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Inside Dental Hygiene
February 2022

Strategies to Ease Dental Anxiety

How to earn your patient’s trust

Stephanie A. Pajot, RDH, BS

All hygienists have encountered patients with dental anxiety, which is common for many reasons: a past traumatic dental experience, the anticipation of pain, or the fear of the unknown treatment needs and costs. When patients are presenting as quiet, overly chatty, or even angry at the start of a visit, hygienists should consider this as evidence of anxiety. In the 2013 book, Behavioral Dentistry, it was noted that nearly half of all Americans have some level of dental anxiety and about 5% to 10% of patients avoid dental appointments altogether because of it. As oral health practitioners, hygienists have to tap into their empathy as much as they do their hands to deliver care during clinical procedures.

From the beginning, actively working to earn a patient's trust is essential. Truly paying attention to patients' verbal and non-verbal cues can tell you what they need from you. Welcome your patient into the operatory with a smile (even if under a mask). Introduce yourself and confirm how you will be helping her or him this visit. When reviewing medical history and concerns, it's imperative to sit at the patient's level and make eye contact, if culturally appropriate. Hygienists are excellent multitaskers, but typing into a chart as patients are talking does not help them feel connected to you.

Patients who have been avoiding the dentist have the perception that you will be shocked at the condition of their mouth and therefore will judge and embarrass them. You will see patients take a deep breath after you offer reassurance that this is not the case, that they have come to the right place, and that they already took the most important step by coming in. This is the first day of the rest of their lives, and they are in a no-judgment zone. They need to hear that you have seen this all before and that everything is going to be okay.

When it's clear the patient will require a lengthy treatment plan that could seem overwhelming, stress that the practice will help with strategizing priorities. Taking it one step at a time is key. Eliminating pain and infection are typically handled first, but it's also critical to ask patients what is most important to them. Offering patients a sense of power and control helps earn their trust. For example, the patient may prefer to improve anterior esthetics before replacing missing posterior teeth. Sometimes hygienists have the privilege of spending more time with the patient than the dentist does, so they serve as an excellent communication facilitator when necessary. If initial periodontal therapy is recommended, don't assume patients know what that entails. Rather, educate them on the options, rationale, and the steps involved. Inform the patient using both verbal communication and visual aids, such as intraoral photos and simple graphics when possible. With scaling and root planing, for example, make sure to mention that the procedure is non-surgical, because often what the patient is imagining is inaccurate. Remember, patients may have heard horror stories from friends, family, and coworkers about their dental experiences, and hygienists owe it to them to set the record straight about what they can expect.

Patients can be given more control over their experience without affecting what you need to accomplish as a practitioner. In addition to the option of holding the saliva ejector, patients appreciate the power to request simple options such as the music in the room, a calming essential oil fragrance, a cozy blanket, desensitizing or topical anesthetic agents, nitrous oxide, or even the flavor of the prophy paste. Remind patients that they are in control and can raise their hand to stop you if there is a problem. By far the best move when working with anxious patients is to educate them on every step before you make it. Someone's hands in your mouth can feel very invasive to personal space.

One of the most rewarding experiences for hygienists is watching a patient transition from terrified to comfortable in an appointment or two. I have seen patients present with a warning that they don't know if they will be able to stay or even sit down due to fear. Immediately, baby steps became the plan. One patient, a successful business owner in his 50s, had never been to a dentist due to fear of the unknown. (For his first appointment, his wife followed him to the office in her own car to make sure he would even show up.) He had multiple teeth sheared off at the gingival margin after working on his own teeth and gritting through pain. After a few appointments, he confirmed he made a good decision by facing his fears. His oral health was on the mend, and he could see his smile improving.

With general anxiety so apparent in today's chaotic world, hygienists owe it to our patients to improve  one aspect of health by easing dental anxiety. One step at a time, we can make a difference.

Stephanie A. Pajot, RDH, BS
Smile Creator of Bingham Farms
Bingham Farms, Michigan

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