Ella Samuel, a dental hygienist and therapist, explores dental anxiety and ways to manage it as a dental care professional.

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‘I just want to let you know before we begin, I hate coming to see the hygienist.' How many times have we heard this one before? How confident does it make you feel for the duration of the appointment as a clinician?

Throughout my time in practice, this statement has been posed to me in several ways. Picture this: a patient walks into your surgery and immediately has their guard up expressing their feelings towards the clinician. The reason behind this? Dental anxiety.

Dental anxiety and dental phobia, being the fear of the dental environment, both affect many patients across the population. It is important to understand the differences between dental anxiety and dental phobia. While both feelings entail fearfulness towards the dental environment, there can be a significant difference in intensity, and how these feelings of fear can impact on a patient's behaviour.

Research from 2018 demonstrates that approximately 53% of the UK population suffer from fear and anxiety when visiting the dental practice.1 This is a particularly worrying statistic, as further studies have shown that patients with dental anxiety commonly ignore dental care and play a role in missed or cancelled appointments for essential care.2 Patients must seek advice and treatment to maintain good oral and general health. Without this baseline treatment, patients may leave themselves open to a plethora of complications, including an increased risk of developing periodontal disease and tooth decay. For patients with severe dental anxiety, it's common for clinicians to come across patients who might have ignored their pain to avoid attending the appointment, with some even turning to self-treatment at home using various tools with little to no guidance on how to use them.

Managing dental anxiety is arguably one of the most difficult things to navigate as a dental professional, and it is important to try and combat these fears by breaking down the barriers bit by bit.

Where does dental anxiety stem from?

Managing dental anxiety is arguably one of the most difficult things to navigate as a dental professional, and it is important to try and combat these fears by breaking down the barriers bit by bit. Dental anxiety often stems from a patient's personal experience of previous pain, alongside individual and secondary ideas and imagination that all dental treatment will involve pain of some capacity. In some cases, particularly with paediatric patients suffering from anxiety, it is often associated with the child's parents or carers, who may demonstrate signs of anxiety of the same (if not greater) level. This in turn can have a huge impact on the child's development as they grow up, making it more difficult to cancel out this fear. Sitting in the dental chair can make patients feel incredibly vulnerable and as though they are out of control during their appointment, contributing to the element of anxiety and fear. Speaking to friends and family who suffer from an element of dental anxiety, there appears to be a common perception of the anxiety associated with ‘the fear of the unknown', stemming all the way from childhood to adulthood. This poses the further question: ‘How well do we explain certain treatments and procedures?'

Ways to aid in managing dental anxiety

Communication between patients is one of the most important factors in providing treatment, especially if a patient has anxiety surrounding the appointment and future treatment. Some patients would prefer to have the proposed appointment broken down and explained in detail, while others would prefer a basic understanding of what to expect. In both situations, it is crucial to take the time to listen and understand what the patient would benefit from. This will especially help those who tend to overthink about the possibilities of different outcomes and can reduce the ‘fear of the unknown'.

As dental hygienists, therapists and other clinicians, we are faced with the struggle of trying to manage these fears and anxiety, as well as trying to provide adequate treatment and care for each patient. Well, it is not always possible to do so concurrently. It is important to gauge the appointment as soon as the patient walks into your surgery; you should ask yourself questions like: ‘What sort of body language is the patient showing?' and ‘Do their verbal cues appear normal?' If a patient is already uncomfortable within the first few moments, the likelihood of them retaining any information given will be slim. This is the point where you should settle the patient into the appointment and have an idea of what the rest of the appointment will look like.

We know that patient education is a fundamental component of our treatment delivery, and as such, we should remind patients how much their oral care at home can have an impact on their overall oral health both at the present time and in the future. Although oral healthcare professionals play a massive role in reducing gingival inflammation, the patient's role at home is key and will also help to reduce any discomfort that they may be experiencing - a common factor of dental anxiety.

Spending the first few appointments going over oral hygiene coaching can allow the patient to regain some of the control they may have felt they were losing, and will establish the groundwork for future appointments to follow. At this stage, patients may begin to open up to you about their fears and concerns regarding the treatment. Try putting yourself in your patients' shoes, really recognising their genuine feelings; a patient wants to feel heard and have their feelings validated.

Many patients fear the various sounds and noises that come from the dental environment, especially those whose trigger of fear stems from noise sensitivity. Instead of avoiding the issue at hand, you can advise patients to bring some earphones with them to their next appointment to tune out the sound from the treatment. Earplugs to reduce the impact of the noise work really well too.

Each patient is different and can experience dental anxiety differently, so it is important to explore all options available for each patient to give them the best experience. Do not be discouraged if you cannot complete all treatment in the first or even second appointment. A patient with a severe phobia may need several visits to acclimatise. The important thing is that they are returning to see you, which in itself is a victory. Praising patients for small changes they can make is highly effective, and can help boost their confidence and trust in you as a clinician.

Providing treatment does not always have to be clinical, but can in many ways be about communicating openly with patients and utilising different approaches to the appointment itself. As we know, maintaining good oral health plays a huge role in our overall health and wellbeing, therefore taking small steps into managing or even overcoming dental anxiety can result in improved oral health. There is never a ‘one size fits all' approach for dental anxiety or phobia, but with plenty of empathy and patience, we as dental hygienists, dental therapists or other clinicians can help to transform the dental experience into a positive one.