How can a dentist tell you are scared?

[Enarete]

I always thought being a nervous patient myself and being interested in "reading people" would give me the possibility to 100% recognize if someone is nervous or not before or during a dental treatment. I particularly thought I would be able to see the fear even in people who don't feel comfortable showing it or tend to freeze (@krlovesherkids777, thank you for your recent voting poll about trauma response.

Well, guess what. I have been working in a dental practice for months now, my main job is to support new patients during their first appointment and I had found myself in several situations of finding out that someone was nervous after a while.. and I had no idea before! People who admit it and feel ok talking about it or who show obvious signs of distress are fine, but I so much struggle with those who appear really calm and compliant while probably freaking out inside. The fact that everyone is different and some things that indicate stress in some people indicate calmness in others doesn't help.

So my question for you is this: if you were about to give your dentist a manual about how to reliably recognize you are stressed, what would it be? How can your dentist see that you are nervous? What is different compared to how you behave when feeling ok? How does it feel different for you?

Any feedback about this is hugely appreciated..

 

[LittleLynnie]

Maybe it would help if they asked?

 

[krlovesherkids777]

Enarete,

Thank you for this post ! This is interesting in so many ways. and LIttle Lynnie definately has a point in that it would be nice if they asked,as unlike your practice, its amazing so many just don't? its weird. I've had a few ask over the years.. but the majority not. Its almost like a don't ask , don't tell in some offices they want to just get on with business and not open the can of worms, but also there are amazingly caring dentists and offices that really care alot and help so many through this, and then those in the middle.

I went to one dentist for 10 years.. he never asked about anxiety and I never really shared either, I just froze.. and he got me through my appointments using humor and just being really chill enough to get me through it with him not being shaming and being painfree, but I did not confront my anxiety and I was still very scared of alot of factors, though his presence did put me to peace being familiar with his ways and he did really care. but funny thing never a mention of the anxiety .

Now, my last dentist the one I write mostly about since my time here was amazing at reading body language, so I would as much as dilate my eyes or wince, or freeze and he'd be asking are you ok, ? whats going on? and talk me through things.. He was very nice and approachable with also a sense of humor so I decided myself to really open up about my anxiety and that took things to a whole new level. It was a very vulnerable place to go with pretty much a stranger.. I didn't know how he responded but he really reassured me every step of the way, every concern or anxiety I brought to him he put to rest and I really actually looked forward to my appts and conquering more fears and challenging myself, and he really was a fun person to go hang out with for an hour or so.. along with the assistant. They were a great team. So this took my healing of dental anxiety to a new level.

I would say like LIttle Lynnie says, it would be nice if they asked up front first off.,then checked in and asked from time to time during a treatment. then paid attn to body language, freezing, pausing when they ask questions might mean I'm in a freeze state, ask how I'm doing if I'm not moving much like my body is just stiffer or my breathing seems a bit stressed.

I think it is amazing your practice offers this , a chance for them to be heard and have like a dental advocate in a way . I think that if a patient hears a dentist ask about anxiety or talk about it first , it relieves them to be able to talk about it too so really it takes two. What a beautiful thing the patients at your practice have this support on their first appt.

 

[comfortdentist]

From a dentist viewpoint I guess I could make a list but really I have paid attention to this for over thirty years so I usually just can tell.
The most important point is does the dentist want to know? DO they care? Or do they just want to get it done?
If you are more than moderately apprehensive I think most dentists don't want to deal with that problem.
I am also sure that many people show signs that they themselves aren't aware of.

 

[ReginaPhalange]

Interesting question!

My first thought is that they probably won't be able to tell with me, I'm hard to read. But this...

Now, my last dentist the one I write mostly about since my time here was amazing at reading body language, so I would as much as dilate my eyes or wince, or freeze

is what I'm hoping for. That they'll be able to tell without me having to say. Even if they were to ask me if I'm nervous, I'll probably either say just a bit, or I'm fine, when inside I'm the complete opposite, and I'll be kicking myself for the truth not coming out.

