|
Apart from the basic familiarization routines, some of which will be outlined below, a key component of TSD is immediate positive
reinforcement, both verbal (praise - e. g. "You're doing great", "That's good") and non-verbal (smiles,
nods). It's also important to use simple, non-threatening language (see "Use of Language" on the previous page)
- firstly, because your patient may be too scared stiff to take in anything vaguely complex, secondly because it's off-putting,
and thirdly because it facilitates rapport by reducing social distance (meeting them at their level).
TSD is rooted in learning theory, which states that behaviour which is rewarded increases in frequency, while bevior which
is punished or unrewarded decreases in frequency. An integral part of TSD is the inaptly named "behaviour shaping".
I'm saying inaptly because this term refers to the client's behaviour (i. e. cooperating with the dentist's requests) without
referring to the effects on thoughts and feelings (such as gaining confidence, curiosity, and lessening of fear) experienced
by the client. Whichever way you like to look at it, behaviour/thought/feeling shaping develops by reinforcing successive
approximations to a desired goal.
This is extremely important - for example, if someone opens their mouth just a little bit because they're scared of what their
dentist will say, you don't say "you're not opening your mouth wide enough", but "that's great, you're doing
well, can you open a little bit wider?", followed by "can you open even more?"
TSD may be especially useful if it's been a long time since a phobic or apprehensive patient last saw a dentist (basically,
they're starting off "from scratch", not dissimilar to the child patients for whom this method was developed). But
unlike child patients, for the most part they've experienced bad situations in a dental environment, and even sitting in (or
going near) the chair may represent a huge obstacle.
Desensitization starts before any treatment is carried out. For example, as mentioned before, it's a good idea to gradually
get used to the environment of the treatment room. Having your first appointment "just for a chat", without actually
sitting in "the chair", helps with the desensitization process. Gradually approximating "the real thing"
removes a lot of the fear factor, and ensures you're never overwhelmed by the situation.
If you're "starting off from scratch" after a long period of avoiding dentists at all costs, even things which
couldn't possibly result in pain (apart from the potential of humiliation) may seem insurmountable.
As you've seen in "What's Your Fear?", embarrassment over the state of one's teeth is extremely common in dental
phobia sufferers, and the thought of actually allowing a dentist to have a look may fill you with sheer terror. Which is where
"gradual approximation" of "the real thing" (i. e. actually sitting in "the chair" and letting
your dentist have a look with a mirror) comes in handy. If you're anything as bad as I was, you'll still need a fair amount
of will power to do it (a huge amount, actually - but I was pretty bad ;)). But it can be done. Here's how you might go about
it:
If you're terrified of having your dentist have a look, you can start off by letting him or her have a look outside the
chair, without any mirror, in a not-too-bright place, just showing your front teeth. It's a good idea to warn your dentist
about the "shocking" site they're in for, not because they might actually be shocked, but because this provides
them with the opportunity to reassure you that they won't be shocked =). Once you're confident that there won't be any negative
remarks, you can then proceed to actually open your mouth (again, with no touching and without a mirror). This can then be
repeated in a brighter place, this time allowing some touching. This can then be repeated using a mirror, but still outside
the chair. Once you're happy that there won't be a negative reaction, you can do "the real thing" in the chair.
Sounds complicated, but only takes 2 or 3 minutes longer than the "usual" "open wide" procedure!
For any dentists reading this and not using TSD already - be aware that embarrassment is often a huge factor. Be very
complimentary about the state of your patients teeth (it helps if you're a good actor ;) - something along the lines of "they're
not bad", if said in the right tone of voice, will suffice if the situation looks OK or salvagable, or "I see much
worse all the time" if it's looking bad). If they point out how bad their teeth are, if at all possible, start talking
about how nice their other teeth are - this will help your patients lose some of their fears and make them even more receptive
to STD.
When you first ask your patient to open, look from a distance, don't touch, and say something positive. Tell them which
teeth you can see and ask them if you can see, for example, their upper teeth, and touch their teeth in a non-threatening
way. This first physical contact is really important, because on a sub-conscious level, it is at this point that your patient
will make up his or her mind as to how gentle you'll be while treating them. It will help really help things along if your
touch is very gentle initially.
When praising your patient for each successive approximation in opening their mouth a little wider, it may help to know
that the situation is pretty much akin to someone with vertigo attempting a bungee jump. It really is that hard, and realizing
this may help to convincingly dish out praise.
The above example may be interpreted to mean that TSD takes an inordinate amount of time - but in reality, it's a "bang-bang-bang"
affair. To be most effective, TSD should be done pretty quickly, if in lots of little steps. Of course, "open wide"
can be done in one second - but if your patient finds this part difficult due to embarrassment, taking a little extra time
initially will hugely speed up things subsequently. Once your patient has "succeeded" once, they'll have faith in
your ability to handle them. They'll be more eager to cooperate and will respond much more quickly to any subsequent familiarization
technique.
memo: add other examples (prophy, handpiece, LA administration, rubber dam) here
Both desensitisation and tell-show-do are highly interactive approaches which facilitate communication and rapport. The very
fact that the dentist is taking time to explain things and acknowledge any anxieties or fears makes the client feel more relaxed.
Perhaps even more importantly, the fact that clients are allowed to actively take part and (literally) get a feel for the
instruments allows them to see things from the operator's perspective. And, of course, it's more fun!
|
