Patient Anxieties: Dentistry’s Elephant in the Room

A topic that often remains unspoken, yet profoundly affects countless individuals: Dental Anxiety. Patient anxieties related to dentistry are, indeed, the “elephant in the room” that requires our attention and understanding. It is believed that between 3 and 16% of adults experience dental anxiety. Dental phobia is one of the most commonly seen phobias in the world, despite the raised awareness and focus on improving the doctor-patient rapport.

In this detailed article, we will embark on a journey to delve into this often-neglected topic, exploring the profound impact it has on individuals’ lives. Moreover, we will shed light on a range of strategies that can help patients overcome their fears, making dental visits less intimidating and fostering a more comfortable relationship between patients and their dental health providers.

Understanding Dental Anxiety:

Dental anxiety can range from mild unease to severe phobia, with physical symptoms such as elevated heart rate, sweating, and even panic attacks. Several factors contribute to dental anxiety, including:

1. Fear of Pain: The most significant cause of dental anxiety is the fear of pain. Many people associate dental procedures with discomfort, which can lead to heightened anxiety.
2. Loss of Control: During dental procedures, patients are typically asked to sit still and keep their mouths open, limiting their ability to speak or express their discomfort. This lack of active participation can make patients feel helpless and out of control, which can be distressing for some individuals.
3. Previous Negative Experiences: The memory of pain experienced during one appointment instigates the person to expect a similar degree of pain during another, resulting in dental anxiety. The re-living factors including physical reaction, re-experience, sight, sound, smell, and remembrance of physical surroundings.
4. Injections and Airotors: The fear of injections and the sights and sounds of dental instruments are common contributing factors to dental anxiety in patients.
5. Fear of Injections:

• Pain and discomfort: Many patients fear the pain associated with injections, such as local anesthesia or numbing shots. The anticipation of a needle can trigger anxiety, and the actual injection can be a source of distress.
• Past traumatic experiences: Previous painful or traumatic experiences with injections at the dentist can lead to a fear of future injections.
• Feeling vulnerable: Patients may feel vulnerable and out of control during the injection process, as they have to remain still and passive while a needle is administered.

1. Sight and Sound of Dental Instruments:

• Airotors and Micromotors: The high-pitched sound of these instruments can be distressing for some patients. The sight of the drill and the sensation of it in the mouth can contribute to anxiety.
• Other instruments: Patients may be frightened by the sight of sharp, metallic instruments used in dental procedures, such as probes, forceps, or scalers.

5. Embarrassment: Some patients may feel embarrassed about the condition of their teeth or fear judgment from the dentist. They may be concerned that the dentist will perceive them as negligent or lazy about their oral hygiene, which can be emotionally distressing. Patients may fear that the dentist’s judgment mirrors the judgment they might be already facing from others. This fear of societal judgment can intensify dental anxiety.
6. The Unknown: Many patients are anxious because they do not know what to expect during a dental procedure. The fear of the unknown can be paralyzing. Without knowledge of the actual dental procedure, patients may create their own worst-case scenarios in their minds, which can be far more distressing than the reality. The fear of the unknown allows the imagination to run wild, amplifying anxiety.

A lack of trust in the new dentist they have approached for the first time can make the fear of the unknown even more pronounced. Patients may question the dentist’s intentions or competence, adding to their anxiety.

Strategies to Overcome Dental Anxiety:

Addressing patient anxieties related to dentistry is crucial for the overall well-being of individuals. Various strategies to help patients overcome their fears and make dental visits less intimidating are:

1. Open Communication

Open and honest communication between dentists and their patients is indeed one of the most effective ways to alleviate dental anxiety. When dentists take the time to listen to their patient’s concerns and answer their questions, it can significantly reduce the fear and anxiety associated with dental visits.

Many aspects of dental care may seem intimidating or mysterious to patients. When patients are informed about their dental treatment, they often feel more in control of the situation. Knowing what to expect and having their questions answered empowers them to participate actively in their own care, reducing feelings of helplessness.

To effectively implement open and honest communication, dentists can take the following steps:

• Actively listen to the patient’s concerns and questions.
• Use layman’s terms to explain the procedure and avoid medical jargon.
• Encourage patients to ask questions and express their fears.
• Provide visual aids or educational materials to help patients understand the procedure.
• Offer emotional support and reassurance throughout the appointment.

2. Build Trust

Building a strong dentist-patient relationship based on trust is essential. Patients are more likely to feel at ease when they trust their dental provider, and this trust is nurtured through empathy, understanding, and clear communication.

Recognizing and validating a patient’s fears, concerns, and past negative experiences can go a long way in building trust. When patients feel that their emotions are acknowledged and respected, they are more likely to relax and cooperate during their appointments.

