Changing the habits of nervous patients

nervous patients Dentistry may continue during this lockdown, but how will the ‘new normal’ impact our more nervous patients? Here, Karon Priestman shares her thoughts on behaviour change and oral health.

Historically, many people fear the dentist but the profession has changed over the years for the better. I have worked in dentistry for 14 years. I’ve seen how developments in both the way we treat patients and the technology have led to an increasing number of patients returning for routine check-ups and hygiene appointments.

Latterly, however, teams have inevitably been challenged by this enforced break in our business.

How can I help?

I began my career in dentistry as a dental nurse. My passion for helping nervous patients began here. It is such an achievement to help someone overcome their fear.

One of the units during my university studies to become a dental hygienist and therapist focused on behavioural science and we learnt how, as clinicians, we can help.

I enjoy spending time getting to know my patients and them to know me as a person. When patients relate to you at a deeper level than just a clinician, they tend to open up more about what is making them nervous.

Communication is key, so I always offer open-ended questions to encourage them to share their true feelings. I ask patients what has made them nervous – if it was a bad experience, or if they dislike the sensation of lying flat, or the water in their mouth.

Once I have an understanding of what is causing their fear, I tailor my approach to their needs.

When talking with patients, I like them to see my facial expressions.

This is a challenge right now – with the new PPE guidelines requiring full mask and visor. However we can at least maintain eye contact, which is an important soft skill.

The new PPE may make patients feel more nervous. Especially as the masks can distort our voices and they cannot see as much of our faces.

However, I am hoping that, where I have built rapport with them, I will be able to continue treatment plans within a safe environment.

Building trust

As a clinician, we have a duty to build a relationship of trust with patients. When treating patients I like them to feel in control, too. I always give the patients a stop signal, so they know the minute they raise their hand, I will cease treatment.

Dentistry is my ‘every day’, but patients may only see me twice a year. So, I feel it is important to explain what I am doing and why. I find that when you explain and give patients the time to ask questions, they are more relaxed in the chair.

The dental surgery is the last place a nervous patient wants to be. I often find they are very happy to take on board my advice with regards to preventive care.

At their first hygiene appointment, I spend a lot of time talking about oral hygiene. I emphasise the importance of home care.

Brushing our teeth is something we do daily but we might not always think about technique. Patients may use incorrect techniques and they over brush or under brush, unknowingly damaging teeth and gum health.

More and more patients are following my advice to change to an electric toothbrush, as they are more effective at plaque control. I like to recommend the Oral-B electric brush with a cross action head. I’ll use a disclosing solution to highlight any areas that have been missed when brushing. I can then tailor my advice to highlight the missed areas.

Oral-B’s test drive toothbrush enables me to demonstrate in the patient’s own mouth. This allows the patient to understand the feeling and gets them used to the grip and technique required while in the chair.

I find when I do ‘tell-show-do’ with patients, they take on more of the advice and I see a big difference in plaque control, thereby improving their oral health. When discussing oral hygiene, I talk to patients in basic dental terminology. A lot of patients say they like this because they understand – it humanises the job.

When I start to debride, I divide the mouth into sextants. I break it down into small sections for nervous patients and say, ‘let’s see if we can do one sextant today’. With them feeling more at ease and relaxed, we often complete three sextants. Patients often leave feeling happy that they have achieved more than we set out to do.

Visual learning

During lockdown, I have had patients reaching out to me via my hygiene Instagram page asking for advice. I have been able to direct them to the relevant post to help them while they haven’t been able to get to the dentist.

Having social media is helpful for patient information and education. It has become incredibly popular. It is definitely the way forward to help reach more of the public.

Social media is very visual and many of us learn more with visual aids. Before these digital platforms became popular, patient education was primarily about what you could show the patient in the room with models.

Videos and images on social media are changing this. We are spending more time online. They can also act as a prompt for patients when they are at home to remind them to follow advice.

It takes 21 days to change a habit. With prompts on toothbrushing and interdental cleaning, I hope it will encourage patients to follow the advice for effective home care routine. 

Keep up to speed

With teams in stricter PPE – I fear patients are anxious to return to the dental practice. However, it is important for patients to return to maintain optimum oral health.

While off in lockdown, dental professionals have been using their time wisely to update their CPD. Especially focusing on decontamination and infection control, mental health and COVID-19 precautions. With more courses going online, it means as a profession we are able to keep up to speed. Having the latest knowledge is a must to provide excellent care and standards along with safety for our patients.

In the future I would like to see a change for dental hygienist and therapists that will become more recognised within the profession for our skills. We have the skills to treat a patient and to return them to full dental health. Yet many dentists still don’t understand our full scope.

Patients also need educating on our scope and the higher skills we have. Especially with new guidelines and PPE, practices should look to utilise us more. I have several patients who I see for regular hygiene visits and have a relationship of trust, who now request for me to do any dental work they need.

When you first come out of university, where you have been living and breathing teeth, you must remember your patients haven’t.

Patients are returning to dental practices. Though, perhaps in pain because they have been unable to access an appointment. We need to spend the time, build that rapport and convert them to regular attenders, not just when they are in pain. We need to show patients we are human. 


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This article first appeared in Oral Health magazine. You can read the latest issue here.

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