Table 3 Management strategies for anxious patients according to anxiety type

Patients who fear specific stimuli eg needle phobics

Gradual exposure of patient to the feared stimulus (eg ‘tell, show, do’, systematic desensitisation). This approach will work better with a patient stop signal. Coping strategies such as relaxation techniques are also helpful.

Patients with free-floating anxiety or generalised anxiety

The patient finds many situations outside of dentistry stressful; often there will be no history of a precipitating event.

The patient needs to develop coping strategies to reduce anxiety.

Patients who have a fear of physical catastrophe

eg choking, retching, asphyxiating or death

Rehearsal and explanation of the patient's psychosomatic reactions are helpful.

Systematic desensitisation, coping strategies and biofeedback can be beneficial once the patient acknowledges the mind-body link to their reactions.

Patients who are distrustful of dentists

These patients may be confrontational in how they express their fears eg ‘the dentist was always in a rush and never asked how I felt’ or ‘always made me feel as if the problems were my fault’.

Listening to the patient's fears and the transference of some control to the patient is helpful. Feedback must be sought from the patient throughout treatment. The establishment of a dialogue in an unhurried, open and non-judgemental manner will help improve the patient's confidence and trust.