What perceived behaviors on the dentist’s part are associated with patient satisfaction?

• Assured me that he would prevent pain 
• Was friendly
• Worked quickly, but did not rush
• Had a calm manner
• Gave me moral support
• Reassured me that he would alleviate pain
• Asked if I was concerned or nervous
• Made sure that I was numb before starting
to work .

What behaviors on the dentist’s part do patients specify as reducing their anxiety?

• Explain procedures before starting.
• Give specific information during procedures.
• Instruct the patient to be calm.
• Verbally support the patient: give reassurance.
• Help the patient to redefine the experience to minimize threat.
• Give the patient some control over procedures and pain.
• Attempt to teach the patient to cope with distress.
• Provide distraction and tension relief.
• Attempt to build trust in the dentist.
• Show personal warmth to the patient.
Corah N: Dental anxiety: Assessment, reduction and increasing patient
satisfaction. Dent Clin North Am 32:779—790, 1988.

What are the major practical considerations in scheduling identified anxious dental patients?

Autonomic arousal increases in proportion to the length of time before a
stressful event. A patient left to anticipate the event with negative self-statements
and perhaps frightening images for a whole day or at length in the waiting area is
less likely to have an easy experience. Thus, it is considered prudent to schedule
patients earlier in the day and keep the waiting period after the patient’s arrival to
a minimum. In addition, the dentist’s energy is usually optimal earlier in the day to
deal with more demanding situations.

Whom do dentists often consider their most “difficult” patient?

Surveys repeatedly show that dentists often view the anxious patient as
heir most difficult challenge. Almost 80% of dentists report that they themselves
become anxious with an anxious patient. The ability to assess carefully a patient’s
emotional needs helps the clinician to improve his or her ability to deal effectively
with anxious patients. Furthermore, because anxious patients require more chair
ime for procedures, are more reactive to stimuli, and associate more sensations with pain, effective anxiety management yields more effective practice
management.

What are common avoidance behaviors associated with anxious patients?

Commonly, putting off making appointments followed by cancellations and
failing to appear are routine events for anxious patients. Indeed, the avoidance of
care can be of such magnitude that personal suffering is endured from tooth
ailments with emergency consequences. Mutilated dentition often results.

Relaxation Script

The following example should be read in a slow, rhythmic, and paced
manner while carefully observing the patient’s responses. Backing up and
repeating parts are beneficial if you find that the patient is not responding at any
time. Feel free to change and incorporate your own stylistic suggestions.


Allow yourself to become comfortable. . . and as you listen to the sound of
my voice, I shall guide you along a pathway of deepening relaxation. Often we
start Out at some high level of excitement, and as we slide, down lower, we can
become aware of our descent and enjoy the ride. Let us begin with some attention
to your breathing…taking some regular, slow…easy…breaths. Let the air flow
in…and out... air in... air out... until you become very aware of each inspiration...
and... expiration [ Very good. Now as you feel your chest rise with each intake
and fall with each outflow,
notice how different you now feel from a few moments ago, as you
comfortably resettle yourself in the chair, adjusting your arms and legs just
enough to make you feel more comfortable.
Now with regularly paced, slow, and easy breathing, I would like to ask that
you become aware of your arms and hands as they rest [ where you see them,
e.g., “on your lap”] Move them slightly. [ Next become aware of your legs and feel
the chair’s support under them. . . they may also move slightly. We shall begin our
total body relaxation in just this way .. . becoming aware of a part and then
allowing it to become at ease.. . resting,  floating, lying peacefully. Start at your
eyelids, and, if they are not already closed, allow them to become free and rest
them downward. . . your eyes may gaze and float upward. Now focusing on your forehead . . . letting the subtle folds become smoother and smoother with each
breath. Now let this peacefulness of eyelids and forehead start a gentle warm flow
of relaxing energy down over your cheeks and face, around and under your chin,
and slowly down your neck. You may find that you have to swallow . . . allow this
to happen, naturally. Now continue this flow as a stream ambling over your
shoulders and upper chest and over and across to each arm [ and when you feel
this warmth in your fingertips you may feel them move ever so slightly. [ for any
movement] Very good. Next allow the same continuous flow to start down to your lower body and
over you waist and hips reaching each leg. You may notice that they are heavy, or
ight, and that they move ever so slightly as
you feel the chair supporting them with each breath and each swallow that
you take. You are resting easily, breathing comfortably and effortlessly. You may
become aware of just how much at ease you are now, in such a short time, from a
moment ago, when you entered the room. Very good, be at ease. 3. Hypnosis, a useful tool with myriad benefits, induces an altered state of
awareness with heightened suggestibility for changes in behavior and physiologic
responses. It is easily taught, and the benefits can be highly beneficial in the
dental setting.
4. Informing patients of what they  may experience during procedures
addresses the specific fears of the  unknown and loss of control. Sensory
information—that is, what physical sensations may be expected—as well as
procedural information is appropriate.  Knowledge enhances a patient’s coping
skills.
5. Modeling, or observing a peer undergo successful dental treatment, may
be beneficial. Videotapes are available for a variety of dental scenarios.
6. Methods of distraction may also  improve coping responses. Audio or
video programs have been reported to be useful for some patients.

36. Discuss behavioral methods that may help patients to cope with dental fears and related anxiety

1. The first step for the dentist is to become knowledgeable of the patient
and his or her presenting needs. Interviewing skills cannot be overemphasized. A
trusting relationship is essential. As the clinical interview proceeds, fears are
usually reduced to coping levels.
2. Because a patient cannot be anxious and relaxed at the same moment,
teaching methods of relaxation may be helpful. Systematic relaxation allows the
patient to cope with the dental situation. Guided visualizations may be helpful to
achieve relaxation. Paced breathing also may be an aid to keeping patients
relaxed. Guiding the rate of inspiration and expiration allows a hyperventilating
patient to resume normal breathing, thus decreasing the anxiety level. A sample
relaxation script is included below.