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Mental Health

When your patient is not OK: 4 ways to create a safe space

June 27, 2023
This author was told "this isn't a therapy session" by a patient who was clearly struggling. How she responded ended up making a huge difference for the patient, as well as how the RDH works with others.

I was recently with one of my patients. “This isn’t a therapy session,” she exclaimed as her body tensed. My patient had just informed me of her husband’s unexpected passing. I told her it must be a hard adjustment, but she insisted she was doing fine, and that she wasn't there for therapy.

I breathed in slowly, became aware of my feet pressing into the floor, and said, “You’re right. We’re here for your dental appointment. Let’s clean your teeth.” I made eye contact as I spoke, then shifted my gaze to the screen displaying her radiographs. As I talked about an area with a carious lesion, I heard her sniffle.

I waited, and was just present with her. She finally said, “It’s been so hard. Some days I don’t care about anything.” I let her speak, and after 10 minutes of venting, she thanked me. “I really appreciate you listening. I’m not surprised I have a few cavities. Lately, I might go days without brushing.”

After her prophy, the dentist and I treatment planned two restorations and I reviewed home care with her. I also googled a local grief counselor and offered to call them for her to see if they accepted her insurance. She was grateful to allow me to do so.

Dental hygienists treat patients systemically. We educate about heart disease, Alzheimer’s, and gastrointestinal issues. We update medications and remind patients to drink enough water. Mental health is also a vital part of a person’s system. According to the CDC, one in five adults have some type of mental illness, and one in 25 have a serious disorder. We should be on the lookout for mental illness, note our observations in patients' medical history, and look for signs of progression at each visit the same way we do for any other condition.

When someone is struggling, every kindness shown to them becomes meaningful. Those with mental illness often harbor traumatic mindsets that make them doubt their worthiness and dignity. Treating them with such can make a huge impact on their oral health and whole wellbeing. Of course, we’re here to “do dentistry.” We aren’t qualified to take on mental illness.

However, in the same way we can support, encourage, and celebrate with our patients who are fighting diabetes, cancer, or other physical ailments, our awareness of someone’s mental illness may make them more proactive in their treatment. The best way to do that with them is to create an environment that makes them feel safe. This not only helps those suffering from mental illness or dental phobia, but it has the side effect of increased compliance, decreased broken appointments, and greater acceptance for treatment. In other words, creating a safe space makes it easier for us to do our jobs.

You might also want to read: Caring for dental hygiene patients with depression and anxiety

4 ways to create a safe environment

Make the area pleasant

The hygiene operatory should be clean and professional but should also include human touches. Photos of family or the office holiday party, candles, and art all make the space cozy and less clinical. I’m a strong proponent of bringing bits of nature inside in the form of aquariums or terrariums, which have been found to reduce stress in many studies.

Don’t rush

I know! How can you not rush when your patient showed up 10 minutes late and is in the mood to talk, your next patient showed up 15 minutes early, your cavitron tip is leaking, and the hygiene assistant is on break? The trick here is to move slowly and deliberately to give a relaxed impression, while still providing the best service.

I had the pleasure of working with a dentist who was a master of nonchalance. He would stroll in, examine the patient while chatting, then sit in his chair backward and calmly tell the patient the treatment needed. He never missed a detail and would often say, “There’s a lot going on here. I don’t want to rush through this, so let’s schedule another appointment to make time to go over everything together.” Let me tell you, that dentist had a cult following! Being relaxed is powerful. Keep in mind that being thorough is important, but not more so than providing a good overall experience.

Use clinical terms appropriately

For a long time, hygienists were told to be heavy in their clinical presence to combat the notion that we’re merely “tooth cleaners.” We’ve come a long way, but there are still patients who don’t share relevant changes in their medical history with us because they think they only need to tell the doctor. Despite this, keep clinical jargon to a minimum as many people find it cold and alienating.

Be attuned 

Since dental hygiene is repetitive, we may do our jobs on autopilot. Thinking about something else while we work is common, but it misses an opportunity; a chance to tune into what the patient is experiencing. An awareness of what’s happening to the person in our chair can heighten our sensitivity, which can make the experience less uncomfortable for the patient but also possibly make it genuinely relaxing.

Notice your patient’s eyes, head position, shoulders, hands, and legs. These all give clues to what they’re feeling. Asking a simple, “How are you doing so far?” as you work goes a long way toward making them feel safe. Accept their feedback and let them have a degree of control. Afterward, give a compliment before a criticism. This will make them more likely to want to improve and keep communication open.

These factors, when coupled with sound clinical skills, pave the way for long-standing patient relationships. I hope these ideas inspire you to create a space in which patients can improve and maintain all aspects of their health.