- Dr Diksha Tahilramani Batra
Versus
Dentistry is one of the only medical faculties that has been infamously linked or associated with pain in the patients’ mind, even though several other specialties like obstetrics come with higher amounts of risks and assured pain, yet we commonly hear people saying -
“I’d rather experience any pain except tooth ache."”
The age old portrayal of dental appointments and dentists even in the media or as we hear it from our family & friends, reeks of horror stories and weapons of torture, but just like everything else has transformed in this day and age, dentistry has not been left behind either. The advent of technology has made almost all procedures supremely comfortable and that is something that we must communicate unanimously as a fraternity, to allow more patients to avail the quality care that we have to offer.
For years, we as dental professionals have identified the biggest challenge to treating our patients has been this all-encompassing fear of going to the dentist that prevents so many people from seeking care at the right time, this in fact makes the occurrence of dental pain a definite reality.
It is important to acknowledge and understand this barrier of perceived pain, from a psychological as well as technological stand point, that will help us create awareness for a better patient experience among our patient populations.
Patient perception of a dental experience - discomfort vs anxiety vs fear vs phobia
In our practices we come across patients who feel no hesitation in receiving dental care or the other end of the spectrum are those that cannot even bear the thought of the dental chair. Somewhere in between are many more who avoid till they could, but still are a bit uncomfortable or anxious. It becomes important to identify where a patient lies on this spectrum in order for us to be able to manage them well as each level of perception requires a different approach by the caregiver as well as the entire dental team.
Mild - Dental Discomfort
It’s a mild degree of an unpleasant sensation that can be endured but not enjoyed. For many patients, a dental appointment is something that they “must” or “have” to do rather than they “want” to do.
These patients have not been scarred by a bad experience and are easiest to manage with routine protocols, however at this stage it’s still important to not create any negative association of dentistry in the patients mind. Effective communication to set expectations, adequate anesthesia and raising awareness about prevention can ensure a successful result so the patient doesn’t experience pain. The aim here should be to replace Discomfort with Delight (a willingness to voluntarily make an appointment for routine follow ups and partner in oral hygiene maintenance)
Moderate - Dental Anxiety
Dental anxiety is defined as an abnormal fear or dread of visiting the dentist for preventive care or therapy and unwarranted anxiety over dental procedures.
It is a slightly more heightened response than mere discomfort. Patients with anxiety do manage to battle this feeling and show up for their appointment but definitely imagining unpleasant scenarios and are cautious with procedures that involve long treatments and instruments. It is the most common since most people don’t know what will happen at the appointment and it heightens their “fear of the unknown”.
Most of these patients are cooperative to tolerating basic dental treatments that they may have experienced before but dental anxiety is the reason why these patients don’t convert to recieve complex or elaborate treatments like implants or smile makeovers immediately and like to think over and return. If we can eliminate this anxiety by treating these patients with effective means of “tell show do” ensuring they understand the procedure, see what will be used and even experience it to some mild degree before committing to it we can see their anxiety reducing with trust and acceptance increasing. Such a patient should never be forced into an elaborate treatment or subjected to multiple procedures in one session or it can compound their anxiety significantly.
Severe - Dental Fear
Dental Fear is a reaction to a known danger (“I know what the dentist is going to do, been there, done that – I’m scared!!”), which involves a fight-or-flight response when confronted with the threatening stimulus.
It’s source lies in the conscious mind and creates definite physical responses. Dental fear is when your anxiety is unmanageable and is now definitely leading to avoidance of dental care. Anxiety when finally progresses to an established feeling of dread that creates physical inaction is dental fear but it is still different from phobia which leads to avoiding dental care at all costs. A fearful patient will approach dental care cautiously and maybe even reluctantly but may not avoid it completely, this can be the initial stages of a developing phobia if not managed.
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