Do you suffer from dental anxiety?

By Dr George Druttman

With all new patients I have a question about dental anxiety in my dental history questionnaire and ask them to score themselves on an arbitrary scale of 1 to 10 (with 10 being the highest) as to whether or not they believe they are a nervous dental patient. It’s interesting to see what people put down when I correlate that with a subsequent verbal discussion during the initial consultation.[

Of course, the interesting and ‘challenging’ individuals are the one that rate their score very highly. Those that consider themselves a 9 or 10 really are not. If they were, they would have to be almost dying to be dragged into a dental practice! So the first thing we do challenge them on is that. Often, in reality they are, say a 7 or 8 at most, or even more like 5 or 6!

What does that mean?

For whatever reasons (and there always are), people who have left it a long time between visits or ignored a dental problem that they ‘knew’ would get worse without intervention, feel they need to justify (perhaps to themselves primarily) why they had not attended sooner. Nevertheless there is no doubt that there is always a cause for a certain degree of anxiety and often it does result in a feeling a dread about a dental visit.

But is it as bad as some report?

Interestingly, I don’t think I have ever come across someone who rated themselves as a nervous dental patient lower than they actually were!

Today, well into the second half of the 21st Century, modern dentistry in the developed ‘first world’ is very, very rarely painful. Yes, perhaps it is uncomfortable, time consuming and perceived to be expensive and possibly not the most pleasurable way to spend time?

However, the old horror stories just shouldn’t ever apply any more. Dentists today have grown up and been educated to very much focus on and address their patients’ dental anxieties and fears as well as treating their clinical problems. Every dentist knows that the quickest way to ‘lose a patient’ is to cause pain.

How we help nervous dental patients

So for us, at the other end of the mask, gloves and dental probe, it’s important to recognise the actual degree of dental apprehension before that anxious patient sits in our chair. Of course, it has to start with a conversation at the initial consultation. The patient has to be open and verbalise their fears and an explanation needs to be acknowledged.

It’s almost always as simple as the memory of one or more ‘bad’ dental experiences in childhood. Over time, these can often become exaggerated… that is ‘normal and human’!

So even before asking the patient to lie down on the dental couch, the dentist should explain how he or she would approach this issue; perhaps even discussing anxiety reducing aids they may additionally utilise (such as forms of sedation such as ‘relaxing gas’,  or even acupuncture or hypnosis).

Then, when they lie in the dental chair, it is important to recognise signs of anxiety that patients will usually involuntarily present. What are the giveaways of a nervous patient? Here are a few examples:

• The hands will clench or grip the sidearms of the chair
• The knees will often draw up
• The brow may perspire
• When asked to open their mouth the lips purse up, tending to cover (protect?) the teeth from being exposed

Such signs must be noticed by the dentist and the nurse and dealt with patiently and gently, so the patient can ‘learn’ that the dentistry to come really is not such a big deal. We all want patients that appreciate, accept and welcome care that results in them having healthy and beautiful teeth and be relaxed about the process. The last photograph is of an ideal patient of ours, albeit before they are asked to ‘open wide’- nice, isn’t it?

Could it be you?

Often, it is indeed the dental fear and society that turns out to be the principle dental problem which results in dental neglect and even in ‘ugly’ teeth. In those cases, that is the problem the conscientious dentist then needs to address first.

Finally, before you claim to be an extremely anxious patient, think about whether you really, really are?  Or is it that to a significant extent you have felt yourself ‘not to have had the time’ and are too busy to make that appointment or that you begrudge paying the inevitable fees? After all, who wants to pay for something they don’t enjoy?

Interestingly, many of our patients that use the ‘Relaxing gas’ technique never seems to begrudge paying for that.

Why?

Probably because it’s something they ‘enjoy’!