Relaxing dental phobics

Oct. 1, 2000
Here`s how to guide patients into a state of mind that helps your patient relax, freeing you to do your best work.

Here`s how to guide patients into a state of mind that helps your patient relax, freeing you to do your best work.

Dr. Barton J. Goldsmith

}Hello, my name is Barton ... and I`m a dental-phobic. Are there any other dental-phobics here?"

Whenever I ask this question of an audience of professionals, a good many of them raise their hands. This is not a strange occurrence, even when speaking to a group of dental hygienists!

It isn`t surprising that most people (hygienists included) are a little frightened of "the chair." As a psychotherapist, I am trained in relaxation techniques, self-hypnosis, and even meditation and visualization (I am from California after all!). However, I still become terrified at the thought of my semi-annual visit to the dentist`s office.

This fear prompted me to examine my own "dental-phobia" and create techniques to lower anxiety for both the hygienist and the patient. My professional background has exposed me to "different" ideas that I have shared with many dental professionals. It makes sense that if the patient`s anxiety is lower, hygienists can be more effective and enjoy their profession. Toward that end, here are some ideas you can use immediately in your practice.

Relaxation techniques

Relaxing patients should start before they arrive at the office. It should begin with an appointment-confirmation phone call. At that time, you or the front-office contact person should ask the patient if he or she has any questions about the upcoming appointment. After answering the questions, tell the patient that this will be a relaxing and pleasant experience. This reassurance creates a holding pattern for the patient`s anxiety. If the patient is a dental-phobic, this will begin to lessen the fear and create an "emotional space" to help lower the anxiety.

Instruct patients to relax five minutes the evening before the appointment and another five minutes just before they see you. Suggest that they imagine a "pleasant and painless dental experience." Creating a painless experience in their mind can make the difference between a very fearful patient and a mildly anxious one.

You also can help patients defuse their anxiety by instructing them to use deep breathing and positive suggestions. A fax or letter describing breathing and relaxation techniques could be sent to patients before their appointments. Here are some suggested techniques:

(1) Remember that only positive suggestions work, so don`t use phrases like, "This won`t hurt," because patients only will hear the word "hurt."

(2) Only present/active-tense suggestions work. Give a specific time frame for patients to relax.

(3) Repetition increases the power of suggestion, so tell patients what you want them to do more than once.

(4) Powerful suggestions are based on emotion. Reframing their fears with a positive suggestion is very calming. Use these examples of positive, present, persistent, and passionate propositions:

"There is no pain, only pressure."

"Every hand that touches you is a healing hand."

"This experience is just confirming your overall good health."

"This time is an opportunity to relax."

The office d?cor

The next interaction with patients is when they first enter the office. In many reception areas, I have seen pictures of a cut-away tooth with examples of abscesses, decay, and even root canal. These pictures can cause apprehension in the minds of normal patients ... and sheer terror for dental-phobics. Instead, select calming pictures and have a relaxation video that plays continually. In particular, use pictures and videos with water. Studies have shown that patients who view water while waiting for or undergoing a cleaning are more relaxed and heal 30 percent faster.

In addition, printed instruction sheets on breathing and relaxation exercises are helpful. They reinforce the instructions given at the time the appointment was confirmed.

Remember every interaction with staff members will affect your patient`s mood. If the receptionist is surly or another staff member walks by the patient without saying, "Hello," it will add to the patient`s discomfort.

Components of stress

Examining the components of stress helps us understand how to lessen it. In the most intense forms of stress - such as life-threatening situations - people have a "fight or flight response." Less intense situations bring up a "freeze or faint response." Dental patients fall into both categories. These responses are automatic and originate in the very core of the brain. The relative importance of any given situation determines the intensity of the response.

Stress motivates and stimulates us into action. Without stress, some people might not even get out of bed in the morning! Stress allows us to respond to life. It is the response to stress that can increase or decrease our anxiety.

Responding negatively to stress creates tension and anxiety. The ability to understand stress and anxiety is the key to keeping patients (and hygienists) happy.

How do you deal with stress in the dental office (and in life)? Picture the mind as a tea kettle that is boiling and full of steam. To stop the noise, let the steam out a little bit at a time, and do that continually. It doesn`t matter if one patient has more or less stress than another. What is important is the way an individual handles that stress - or more accurately doesn`t handle it. This sets the tone for the entire dental visit.

Coping with stress

Stress is a signal to begin using coping exercises. Four steps can be used to cope with stress:

The first step is preparation. If you have given your patients some information or if there is stress-reduction information available in the reception area, you have prepared them. If not, you may want to begin by using a stress-coping statement, such as "You`re going to be all right" or "This is going to be so easy." These simple statements have the power to lower stress and anxiety. As Albert Einstein said, "Make things as simple as possible, but no simpler." Many times, people overlook this type of coping mechanism because it seems too simple.

