Effective Strategies for Managing Dental Anxiety During Dental Visit!

It is very often we come across patients who are very anxious during their dental visit. Dental anxiety is the stressful and fearful state, a patient may show during their visit to the operatory. It is generally associated with previous trauma, foreign feeling for patients who have not visited a dentist previously, or due to the fear inculcated by parents on their children over time.

In a dental set up, the drills, injections, operatory and dental instruments can very often cause patients to be scared. Moreover, the impending fear of pain before, during and after treatment haunts a lot of patients.

Anxiety can be closely related to painful stimulus, higher pain perception and long lasting memory of pain. It not only creates an unpleasant experience for the patients, but also for the treating doctor.

Many a times, anxious patients, avoid visiting the dentist, they only visit once their condition is worse, rather than option for regular check ups. This leads to poor periodontal health, increased chances of grossly decayed teeth, missing teeth and poor oral health.

It is essential for a clinician to identify the signs of dental anxiety in a patient, and treat the patients accordingly.

How to identify dental anxiety?

An honest conversation between the dentist and the patient is key to understand patient psyche and fears.

• Semiconstructed questionnaires: Many subjective and multiple choice questionnaires are available for addressing anxious and phobic patients. These include Corah's Anxiety Inventory Scale, Modified Dental Anxiety Scale, Spielberger State–Trait Anxiety Inventory amongst others. Based on the results of these questionnaires, patients can be categorised on the basis of their anxiety levels.

Objective measurements include of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response. Galvanic skin response takes advantage of the electrical changes induced by minute amounts of fluid from epidermal sweat glands released secondary to anxiety. it is highly accurate and validated tool to measure anxiety.

Management of dental anxiety

The etiology for dental anxiety is multifactorial, hence, multiple measures may need to be taken to alleviate dental anxiety. Measures may be psychotherapeutic or pharmacological, depending on the the choice of the clinician.

1. Dental Clinic

The environment of some dental clinics, may create sense of fear in a patients. Some people feel the fear as soon as they walk into the reception of the dental office. It becomes vital to make the office ambience such that it feels nurturing and comfortable. The dental team must exuberate a positive attitude. Studies have shown that slightly cooler dental offices are felt as more welcoming amongst patients. Walls adorned with posters and textures, place filled with plants and a play area for pediatric patients play important role in calming the patients. Aromatherapy and light music may also make some people feel better. It is imperative to make sure that the operatory noise doesn't reach the waiting area, as it may cause uneasiness in some patients. A sensory adapted dental environment, like the Snoezelen environment concept, which aims to stimulate the primary senses of sight, touch, feel, and smell, along with patient-centered therapy may also be helpful.

2. Patient- Dentist Relationship

The patient dentist relationship should allow two way communication. The clinician must listen to the fears, complaints and problems of the patient with utmost patience, non judgmental and caring attitude. The Patient must be kept completely informed during the course of the treatment and should be allowed to ask any questions. The dentist must have a caring front and a sensitive attitude.

3. Behavior Management

This aims to change behavior via learning. Behavior management methods may range from operant conditioning, classical conditioning to social learning. Tell Show Do is a technique that works well on kids as well as patients with anxiety.

4. Relaxation Techniques:

Physical relaxation makes psychological relaxation easy, deep breathing exercises are helpful.

5. Hypnosis, Biofeedback and Guided imagery:

These are some of the methods used by clinicians as well. Guided imagery involves directed, deliberate daydreaming using all the senses to create a sense of focused state of relaxation along with physical and emotional well being. Biofeedback is a mind-body technique, which uses  instruments to measure, amplify, and feed back physiological information to the patient being monitored. this monitoring information is used to practice and achieve self-regulation. Several studies have shown hypnosis is useful in reducing pain in patients and effective results towards alleviating anxiety have been noticed.

6. Distraction:

Distraction is one of the easiest way of relieving anxiety. it can be achieved through conversations during the treatment, music and even television shows and movies. These days a lot of clinics are using VR as a method of distraction.

7. Pharmacological methods:

These include conscious sedation, local anesthesia and inhalation sedation to achieve paint cooperation.

There are many methods of alleviating anxiety in patients who step in our practice. the ultimate goal of all is to provide a comforting environment and achieving patient trust.