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Anxious patients: Understanding the causes of apprehension can foster a positive dental experience

Oct. 18, 2016
Anne Guignon, RDH, says that understanding the causes of apprehension from patients can foster a positive dental experience.

By Anne Guignon, RDH, MPH, CSP

Through the years it seems like I've gotten more than my fair share of anxious, picky patients. Some clinicians don't like working with these people, and they get very uncomfortable when the patient insists they only want to be treated by one particular hygienist.

While none of us will ever appeal to all patients, it is important to treat everyone with professional courtesy. We don't have to like their personal antics. Patients, though, are human beings, and we are here to serve them, not make fun of them behind their backs.

Staff support is critical when we encounter a difficult patient. Every doctor on the planet has treated a difficult soul and every business office administrator has had to work with a patient who is reluctant to schedule, complains about the fees, or does not want to pay their bill in a timely fashion. If you know the patient is going to be difficult, ask the doctor of other staff members to be flexible and support you.

Most difficult patients are scared.1,2 The sources of their fear can be a mile long, but once you identify the reasons for their anxiety it is possible to find a solution that will help them be more comfortable.2 It is estimated that one in seven are highly anxious about having dental treatment.2 Fear is a huge roadblock and can include more than fear of pain, being scolded, the unknown, or being put in a vulnerable physical position. Past dental offices experiences that were negative can play a huge role in the development of dental treatment anxiety. Patients with a history of negative dental experiences are 14 times more likely to report fear of the dental office.3

Patients can also be anxious about how their teeth look, being touched, gagging,4 or having poor language or communication skills. Cognitive issues can come into play, as can self-esteem, psychological challenges, or even a history of physical abuse. Losing control of one's environment can lead to all kinds of unpredictable behaviors from lack of cooperation to literally being unable to cope with a situation.

Call me crazy, but some of my best and most memorable patient relationships started out as less than ideal. It's never fun to work with a stressed-out patient, a gagger,4 someone who has severe dentinal hypersensitivity, or someone who is mad about all things dental. It is important to remember that they made a choice to come in for dental treatment, and we are obligated to serve their needs as best we can. Good communication, establishing a rapport, and understudying the nature and source of their anxiety will go along way to reducing patient fear.5

First things first, don't take a person's anxious, picky behavior personally. It is quite unlikely that the source of their agitation or negative behavior has anything to do with you. Typically, they are playing an emotional tape over and over in their head, and you're witnessing the external manifestation of their inner fears.1-3 Take a deep breath, keep your voice calm, and ask them if there is anything that will make them more comfortable. Sometimes it is as simple as not flossing their teeth, a change in prophy paste flavor, or finding a way to reduce their gag reflex that makes all the difference.

Other times the issues are more complex and require creating a safe, low-stress, unhurried environment. Anxious patients are not stupid. They can sense empathy. They are anxious for a reason, which can be either real or imagined, but breaking down the barriers can build trust.5 As the trust builds, so will the relationship. From the standpoint of the anxious patient, you have given them a huge gift. You took the time to acknowledge their fears and address them openly. You treated them with respect and in return they will become your most loyal champion, get needed treatment completed, and be a rich source of new patient referrals. RDH


1. Rafique S, Banerjee A, Fiske J. "Management of the Petrified Dental Patient." Dent Update. 2008 Apr;35(3):196-8, 201-2, 204 passim.
2. Armfield JM, Heaton LJ. "Management of fear and Anxiety in the Dental Clinic: A Review." Aust Dent J. 2013 Dec;58(4):390-407; quiz 531.
3. Bracha HS, Vega EM, Vega CB. "Posttraumatic Dental-care Anxiety (PTDA): Is "dental phobia" a misnomer?" Hawaii Dent J. 2006 Sep-Oct;37(5):17-9.
4. Almoznino G, Zini A, Sharav Y, Yanko R, Lvovsky A, Aframian DJ.

"Overlap Between Dental Anxiety, Gagging, and Blood-Injection-Injury Related Fears - A Spectrum of one Multidimensional Phenomenon." Physiol Behav. 2016 Jul 28;165:231-238.

5.Morgan AG, Rodd HD, Porritt JM, Baker SR, Creswell C, Newton T, Williams C, Marshman Z. "Children's Experiences of Dental Anxiety." Int J Paediatr Dent. 2016 Jul 4.

ANNE NUGENT GUIGNON, RDH, MPH, CSP, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971, and can be contacted at [email protected].