Alleviating anxiety for patients

and stress for hygienists

By Cicily Beckstead, RDH, BSDH

Many factors of a dental appointment can trigger anxiety in patients. We have all likely seen patients who are uneasy in dental offices in general, including the classic scenario of a patient who is terrified by the sound of a dental drill. But in general terms, one of the root causes of anxiety for many patients, particularly when dealing with dental diagnoses, is simply “the unknown.”

In a typical dental appointment, the patient comes into the office, is put in the vulnerable position of lying back in a chair with strangers hovering over him or her, and is then given a diagnosis and advised on the recommended treatment. While recommending treatment is all in a day’s work for a hygienist or dentist, the patient on the receiving end of this information is not as familiar and may not be prepared for it. When the diagnosis or treatment is unfamiliar to the patient, he or she may experience anxiety or fear while the dental team is explaining.

In addition, patients can often feel pressured or judged when a medical professional is recommending a procedure. Many dentists and hygienists have practiced speaking to patients in an easy-to-understand, nonjudgmental way. But sometimes these skills can fall by the wayside over time, or in the rush of a busy day.

However, hygienists can play an important role as the patient’s ally in the dental practice, watching for signs of anxiety and being proactive throughout the appointment to help prevent additional stress.

How verbal education can backfire

One important technique in alleviating anxiety for patients is delivering patient education in the best way. In many practices, the hygienist or dentist simply explains the diagnosis and treatment verbally, or perhaps uses drawings or charts to illustrate conditions. While this has the advantage of being simple, there are also a number of drawbacks to verbal explanations. First, they are not consistent across the practice. One hygienist may explain a condition using one set of terms, while another uses different language and examples. Practices should aim for consistency and common language across practitioners, to help patients avoid confusion and to keep staff members “on message” when explaining each procedure or topic.

An additional drawback of verbal explanations is that they can add to staff fatigue and stress. The staff can spend a significant amount of time each day explaining diagnoses to patients and answering questions, cutting into time needed for other important activities. If the hygienist is rushing through explanations or not fully focused on engaging with patients and soothing their uneasiness, patients are able to pick up on these cues.

Finally, patients can often feel pressured into treatment when the practitioner explains the treatment recommendation verbally and immediately asks whether the patient will consent. Obviously, we do want patients to consent to treatment, but we also want them to leave the office feeling that they made their own decision and had time to consider the proposal.

A case such as severe periodontal disease represents a good example of how patient anxiety can get in the way of effective treatment.

Many hygienists have likely had long discussions with patients about the treatment for this condition, explaining effects such as bone loss and infection that can result from leaving it unchecked. Despite our best efforts, however, some patients simply do not absorb the message. They may be in denial about the severity of the problem, and not fully understand the situation, or even more frustratingly, may schedule the scaling and root planing treatment but then fail to show up for their appointments.

Clearly, in these situations, something has gone wrong in the way we communicate with patients, and they have not grasped what they need to do to improve their oral health and why that matters.

A better tool for reducing anxiety

In efforts to alleviate the drawbacks of verbal explanations, many practices have discovered alternate ways of delivering patient education that effectively alleviate patient anxiety. One popular method is video-based patient education, such as CAESY Patient Education Systems from Patterson Dental (www.CAESY.com). This system has nearly 300 clinical presentations, giving the dental team an educational tool for almost any diagnosis. The presentations can also be accessed via the “cloud,” which makes it easy to use the system in any operatory and on a variety of computers or tablets, such as an iPad, and mobile devices.

There are many advantages to delivering patient education with this method. First, practices can ensure that they are delivering a consistent message to patients that is specifically designed to illustrate the issue and answer the most common questions. With clear 3D illustrations, a video presentation can effectively show patients the proposed procedure, but without graphic photos or other unpleasant visuals. It also frees up the dental professional’s time, giving hygienists and dentists valuable extra minutes to complete tasks while the patient views the video.

