Odontophobia or dental anxiety is something many people struggle with. There are many reasons for this phobia but the most known reason is earlier traumatic experiences with not so considerate dentists. Now the term “not so considerate” is kind of an unfair description cause the generation of dentists in the last 10 years has gone through a different education compared to dentists educated say 20-30 (or more) years ago.
In the recent decade, the emphasis on patient psychology, comfort, and autonomy have reached its highest level through the history of dentistry. This in itself should be a comfort for people with dental anxiety, at least to a degree.
This can also translate to the following requirements of a dentist:
The patient should not feel any pain in the dentist’s chair
The dentist is not allowed to do anything unless the patient gives his/her complete informed consent
The patient should be relaxed in the dentist’s chair during any procedure
Now, the purpose of this article is to give dentists, dental students and frankly all adults with dental anxiety insight into the most effective techniques that can be used to rehabilitate patients with odontophobia.
The first essential thing in this process is for the dentist to take his/her time to talk to the patient. The talk should not only be about teeth and mouth. But it should also be a casual friendly talk in order to establish a friendship and a degree of trust in the patient. While the talk is progressing, it’s much better if there is a calming background music with even soothing scents in the room. This talk should be like a friendly chat between two equals. The patient should be sitting in an upright position in the chair. The sitting position of the patient should be in the same height as the dentist. In this manner, the dentist will not appear as an authority figure. The latter should be avoided at all costs.
During this talk, the patient should be assured and convinced that there should not be any pain when sitting in the chair. No pain whatsoever. This is of course assumed that the dentist has this capability.
After this, the session should start with a palpation of the facial and cervical (neck) muscles. This is perceived as very soothing and a trust-promoting by almost all patients. The palpation of facial muscles should always be part of the routine check-up that a dentist does. This can reveal the existence of possible myalgia, bruxism, TMD, spasms or any other parafunction in the biting pattern (occlusion) and musculature.
At this stage, the patient should have lost 50% of his/her stress and concerns. During this procedure, the dentist should keep communicating with the patient making sure that she or he is comfortable. Having humor at this stage will also increase the trust in the patient. The next stage will be giving small short opportunities for the patient to come up and rinse. This removes the feeling of being locked into someone’s hands. While doing this, asking the patient if he or she is OK.
At this stage, the level of the patient’s anxiety must be evaluated. If there is room for progress, then the dentist will move forward. At this stage, the dentist should attempt a careful and gentle scaling and polishing. This should preferably be done with manual instruments rather than ultrasonic instruments with water spray. This will keep the fuss and the ongoing action to a bare minimum. This phase must be done very carefully as to not hurt the gums and provoke the slightest amount of discomfort. This entire starting process is meant to underscore the idea that “It shouldn’t hurt when sitting in the dental chair”, in the patient’s mind.
During the first visit of a new patient with dental anxiety, it is always a bad idea for a dentist to perform anything more complicated like a dental surgery or doing braces.
The process described above aims to get the patient accustomed to dental treatment, the new dentist, and the idea that dental treatment can actually be completely pain-free. Therefore, the dentist must understand that the patient needs the time to process the things that happened and little by little getting rid of dental anxiety after each visit free from discomfort and pain. Now, this process can be slower for some and faster for some other. It is the dentist’s responsibility to recognize where in the rehabilitation process the patient is.
This process can be combined with a good sedative like Flunitrazepam if necessary to make things even easier. This will make the rehabilitation faster and more profound. If the patient knows about this alternative, he or she could demand it from the dentist.
(BP Dental Solutions)
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