Top 10 Ideas to Handle Dental Anxiety

Almost 90% of the Indian population is dealing with anxiety problems.

Today, if we talk about this issue, then we can easily observe around us that not only teenagers and old age groups have become its prey, but even kids are suffering from the same difficulty. Anxiety exists everywhere, whether its workplace or home. It’s everywhere!

Patient’s anxiety causes stress to the dentist

A dentist has to tackle so many things in clinics and hospitals, and one of them is patient’s anxiety on dental chair. Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. Anxiety is often closely linked to painful stimulus and increased pain perception, and thus these patients experience more pain that lasts longer; moreover, they also exaggerate their memory of pain.1 Treating such anxious patients is stressful for the dentist, due to reduced cooperation, requiring more treatment time and resources, ultimately resulting in an unpleasant experience for both the patient and the dentist.2 The practitioner should aim at alleviating the anxiety and fear in such a way that these patients are positively motivated on a long-term basis for future dental visits. Next are top 10 strategies to manage dental anxiety patients:

1. Relaxation techniques - Jacobsen’s progressive muscular relaxation

A relaxation response is the opposite of a stress response, and when practiced regularly it not only lowers stress and anxiety levels, but also enables an individual to cope with the symptoms of anxiety. This can be achieved by both deep breathing and muscle relaxation. Once a person is physically relaxed, it is difficult to be psychologically upset at the same time. Anxiety-provoking stimuli give rise to physical tension, which in turn increases the person’s perception of anxiety. Jacobsen’s progressive muscular relaxation: The most common technique taught to the patient is Jacobsen’s progressive muscular relaxation. This involves tensing specific muscle groups for 5–7 seconds, followed by 20 seconds of relaxation. The method can be demonstrated chair-side, and should be practiced and rehearsed by the patient at home. Four major muscle groups are commonly tensed and relaxed. These are:

1. feet, calves, thighs, and buttocks
2. hands, forearms, and biceps
3. chest, stomach, and lower back
4. head, face, throat, and shoulders.

Allow 15–20 minutes to practice the relaxation technique.3

2. Guided imagery

Guided imagery has been defined as a directed, deliberate daydream that uses all the senses to create a focused state of relaxation and a sense of physical and emotional well-being. It is a mind–body exercise, wherein patients are taught to develop a mental image of a pleasant, tranquil experience that consciously guides their attention to achieve relaxation, thereby reducing anxiety. There are generally three stages to guided imagery:

• relaxation
• visualization
• positive suggestion. 4

Imagery can be a pleasant place such as a beach, mountains, lake, or a safe place, and should be engaging and customized to each patient. Patients can be allowed to choose their own mental image or they can be guided by using scripts by the dentist. It is relatively easy to learn, teach, and use in practice. It can be performed by an adequately trained dentist or with the use of audio recordings, and can be performed daily or as needed by the patient.

3. Caring and communication

For patients with dental anxiety, empathy and understanding go a long way. Taking time to listen to patients voice their fears and concerns can make them feel welcome and, ultimately, relaxed. The most important thing about being a good dentist is being comforting and being a good communicator. A patient’s relationship with his/her dentist and dental team is just like any other—it benefits from open, honest communication.

When speaking to patients, normalizing anxious feelings and avoiding negative phrasing is beneficial. Furthermore, patients should be encouraged to ask questions, and they should be kept informed throughout the dental procedure.5

4. Acupuncture

Acupuncture is a technique, wherein a disease is treated by inserting needles at various points on the body, known as acupuncture points.6 It has been reported that acupuncture is effective in treating dental problems such as

• anxiety,
• temporomandibular dysfunction syndrome,
• pain, and
• Sjögren’s syndrome.

It is a simple, inexpensive treatment modality that requires special training before it can be incorporated into practice. Reports on the use of auricular acupuncture for treating chronic and acute anxiety have shown promising results.7

5. Hypnotherapy

The term ‘hypnosis’ denotes an interaction between one person – the ‘hypnotist’ – and another person or people – the ‘subjects’. In this interaction, the hypnotist attempts to influence the subjects’ perceptions, feelings, thinking, and behavior by asking them to concentrate on ideas and images that may evoke the intended effects. The verbal communications that the hypnotist uses to achieve these effects are termed ‘suggestions’. Suggestions differ from everyday kinds of instructions in that they imply that a ‘successful’ response is experienced by the subject as having a quality of involuntariness or effortlessness.8 It is inexpensive, and has a very low risk of side effects. The technique needs to be avoided in those with mental health problems, personality disorders, and neurodegenerative disorders. Dentists require special training before they can practice hypnotherapy.

In a meta-analytic review, it was shown that 75% of subjects experienced pain reduction following hypnosis. Studies have also shown effectiveness in anxiety reduction, allowing people to handle stressful dental treatments.9