Rest Breaks and Structured Time
A really basic but effective way of enhancing control is by taking frequent breaks or doing things in short bursts. Many people feel overwhelmed by the prospect of dental treatment because they’re worried they won’t be able to cope. But often, you may find that you are able to cope if a procedure is broken up into manageable and controllable chunks of time.
It’s not uncommon for people to feel obliged to continue with a procedure until they can no longer bear it, at which stage the fight or flight reaction has kicked in. This can make it harder or even impossible to continue.
To nip this problem in the bud, either you or your dentist can initiate breaks during a procedure.
Jason Armfield and Lisa Heaton 1 give the following tips:
1. Patient-initiated rest breaks
At the start of appointments, many dentists will tell you to indicate if you would like to take a break at any time in the procedure. This is usually done by using an agreed signal. Being able to pause the procedure can give you a sense of control.
2. Dentist-initiated rest breaks
Dentist-initiated rest breaks are extremely helpful. Many (if not most?) people with dental fears find it difficult to be assertive in the dental situation. You may also have a tendency to ‘freeze’ in the dental chair, or you may be tempted to ‘push through’ appointments to get it over and done with. Some people find it difficult to request a rest break for fear of appearing to be a ‘difficult’ patient.
For all these reasons, it’s great when dentists are thoughtful enough to plan the rest breaks in advance. An example is letting you know they will work for five minutes, and then take a one-minute break. This increases the sense of predictability and control over the procedure.
3. Pauses in treatment
Natural pauses in treatment (e.g. when switching to a different piece of equipment) can be used to encourage you to take a break, close your mouth, and rest a little.
4. Unscheduled breaks
Of course, dentists should also take a break if they notice their patients become anxious or restless.
“To help my patients feel in control, I usually tell them to count to 10 (internally) then we’ll stop on some agreed signal, then a count to 20 and so on.”
This technique is sometimes referred to as “structured time”.
- means you only have to deal with the situation for a short, finite period of time, and won’t feel overwhelmed.
- gives you a chance to check out what a piece of equipment is like and what sensations and sounds to expect for a few seconds at a time. It can hugely increase your confidence that you’ll be able to handle the situation.
- means that even if you feel unable to give a stop signal, you know that you will be able to take a break shortly.
- is useful if you are worried about panic attacks – panic attacks are usually about anticipatory anxiety (“what might happen if…”). If the time frame is short enough to prevent anticipatory thoughts from happening, then this lessens the chances of experiencing panic.
How can structured time be used to help with dental fear and anxiety?
Structured time can be used in several ways:
- If you are unfamiliar with a dental procedure, your dentist can count, or let you count internally, in intervals of seconds (e.g. to the count of 3). Once you are confident that you can handle the situation or the sensations, and you feel more relaxed, the interval can be extended.
- It can be used to practice the stop signal, and put you in control of the situation.
- It can be used for longer time segments (e. g. your dentist stopping every 5 minutes), to ensure that you can take a break without having to ask for one, and to let your dentist know if everything is going ok for you. It also gives you a chance to just chill, have some water, blow your nose, or just sit up and regain your composure if needed.
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- Armfield, JM, Heaton LJ (2013). Management of fear and anxiety in the dental clinic: a review. Australian Dental Journal 2013; 58: 390-407.