Patients can also feel more empowered in making their health-care decisions after receiving education from a third party in this manner. No longer is it the dentist or hygienist who is “lecturing” them or asking them to make an immediate decision. Instead, patients can spend a few minutes alone with the video learning about the proposed treatment, and then have a more informed discussion with the dental team about the next steps.

Video presentations can also do a better job of addressing patients’ different learning styles. Because the message is being explained with audio and visual components, as well as on-screen text, the practitioner can feel more confident that patients will understand the message and have their fears soothed. Furthermore, many patient education videos are available in Spanish, which can be especially helpful for patients who are not native English speakers.

The unknown can be a powerful source of anxiety for people in any situation, but particularly as it affects their health. However, by using the right tools to help transform the unknown into the known, hygienists can do a better job of making sure their message gets through. With a third-party education system that lets patients learn for themselves, practices can help patients feel empowered in their treatment, and can also ensure that the right message is being delivered. When patients can get past their anxiety to see their situation more clearly, that is when they can work most effectively with the dental team to improve their oral health. RDH

Cicily Beckstead, RDH, BSDH, has been in the dental field for the past 23 years in various roles as an orthodontic assistant, dental hygienist, and most recently as a technology advisor with Patterson Dental since 2010. She resides in Utah with her husband and three children.

A counselor’s view of medical anxiety

By Amanda Finley, MS, LPCC, LAMFT

Medical anxiety often fits into one of two categories: anxiety that is “future-oriented,” relating to a fear of the unknown, or anxiety that is based on a bad experience in the individual’s past. In either instance, patients often create cognitive distortions, “catastrophizing” what has already happened, or what they are afraid is going to happen.

This practice of catastrophizing highlights the importance of patient education in a medical setting. By presenting a clear, factual explanation of a medical procedure, dental professionals can do a lot to help anxiety-prone patients prepare themselves.

In my practice, I often utilize cognitive behavioral therapy to help clients create a new “script” for the story they are telling themselves. In this method of therapy, we focus on envisioning a realistic scenario in place of the unpleasant scenario that is causing the client’s fear. In the case of medical anxiety, the more information a client has about a proposed procedure and its possible outcomes or side effects, the more realistic a picture we can paint to help that client prepare mentally. Patient education presentations that illustrate exactly what will happen during a medical procedure are a great tool for patients to use when creating their own realistic scripts.

Being realistic — not idealistic — is an important focus of this therapy, as clients need to be prepared not only for a perfect outcome, but for other scenarios as well. Sometimes a medical procedure may indeed be painful, or may have side effects that are unpleasant. Dental treatments may not always be wonderful, but being prepared appropriately can be calming in and of itself. When they are properly prepared, patients can tell themselves, “I know this discomfort is normal, and I expected that.”

I counsel my clients with medical anxiety to prepare as thoroughly as possible for their visits to a health-care professional, and to write down the questions and concerns they’d like to discuss. When clients begin to see themselves as their own advocate, they are able to feel more in control of the situation, which goes a long way in helping them stay calm.

I also emphasize that it is important for clients to let their health-care providers know that they experience anxiety, so that the provider can take any appropriate extra steps to help assure patients. Of course, not every person who experiences anxiety will have the advantage of professional counseling, and so health-care providers must be on the lookout for patient anxiety themselves — and the vast majority are.

By having an organized patient education program in place, such as CAESY Patient Education, dental offices can help people who experience medical anxiety understand proposed procedures, ask questions to help themselves feel in control, and prepare for the treatment by painting an accurate — not catastrophic — picture in their minds.

Amanda Finley, MS, LPCC, LAMFT, holds a master’s degree in community counseling and a certificate in marriage and family therapy from Saint Cloud State University. She is a licensed professional clinical counselor and a licensed associate marriage and family therapist. She holds a bachelor’s degree in psychology from Winona State University. Amanda provides therapy at a group private practice throughout Minneapolis, Minn.