That's why I mentioned in my original email that I was very nervous (well that and the tips I got here), because I knew in person I wouldn't say it.

I guess what I'm hoping for is one like comfortdentist, who will be good at reading body language and treating me accordingly.

 

[SallyUK]

Such a great question to consider. Personally I have anxiety about most medical procedures, environments. I've thought about it long and hard and for me it all feels so impersonal yet it's incredibly 'intimate'. Many medical professionals do appreciate this and there are good and careful ways of approaching the patient and explaining things etc. This puts me somewhat at ease but...... I hid my fear for years and it got to the point that I couldn't anymore. I needed to express more about my beliefs, fears and general attitude to it all. Until then I was tolerating and almost adapting myself, trying to know more than I need, in attempts to control, basically internalising so much to try and manage. The trouble is I always feared not managing and then what.....what if I really was upset, freaking out, what if I was emotional! Speaking about emotions doesn't always mean you can express them....

I'm rambling a bit but it's complicated and unique to each person. In general I think that the patient has the responsibility to manage their fears to some extent, what I mean is, find out what works for them. The dentist could have a list of suggestions or resources, whether that's in the surgery or outside. Ultimately I see my dentist as an expert, an engineer of sorts, doing very precise work. I don't expect him to be empathetic at all times but I also want time and space to tell about my experience. So basically I feel there are two very different types of 'jobs' going on in the room. I now tell him what I'm going to do while he does what he's doing. So I might be focussing on breath or a particular worry. He offers reassurance if he can, the nurse is brilliant and will give me a clear description of what is happening if she feels I might need it. So really it's a team effort.

This has taken ten years to get to! But still I have never really expressed just how much I fear almost everything. Recently more so and to be honest I think it's made it harder. I have to trust he can handle what he's doing and he has to believe I can handle things too. It's a fine line where you can both come together and have a good outcome. Both emotionally for patient and for the work.

Like any relationship it's so unique and I've noticed through this journey that he asks me more often 'what are you afraid of exactly' he tries to understand my phobia but I also respect that to do his job, there has to be a certain amount of emotional distancing. Otherwise he's at risk of feeling like he's doing me harm. That's where I think it's our responsibility as patients to work with them and find ways we can heal and grow and tolerate things.

On the other hand I've not experienced any other dentist that wants to know about the human element and perhaps there are some that would be absolutely fine with you freaking out there and then! I just know that for true healing, it is us that needs to find out what really is behind the fear. If it's superficial, I think a dentists communication skills, informative and inclusive treatment planning is key.

I've rambled.....I'm currently thinking about all this as my progress with fear has taken a backwards step and I need more empathy than I think it reasonable for my dentist to give. Sometimes fear is fear and we have to ignore it, do what we must and other times we can use the experiences to heal and grow together.

 

[SallyUK]

In addition. I have a counsellor who supports me with many things and one key aspect is me learning to feel my feelings and not cut them off, hold back etc. Work through them. So I'm busy doing that from the moment I step foot in the surgery.

It's not going to be feasible for medical practices to have a third party counsellor type person but maybe nurses and reception can more formally offer a little extra time for counsel; be it a debrief after, how did you do? Or time to prepare, with any fears and tips for coping. It might be overkill for some, but having that connection to your emotional experience in the same place as the functional, practical one, might help. There never seems much time when I visit.

 

[Mugz]

From a dentist viewpoint I guess I could make a list but really I have paid attention to this for over thirty years so I usually just can tell.
The most important point is does the dentist want to know? DO they care? Or do they just want to get it done?
If you are more than moderately apprehensive I think most dentists don't want to deal with that problem.
I am also sure that many people show signs that they themselves aren't aware of.

You’re 100% correct about them not wanting to deal with more than moderately apprehensive patients. I’ve been on the receiving end of that many times I’m sorry to say.

 

[comfortdentist]

You’re 100% correct about them not wanting to deal with more than moderately apprehensive patients. I’ve been on the receiving end of that many times I’m sorry to say.

I have received phone calls over the years from dentists basically begging me to take them off of their hands.

