Here you can find an overview of technologies which have proven useful for anxious dental patients. They are roughly ordered by cost, starting with the most affordable.
- Stop Buttons
- Aromatherapy Diffusers
- Music and Noise-Cancelling Headphones
- Overhead TVs
- Computer-controlled LA delivery systems (Wand, QuickSleeper, Dentapen)
- CEREC and Digital Dentistry
Stop buttons are a great alternative to raising an arm. Some anxious patients report that dentists did not stop in the past when giving the stop signal, so anything that makes the experience a bit different will be welcome.
The mere act of giving your patient a stop button sends out a signal that you really care about their comfort. It goes without saying that you do have to stop when they use the button!
Stop buttons are also useful for those who wear powerful loupes or microscopes who risk missing a subtle hand lift.
Kit Calm (pictured above) consists of a wireless receiver that emits a light and sound signal when the patient presses a remote control button. The receiver can be attached to the dental unit. Kit Calm comes with a green button for kids which emits a cricket sound that can be incorporated into gameplay, and a white button for adults, which sounds like an email or mobile phone notification. It currently retails at €129, including worldwide free shipping.
I have to say I do like Kit Calm. It is slick and patients are impressed by it. It’s common to get the “wow, dentistry has come a long way” comment. – Niall Neeson
A cheap but effective alternative is a button clicker (dog clicker), for example the Viskey model which retails on Amazon for about £1:
You can hear them, but not quite as clearly as the Kit Calm sound signals.
Some patients may find it difficult to use any stop signal, including a stop button. This is especially common in those who have a history of trauma and abuse. You can find some tips for helping these patients here:
Aromatherapy using orange and lavender scents has been shown to work really well for calming anxious patients 123. Roasted coffee aroma has also been found to lower stress levels in patients undergoing dental procedures:
Preferences to coffee aroma or the frequency of coffee drinking had no effect on whether a person will benefit from coffee aromatherapy or not… levels of sAA and sCort similarly decreased among patients who did not find coffee aroma pleasurable or who did not regularly drink coffee. 4
Aromatherapy diffusers are generally in the region of £20-40. There are many different designs to choose from.
Use a variety of scents so that one scent doesn’t become conditioned as the new “smell of the dentist”. You can even use festive scents at Christmas etc.!
Music and Noise-Cancelling Headphones
Most anxious patients appreciate music as a form of distraction, either in the background or using headphones 5You can read about the pros and cons of different options (earphones vs. background music) here:
Offering your patients a choice of music gives them more control over the situation, and will score you brownie points for being thoughtful.
Always make sure that you have a method of continued communication with your patient:
I often practise a ‘check-in’ technique beforehand where the patient gives a thumbs up or down signal indicating how they are coping, which is promoted by a tap on their left hand. It is crucial too that the ‘stop signal’ is available and respected throughout the treatment.6
The Vibraject is a small device which attaches to a standard syringe and makes the needle vibrate. The sensations of pressure and vibration compete with sensations of pain for transmission to the brain, so the vibrations essentially mask any discomfort during injections (Gate Control Theory).
You can find a product test here: Good vibrations? – DentalVibe vs Vibraject
Overhead TVs can be great for distraction. They’re especially useful for children, including very young children, who tend to go into a hypnotic trance when watching their favourite programmes.
Many adults also enjoy watching TV as a distraction, especially during long procedures. If you offer overhead TV, you can ask patients beforehand if they’d like to watch TV and what type of programmes they prefer. Here’s an example from a new patient questionnaire:
We have Spotify and Netflix in the practice to help you feel more comfortable. Is there a music album or genre that would make you feel more comfortable or at ease during your visit? ……
What would you like to have on the TV?
Nature/Wildlife • Cars • Science • Comedy • Other……
Computer-controlled local anaesthesia delivery systems
In the UK, The Wand is by far the most commonly used computer-controlled local anaesthesia delivery system. Other devices include the QuickSleeper 5 and the Dentapen. Here is how they compare.
The Wand STA
The Wand STA is visually far less imposing than a full dental syringe because it’s just a small handpiece that you hold. This makes it popular with those who have a fear of dental injections. You can read for yourself what members of the Dental Fear Central forum have said about it on The Wand page for patients.
