________________________________________________________ Treating the Apprehensive Dental Patient
have been reports of infertility, congenital abnormalities, and spontaneous abortions following prolonged occupational expo- sure, which is more of an issue for dental staff members than patients [31]. The patient’s obstetrician should be consulted before nitrous oxide/oxygen is used during pregnancy. DENTAL TREATMENT MODIFICATIONS While the actual techniques for restorative, surgical, prosthetic, and periodontal procedures are exacting and can bear little if any modification themselves, the manner in which they are delivered and the atmosphere in the office can be modified to decrease patients’ fear and anxiety. These techniques will prove beneficial for patients who are sedated and those who are not. Patients with known dental fear and/or anxiety should be scheduled for appointments as early in the morning as pos- sible, as this will minimize their opportunity to dwell upon the source(s) of their apprehension. Upon arrival at the office, patients should be greeted warmly, escorted to the treatment area promptly, and made to feel welcome by the dental assistant and the dentist. It is important that patients are not left to wait by themselves for an extended period after they are seated, as this will also provide an opportunity to contemplate the situ- ations and items that are a source of their dental fear, anxiety, or phobia. This can be amplified if they hear patients in the adjacent operatory complain of pain or discomfort during a dental procedure. Because some patients will feel vulnerable in a completely supine position, a semi-reclined position may be used for the procedure (or an upright position if impres- sions are required) to reduce feelings of vulnerability and helplessness. If a patient feels unable to communicate pain or discomfort with the dental staff during anesthesia, when a rubber dam is placed to isolate a tooth, or when dental instru- ments occupy much of the oral cavity, a prearranged hand signal can serve to communicate this need and ameliorate the patient’s concerns. The tell-show-do technique can also decrease patients’ fears about unfamiliar dental procedures [46]. This involves telling the patient what will be done, showing a diagram or video of the actual procedure, and then finally doing the procedure. Any explanations should be given in terms the patient understands and at a pace that allows for absorption of the information. Because the sight of dental instruments can be a source of apprehension, they should remain out of the patient’s line of vision as much as possible. Placing instruments on a bracket stand behind the patient and delivering them to the clinician without being seen by the patient will help decrease these fears. A patient’s apprehension will increase if the he or she believes the clinician is having difficulty with a procedure. For example, a clinician with minimal experience with oral surgery should not attempt a difficult surgical procedure on any patient, especially those who are apprehensive about dental treatment.
Clinicians should confront the limits of their clinical skills and should refer patients who require procedures that are beyond their expertise to another practitioner or to a specialist who can ensure the patient is treated appropriately and comfortably. A positive dental experience and outcome may give apprehensive patients the confidence to return for future treatment. THE EMOTIONAL ASPECT OF TREATING APPREHENSIVE DENTAL PATIENTS The demands of practicing dentistry are numerous, and this can take a toll on all members of the dental staff. The ability to successfully treat apprehensive dental patients is rewarding, but the cumulative stresses of addressing these patients’ fear and anxiety can lead to compassion fatigue [47; 48]. Compas- sion fatigue is comprised of two components: burnout and vicarious traumatic stress [51]. The first component consists of characteristic negative feelings such as frustration, anger, exhaustion, and depression. The second component, vicarious traumatic stress, may result when the professional is negatively affected through vicarious or indirect exposure to trauma through their work. Compassion fatigue can be insidious in its development, taking months or years to develop. Each individual’s susceptibility to compassion fatigue is different, with some clinicians exhibiting no or minimal levels while others suffer personal and profes- sional repercussions that can compromise their professional abilities and impact their quality of life. The cumulative expo- sure to apprehensive dental patients, the emotional energy expended to maintain their comfort, pressure to complete the dental procedure quickly and effectively, and the need to maintain a reassuring and confident demeanor can lead to emotional exhaustion. General signs of compassion fatigue include feeling anxious or developing a sense of dread when treating dental patients or feeling unusually tired or exhausted after completing procedures that had not previously evoked this response. It is beyond the scope of this course to explore all of the emotional and psychological experiences of the dental staff as they provide treatment for patients, apprehensive or otherwise. However, dental staff members should be cognizant that these problems can arise and adversely affect all aspects of their lives, including their ability to provide dental care. Professional intervention should be sought to address and rectify these emotional or psychological problems if they are identified in a staff member. Essential to preventing and treating burnout and compassion fatigue is creating and maintaining a healthy balance in one’s life [34]. This balance may be different from individual to individual and within a given individual over time. Common components to achieving balance and optimal functioning involve the following basic self-care strategies: taking time off work periodically to rejuvenate oneself; building in time in one’s schedule to attend to one’s own needs; regular exercise,
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