change to healthier behaviors, such as coming in for regular dental appointments, adhering to appropriate daily oral hygiene regimens, and completing recommended treatments, which can Distraction The purpose of distraction techniques is to direct the focus of the patient’s attention away from a potentially unpleasant and feared stimulus. The distraction may be as simple as jiggling the patient’s cheek during an injection. Other suitable distractions include having the patient watch a video, play video games, or listen to music. Active distraction has been shown to be more effective than passive distraction in reducing anxiety (Attar & Baghdadi, 2015). It can be posited that any activity that mentally engages the patient can be effective. For example, patients can be asked to count backward by threes, followed by fours, and so forth, or to count the tiles on the ceiling or recite the alphabet backward. Patients may report having their own coping skills, including imagining pleasant scenery or reflecting on positive past experiences using imagery. It may be more helpful to encourage the use of such familiar strategies instead of introducing new skills at a time of stress. Having choices lets the patient feel that he or she has some control. Music or an audiobook can be an effective distraction technique (Apple, 2019; Mark, 2017) with the effectiveness of music increased Guided imagery Guided imagery is a form of mental distraction. It uses the imagination to direct thoughts and suggestions in a manner that results in a more relaxed state. The patient is asked to focus on a favorite pleasant scene. The patient is then asked to sit quietly, breathe slowly, relax the muscles, and think of as many sights, sounds, and smells connected to the scene as possible (Apple, 2019). The practitioner and or the patient can develop images Focused/relaxation breathing Another distraction technique encourages the patient to shift attention from the dental procedure to breathing slowly. Slow respiration is relaxing. The practitioner directs the patient to place his or her hands on the stomach and to follow simple directions: 1. Take a deep breath, hold it briefly, and then let it out slowly. 2. Take a normal slow breath. 3. Take another deep breath, hold it briefly, then let it half out, hold it, then let the rest out. Tell-show-do This simple, rapid technique was originally developed for use with children, but it can also be used for adult patients to help foster a sense of control (Bradley, 2018). In a calm voice, using nonthreatening words, the dentist or hygienist describes the proposed procedure. The patient is then shown the instruments that will be used and is allowed to touch, examine, and manipulate them. The instruments are then gently applied to Relaxation techniques Lovas and Lovas (2007) describe a rapid relaxation technique that requires no prior patient instructions and is appropriate for managing mild anxiety. The technique takes a few minutes and involves five steps. Thus this technique can easily by incorporated into a busy clinic schedule and can save time as a patient who is relaxed can be treated more quickly and efficiently than an anxious patient that requires frequent breaks during dental treatment. The five steps are described below: 1. The patient is shown the cotton-tipped topical anesthetic applicator, and as the topical anesthetic is applied, the patient is assured it will numb the area being treated. All the while, the dentist assesses the patient’s body language and makes appropriate suggestions to help the patient relax. For example, noting tightly clenched hands, the dentist may say, “You might be more comfortable letting your arms rest loosely on the armrest.” Making suggestions is more effective than giving outright commands. 2. The patient is then gently instructed to become aware of any part of the body that feels tight or tense. He or she is
be difficult for fearful patients. Ask open-ended questions, listen and understand, and explore goals and values.
when the patient is allowed to select the music or audiobook. With this in mind, practitioners may wish to encourage their patients to bring their favorite music with them. It is important to note that distraction by any means may be effective for patients with mild to moderate dental anxiety but may not be a suitable option for all patients with dental anxiety or dental phobias (Armfield, 2016). Also, this technique may be more effective with children. Another distraction method being studied is the use of virtual reality. Interestingly, virtual reality was shown to have benefits not only during treatment but afterward as well (Sweta et. al, 2019). Virtual reality has the potential to influence the patient’s perception of pain, reduce the anxiety associated with dental procedures, and block the development of vivid memories associated with the dental visit (Sweta et. al, 2019). The combination of these results can promote decreased anxiety and positive anticipation for subsequent dental visits. that are rich in sensory detail for the guided imagery protocol (Anthonappa, 2017). After the procedure is completed, the dentist should follow through by asking questions and showing an interest in what the patient had imagined. For additional readings on the use of guided imagery for relaxation, see the works of William Fezler, Anees Sheikh, and Adelaide Bry. 4. Take a normal breath. 5. For each successive breath, let the breath out a third at a time, a quarter at a time, a fifth at a time, and so forth. Between each breath, have the patient take a slow normal breath. There are several variations of breathing techniques that foster the reduction of anxiety that can be practiced at home before the actual dental appointment (Armfield, 2016). various areas inside the mouth. The actual procedure follows immediately. This technique addresses the patient’s fear of the unknown and reinforces the impression of a caring, unhurried practitioner. It is worth noting that although it is a commonly used technique, the consistent effectiveness of this technique among patients is variable (Bradley, 2018). instructed, “Just let these tense areas go soft and floppy.” If the patient remains anxious, he or she is advised to stop anxious thoughts by focusing on breathing. He or she is instructed, “Feel your breath at the bottom of your lung in your belt area. Each part of your breath, beginning, middle, and end, feels subtly different, and every breath is subtly different. There is no need to control your breathing. Just observe the subtle feel of your breath in your belt area. Breathing deep down in your lungs is a very efficient way to slow your breath. Keep bringing your attention back to the subtle feel of your breath in your belt area.” 3. Before injecting an anesthetic, it is helpful to prepare the patient by describing how he or she may react to the injection. Say, “The slight pinch from the injection might cause you to tense up and hold your breath. That does not really help. When your body is relaxed and your breathing is smooth, you feel much less discomfort, so as soon as you feel a pinch, continue to relax and breathe through the discomfort.”
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