A successful dentist will have good communication skills to build rapport and trust.
A good dentist will be able to really get along with his/her patients and this relationship is crucial for the management of their anxiety.
There are various communication strategies, general and specific, both of which are very important. This communication should always be two way but the dentist should first take the lead and a good place to begin is to introduce themselves and their nurse personally with the patient in the treatment room.
Initially, ask them something non-dental and just listen carefully in a calm, composed way. A general question asking them about their dental concerns is information to be acquired from the patient but also to listen about their fears which forms part of the iatrosedative technique.
Further down the line, patients should be encouraged to ask questions about their treatment and should be kept fully informed about what they think can be done before starting any treatment and also during their treatment/care.
During any treatment, you and your nurse need to keep inquiring if the patients are having any discomfort, want to have a break and to give continuous moral support plus to always reassure during the procedure. The patient should feel genuinely that their words are taken seriously and with caring concern.
Following GDC guidelines/principles, dentists should give all the necessary complete information regarding description of the treatment, alternative treatment options, costs, advantages, disadvantages, lifespan and preventive advice. Consent should be informed and valid.
This initial visit is the hub to build good rapport and increase the patient’s confidence in the dentist. Patients appreciate clear, honest, and straightforward answers in a language that makes sense to them avoiding medical terminology/jargon; one must also avoid unrealistic outcomes or reassurances, as these can break trust.
Normalizing feelings of being nervous does help and avoiding negative phrasing can be beneficial so always put phrases into the positive.
Nonverbal communication with patients is an essential acquired skill. Dentists and their staff should go on NLP courses to learn anchoring, circle of excellence, reading eye cues and mirroring. Touch can be used to comfort and guide nervous and phobic patients.
The dentist with their dental nurse on the 1st visit should face the patient, make eye contact, nod gently and observe them. Talk less and listen more! Avoid hurrying them, mirror movements, empathize with the patients, and make them feel welcome, and use non-jargonistic words when talking about the treatment.
Usually, a friendly, sensitive, and sympathetic approach is all that the patient wants and will be well appreciated. Patients then go home and will brag about how good you all are.
The Distraction Technique
Distraction is a very useful technique of moving the patient’s attention from what they perceive as an unpleasant procedure/process. This enables decreased anxiety levels and avoids negative or avoidant behaviours.
Giving the patient a short break during all procedures can be an effective use of distraction such as asking them to have a quick rinse out even though they may not need one. Always use a simpler procedure prior to considering more advanced procedures such as carrying out a fissure sealant before a composite filling.
Several technological options are available for both visual and auditory distraction such as bringing your own music device, background music of their choice, television sets on the ceilings , computer games to play, and also 2-D/ 3-D video glasses for watching movies.
Suitable music has been shown to influence in a good way human brain wave activity leading to deep relaxation and therefore alleviating pain and anxiety.
Music distraction is a non-invasive technique which is low cost and easy in which the patient listens to pleasant music during a procedure such as a normal crown prep which involves sounds to be drowned out. The best use of this is to ask the patient to bring their own music in.
Loss of control over being at the dentist is a significant cause for anxiety, and hence providing control is very essential. Telling the patient what to expect and how everything will be fine will help make the treatment and them as comfortable as possible.
“The Tell-Show & Do Method”
Control can be provided with this “The Tell-Show and Do Method.”
The Tell-show-do is a behaviour shaping technique that reduces uncertainty and increases predictability for the patient in the clinical setting and non-clinical aspects of going to the dentist.
This “Tell-Show and Do Method”/technique can be used for both children and adult patients.
It involves a verbal explanation of procedures in phrases appropriate to the developmental level of the patient (This is called: tell); Then we have a demonstration for the patient of the sensory modality visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined manner which your nurse can also do: (show); and then the completion of the procedure: (do).
“Tell-Show and Do Method” is also used with communication skills (verbal and nonverbal) and positive reinforcement. However TSD can’t be used for injections.
Modelling As a Technique
It is shown that Individuals learn much about their environment from observing other people’s behaviour. Modelling is a technique used to alleviate anxiety/phobias. This can be achieved through observation of a dental procedure either by viewing a videotaped model who is demonstrating appropriate cooperative behaviours in the dental setting or through observation of an actual live successful dental procedure.
This could reduce anxiety due to removing “fear of the unknown” and demonstrates to the anxious patient what is considered appropriate behaviour in the dental practice environment setting and also as to what can be expected in the upcoming treatment plan.
When setting up the Modeling technique/program, the following details should be taken care of: the model should be close to the age of the patient, the model should be shown also as entering and leaving the surgery to prove treatment has no adverse effect and the dentist/nurse/receptionist should be shown to be a caring person who praises the patient.
Signaling control involves giving the patient a chance to feel that they are in control of the treatment procedure and involves signalling to the dentist to stop the procedure.
And this increases the patients’ sense of control and trust in the dentist. A signal can be as simple as a raised hand to notify the dental practitioner that the patient would like to stop the procedure. The actual specific signals can be decided before the treatment commences.
The dentist should always stop the procedure as agreed earlier because failure to do so will breach the trust/relationship. Patients can also be given mirrors to watch the procedure, so as to feel they are in control but it depends what the procedure is and most don’t want to look.
Systematic Desensitization Technique / Exposure Therapy
Wolpe’s technique known as “systematic desensitization”, is based on relaxation and played a very prominent role in behavior therapy during the 1960s and 1970s. The treatment procedure is carried out in multiple sessions and the use of systematic desensitization involves three sets of activities.
Firstly, to encourage the patients to discuss their status of fear and anxiety, in order to construct a hierarchy of feared dental situations, from the least to the most anxiety-provoking.
Then the second step is to teach the patient certain relaxation techniques. The most commonly used techniques are progressive breathing and muscle relaxation. The final step is to gradually expose the patient to these situations from the least to the most anxiety-promoting.
When it is difficult to expose the patient directly to the dental setting, it may be appropriate to instruct the patients to practice imaginary systematic desensitization wherein the patients are encouraged to imagine that they are entering the dental clinic, able to sit in the dental chair, and eventually able to receive dental treatment. Flooding or implosion therapy is an intensive form of in vivo exposure therapy for treating phobias.
The patient is confronted with the feared stimuli for repeated and prolonged duration until they experience a reduction in their anxiety level using Systematic desensitization technique/ exposure therapy.
Positive reinforcement is an effective technique to reward desired behaviours and thus strengthens the recurrence/repeating of those behaviours.
Reinforcers include positive voice modulation, positive facial expression such as smiling or nodding, obvious verbal praise and appropriate physical demonstrations such as tapping their arm. These when individualized, frequently provided, and varied over time produce anchors.