Dental phobia has continued to endure, despite decades of technological advancement and with the days of drill and fill long gone. But this does not reassure those who remain fearful of the dentist, which is around 1 in 10 UK adults, that their experience won’t be traumatising in some way.[i]
Dental phobia is associated with poor oral health.[ii] The obvious consequence of being too anxious to attend for regular consultations, or not making an appointment when in pain, is that problems won’t get intercepted early. An issue that could have been fixed easily then becomes advanced enough to require a major intervention.
Anxiety is often rooted in a person’s fear of not being in control; being prone in the dentist’s chair, feeling self-conscious and uncomfortable, while their mouth is examined by a near-stranger. Yet a crucial element of the preventive approach now favoured by practices is that the patient is the one in the driving seat. They must be willing to take ownership of their health and know the role they must play in reducing their risk of disease.
Patient-focussed care means taking an individual’s specific needs into account. Even before diagnosis, there needs to be substantial information-gathering by the dental team, not just to discover behaviours that could compromise oral health, or limit their treatment options, but to gain a true picture of all the patient’s concerns, no matter how small they believe them to be.
A very anxious patient might require support outside the practice. Cognitive behavioural therapy (CBT), is a short-term talking therapy that has shown to be successful with reducing dental anxiety and increasing attendance. Severe cases of phobia might even benefit from clinical psychology.[iii] But if the anxiety is mild to moderate, maybe exacerbated by new oral pain (“something terrible must be wrong”), you may be able to allay their concerns via collaboration and communication, to ensure that your clinical aims align with their needs and expectations.
Education is where it starts. What is making them nervous? Is it a bad childhood experience, fears about infection control or a particular treatment? Or is it a control issue? If a person tells you they’re nervous, the fact they’ve presented at all means the glass is half full. These patients would benefit greatly from talking with every practitioner who will be involved in their care, with supplementary resources to read in their own time. Keep the door open for further queries though and emphasise that this isn’t about supporting them through just one treatment, but keeping them in oral health for years to come. If a patient asks about sedation, for example, this is an option but it won’t help them overcome their anxiety in the long term.
This is a key reason why a minimally-invasive, conservative approach massively benefits patients, wherever they are on the dentally-anxious scale. With the healthy tissue and enamel protected, the patient can avoid further problems and keep the result stable. Treatment is efficient, so less time in the dental chair, which is also a way to keep costs down, if that is something else that they are worried about. The techniques for minimally-invasive dentistry allow the clinician to use the latest materials and tools, developed for this way of working. So anxious patients will get the gold-standard of care, using the most advanced products on the market.
Endodontic therapy has associations of being painful and invasive, with no guarantee there won’t be a reinfection, when it is actually the most efficient way to save a tooth. For an anxious patient who requires a tooth to be endodontically treated, they need to know that it will get them out of pain, fast. Tell them the processes and products you will use, to fight fear of the unknown. Quality endodontic treatment is a quicker solution than an extraction, with the significant benefit it will support better long-term oral health. Tools for delivering conservative endodontics include the new MicroMega One RECI reciprocating file, available from COLTENE. This file is very thin, yet strong and flexible, for minimally-invasive treatment that preserves the healthy tooth tissue. Based on the MicroMega controlled memory technology, as used in its One Curve file, the design of this instrument supports a comfortable experience for the patient and enables the techniques that lead to successful outcomes.
Conservative dentistry is invaluable when treating dentally anxious patients. A reputation for delivering efficient, comfortable can allay fears of an ordeal, encouraging people to seek an early intervention to get them out of pain and avoid invasive procedures. A dentally anxious patient – like any patient! – wants to spend the least amount of time at the practice as possible and minimally invasive tools, techniques and materials, along with a preventive approach, offers them the chance to take control of their fears and elevate their oral health and general wellbeing.
Author: Mark Allen, General Manager at COLTENE
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
[i] Helping patients face their fears. King’s College London, 14 February 2020. Link: https://www.kcl.ac.uk/helping-patients-face-their-fears
[ii] Heidari, E., Newton, J. & Banerjee, A. Minimum intervention oral healthcare for people with dental phobia: a patient management pathway. Br Dent J 229, 417–424 (2020). https://doi.org/10.1038/s41415-020-2178-2
[iii] King’s College London, 14 February 2020.
