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Dental Anxiety

Firstly, let’s get something straight.

Nobody likes dentistry.

We’ve tried as hard as we could over the decades to make it as much fun as possible, with infinitely better anaesthetics, less stressful diagnostic tests and greater predictability about almost everything we do, but it remains the case that our teeth can cause us a lot of problems and having these put right can be a challenge.

I’ve spent my whole career learning about dental anxiety and how to alleviate it if I can, and I’d like to share a few of the ways we can make you feel confident enough to make the first step by coming to see us.

Almost all “ dental phobics “ ( a term I hate because labels aren’t at all helpful ) describe a particular episode when a dentist in their childhood did something unpleasant.

Not all dentists are able (or willing !) to take the time to think through how intimidating dentistry can be for small children. We all remember the funny smells, bright lights and odd sensation of someone looking in our mouths, and for some of us there may have been stress, discomfort and even pain, all with the active collusion of our parents !

I also hear stories of heavy-handed unsympathetic dentists and a rushed process, and I honestly think the NHS is to blame for a lot of this. Children’s dentistry requires an understanding of child psychology, a child-friendly environment but above all time to explain and reassure the child and ensure the process takes place in a controlled and relaxed manner.

Having previously owned dental practices with NHS contracts and very inconsistent degrees of support from NHS management, I can tell you that a busy NHS list with emergencies, treatments and “ one price for everything “ basis can make it difficult to prioritise a child’s first check-up.

I always tried hard to make this happen, and there are hundreds of young people going on to adult life with perfect mouths and no concerns about dentistry because of the care we have taken since meeting them as toddlers.

Not everyone is in this position though, and a poor experience in early childhood makes it very hard for some to think logically about their dental care.

Once young people with this history become adult and leave home, the easiest thing for them to do is simply to avoid dentistry and the negative memories they associate with it.

Sooner or later, problems develop and a person with dental anxiety is forced to come to see us. There is a spectrum of dental anxiety, but in the more severe cases the person has buried the memory of childhood trauma deep inside, almost as if they’ve locked it in a box and filed it away.

What we need to do is very carefully try to work out what the experience was and talk through how we can avoid such a thing happening again.

Anxious patients usually need reassurance that they won’t be placed in a situation where they have no control. It’s really important to have an easy signal to let us know when to take a break and put the patient back in the driving seat.

Most patients find it reassuring to be reminded that we are legally not allowed to carry out any treatment without consent. In more relaxed patients, this consent can be taken to be implied by the fact that they are still sat on the dental chair with their mouths open.

This can’t be the case with a known anxious patient, as they may have reverted to a childlike state where they feel unable to interrupt the treatment and the anxiety can spiral to a crisis which obviously just reinforces the negative feelings and worsens the anxiety.

It is absolutely crucial therefore to empower anxious patients with the knowledge that once they have used the agreed signal to stop, this indicates they have withdrawn ( hopefully temporarily ) their consent and any further treatment would technically constitute assault.

I’m not aware of this ever having been taken to a court of law, but the legal principal is true, so no dentist in their right mind would continue after the signal has been given.

The other important management tool is to set easily achievable targets and constantly reassure the anxious patient that all is going to plan. No-one likes surprises in the dental chair, so a running commentary about how much longer the procedure will take can help the anxious patient to decide whether or not a break needs to be taken.

Simply put, we all like to have a beginning, middle and end with the ability to pause at any time should we need to. Initial treatments should be split into short, manageable appointments to build confidence slowly.

Anxious patients above all should never ever be rushed, and the outcome is a patient who, despite earlier problems, feels confident that they will remain in control of a process necessary to avoid more unpleasant outcomes later.

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