Dentists should ensure that patients fully understand the proposed treatment plan, potential risks, and expected outcomes. This transparency allows patients to make informed decisions about their dental care, which can further strengthen the trust between the dentist and patient in case of any untoward outcome of the treatment.

3. Pain Management

Dentists can use a variety of pain management techniques to minimize discomfort during procedures. These include local anesthesia, sedation options, and the use of modern, less painful techniques and tools.

Dentists should employ both psychological (relaxation and behavioral techniques) and pharmacological methods (local anesthetics, sedatives, analgesics) to manage pain and anxiety. The following techniques can be used with or without local anesthesia in order to reduce pain and thus anxiety in patients:

1. Topical Anesthetics: Used to numb the mouth or gums before injections with a local anesthetic.
2. Electronically Delivered Anesthesia: Alternative to injections using electrical impulses. Can be quickly reversed.
3. Nitrous Oxide: Inhaled through a mask, a common sedation method with quick effects.
4. Intravenous Sedation: Injection of sedative into a vein for extensive procedures or anxious patients. Monitored closely.
5. Oral Sedation: Oral medication to relax patients by affecting the central nervous system, takes about 30 minutes to take effect.
6. General Anesthesia: Used for extensive dental work in a hospital setting, patients “sleep” during the procedure, with risks and close monitoring.

4. Gradual Exposure

It is a psychological approach used to help patients with severe dental phobia or anxiety gradually become more comfortable with dental treatments. This approach involves a step-by-step process to desensitize patients to the fear of dental procedures.

The first step in gradual exposure is to begin with non-invasive and less intimidating treatments. This typically includes routine dental cleanings and check-ups. These procedures are generally quick, painless, and non-invasive, making them ideal for building trust and confidence in the dental setting.

Once the patient has developed trust and confidence in the dental setting, we can gradually introduce more complex procedures as needed. This might include fillings, extractions, or other necessary dental work. By this point, the patient is more likely to be receptive to these treatments because they have already experienced positive dental visits.

5. Distraction Techniques

They are a valuable approach in dentistry to help alleviate anxiety and make the dental experience more comfortable for patients. These techniques involve providing patients with engaging distractions to divert their attention away from the dental procedure. This can be done by engaging their senses in one of the following ways:

• Music: Playing soothing or favorite music in the background can create a calming atmosphere and help patients relax. It provides an auditory distraction that drowns out the sounds of dental equipment and can be comforting.
• Videos: Showing videos or movies on a screen in the treatment room can be an effective distraction. Patients can watch something they find interesting, which takes their attention away from the procedure.
• Virtual Reality (VR): Some dental practices offer VR headsets that allow patients to immerse themselves in a virtual environment, effectively transporting them to a different place while the dental work is being done.
• Aromatherapy: Pleasant scents in the room, such as lavender or other calming fragrances, can create a relaxing atmosphere and engage the sense of smell.

6. Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a well-established form of psychotherapy that helps individuals recognize and modify negative thought patterns and behaviors. Behavioral therapy begins by identifying the underlying causes of a patient’s dental phobia. This is crucial as fear of dental procedures can have various triggers, including past traumatic experiences, fear of pain, a sense of loss of control, or generalized anxiety.

In the context of dental phobia, CBT can be particularly effective in addressing irrational fears and negative beliefs associated with dental visits.It equips patients with practical techniques to manage anxiety. Patients learn relaxation exercises, deep breathing, and other strategies to stay calm and composed during dental visits. Identifying the root causes of anxiety, teaching coping strategies, and gradually exposing patients to their fears thus help them deal with their fear.

To summarise

In summary, dental anxiety is a substantial issue that has far-reaching effects. We as dentists have the power to make a substantial impact by fostering open communication, building trust, and utilizing a variety of techniques to reduce anxiety. By doing so, the dental experience can be transformed from one of fear and apprehension to one of comfort and well-being.

References:

1. Experience with dental pain and fear of dental pain; DOI: 10.1177/154405910508401014
2. Influence of the previous dental visit experience in seeking dental care among young adults; doi: 10.4103/jfmpc.jfmpc_1109_19
3. Association of Fear and Annoyance with Acoustic Levels of Dental Equipment Among Adolescents Attending Rural Dental Health Center: A Cross-sectional Study; https://opendentistryjournal.com/VOLUME/15/PAGE/595/
4. Strategies to manage patients with dental anxiety and dental phobia: literature review; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790493/
5. Anxiety and pain management in the dental office; https://www.ijsdr.org/papers/IJSDR2002036.pdf