Dental Anxiety, can you manage what you don’t understand?

It’s fair to say that the Dental Healthcare system takes great pride in the way it delivers dentistry.  The rigorous training and robust evidence base behind each team members qualification make for a sound base of professionalism.  It is quite right that this should be so, patients deserve a system that they can trust when they surrender responsibility for their wellbeing to a dental team.  In my experience, as a member of such a team, every diagnosis, procedure and process in the care of a patient is developed with a depth of knowledge, understanding and background education that assures quality of treatment, essential for appropriate design of any treatment plan.  In short we don’t do it unless we understand it.  In this post I am asking if you apply this to the way you manage anxiety in our patients.

My background as a Dental Hygienist had me spend many an hour pondering the intricate wonders of immune response to bacteria that defied any spell check.  Before I could comprehend the effects of my treatment of a condition I had to demonstrate a clear understanding of it’s cause and effect on a patient and the desired outcome of treatment.  Today I am no longer working in practice as a Hygienist, but I have continued to work with clients and their experience of Dentistry.  Dental anxiety was cited as a significant barrier to care in the Adult Dental Health Survey 2009, of those adults surveyed that had seen a dentist before, twelve percent were identified as having extreme dental anxiety.  My passion has always been to make access to Dental Healthcare as simple as possible and building relationships with clients in a way that reduces anxiety surrounding treatment made sense.  There are many options open in a practice to deal with this, sedation, pain relief and encouraging staff to take an empathic approach, but how much do you understand about the nature of a patients anxiety before you decide on how it’s to be managed?  I had a talent in the treatment of those patients suffering most found a challenge with some of the most phobic patients committing to appointments up to four times a year.  Persueing the underlying issues of a patients presenting nervous state may not be appropriate in a Dental surgery unless you have expanded competencies in psychotherapy or counselling, but understanding a little of the possible complexities and complications will lead to a more informed and incisive interventions from the team.  Imagine the stress relief of knowing your most anxious patients have become your most willing advocates, in fact they are more likely to foster loyalty and trust that leads to enthusiastic promotion of your practice, word of mouth is a powerful thing.

As an integrative therapist I now spend much of my time working with anxiety of all kinds, not just related to dental treatment.  The mechanisms behind anxiety, its physical and psychological presentation can be life limiting for some, Behaviour resulting from anxiety often confuses things and hinders more resourceful engagement.  My training in Psychotherapy and Hypnotherapy was different to that as a hygienist in as much as my clients didn’t have to sit back quite as far, but there were similarities in the requirements for me to demonstrate understanding, gather evidence and be sure of the full history of an issue before designing the appropriate intervention.  How many questions do you ask your anxious patients? Are they afraid of losing control or is it the idea of pain that worries them? Is it a trust issue or do they feel vulnerable?  Sedation maybe right for some, but over treatment for others, the answer may be more simple or the patient may benefit from a few therapeutic sessions with another qualified professional to help with strategies that can enable treatment to be continued willingly rather than with reluctance.

There is no other dental related issue that is managed by the dental team without some education on its causes and effects.  The question I would ask a team to consider is whether you see Dental anxiety as a barrier for the access to a patient you must overcome, or do you adopt a more patient centric approach by understanding the barriers anxiety presents in the patient’s battle to access the excellent care you have to offer.

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Lets face it….

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I have recently been reminded that there is no perfect solution to the problems people face in life.  None of us can truly walk in another shoes, all we can hope to do is get a sense of how it is for others and relate with empathy and compassion.  Therapy has been an inspiring journey for me both as therapist and client, but the most profound moments have often occurred when I have been in the dark, alone and struggling with my inside voice, I don’t doubt that there will be many more of these moments in my life but thanks to therapy I walk into the dark with more confidence and face the discomfort that I know will engulf me with a certainty that not only will it end, but that there will be some good as a result of accepting it as part of my journey.

Therapy is rarely simple, it involves exploring change, getting to know your current position and considering the possibility of what the choices for change may bring you.  It may be decisions to develop in one area requiring acceptance to let go of potential in another, or it could be coming to terms with loss, anxiety or unwanted thoughts and behaviours.  It is fair to say that resistance and reluctance dance around engagement in change and sometimes grow in the light of vulnerability.  Respecting strategies in ourselves that intend to protect is vital, but recognising when these strategies are more limiting than helpful needs a little help sometimes.  The trust in a therapeutic relationship helps provide a safe and appropriate place to consider, empower and support you without judgement as you work out what needs to be different in your life.

Therapy for change
Therapy for change