 

[kitkat]

So my question for you is this: if you were about to give your dentist a manual about how to reliably recognize you are stressed, what would it be? How can your dentist see that you are nervous? What is different compared to how you behave when feeling ok? How does it feel different for you?

This is such an interesting topic! I think on a good day, I could be one of those people that fly under the radar and I probably have which hasn’t helped me in the long run. When I am struggling with anxiety I am very quiet (mostly short 1-2 word responses), my voice gets higher and squeakier sometimes, and I avoid eye contact and won’t really look in her direction. I didn’t realize this until recently but I will also physically angle my body so that I am turning away from her and more towards the assistant. Once she gently used her hand to guide my head back towards her direction and during my last appointment, she asked if I could turn more towards her. It was then that I realized that I was completely turning away! Sometimes, I’m more jumpy and I just startle more easily. I may have small repetitive movements like fidgeting with a scrunchy around my wrist or tapping my feet or bouncing my legs, etc. I tend to sit more rigid (arms and legs crossed-although I make an effort not to do this anymore!). Also, I gag a lot when I’m nervous.

As far as asking me, my dentist started out with some guiding questions “have you ever had this done before?” “Was it a positive experience last time?” I felt more relaxed just by the inquiry but the trust wasn’t there yet and I am usually not open about my fear so I didn’t take the bait. I just froze and sat quiet with 1-2 word responses or head nods. She also was just about to start a procedure and I was terrified and in no frame of mind to have complex conversations about my fears. At a later appointment, when I was visibly shaking she did ask me directly. I did admit that I was scared but I was unable to verbalize why because I froze AGAIN (also right before a procedure). After that she never really pushed the question again...she just started treating me like a scared person and I was good with that. I think she’s learned my triggers and how to read me over time. Sometimes she does reference me being fearful during treatment which I hate from an embarrassment aspect but love from a reassurance aspect that she KNOWS I’m scared without me having to say it and she’s fine with it. I think she’s actually more comfortable with my fear than I am! She’ll say things sometimes like “you’re going to feel some pressure, don’t be scared” or “lots of water now, don’t be frightened” and those little reassurances work really well for me especially if I’m feeling jumpy or uneasy.

 

[Enarete]

After that she never really pushed the question again...she just started treating me like a scared person and I was good with that. I think she’s learned my triggers and how to read me over time. Sometimes she does reference me being fearful during treatment which I hate from an embarrassment aspect but love from a reassurance aspect that she KNOWS I’m scared without me having to say it and she’s fine with it. I think she’s actually more comfortable with my fear than I am! She’ll say things sometimes like “you’re going to feel some pressure, don’t be scared” or “lots of water now, don’t be frightened” and those little reassurances work really well for me especially if I’m feeling jumpy or uneasy.

Thank you very much, this is really valuable and has some great insights.

Dental team can do so much wrong in the surgery if their feel about the patient is wrong. There are people who feel able to tell openly what they are afraid of and there are people who don't but are very grateful if they get treated as nervous patients anyway. And there are people who do not admit their fear and need reassurance but they need it in a decent way so that they don't lose their face. There are people who just act like they hate you or like their dental team is in a way a team of their slaves. Which is a form of fear as well and we do not take it personally, it's just a little bit more challenging to make them feel ok.. And there are some (very few) who seem to see dental visits as a routine and do not have much problem with it. And then this all changes during one visit and during a course of visits as the fear is something really dynamic.

@comfortdentist: yes, experienced dentists willing to work with very nervous patients seem to just know how to deal with them and read signs, I had noticed that it's the younger dentists or the rest of the dental team who do not always understand what dental phobia is about. I also believe that for many people just the job as is busy and hard enough even with people who are completely fine. I have been to a congress last year and was very surprised to learn that some dentists are "scared" to deal with nervous patients as they do not know what to do and don't want to do anything wrong. And of course there might be some who just are not interested. I however believe in kindness so just want to assume that if someone working in dentistry looks not interested in dental fear it's just because they never learned abut this topic and do not grasp the importance of it.

