DR. MANSKY’S SIMPLE FIVE MINUTE DENTAL ANXIETY CURE
Dental treatment creates anxiety for many people. In a survey by Noven Pharmaceuticals, researchers found that 50 percent of adults expressed some anxiety when faced with a prospect of sitting
in the dentist’s chair, and one in ten people equate going to the dentist with fear of dying. This paper discusses some of the causes of dental anxiety and presents a simple technique for quickly and effectively giving patients control over anxiety. With this information and technique, the dentist can provide a dental experience that is less stressful and more rewarding for both patient and dentist.
What Is Dental Anxiety?
Anxiety is an unpleasant emotion aroused by internal or external events that are perceived to pose a threat to the person's physical or mental well being. It is often triggered by unknown or not easily identifiable causes. Anxiety becomes a problem because it causes physical discomfort. We have a threatening thought, and discomfort immediately follows. For example, the thought “I need an injection,” may immediately be followed by a knot of tension somewhere in the body. What makes this physical discomfort especially difficult is the feeling we have no control over it. Feeling a loss of control can limit us from dealing effectively with the underlying anxiety-provoking situation
What are the Costs of Dental Anxiety?
Dental anxiety has negative consequences for both patient and dentist. For many patients, the dental experience is emotionally unsettling and physically uncomfortable. Patients handle anxiety by making and frequently breaking appointments, by being late, and by not making payments in a timely manner. They may become angry with the dentist, make him or her wrong, become distrustful, and delay or not accept needed treatment. Preventive home care might be neglected, and routine office visits avoided. Dental emergencies, greater dental expense, unnecessary tooth loss1, unattractive smiles, bad breath and more complicated dental treatments ordinarily result.
Unfortunately, patient anxiety often causes the dentist to become anxious. When dentists feel anxious they do not feel appreciated or competent. They may feel upset, angry, helpless or attacked. One significant effect is that the dentist may emotionally detach from the patient (and others) at a time when the patient most needs to feel connected to the dentist.2
What Causes Dental Anxiety?
At birth, the tongue is the infant’s only fully developed organ. Because the tongue is necessary for sucking, the infant’s survival depends on its full function at birth. For the first two months of life, the mouth is the infant’s primary functioning organ. Besides survival, the fully functioning mouth connects the infant with others. It is used to communicate, express feelings and explore the world. As the child grows and matures, the mouth continues to play a significant role in everything he or she does.
At the same time that the mouth has such great significance for the infant , the infant is helpless, cannot fully express itself fully, is at the effect of others, and can be physically hurt. As the infant matures into childhood and adulthood, unconscious memories of this relationship between the significance of the mouth and helplessness are stored as emotional memories. In dental situations as the dentist treats the mouth patients frequently feel defenseless. Unfortunately, feelings of vulnerability bring up emotional memories of infancy and cause significant dental anxiety. 3
What Else Can Contribute to Dental Anxiety?
- In our society a dentist is perceived as an authority figure. A person with difficult, abusive, or otherwise threatening early childhood authority figures may transfer these feelings to the dentist. Considering the aggressive nature of many dental procedures, if the person treating your mouth is considered difficult or threatening4, anxious feelings arise more easily. These feelings can negatively effect the connection that develops between that person and the dentist..
- Another factor increasing dental anxiety for some patients is the seeming intimacy generated by the physical closeness required for dental treatment. The dentist and patient sit close to each other within an ‘intimate space’. They talk softly. They only see part of each other. They can smell each other, and feel differences in body temperature. The reclining position is best suited for treatment and the dentist leans over the patient and puts his or her hands in the patient’s mouth. Because of this physical closeness, the dentist-patient interaction unconsciously reflects intimate relationships the dentist and patient may have in their personal lives. If a patient is brought up in an environment where there is little touch or intimacy the closeness that is part of the dentist-patient relationship may dramatically increase a patient’s anxiety
- Difficult dental treatment experience and difficult relationships with previous dentists can cause a significant increase in a patient’s dental anxiety.
Eliminating Anxiety
The most significant factor in reducing dental anxiety is the ability of the dentist and staff to quickly develop a connection with each patient. With a connected relationship, the patient feels understood, 5 safe and protected and the treating professional wants to do the best he or she can. Knowing how to ask the patient what he or she is thinking, feeling and wants is crucial to developing a connection.1 By eliciting this information, the dentist can respond to each patient appropriately and meaningfully.
In addition, a connection with each patient is fostered when the dental office environment is relaxed, well organized, and the staff friendly, warm and caring.
Immediately responding to a patient’s disclosure that they are anxious with an explanation about how you can manage their anxiety helps reduce anxiety. The following is basically what I tell an anxious patient.
“There are a few things I can do to help you eliminate your anxiety. The first is training you in a simple exercise that will get rid of the physical discomfort that is caused by anxiety…The physical discomfort I mean is a tense area in your stomach or your chest or your neck. This uncomfortable feeling is screaming at you to not do whatever is causing you to feel anxious.
