that practices can implement to eliminate the barriers of access for anxious patients. As well as making the dental environment a comfortable and safe place for patients to attend.

The mannerism and etiquette of the entire dental team and the rapport they build with patients heavily influences this.

An array of factors often cause dental anxiety, hence there is not one single cure. But by making multiple changes, these can cumulatively make a positive impact.

In this article I hope to discuss primarily the psychological methods I would use to design a dental practice and increase access for those suffering from dental anxiety using evidence based practice.

Although pharmacological methods such as sedation and general anaesthetic can be useful for dental phobic patients/special needs patients, it is important to try behaviour therapies first. Pharmacological methods carry greater risks, require proper equipment and monitoring, require specific skill, training and experience as well as inflicting a greater cost. Hence, although incredibly useful, it may not be feasible to perform in practice.

Dental practice ambience

As mentioned, ambience of the dental practice has a crucial role in triggering dental anxiety. The environment, as well as the behaviour of the dental team, contribute to this.

In my practice, I would ensure the staff undergo regular training to ensure they are radiating positivity. Using both verbal (ie vocabulary, tone) and non-verbal (ie body language) communication methods and ensuring they make patients feel as though they are listened to contribute to this.

Examples are standing up and shaking a patient’s hands as they walk in. Frequently nodding their head and repeating what the patients are saying to display active listening. Using a soft, mellow tone.

Additionally, I would modify the environment of the dental practice to make it a welcoming and calm environment. A study by Bare and Dundes shows patients prefer a cooler dental office. Therefore, I would ensure the practice regulates the temperature and it isn’t overbearing.

Furthermore, I would ensure that soft, quiet music is always playing in the background and there are no bright, white lights. We want to create a calming and relaxing environment.

Adapting to the senses

Many studies show the smell of dental materials such as eugenol are suffice to elicit anxiety amongst patients. In my dental practice, I would mask these odours. Aromatherapy has been shown to reduce anxiety and promote positive moods amongst patients. So I would ensure from the moment patients enter the practice, they are inhaling scents of essential oils of aromatic plants and lavender. This decreases systolic blood pressure.

However, smell isn’t the only sense that has an impact on anxiety. Sight, touch and feel also play a role. Shapiro et al changed a sensory-adapted dental environment. A ‘Snoezelen’ dental environment comprising dimmed lights, soothing music and a butterfly vest which hugged the child patient. This evidently had a positive impact on improving relaxation significantly.

Therefore, incorporating the dim lights and music as above is essential. Alongside providing the option to patients to hug a vest during treatment, initiating relaxation and reducing anxiety.

Patient communication

A good rapport between dentists and their patients is pivotal in managing anxiety. Effective communication is essential.

The dentist should ensure patients feel at ease by personally addressing the patient and responding to their needs in a sensitive, non-judgmental manner. This includes learning and listening. Not only about the patient’s dental issues but also about their fears.

Patient’s should also feel as though they have an element of control. Encourage them to ask questions. The dentist should constantly ask the patient if they are feeling at ease.

Additionally, the dentist must avoid rapid hand movements and use the ‘tell-show-do’ method. This ensures the patient isn’t startled by any aspect of the procedure. It conveys a sense of genuine care and empathy to the patients.

Both verbal communication ie using clear, concise language and avoiding negative phrasing, may also be beneficial in reducing anxiety. Non-verbal communication ie dentist should face the patient, lower themselves to the patient’s level and make eye contact, would also enhance the patient-dentist relationship.

Psychotherapeutic methods

Several psychotherapeutic methods are effective in reducing dental anxiety amongst patients. They aim to change undesirable behaviours, such as anxiety, through learning.

These strategies include; relaxation techniques, guided imagery, hypnosis, acupuncture, distraction, positive reinforcement, stop-signalling and exposure-based treatments, like the ‘tell-show-do’ method, as discussed above.

A relaxation technique I would incorporate in my practice is Jacobsen’s progressive muscular relaxation. This is extremely common and aims to reduce relaxation by teaching the anxious patient to tense specific muscle groups for five to seven seconds. Followed by 20 seconds of relaxation. Dentists can use this method chairside. And the patient can perform and practise at home. This method has been shown to decrease the anxiety and stress of anxious patients. It supports the theory of ‘once a person is physically relaxed, it is impossible to be psychologically upset at the same time’.

This technique has a 0 cost and is simple, as well as effective. Which is why I would incorporate it into my practice.

Conclusion

In conclusion, dental anxiety has a severe impact, not only on a patient’s oral health, but also on their quality of life. It is imperative that dental practices implement modifications to enable and encourage patients to visit the dentist at regular intervals.

Psychological methods as mentioned in this article are effective in reducing dental anxiety.

If these are not suffice and if indicated, pharmacological control of pain and anxiety by using general anaesthetic and sedation may be justified, and patients can be referred appropriately.

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