@SallyUK: your points are very interesting ones, I love the way you consider the point of the dental team and of yourself as a nervous patients. The line between the own responsibility and the responsibility of the dental team really is a fine one. I admire everyone who goes the way of getting a counsellor to beat their fear, it's not the easiest one but shows that you really want to beat the problem and use all possible sources. I strongly believe that medical and dental professionals should be given some tools to deal with nervous patients and learn how to make them feel at ease and help them going through procedures. Not only in dental field but in other fields as well.

@ReginaPhalange: that's exactly it. As LittleLynnie suggests, we ask the patients on the form whether they are nervous and if they are they even get a second form with some more questions about it. Despite that there are just people who don't disclose their anxiety and do not mention it at all. Sometimes, after a while they start disclosing their past experiences and say they are nervous (which I always see as a victory and see it as a sign they start to trust us) or, if things do not go that well, there will be a point where they get really uncomfortable and we had no idea.

 

[kitkat]

Thank you very much, this is really valuable and has some great insights.

Dental team can do so much wrong in the surgery if their feel about the patient is wrong. There are people who feel able to tell openly what they are afraid of and there are people who don't but are very grateful if they get treated as nervous patients anyway. And there are people who do not admit their fear and need reassurance but they need it in a decent way so that they don't lose their face. There are people who just act like they hate you or like their dental team is in a way a team of their slaves. Which is a form of fear as well and we do not take it personally, it's just a little bit more challenging to make them feel ok.. And there are some (very few) who seem to see dental visits as a routine and do not have much problem with it. And then this all changes during one visit and during a course of visits as the fear is something really dynamic.

Yes, I figured I must not conceal my fear as well as I think because my dentist is very confident in addressing it with me (even early on)...either that, or she’s just really good at reading the signs (I like to think that’s the reason and that I don’t actually appear to be a panicked mess! ). From a perspective of the dental team, I’d be worried about making the wrong assumption about somebody who is not forthcoming about it but I also wouldn’t want to ignore the signs. It’s a tricky position. When my dentist asked me directly, she actually described what I was doing (behavior) as an intro to the question which made the question a little more objective. That might be why I was able to say I was scared because there was no getting around it...I was found out. I was shaking all over and my lips were actually trembling and she said very calmly and matter of factly, “I see that your lips are fluttering quite a bit; are you nervous?”. That’s very different from asking “why are you shaking?” Which I probably wouldn’t have answered or just said “I don’t know!” To avoid answering. Just having to reply with a “yes” or a head nod made it easier.

@ReginaPhalange: that's exactly it. As LittleLynnie suggests, we ask the patients on the form whether they are nervous and if they are they even get a second form with some more questions about it. Despite that there are just people who don't disclose their anxiety and do not mention it at all. Sometimes, after a while they start disclosing their past experiences and say they are nervous (which I always see as a victory and see it as a sign they start to trust us) or, if things do not go that well, there will be a point where they get really uncomfortable and we had no idea.

I think having a simple form to check indicating your attitude towards dentistry is helpful. My Endodontist included a form with 4-5 faces conveying different emotions to indicate how you felt about your appointment that day and it included something like Happy, Ok, Frightened, Pained, and Miserable or something like that and you could check any that applied. I liked that, it was quick and gave a lot of information. I am much more willing and likely to check a box than I am to actually verbalize that I am scared. Also, it tells me that they are concerned about me as a person plus there is peace of mind knowing that they already know that I am terrified before they meet me. My dentist included an anxiety rating scale for a little bit that just rated degree of nervousness and that had not at all, slightly, moderately, and extremely. I only recall seeing it once and I don’t remember what I put. I think I put slightly which probably isn’t entirely true . That one is a bit more ambiguous though because it depends on the day and the procedure. My anxiety can range the full spectrum and it can be a little unpredictable which makes it hard to gauge. One interesting thing is as I began to trust my dentist, my anxiety actually seemed to get much worse initially which was a very confusing and frustrating time but looking back on it, I think I was just letting my guard down and not trying to hide it as much because I felt like I safely could just be openly fearful without ridicule or judgment.