A second thing that we can do is use Nitrous Oxide Gas. If you never tried Nitrous Oxide we can try it before we start any treatment. Because when you use it you are awake with Nitrous you can talk with me tell me if you like it or don’t like it or if I need to adjust it for you to feel comfortable.
A third thing you should know about is that if you need an injection it can be given without pain. An anesthetic liquid injected quickly causes too much pressure in the tissue under the gum and results in pain. A slow injection allows the tissue under the gum to gently adapt to the anesthetic liquid and is essentially painless.
If you still feel anxious after we do all of this of this, then there are some medications such as Halcion or Valium. It only rarely that someone ends up needing these but if you do it can be a great help.
One other thing that is important for you to know is that all of us in the office are interested in making this a anxiety-free experience for you. That may be as valuable as all the things I already mentioned.
If you are feeling anxious now let me coach you in the 5 minute dental anxiety cure exercise.”
Dr. Mansky’s Simple Five Minute Dental Anxiety Cure
Practically speaking, anxiety is a problem because it creates physical discomfort. Most anxious dental patients feel a knot in the stomach, chest, head or hands. When the dentist elicits that a patient is anxious, coaching the patient in the following seven-step exercise (in the dental chair) successfully gives even the most anxious patient control over the physical discomfort caused by anxiety.
1. “We are going to do a short exercise to eliminate anxiety. You will also be able to control any anxiety you feel now and in the future. I will ask you to do certain things and after you complete each one let me know so I can give you the next thing to do. Is that O.K.?”
2. “Dental anxiety generally causes discomfort in the stomach, chest, head, shoulders, or the hands or arms. Close your eyes. Travel inside your body with your mind and find the area that feels uncomfortable. When you find the area, use your hands to show me how large the area is. Good. Now notice that because the discomfort is mainly in one area, this area feels different and is separate from the rest of your body.”
3. “At this point, think of the degree of discomfort you are feeling as a ‘10’ on a scale of ‘0 to 10’ with ‘10’ being the worst. This awareness will allow you to know how well you are doing. For example, if it gets to a ‘5’, it will mean you are doing better.”
4. “Because the area feels isolated, be aware that it has a shape and a wall around it that separates it from the surrounding area. Explore it with your mind. Now tell me if it is round, oval, or square? How deep does the area go? Does it go all the way to your back? Halfway? Or is it just on the surface? Does it feel solid, mushy or fluttery? “
5. “Now that you are familiar with the area, you can manipulate it. Open up the surrounding wall and let it spread out into a wider area.” (Note: This is generally easy for people to do but in some cases it may take some effort. It is my experience that almost everyone can do this. If the person is finding it difficult just ask them to keep trying because it is really worth it.) “When successful, and I know you can do it, let me know how it is on a scale of 1 to 10.” (Most likely the patient will tell you it is either a 7 or an 8.)
6. “Now make the area smaller, about the size of a Ping-Pong ball.” (After the patient indicates this is done then say) “Now move it up or down or to either side. To move the ball, open up a space above it or below it. Move the ball into this space. How does it feel on a scale of 1 to 10? You are getting control over your discomfort. In only a few more moments, you will have complete control.”
7. “Open a pathway ‘like the Red Seaparting’ from where discomfort is to your throat. Move the ball to your throat. Now take a deep breath and blow the ball out through your mouth. Where are you now on a scale of 0 – 10? If there any left you now know how to get rid of it. It’s a crummy feeling, so take another deep breath and blow out the rest of it.”
At this point, even from the most anxious patients is relaxed and ready for treatment.
Our lives are frequently stressful and pressure-driven. Having a tool that gives us control over anxiety is very valuable. It can eliminate the roadblocks to success we often set up to prevent ourselves from feeling anxious moments.
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1 P. Doerr, W. Lang, L. Nyquist, D. Ronis Factors Associated with Dental Anxiety.
JADA 1998; 129:1111-19
2 M. Mansky, DDS, A Question about Those Connections. Dental Economics. August 1998: 88(8) 65-67
3 L. Lefer, DDS, MD.Personal Communication October 1967
4 Locker D, Liddell AM. Correlates of dental anxiety among older adults. J Dent Res 1991; 70(3):198-203
5 C. Jepsen, DDS Behavioral Foundations of Dental Practice. Clinical Dentistry; Vol. 5, Chapter 23:1-18
Dr. Marvin Mansky has long been interested in understanding dentist/patient relationships. His seminars, articles, and audio tapes present easy to learn techniques to simplify the complex interactions characterizing the dentist-patient exchange. It is his belief that connecting with patients by understanding what they think and feel is essential for building a strong, private, fee-for-service practice. His seminars are interactive and participants can immediately incorporate techniques for improving dentist-patient relationships in their dental practices. Dr. Mansky can be reached at 888-808-8997, via e-mail at relax@personaldentistry.com or visit his websites at www.personaldentistry.com.
