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Inside Dentistry
Jul/Aug 2008
Volume 4, Issue 7

Anxiety and Ability to Recognize Clinical Information in Dentistry

Howard E. Strassler, DMD

Eli I, Schwartz-Arad D, Bartal Y. J Dent Res. 2008;87:65-68.


Stress significantly affects a person’s cognitive ability to process information. Therefore, we hypothesized that patients’ ability to recognize information related to the procedure they are about to undergo will be affected by the stressfulness of the situation (less recognition under a high-stress situation as compared with a low-stress situation). Patients (n = 66) were evaluated for their ability to recognize clinical information supplied on two different occasions: immediately before oral surgery (high-stress condition) and before suture removal (low-stress condition). Dental and state of anxiety and expectation of pain were also assessed. On both occasions, the patient’s ability to recognize information correctly was low (less than 50%). Patients recognized significantly less information preoperatively than before suture removal. State of anxiety, dental anxiety, and expectation to experience pain had a profound effect on their ability to recognize provided information correctly. Apparently, before dental treatment (high or low stress), patients’ ability to process information may be severely impaired.


Are we more receptive to and better understand what the options are before we have an emergency condition or when we are informed that the condition dictates a procedure must be done now—please sign all these forms? Just as for medicine, we as clinicians deal with the same issues. Before a patient can provide informed consent and agree to accept treatment, it is critical that the patient understand the relevant and important information about the procedure being described and recommended. While for routine procedures this is not very challenging, for more invasive procedures where the actions we take are more involved and in some cases irreversible, we want the patient to fully understand the implications of their decisions. Also, many times when we are providing routine care the patient is required to understand postoperative instructions so that the procedure will have a better prognosis of success. When and how do you provide the patient with postoperative instructions?

This well-designed research study provides all clinicians with important insight into what our patients perceive during treatment and when they are provided clinical information they must use for their decision making and postoperative care. The primary focus is how stress impacts patient understanding. Stress includes both physiological and psychological components. The results of this study were obvious, but do we use this understanding of how patients process information wisely when we provide treatment planning and postoperative instructions that require an active participation by the patient? Whether it be a routine sealant placement for a child, a posterior composite resin, even a routine dental cleaning that involves subgingival scaling—does the patient under-stand the potential changes to occlusion, tooth sensitivity, gingival swelling, and soreness with just a mere mention to them before they exit the dental chair? Probably not. Written instructions are valuable for all dental procedures to be certain the patient understands. There are procedures where a follow-up telephone call or message to the patient later that day will be valuable to have them listen and understand what has been done and what is normal for postoperative conditions—the patient is less stressed and more receptive to understand and ask questions.

A mere dental visit is stressful enough to some of our patients. Our actions to make the appointment and treatment less stressful and to provide the patient with a better understanding of what has been done and what to expect after treatment is very much appreciated.

About the Author

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore, Maryland

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