It also allows you to do certain things that you couldn’t do with a standard injection. Its special trick is single-tooth anaesthesia (intraligamentary injections). The Wand’s unit has coloured lights and beeps which actually tell you when you’re in the periodontal ligament. So there’s good confidence that the tooth is going to be numb.
Because you are just anaesthetising the single tooth, The Wand is a great choice for patients who fear feeling numb. You also use far less volume of local anaesthetic, which is very useful for patients who say they have reactions to local anaesthetic.
The Wand allows for some other techniques, such as the anterior middle superior alveolar (AMSA), which again means no soft tissue numbness and a much smaller quantity of local anaesthetic. It does the P-ASA as well.
Another advantage is that if you’re prone to hand pain from giving slow injections, The Wand will pretty much eliminate that.
So there’s a lot to like. The main disadvantage is that it ties you into using dedicated needles and tubing that costs about £3 per injection. As with anything, there is a learning curve. If you’re not really proficient with it, the intraligamentary injections are not always 100% reliable.
Unlike The Wand, the QuickSleeper 5 uses regular needles, so there are no ongoing additional costs – although the upfront cost is about twice that of The Wand.
It can do more or less everything the wand does – AND give intraosseous injections.
It is really easy and predictable to give painless palatal injections with it. Like The Wand, it’s great for kids.
However, the learning curve for giving reliable and painless intraosseous injections is fairly steep. Intraosseous also wear off fast, so it’s not great for long procedures.
Another disadvantage is its size – if you’ve got small hands, it may be difficult to handle.
The Dentapen is a computer-controlled syringe that injects slowly and with the pressure controlled.
Unlike the Wand, it does not have the sensor for intraligamentary injections which tells you if you are in the right position. Neither can it be used to give intraosseous injections like the QuickSleeper. It’s quite expensive for something that can’t do anything really special.
But one huge advantage is that it’s cordless, which is nice. It also uses regular needles and takes standard 2.2ml cartridges, so there are no ongoing additional costs, and it’s very lightweight at 40 grams. Like The Wand and the Quicksleeper, it looks more modern and friendly than standard syringes.
CEREC and Digital Dentistry
Digital technology is perfect for anxious patients. There is no impression required, which can be useful when dealing with a strong gag reflex. CEREC is same-day dentistry, so the patient is getting the definitive restoration there and then. This avoids the need for local anaesthesia during the second visit.
As a bonus, when the patient is able to see the scans, see the process and understand more of what’s happening inside their mouths, they are more interested and engage far more with the process. This is ideal for patients who like a sense of control.
‘Crowns in a day’ will also appeal to those who have their treatment carried out under sedation. Being able to provide a completed crown within a single sedation visit can avoid the need for a second sedation visit (and all the inconvenience that can accompany that such as time off work, needing an escort etc.).
Sources of Information
- Jafarzadeh, M., Arman, S. & Pour, F. F. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: a randomized controlled clinical trial. Adv Biomed Res 2, 10. https://doi.org/10.4103/2277-9175.107968 (2013).
- Lehrner, J., Marwinski, G., Lehr, S., Johren, P. & Deecke, L. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol. Behav. 86, 92–95. https://doi.org/10.1016/j.physbeh.2005.06.031 (2005).
- Kritsidima, M., Newton, T. & Asimakopoulou, K. The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial. Community Dent. Oral Epidemiol. 38, 83–87. https://doi.org/10.1111/j.1600-0528.2009.00511.x (2010).
- Pachimsawat, P., Tangprasert, K., & Jantaratnotai, N. The calming effect of roasted coffee aroma in patients undergoing dental procedures. Scientific Reports volume 11, Article number: 1384. https://doi.org/10.1038/s41598-020-80910-0 (2021)
- Gupta, A. & Ahmed, B. Experience of listening to music on patient anxiety during minor oral surgery procedures: a pilot study. British Dental Journal 228, pages 89–92. https://doi.org/10.1038/s41415-019-1162-1 (2020).
- Gillian C. Howie in ‘The first challenge in managing anxiety is recognising it’. Britsh Dental Journal 228, pages 401–403. https://doi.org/10.1038/s41415-020-1477-y (2020)