As published in the Compendium of Continuing Education in Dentistry
September 2015, Volume 36, Issue 9
We live in an exciting era to be practicing dentistry. With recent developments and enhancements in dental implants, CAD/CAM restorations, esthetic dentistry advancements, Botox and Restylane, high-tech root canal therapy, CT imaging, etc., dentists are on the cusp of meeting and surpassing our patients’ needs and expectations. However, in our zest to use the most up-to-date equipment and techniques, we can sometimes forget that patients’ dental fears and anxieties can prevent them from getting the care they need.
Helping patients overcome dental fears is an important but sometimes overlooked aspect of dentistry. Make no mistake, patients can be dentally crippled by fear. The past experience that causes the most fear among patients is the memory of a dentist causing them pain during treatment. This can be compounded when the dentist appears to act insensitively toward them when they complain about the pain. Even though the pain from the treatment may fade quickly, any insensitive comments made by the dentist or dental team member continue to live on in the minds of the recipients of those comments.
There are also large numbers of people who are simply “afraid of the dentist” or of certain dental procedures but have never actually had a bad experience at the dentist’s office. These are patients who have heard from others that dentistry is painful and believe it. This type of learned fear is called vicarious learning2 and is quite common. Dentists and dental treatment are often portrayed in a negative light in the media and on television. This often reinforces the fears that some patients already have. This is why dentists should always make an effort to emphasize the positive contributions they make to eliminate patients’ pain while improving their function and appearance. Dentists can do this by posting positive and authentic patient testimonials on their blogs, websites, and social media. They should also give affirming information about the dental profession when interviewed by media outlets.
There are typically three primary reasons people fear the dentist: 1) the potential for pain during dental treatment; 2) the fear of being scolded by the dentist or hygienist about the condition of their mouth; and 3) the fear of loss of control during dental treatment. By addressing each of these fears with an empathetic attitude, dentists can help almost all patients overcome their fears and allow them to get the dental treatment they need.
One technique the author has found useful over the years is to ask patients to identify what specifically has made them afraid of dental treatment. Once the dentist knows what triggers their fear, the staff and dentist are better equipped to do everything possible to eliminate a fear-provoking event. This will also encourage practice growth by increasing treatment production, acceptance, and, ultimately, patient referrals.
Most patients, even those who are not especially fearful of dental treatment, are concerned about the potential for pain during treatment. There are several ways to reduce or eliminate pain during dental treatment. The most basic, and important in the author’s view, is dealing with pain associated with dental anesthesia. Several tactics can be used to reduce the potential for pain during injections, including using strong topical anesthetic gels like Oraqix® (DENTSPLY Pharmaceutical, www.dentsply.com), warming the local anesthesia with an anesthetic warmer, using newer and more potent anesthesia like articaine, and, most importantly, buffering the anesthetic with a product like Onset® (Onpharma Inc., www.onpharma.com). Some dentists can incorporate computer-controlled anesthetic delivery systems (eg, The Wand®, Aseptico Inc., www.aseptico.com) to reduce injection pain. These techniques not only greatly reduce injection pain and the amount of time it takes for a patient to become numb, they also create a more profound anesthetic effect allowing treatment to be provided with much less potential for discomfort.
It should go without saying, but dentists should never criticize patients about the condition of their mouth, and they shouldn’t disparage the dentistry that has been done. Making a patient feel ridiculed and insecure is no way to build a positive long-term relationship because it ultimately creates a barrier of resentment. Instead, consider patients with poor oral hygiene and numerous dental problems as opportunities to help them turn their oral health around. By asking patients in a non-judgmental way why they have avoided dental care in the past, dentists can gain powerful insights into how to help them overcome their fears while building an atmosphere of trust. It may take time, but it can be done.
Give the Patient “Perceived Control”
Some people who fear dental treatment are those who are used to being in control at home, at work, and in personal and professional relationships. Some of these high-powered people can be difficult patients because they are accustomed to controlling their environment. When people who are used to being in a position of control are put into a situation where they must relinquish that power to their dentist, anxiety, confrontation, and avoidance are the most common reactions. For some of these patients, giving them “perceived control” is an effective technique. Let the patient decide which tooth or area he or she wants treated first or some other minor aspect of their care. As long as it doesn’t affect the dentistry it is often helpful to let the patient have an active role in his or her treatment.
Helping patients overcome their fear of dentistry is worth the effort on a personal, professional, and economical level. Just one bad, painful experience in a dentist’s office can do significant damage to that practice. Bad news travels fast, especially in this online age of Google, Yelp, and other services. You would be surprised how many prospective patients rely on those reviews when choosing any service, including dental care. Helping patients overcome their fears can help create positive online reviews (in addition to word of mouth), which are necessary for sustained practice growth.
- Smith NB. The role of painful events and pain perception in blood-injection-injury fears. J Behav Ther Exp Psychiatry. 2012;43(4):1045-1048.
- Carter AE, Carter G, Boschen M, et al. Pathways of fear and anxiety in dentistry: A review. World J Clin Cases. 2014;2(11):642-653.
- Moore R, Brødsgaard I, Rosenberg N. The contribution of embarrassment to phobic dental anxiety: A qualitative research study. BMC Psychiatry. 2004;4:10.
- Reed KL, Malamed SF, Fonner AM. Local anesthesia part 2: Technical considerations. Anesth Prog. 2012;59(3):127-137.