An Updated Look at Options for Setting Our Patients at Ease
Two of the main culprits that prevent our patients from seeking care are fear and anxiety. Dentophobia (or odontophobia) is defined as “the extreme fear of going to the dentist”.1 True phobias, stronger versions of the common fear, require different and sometimes more intensive measures. Phobias are considered a type of anxiety disorder, and are known to cause extreme distress and avoidance — so much so, that these interfere with your daily life.1
Managing these patients may require psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations.2
However, we may be able to improve dental fear by changes we can implement in-office to decrease triggering stimuli and promote relaxation.
The Start of My Anxiety…
My earliest introduction to dentistry was a blur of tears and the sound of drills. Growing up in Romania, dental care was limited at best. The modus operandi in those years was to instantly pull teeth that were hurting, dental cleanings weren’t a “thing” (they’re still considered a luxury there!) and seeing people in their early 20s with multiple missing teeth was the norm.
The lack of comprehensive dental treatment and education led to rampant childhood caries. (At least that’s what I’ll try to blame it on, instead of my love of chocolate and dislike of brushing my teeth!) All my posterior deciduous teeth were riddled with decay. As a result, I have vivid memories of multiple visits to the dentist to have my teeth filled. The clearest memory, however, is not of pain or blood, but of the smell and sound. Zinc oxide eugenol was predominantly used, particularly for pedodontic restorations. The smell was so powerful and lingering, that for the rest of the day everyone within a 4-metre radius would know, without a doubt, that you’ve been to the dentist. The sound of various handpieces used by the dentist, given loving names such as “the bumble bee”, did little to assuage my fears.
Planning for the Fearful Patient
Virtual consultations – For new and anxious patients, virtual tours of the office on your website can help the patient feel as though they’ve been there before. Treatment coordinators can field initial questions and assess insurance matters prior to the appointment, and time permitting, a brief meet and greet with the doctor can set the patient at ease for their upcoming examination. Companies such as Dental Monitoring® have streamlined remote assessment for convenience which can be particularly effective for the anxious patient.
Weighted blankets – According to the ADA, “weighted blankets apply deep touch pressure. This is a proven technique to help alleviate anxiety and fear associated with dental treatments”.3 Look into DentaCalm™, they provide heated weighted blankets that conform to disinfection protocols. Your lunchtime naps are about to reach a whole other level of comfort!
Scheduling – Book nervous patients earlier in the day, such as first thing in the morning. There will be fewer other patients in the office and therefore fewer dental sounds to cope with. In addition, it prevents their apprehension from rising in level throughout the day.
Seating – Bring the patient in as soon as possible upon arrival. Dental anxiety is shown to be “significantly higher in patients who had longer waiting time prior to treatment.”4
Come on down! – Allow nervous patients to be accompanied by a friend or family member into the room if it makes them more comfortable.
Atmosphere
Pet therapy – Human-animal interaction has been proven to benefit “stress-related parameters such as cortisol, heart rate, and blood pressure; self-reported fear and anxiety.”5 While you may want to keep the pooch outside of the operatory for surgical treatment such as implants, the CDC reports that “there is no evidence to suggest that animals pose a more significant risk of transmitting infection than people; therefore, dogs do not have to be excluded from such areas.”6
Spa-like services – When you really want to spoil your patients. Commonly seen in dental spas, the treatments offered can include paraffin wax hand treatments, massage and relaxation therapy,
aromatherapy, heated hand mitts and more.
Music – Play relaxing ambient music in the waiting room. Include calming décor such carefully chosen art or an aquarium; exposure to natural environments can have calming and stress-reducing effects.7
Lighting – When possible, use natural or ambient lighting rather than harsh fluorescent light.
Glass doors – Sliding glass doors will minimize sounds and smells permeating through the office without making it feel too enclosed.
Colour – Choose a colour scheme that is pleasing to look at and portrays the atmosphere you want to exude. Allow your personal preference to guide you, and remember that colours “limited in contrast will reinforce the ‘restful’ response, while colours selected from a range of high contract (dark to light) will elicit a ‘wow’ response”. 8
Technology
Computer-assisted local anesthesia – The Wand® offers a system to guide dental professionals in administering single-tooth anesthesia. Patients have found it “offers less pain and more contained numbness for the area that is being treated”.9
Virtual reality glasses – “Virtual reality (VR) has the ability to remove the association of fear, pain, and anxiety during patients’ dental visits.”10 You have the ability to preselect a soothing theme that will help your patients feel relaxed and calm. Check out MeditainmentVR® if you’re looking to make your patients feel like they’re on a beach in Bali instead of getting a root canal!
