Establish Clear Communication
Good communication is essential in any relationship. Both patients and dental professionals need to clearly communicate their expectations and concerns, but ultimately it is the practitioner’s responsibility. The desired outcome of establishing clear communication is to build trust between patients and those treating them. Building trust is the key to establishing a good rapport with patients.
Assess fear and anxiety
From the moment a patient walks through the door to check in for an appointment, there are opportunities to ask questions about any anxiety or fear that they are experiencing or expect to experience. The use of questionnaires such as the Modified Dental Anxiety Scale (MDAS) can help to assess fear and anxiety related to dental treatment without affecting a patient’s emotional state.1,2,3 Additionally, direct questions and open-ended questions can be used to identify a patient’s expectations, allowing an opportunity to explain the details of a procedure, reassure the patient, and offer solutions to ease their fear.
Different people have different fears about going to the dentist. Patients can be just as anxious about a routine cleaning as they are about complex oral surgery. Sensory triggers of anxiety can include sights, sounds, and smells associated with a dental practice as well as pain.4
Listen to the patient
One of the simplest (and perhaps often overlooked) ways to understand a patient’s anxiety is to simply listen to the patient. Patience and empathy are useful tools to help discern what a patient is experiencing. Communication is a two-way street; be sure to ask open-ended questions and allow time for patients to respond. Sensory triggers, a past negative experience, or an expectation of pain can all contribute to anxious feelings.4 Exploring the reasons for a patient’s anxiety allows you to identify what steps you can take to alleviate their stress, but only if you take the time to listen.
One way to shift a patient’s focus away from a potentially anxiety-inducing experience is through distraction.1,4 Providing patients with interesting stimuli gives them something to turn their attention to other than their dental treatment.
The environment sets the mood
Simply entering a medical office can trigger anxiety or at least unease. In addition to comfortable chairs and ample reading material, a patient waiting area should feel inviting, welcoming, and comforting.1,4 A fish aquarium, plants, artwork, soothing music, or a television can make a waiting room feel more like a living room — a place to relax and feel safe. The same principle applies to treatment areas as well.
Engage the patient’s attention
A television, a window with a view, and artwork or posters in the treatment area can provide patients with distractions. Allowing or encouraging patients to use headphones or earbuds can let them focus on listening to music, an audiobook, or a podcast rather than potentially anxiety-inducing noises or other stimuli.5 Talking about things other than dental care can also help ease a patient’s anxiety.
Techniques to Ease Anxiety
There are several useful techniques for easing a patient’s anxiety. These include involving the patient in their own care, which allows them to exercise some control over their dental experience.
The tell-show-do technique can ease patient anxiety by clearly communicating what a patient should expect during a procedure.6 Tell patients what you are going to do and introduce them to the instruments that you will be putting in their mouths. You can then show them what you are going to do and demonstrate how the procedure will be performed before doing it. This technique is effective for both adults and children, especially those individuals without experience with dental care.
Control how you speak
How you speak to patients influences their stress levels. Speaking in a calm, clear voice and being mindful of your tone of voice can help patients feel calmer.4
Giving patients opportunities to signal when they are in distress can allow patients a chance to exercise some degree of control over their experience.4,7 Using a predetermined signal, such as raising a hand, can alert dental personnel and let them know the patient needs to pause briefly. This creates an opportunity to determine if a patient needs better pain control or other adjustments to ease discomfort and anxiety.
Techniques patients can perform
Controlled breathing exercises and progressive muscle relaxation can help patients keep themselves calm during procedures.4 Employing mindfulness techniques can also help patients deal with their internal experiences during a dental visit.5,7 These techniques can provide the patient with some degree of control over their emotional state during a procedure.
Preventing or relieving pain with local anesthetic is standard practice, but this may be insufficient for some patients, especially for more involved or more painful procedures. Depending on the patient and the procedure, general anesthesia may be needed to allow effective treatment.6 However, conscious sedation using nitrous oxide or oral medication can provide pain relief and ease anxiety while still allowing the patient to exercise some control.5,6 Properly trained practitioners can also use hypnosis to provide analgesia and anesthetic-like numbing of affected areas while avoiding potential complications due to medications.4
Managing Anxiety Is Essential
Patient anxiety can make any procedure unpleasant and can also present challenges to the practitioner, increasing their level of stress. Managing anxiety is essential for the well-being of both doctor and patient. Creating a comfortable environment and using distraction are important, but the single most important tool for relieving patient anxiety is good communication before, during, and after dental procedures. Ultimately, helping patients understand what to expect and offering them some degree of control over their experience benefits everyone involved.
- Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: Literature review. Clin Cosmet Investig Dent. 2016 Mar 10;8:35-50. doi: 10.2147/CCIDE.S63626. PMID: 27022303; PMCID: PMC4790493
- Kassem El Hajj H, Fares Y, Abou-Abbas L. Assessment of dental anxiety and dental phobia among adults in Lebanon. BMC Oral Health. 2021 Feb 4;21(1):48. doi: 10.1186/s12903-021-01409-2. PMID: 33541354; PMCID: PMC7863489
- Humphris GM, Clarke HM, Freeman R. Does completing a dental anxiety questionnaire increase anxiety? A randomised controlled trial with adults in general dental practice. Br Dent J. 2006 Jul 8;201(1):33-35. doi: 10.1038/sj.bdj.4813772. PMID: 16829885
- Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: A review. Aust Dent J. 2013 Dec;58(4):390-407; quiz 531. doi: 10.1111/adj.12118. PMID: 24320894
- American Dental Association. 8 Tips for Conquering Dental Anxiety. Accessed March 9, 2023. https://adasmileplace.com/tips-conquering-dental-anxiety/
- American Academy of Pediatric Dentistry. Behavior Guidance for the Pediatric Dental Patient. Accessed March 9, 2023. https://www.aapd.org/globalassets/media/policies_guidelines/bp_behavguide.pdf
- American Dental Association. 5 Tips to Reduce Anxiety and Stress in Dentists, Patients During Their Visit. Accessed March 9, 2023. https://www.ada.org/publications/new-dentist-news/2022/february/5-tips-to-reduce-anxiety-and-stress-in-dentists-patients-during-their-visit