● Possibly making negative comments about dentistry. (Armfield, 2016; Pocket Dentistry, 2016) If anxiety progresses to panic, the dental staff may also observe the following: ● Perspiration and moist palms. ● Hyperventilation. ● Muscle tension (common with general anxiety as well). ● Increased heart rate or palpitations. ● Trembling or shaking. (National Institute of Mental Health, 2016) Anxious patients may become restless, fidgety, and unable to concentrate, or they may complain of feeling uneasy. Others become excessively talkative and use this strategy as a delaying tactic. Some fearful patients may become irritable, uncooperative, or even aggressive (Apple, 2019). Assessment becomes more complicated when you consider the fact that many anxious patients cover their real feelings with sarcasm, joking, anger, or hostility (Armfield, 2016). Some clinicians find these behaviors annoying; however, these behaviors should alert the dental team of possible patient anxiety. NONPHARMACOLOGICAL GUIDANCE TECHNIQUES FOR FEARFUL ADULT PATIENTS Dental office ambiance
A patient’s first contact with the practice may be reassuring, or it may reinforce preconceived negative feelings about dentistry. Much depends on the welcome from the dental staff. Regardless of whether the first contact is by phone or takes place on the initial office visit, patients respond favorably to a warm, friendly welcome (Minja & Kahabuka, 2019). When questioned about their office preferences, anxious patients preferred a cooler temperature and adorned walls (Apple, 2019; Appukuttan, 2016; Karnad, 2015). A supply of reading material and background music are also preferred (Karnad, 2015). Anxious patients also preferred to be seen by an older dentist and liked the Communication Good communication is the foundation of all guidance techniques and strategies. The dentist can encourage solid two-way communication by speaking face to face with the patient before any dental work begins (Appukuttan, 2016). This conveys the practitioner’s interest and a caring attitude. At the same time, it affords an opportunity to observe nonverbal communication, such as the patient’s facial expression. The latter may be more revealing than words. It is also important that ample time be allotted for this initial conversation and that the patient not be rushed. The dentist should encourage questions, listen attentively, and keep the patient informed throughout the visit. Components of cooperative communication include the following: ● Making the patient feel welcome and safe (e.g., using a calm tone, pleasant facial expressions, and reassuring body language).
practitioner to be dressed professionally rather than casually or wearing scrubs (Zeren et al., 2016). Other recommendations include avoiding dental smells where possible and keeping dental instruments out of the patient’s view (Rosehill, 2018). Sounds coming from the operatory, including the sounds of the drill or a crying child, can also act as triggers for patients sensitive to such noise (Appukuttan, 2016; Tellez et al., 2015), and anxious patients have reported that they found the sound of the drill frightening (Rosehill, 2020). It is therefore additionally advisable to keep the door to the reception area closed. 2. Distrust of the dental staff members and their professional capabilities. 3. An overall anxiety about dentistry. 4. Anxiety about a catastrophic event that could occur during their dental appointment. (Appukuttan, 2016) Some patients may be afflicted by more than one of these issues, each of which needs to be addressed by the dental team in order to provide dental treatment that will be successful at the initial appointment and that will encourage the patient to return for regular periodic dental care. When a patient admits to fear, a well-intentioned response of, “It will be fine” or “Do not worry” is inappropriate. Patients seek information and are interested in learning how the practitioner intends to address their problem. Offering solutions indicates that the patient’s fears are taken seriously and are not considered trivial or ridiculous. Fearful patients are often ridiculed or mocked for their fears. Choosing nonthreatening language is important. Frequently used expressions such as “root canal,” “pulling a tooth,” or “getting a shot” reinforce negative thoughts. The same information can be conveyed by substituting “endodontic treatment,” “removing a tooth,” and “making the area numb.” The use of phrases such as “it will not hurt” or “you’ll feel no pain” is counterproductive. All the anxious patient hears is “hurt” and “pain.” Patients may have experienced a failed local anesthetic in the past and dread feeling pain. It is better not to promise they will feel nothing but instead to prepare them to anticipate some sensation of pressure or vibration. Patients frequently fear losing control. Sitting with their mouth wide open allows for little verbal communication. By prearranging for a signal, such as raising a hand (opposite to the dentist’s hand, where it is out of the way and can be seen) or raising a leg, the patient can signal a request to pause a procedure. This request should then be honored and never ignored. This assures patients that they have some control (Anthonappa et al., 2017; Appukuttan, 2016).
● Maintaining eye contact. ● Observing the patient. ● Avoiding big or sudden movements. ● Being empathetic. ● Using language the patient will understand.
● Using good listening skills. (Apple, 2019; Appukuttan, 2016)
The dentist and dental team members should not only be observant and good listeners but also capable of conveying to patients that they are being heard. A patient who repeats his or her concern does not feel heard or understood. A reply such as “I understand,” to a patient’s voiced concern, followed by the practitioner’s interpretation of the patient’s message, may be all that is required to convince a patient that he or she is being heard. The patient must be convinced that their concerns will be addressed promptly and compassionately, especially among the four different groups of anxious patients that have been categorized based upon the origin or source of their specific fear or anxiety: 1. Anxiety from specific dental stimuli, such as the sound of a drill, the sight of dental instruments, or the sight of an anesthetic syringe. Motivational interviewing Motivational interviewing is an emerging practice used in dentistry to increase healthy behaviors among patients. This approach focuses on exploring and resolving ambivalence and centers on motivational processes within the individual that facilitate change. It is suggested that patient engagement
with treatment may be a potential mechanism for change in populations with mental health disorders, such as anxiety (Romano & Peters, 2015). Motivational interviewing is a collaborative conversation between dental provider and patient to strengthen the patient’s motivation for and commitment to
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