Air purifiers – A medical-grade air purifier can “remove chemicals, toxins, germs, odours, and most importantly they kill airborne viruses to help reduce the spread of illness”.11 Canadian company Surgically Clean Air™ has an excellent brochure online to have your office smelling fresh and clean, and remove the scents your acclimated nose no longer picks up.
Start Here
Netflix and noise-cancelling headphones – These can help patients who are sensitive to the dulcet sounds of your cavitron or “bumble bee” handpiece.
Dental anxiety can be problematic for the dental office for multiple reasons. Anxious patients are more likely to cancel appointments and have a greater pain response. They can be irritable and difficult to work on, which translates to a significant challenge to the dental staff. The suggestions presented in this article are meant to encourage you to step into your own office as though you are a fearful patient, see which sights, sounds and smells may trigger anxiety, and assess what can be done about them. Implementing some of these technologies or suggestions may set your patients at ease, establish your office as cutting-edge in technology, and amount to less cancelations and less stress for both your patients and your staff.
Isn’t that something to smile about?
References
- Cherney, Kristeen. “How to Cope with a Fear of the Dentist.” Healthline, February 7, 2020. https://www.healthline.com/health/mental-health/fear-of-dentist.
- Appukuttan, Deva Priya. “Strategies to Manage Patients with Dental Anxiety and Dental Phobia: Literature Review.” Clin Cosmet Investig Dent 8 (March 10, 2016): 35–50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790493/#b1-ccide-8-035.
- “DentaCalm™ Adult – Product Profile.” American Dental Association. Accessed April 19, 2020. https://www.ada.org/en/publications/ada-dental-product-guide/product-category/product-profile?productid=1775&catid=32.
- Fux-Noy, A., Zohar, M., Herzog, K. et al. The effect of the waiting room’s environment on level of anxiety experienced by children prior to dental treatment: a case control study.BMC Oral Health 19, 294 (2019). https://doi.org/10.1186/s12903-019-0995-y
- Beetz, Andrea, Kerstin Uvnas-Moberg, Henri Julius, and Kurt Kotrschal. “Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin.” Frontiers in Psychology 3, no. 234 (July 9, 2012). https://doi.org/10.3389/fpsyg.2012.00234.
- “Background H. Animals in Health-Care Facilities.” Centers for Disease Control and Prevention, last reviewed November 5, 2015. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/animals.html.
- Cracknell, Deborah, Mathew P. White, Sabine Pahl, Wallace J. Nichols, and Michael H. Depledge. “Marine Biota and Psychological Well-Being: A Preliminary Examination of Dose–Response Effects in an Aquarium Setting.” Environment and Behavior 48, no. 10 (July 28, 2015): 1242–69. https://doi.org/10.1177/0013916515597512.
- Carter, Jeff, and Pat Carter. “Using Color in the Dental Office.” Dental Economics, April 1, 2013. https://www.dentaleconomics.com/science-tech/cad-camand-3dprinting/article/16393498/using-color-in-the-dental-office.
- “The Wand.” Milestone Scientific Inc. Accessed April 19, 2020. https://www.milestonescientific.com/dental-solution/the-wand.
- Schermerhorn, Lisa. “Can Virtual Reality Change Your Dental Practice? It’s Worked for Others.” DentistryIQ, January 10, 2020. https://www.dentistryiq.com/practice-management/patient-relationships/article/14074604/can-virtualreality-change-your-dental-practice-its-worked-for-others.
- “It’s a Matter of Life and Breath.” Accessed April 19, 2020. https://surgicallycleanair.com/medical-dental/.
About the Author
Alina Fintineanu is a Registered Dental Hygienist with 10 years of experience in dentistry. She currently works in private orthodontic practice in Toronto. Alina has obtained a Certificate in Adult Education and is a Certified Training Practitioner. She is an educator on Invisalign and profoundly passionate about all things Orthodontics. When she is not reminding patients to wear their elastics, you can find her traveling, baking and petting dogs. Contact her at: alina_fin@yahoo.ca
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