The second step is to confront the stressful situation. Once patients enter the exam room, their stress level may rise. Try talking to them using stress-coping statements to redirect their thinking. Use statements such as, "Think about your last vacation," or "Where in the world would you like to visit?" If you can get phobic patients to imagine or talk about things that are totally unrelated to the procedure, it will ease their tension ... and yours!

Continue to talk to patients in a calm tone of voice throughout the cleaning or exam. Remind them to "Relax, breathe deeply; we are almost finished." At the end of the procedure, reinforce the patient`s success with the experience. This will remind patients of how well they (you) did and will make them even more relaxed at the next visit. Statements such as, "You did very well. Next time will be a breeze!" work great.

For more difficult patients, continued instruction on breathing/relaxation techniques is invaluable. Offer this to your patients as an "opportunity" to reduce their fears and to feel more relaxed. Here are some steps to help patients release tension and lessen their pain:

4Help them get as comfortable (physically and emotionally) as possible.

4Instruct them to breathe into their abdomen and say, "Breathe in relaxation."

4As they breathe out (from the abdomen) say, "Breathe out tension."

4Instruct them to picture the relaxation entering and the tension leaving their body.

This breathing exercise is very relaxing and will help to calm down even the most anxious patients.

Pain management

To further help you to understand what your patients are going through, it`s important to understand the psychology of pain. The purpose of pain is to get one`s attention; in fact, 80 to 90 percent of pain is actually the brain amplifying the signal. Once the attention is focused away from the cause, the amplification is no longer necessary and the pain decreases. Understanding this can assist you in determining how to help your patients.

Yoga breathing is a great pain-reduction exercise. In this type of breath-control exercise, instruct patients to inhale slowly and fill first their stomach, then their lungs, and finally their upper chest with air. They then need to hold their breath for five seconds and exhale slowly, reversing the process. This is a deep-relaxation exercise. Some patients may become light-headed, so make sure they are aware of this possibility. It also is wise to make sure they are seated.

The next level of relaxation is accomplished through meditation. People who meditate are able to control pain and discomfort 70 to 80 percent better than those who do not. Some patients are so good at this that they have had extractions (even wisdom teeth) without the aid of medication. Teaching meditation techniques will not only aid in your practice and your own comfort, but it also will improve the quality of your life. Here are three basic meditation techniques that you can quickly and easily teach your patients and learn yourself:

(1) Gazing - Select a small object in the room and stare at it. Keep your eyes soft and just notice it. This is a something we did naturally as children, and it is easy once you practice it a couple of times.

(2) Breath-counting meditation - Have your patients count each exhale. Tell them that if their mind wanders, just begin again. The object is not to see how many breaths you can count, but to keep the mind focused on something other than the procedure.

(3) Mantra meditation - Instruct your patients to repeat a healing phrase, such as "I am relaxed and feeling fine" to themselves. This has the added benefit of increasing their natural healing ability.

These basic meditations are very useful in anxiety-producing situations. In addition, a powerful anxiety-reducing exercise is called "feeling fFocusing." This initially was created to help children deal with fear. It has worked so well that their parents have informed me that they are using it, too! First, have patients locate the anxiety in their body, and tell them to breathe deeply. Once they have found the physical location (usually around the solar plexus), instruct them to keep their attention focused on that spot. Just like in the breath-counting meditation, if their minds wander, simply bring their attention back to the spot where the anxiety is. If the feeling moves, have them follow it. The anxiety will begin to fade and disappear. You can coach them in this exercise by simply reminding them to focus their attention on the feeling every minute or so and to continue to breathe deeply. Keeping your voice calm and gentle will aid in their relaxation.

Doing your best work

All of these exercises have the same effect. They relax the patient. If your patient is relaxed, you are free to do your best work. When using these stress-relieving exercises, you become not just the hygienist, but the patient`s guide to a state of mind that he or she is unable to get to without your caring assistance. You may find that your patients will bond with you more quickly and easily. In addition to the added benefit of m more referrals, these techniques create a sound business practice that results in greater personal and professional satisfaction and success.

Dr. Barton C. Goldsmith is president of Goldsmith Strategy, and an international speaker who addresses Fortune 500 companies, YPO (Young Presidents Organization) and TEC (The Executive Committee) groups throughout the country. He is a Westlake, Calif.-based management consultant who specializes in creative and balanced leadership as well as organizational effectiveness. For more information, please call (818) 879-9996.

10 Tips to decrease stress

1) Get into a relaxed state of mind (so your patients can do the same).

2) Trust your intuition (your heart is always in the right place).

3) Use positive, present, persistent, and passionate thoughts and words.

4) Remember that tension is a signal to use coping exercises.

5) Visualize your goal of relaxation for your patient (and yourself).

6) Encourage them to breathe deeply, slowly, and often.

7) Teach your patients basic meditation (and learn it yourself).

8) Communicate with understanding.

9) Avoid criticism and self-doubt.

10) Believe in your abilities and live your dreams.