Some Thoughts On The Treatment Of Anxious And Phobic Dental Patients

Written by Douglas Miller BDS

Hello and welcome to my page. I’m a dentist in North London who treats phobic and highly anxious dental patients.

I use a wide variety of techniques including, but not limited to, sedation. Part of the way I work is to understand my patients and their needs and aspirations. After all, I’m not just treating a set of teeth – I’m treating a human being who has feelings, fears and expectations. I always strive to deliver the dentistry a patient wants in a manner they feel most comfortable with. So a large part of a first visit with me is spent chatting with a new patient to learn what it is they want, how to manage their fears, and how best to achieve a better dental future for them. 

Below I’ve written down a few thoughts on how I treat dental patients who are very anxious or phobic of dentistry, who make contact with or attend my practice. I’ve included some helpful tips for those thinking about approaching a new dentist or communicating with an existing one. These tips are not in any particular order, but I hope they will help you in your journey to finding a dentist you can trust. 

1. The most important person…

I’d like to start by asking you a question: Who’s the most important person in the dental practice? 

The most important person in the dental practice is YOU.

If you answered “the dentist”, you’d be mistaken. The most important person in the practice is YOU, the patient! It may not have felt like that in the past, but it is important to remember this fact. A caring and considerate dentist will know and understand this and act accordingly. 

2. Control

This brings me on to another question: “Who should be in control at the practice, you or the dentist?”. The simple answer is you. This is your body and you have rights over it. A dentist should only do things with your consent – don’t be afraid to ask for breaks in treatment to allow you to ‘gather yourself’.

Often it’s all about who is in control. The right dentist for you will let you control what happens to you, will discuss your situation fully with you, and let you dictate the pace of your inspection and future treatment. The dentist will probably tell you to use a signal, such as a hand raise when treating you so they know when to stop treatment, as you wish. It is vital that the dentist obeys this simple but important command. And it’s good to test your dentist occasionally to make sure they stop when you ask. If they don’t, you may choose to leave their care.

3. A gentle pace

The mouth is a very intimate area and you may have a sense of vulnerability when you open it for a dentist to check or treat things. The right dentist will understand this and go at a gentle pace for you. 

4. Explanations

Some patients like explanations so they can understand and process what the dentist will be doing to help them, whilst getting the treatment they need. This can be done carefully by a dentist (without being too technical) in a gentle step by step manner.

Some patients do not like explanations and you can ask not to have explanations if you prefer. However, a dentist has a duty to gain consent (a legal way of asking permission to do a treatment or procedure). So some conversation is necessary, but it doesn’t have to be too detailed. 

5. Finding a practice that’s right for you

I don’t let a plumber in my house without knowing something about them and checking their ratings, so I’d do the same with any dentist. Check out their feedback, reviews and testimonials. Asking a friend, neighbour or family member who they go to and why they attend there is also very helpful.

Look at feedback and reviews when choosing a dentist

You could send an email to the practice and see the response you get. Remember that you are under no obligation when emailing. Email is the perfect way to chat over things without speaking directly to someone. A suitable dentist will respond (hopefully quickly) and be encouraging.

However, if you have a lot to discuss, don’t be too surprised if the dentist asks to call you or you to call them. Nothing beats a two–way conversation: it allows you to ask more questions and you’ll get a real feel for how caring and responsive the dentist is. Remember that you are still under no obligation. You can choose to make an appointment or not, based on how you feel.

Things to include in your email are:

  1. Your situation – are you in pain? Do you have a broken tooth/teeth? 
  2. Is your appearance and confidence affected by your teeth?
  3. Is it difficult to speak or chew well?
  4. It’s reasonable and helpful to mention your nervousness and any fears you may have. 

Please remember that some emails go astray (just like letters, unfortunately) so don’t be afraid to re-send it if you’ve not heard back.

6. Who’s interviewing who?

Another question is: at the first appointment who’s interviewing who? You can and should see it as an opportunity to interview your dentist and this will enable you to check out your prospective dentist just as much as they are interviewing you.

If you feel the ‘fit’ isn’t right, their personality doesn’t seem right for you, or you just don’t feel comfortable, then you may decide not to return.

It is also perfectly ok to bring a trusted friend or family member with you. An extra pair of ears is particularly helpful as not all the information chatted about will be absorbed by one person, especially if you are very nervous. A suitable dentist will not object to an extra person in the room (even in times of COVID) and this can give you some much needed extra assurance.

7. A question of trust

Any good relationship is built on trust and this probably won’t happen straight away, especially if you’ve had bad experiences in the past. But trust can develop during treatment – above all else, there is one question to ask yourself: “Do I feel my dentist is acting in my best interests?” If the answer is ‘Yes’, then that is a big plus.

8. Baby steps

Another point to think about is if you’re not in pain when you attend, begin with something simple as a treatment and work up to more complicated stuff. Not running before you can walk is the way to go, if possible.

9. Comfortable numbing

It would be helpful to find a dentist who keeps up to date with current and latest numbing techniques to keep you as comfortable as possible. 

He or she doesn’t have to invest in expensive equipment to be able to offer surface or topical anaesthetic to make numbing a more straightforward experience. The trick with numbing paste is to let it work for an appropriate time. Although the manufacturer of the numbing gels suggests using it for 30 to 60 seconds or so, I find that if it’s used for 6 to 8 minutes, my patients are mostly completely unaware of the process, and this includes its use on children.

10. Time

Your teeth are important so you should consider investing in them. Healthy teeth aren’t painful, they look good and help you speak and chew your food effectively.

Quality dentistry takes time

Modern dentistry is a highly skilled and technique sensitive process. Whilst you may want to be in and out of the dental chair as quickly as possible, in order to perform your treatment to a high standard, it can take time. If the dentist you visit is prepared to spend time on you that’s a good sign.

Most NHS dentists are under time constraints. That’s not to say you won’t find someone who is kind, considerate and right for you under an NHS contract, but they might not be able to devote the same time as a dentist who sees you under a private contract. 

11. Qualities of a suitable dentist

I’ve listed below some of the qualities of a dentist who may be right for you:

  • Being able to listen carefully to your needs and concerns and acting upon them
  • Showing empathy/understanding
  • Being genuine and sincere 
  • Being able to communicate well with you
  • Being non-judgemental. Many patients are deeply embarrassed by their teeth and fully expect a dentist to chastise them over this. A good and understanding dentist will not criticise or judge you. They should be eager to help you overcome your dental problems in a caring and non-judgemental fashion.  
  • A suitable dentist will make you feel cared for and valued. You are actually doing the dentist a great favour by attending their practice. I feel it is a privilege to be able to treat people who are so fearful of treatment at the dentist that they’ve spent hours researching me and others before putting their trust in me to attend an appointment. Any caring dentist worth their salt should be grateful and highly appreciative of this fact.  
  • A suitable dentist will attempt to give you a sense of empowerment and the confidence you need to go forward with your treatment for the rest of your life.

I hope you’ve found this piece useful. Dental Fear Central is a great website for getting help and support. It also has a great team of dedicated dentists who are here to help you achieve your dental goals. I wish you the best of luck in your search for a dentist who’s right for you.

Douglas Miller. 

© Douglas Miller 2020

For more information about Douglas and his practice in North Finchley, London, visit his website: Douglas Miller Dental Practice

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