Quality Resource Guide –

Management of the Anxious, Fearful or Phobic Dental Patient 1st Edition

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Page 2

Phobia

Phobia is defined as a strong, persistent irrational

fear, anxiety, and/or avoidance reaction to a person,

object or situation. Phobias commonly focus on

animals, insects, germs, heights, flying, public

transportation, dental or medical procedures and

elevators. Although people with phobias realize that

their fear is irrational, even thinking or talking about

it can cause extreme anxiety. Even though the

fear may not make any sense, individuals feel like

they are unable to control or stop the fear. People

with a phobia or phobias can lead a disrupted life

because they will go out of their way to avoid the

uncomfortable and often terrifying feelings of the

triggering stimulus.

Origins of Dental Anxiety, Fears

and Phobias

Dental anxiety, fear and phobia do not always

function as unique and separate categories, or

states of being. They are fluid emotional states that

are triggered by both real and imagined threats. The

acquisition of dental anxiety, fear and phobia has

been attributed to:

8,9

•

Influence of parents

•

Bad dental experiences as a child, or as an adult

•

Fear of specific stimuli

•

Pre-existing anxiety disorder

•

Lack of control

•

Poor oral health

•

Childhood sexual abuse

•

Post-traumatic stress disorder

•

Substance abuse

Parents play a significant role in how their children

interact with the dentist. Fear of the dentist can be

passed on to children by their parents.

Involving

the parents in at least part of a fearful or anxious

child’s treatment could be beneficial to parent

and child. The use of positive verbal cues and

sequencing treatment with non-invasive procedures

first could help to desensitize both parent and

child. Counseling the parent regarding their child’s

condition should also be considered.

Measuring Dental Anxiety

Several questionnaires have been developed to

measure a dental patient’s anxiety. The

State-

Trait Anxiety Inventory

(STAI),

the

Dental Anxiety

Inventory

and for children, the

Venham Picture

Test

or the

Children’s Fear Survey Schedule

were

all created for that purpose. The most frequently

used questionnaire is the

Dental Anxiety Scale

(DAS).

The DAS is a four-item questionnaire with

each item scored from not anxious (1) to extremely

anxious (5), resulting in a score from 4 to 20. A

higher score denotes greater anxiety.

For busy practitioners, the

Short Dental Fear

Question

(SDFQ) may be a good option. The SDFQ

is a single question, “Last time you visited the

dentist how did it go?” The answer given is scored

one to four on a Likert-type scale (

Table 2

16-18

To quickly screen for anxious patients, the SDFQ

question or the DAS questions can be placed in the

health history questionnaire.

Successful Management of

Anxious and Fearful Patients

If the goal is to empower patients so that routine

dental care can become just that, then identifying

the best way to structure a dental appointment

should be the starting place. Front office staff

and dental assistants play a big role in managing

anxious and fearful patients. Their understanding

that almost everyone is anxious about something

(snakes, spiders, height) can help them structure

their interaction with a patient by deescalating

any potential triggers in the environment creating

a smooth transition from the waiting room to the

operatory. If the front office and dental assistants

know in advance to expect an anxious patient, they

can:

•

Give an anxious patient the first appointment of

the day to reduce his/her time to think about the

appointment.

•

Greet a patient with positive cues like “It’s great

to see you today” and avoid asking how he/she is

feeling, which may lead to musing over triggers.

•

Keep the patient engaged until escorted to

operatory.

•

Make

the

operatory

environment

accommodating by offering to adjust room

temperature, lighting, chair position, and TV or

radio selection.

Prior to, during, and after treatment, communication

plays a significant role in patient perception.

Information in

Table 3

may be used as a guide

to direct communication with the anxious patient

before starting treatment.

Table 4

may be used as a

communication guide during treatment and

Table 5

for communication after treatment.

The dentist and their staff members should always

be mindful of their, and the patients, nonverbal

communication. Dental staff can increase patient

confidence and reduce patient anxiety through the

use of positive body language such as standing

and sitting straight and giving a genuine smile. If a

problem is noticed or suspected during treatment

providers should make a conscious effort to control

body posture and facial expressions so as not to

alarm the patient. If dental team members take time

to focus on breathing and muscle relaxation at the

end of the appointment they will not only feel better

but will also have a better chance of placing the

patient at ease.

Monitoring patient nonverbal behavior such as facial

expressions, position in the chair, location of hands

in proximity to the mouth and making nonverbal

noise are all indicators the patient needs a break.

This is also a good time to monitor perceived pain

levels and reassure that what they are experiencing

is temporary and will soon be over.

Table 2

Answer Classification for

Short Dental Fear Question

1. I was totally relaxed during treatment

2. Nervous, but treatment was carried out

successfully

3. Nervous; treatment was just carried out

4. I was so frightened and/or nervous that:

a. Treatment was difficult

b. Treatment was not successful

c. I missed my appointment