Dr Niall Neeson, aka the Calming Dentist, looks at how to help patients who may experience anxiety about visiting the dentist.
I became interested in this topic because I noticed that with a lot of people who have dental anxiety once you give them one or two comfortable visits, it can drift away and is no longer a big challenge for them. However, for others you could be at appointment five or six and they’re still struggling. And I noted that those people who were still finding things difficult after a number of positive experiences often had other challenges relating to their mental health.
Also, the interaction between dental anxiety and mental health can work both ways and it can result in a vicious cycle or spiral. One of the behaviours you’d associate with dental fear is avoiding the dentist. Over time, this will lead inevitably to a deterioration in people’s dental health and their teeth could start to look unsightly. That can affect their confidence and they may feel embarrassed about the appearance of their teeth which may then lead to them starting to avoid social situations, or certain interactions. They may even avoid relationships or intimacy as well, so we can see how that can lead to a downward spiral.
A challenging environment
For people who already live with anxiety, a visit to the dentist can present several challenges. Also, they may not be dealing specifically with dental fear. They may be experiencing social anxiety and are anxious about the social interaction of visiting the dentist and having to discuss things with the dentist. Agoraphobia is another example of how anxiety can play into things. Others may fear having a panic attack and have lots of ‘what ifs’ running round in their mind. These can all make a dental visit very challenging and can be a barrier to seeking regular dental appointments.
We’re so used to working in practice that we can sometimes forget the nature of the interaction. When you think about the situation: we have a person lying back in a dental chair, with us right in their personal space, our fingers in their mouth, and we’re putting dental instruments in there, too. There can be water, and it can be difficult to breathe at times. There are so many challenges and potential triggers there that could make the whole thing incredibly difficult for some people.
This can be especially challenging for those living with the effects of trauma. There are a staggering number of people who may have experienced abuse. A huge number of adults (potentially as many as 1 in 5) have been subjected to physical, sexual, or emotional abuse as children. The triggering effects of this can have far-reaching consequences. They may not want or feel able to share this information with their dentist, especially if they have only just met you. That’s why it’s important to adopt a compassionate and caring approach.
We should always consider how we can make things as smooth and as comfortable as possible, and not dismiss people’s anxieties or concerns. We need to give them space and allow them to take things at a pace that’s comfortable for them.
Ways to help
The support of a family member or a friend can be helpful in these circumstances. Also, it’s always worth encouraging people to let the dentist know how you feel. If they let us know how big a deal it is for them, we can approach that interaction in a different way. And if they just can’t bear the thought of picking up a phone to book an appointment, I suggest sending an email which explains how they feel about visiting the dentist and that they’re looking for an understanding, compassionate dentist. They could even copy and paste it and send it to several places. The nature of the response they receive will tell them a lot about the sort of practice it is and can help guide them to the right place.
Another option is to seek some psychological help. Cognitive behavioural therapy (CBT) has proven to be helpful for people experiencing anxiety. It would help not only dental anxiety, but also other types of anxiety, too. And they could potentially make progress with their dental anxiety without even stepping foot in a dental practice. After a few sessions of CBT, they may be able to contact the dental practice and attend their initial appointment.
Give back some control
As dentists, the best way we can help is to adopt a compassionate attitude towards dental anxiety and try to be open-minded. We’ve no idea what’s going on in the background of people’s personal lives, so we’re in no position to judge. Try to avoid lecturing or telling people off for not brushing their teeth well or criticising them for not having been to a dentist for years. They know all that.
Start from scratch, congratulate them for making it through the door. It’s a big deal for them and that will help them settle. And when it comes to the mental health side of things, I’d encourage dentists not to shy away from it. Acknowledge it and just let them know that you get it. This can help build rapport and will allow them to feel more open to discussing things further. And ultimately the more they are willing to share, the easier it is for us to put a plan in place to help them. We can tailor it to them once we know their specific concerns and triggers.
Control is a big part of things. Often loss of control can be a challenge for people. I’d always encourage giving patients as much control as we can within reason, and I see this as involving three different elements. One is the patient having an input, or a degree of control over the plan. So, the pace of things, how much we do on each visit, and spreading out visits. Get them involved and give them a degree of ownership and control over that progress.
Next, I’m a big fan of breathing exercises. I like these because often people are lying back in the dental chair feeling helpless. But simple breathing exercises are things they can do for themselves to help in that moment. It can help physiologically settle the body to feel calmer. It can lower the heart rate, the blood pressure, and reduce cortisol (stress hormones). It can also be a good distraction too. I ask people to focus on counting to four on the in breath, and six on the out breath so the out breath is a bit longer.
And the third element of control is having an established and effective stop signal. That can be as simple as the patient knowing they can raise a hand at any stage if they want you to stop what you’re doing. For somebody with panic disorder, they may just need a breather, or they may have a question. So having a way where they can temporarily pause the visit is great for them.
Being open to mentioning or discussing the option of CBT for people is also helpful. Explain it’s a talking therapy that aims to change unhelpful behaviours and beliefs and is commonly provided by psychological therapists. It’s a brilliant way of being able to break the vicious cycle I mentioned. And if we can break that cycle, then it has a positive impact not only on dental anxiety, but on overall wellbeing and mental health and it can be an absolute game changer for them.
Known on Instagram as @thecalmingdentist Dr Niall Neeson is a practising dentist at Boyne Dental in Navan, County Meath, Ireland.
Niall is a member of the International Society for Dental Anxiety Management (ISDAM), Society for the Advancement of Anaesthesia in Dentistry (SAAD), British Society of Medical and Dental Hypnosis (BSMDH) and Dental Sedation Teachers’ Group (DSTG). He also enjoys his role of teaching and supervising dental students on a weekly basis at Dublin Dental University Hospital, passing on his passion for helping fearful dental patients to the next generation.