Top Tips for Treating Nervous Patients

photo of Fraser Hendrie, BDS
by Fraser Hendrie BDS MFGDP

Don’t get involved unless you really want to help…

Firstly I would say, please don’t look to treat nervous patients if it does not genuinely interest you. We all know that for every patient there is the right dentist somewhere. So if you are certain treating very nervous and phobic patients is not for you, please don’t read any further. Equally if you are looking for a few ideas of what has worked for me and my team over more years than we now care to count, please read on. The list is not meant to be exhaustive by any manner of means and is more a collection of thoughts.

Be on Time

This is a real old chestnut in dentistry, we all know that running exactly to time is exceedingly difficult but arriving for a first appointment and having to sit around for ages waiting is every nervous patient’s nightmare. So if possible set up your practice systems so that new patients coming to see you who are nervous are identified in advance and wherever possible offer a time slot where you are most likely to be on time. For example, the first appointment of the day, after a break or after lunch.

The Longest Walk

It is true that you only get one chance to make a good first impression. There are many ways of doing this including simply walking out to your waiting room, introducing yourself to your patient and making polite chat on the way to the surgery. At Craigentinny, our Nurses are very much part of the whole care process and act as advocates for their patients. So they will call the patient from the seating area, say Hi X my name is y and I will be looking after you today when you meet Dr Z. On the way to the surgery their nurse will make a little polite chat with the patient and quietly let them know that if there is anything that they need she is there for them. On entering the surgery, the patient’s nurse then introduces the dentist. This way the patient feels supported the whole way and hopefully does not feel so intimidated when walking into the surgery with the dentist for the first time.

Do we see what our patients see?

When you work in an environment every day you become blind to how it actually looks. So why not walk out of your surgery right now, clear your mind and walk back in again with curious eyes. What do you see? Is there a lot of clutter, scary dental stuff lying around? A nervous patient is quite likely to assume that everything that they see out on a worktop is for use on / with them. While this is not the case why not remove that doubt for them by clearing the work surfaces as far as you possibly can. Keeping trays on instruments out of line of sight is another important step.

Choices Choices

Give the patient as much control as possible, e. g. most patients will expect to be ushered straight into your chair, why not tell them they are welcome to choose whichever seat they feel most comfortable in. Most will choose the one in the corner of the room as far away from the dental chair as possible. But at least now the patient will have retreated to where they feel safest in the room, which is a great place to start your conversation. Wherever possible keep the conversation flowing with questions.

Big Ears

You really need to listen harder than ever before to the patient as they tell you their story, in it will be all the clues you need to help them, their fears, their triggers, and what things you need to find a way around to stop from scaring them half to death. By asking questions you are showing that you are interested in what the patient has to say and as such are more likely to act on it. Resist the temptation to jump in with solutions as they come to mind, just take notes and let the patient talk out all of their fears. After we are all talked out I usually ask if the patient feels up to letting me look at their teeth, if they prefer to be upright or lying back etc etc. By offering choices all they way you will build trust rapidly. We all know that it is almost impossible to do a thorough examination with a patient sitting upright, but if that is where someone feels able to start lets go. It is fine to be honest and explain to your patient that you can’t see everything as clearly as you would like with them sitting upright. But done nicely and positively it creates a basis of working towards the ideal situation where ultimately your patient will let you tip the chair back in the traditional manner. By reaching out and demonstrating that you are willing to respond to their needs and be flexible along the way, you will continue to build trust and confidence.

There Is A Control Freak in All of us

A few words about the “stop sign”, we all tell our patients about this but you absolutely must respond to it. If you are beavering away and your nurse spots even a waver of a finger, she needs to tell you to stop right away to check where your patient is at. Making sure you have chatted to your nurse to make it entirely clear that she is empowered to stop you at any point is critical, especially with newer team members. Be warned that if you fail to respond to the stop sign, then all trust will be instantly lost and you will have a very difficult treatment session.

It is worth mentioning that sometimes you have to just stop anyway. If you sense that the patient is in any kind of discomfort however mild, stop and remind them that it is ok to raise a hand at any time. Remember that some patients have fears or histories that prevent them from actually doing this even if you give them permission. So respond to a raised hand immediately but don’t rely on it.

Expectations

It is important to develop a basis on which you and your patient can work together. Right up front I think it is important to tell patients that if you work together in a spirit of mutual co-operation then it is highly likely that you will be able to help them. You must however manage their expectations that while you are a committed professional and will do anything in your power to help, it will not all be plain sailing. Explain in advance that there will be some visits where your patient feels that they have taken a huge step forwards and they may have other visits where they feel disappointed in themselves for not being able to make more progress. Remind them that any progress is good and that anything that you try together that does not work is still progress as you have identified something that they would prefer to avoid in future. Truth and honesty need to pervade every aspect of your working relationship, so before doing any treatment at all, it is important to manage expectations and explain that so long as you both agree that overall progress is being made, good and less good visits will be a part of it. A follow up call after a visit never does any harm either.

Attention Attention

Nervous patients need active care and attention 100% of the time. As the dentist you are dealing with what treatment you are doing for the patient, what materials you need etc and managing your patients emotional state too. Recognise that it is difficult to give 100% of your attention 100% of the time. Make it easy on yourself by making sure that everything is set up in advance and that your nurse is totally supportive and on board with helping nervous patients. Your nurse’s job is to support you and the patient throughout the process. If for any reason you need to take your focus away from the patient, your nurse seamlessly will take over. That way between the two of you someone always has 100% of their attention focused on the patient and how they are doing. We train our team to look at things like how the patient is coping overall, how are they looking pale / florid , what is their breathing like, are they showing signs of a panic response, are their hands relaxed or tightly clenched etc etc.

Talk, Talk, Talk

Some patients like to know nothing about what you are doing, others want to know every little step. Either way you have got to talk, communication is at the very heart of helping the nervous patient relax and feel ok with the situation. Choose your words really carefully, reframe any part of the process that you know will stress them out. E. g. anaesthetic is not injected, we simply let it soak in r—e—a—l—l—y slowly – sounds a heck of a lot less threatening and if it is pain free then it will boost the patient’s confidence in your skills. If the patient does not want to know anything about the technicalities that is fine, but make sure you still chat to them throughout.

Don’t distract me!

Ok, actually why don’t you distract me just a little then. Music, video, chat whatever it is but preferably something that is inclusive and everyone in the room can participate in. A patient with a walkman turned up full blast is very isolated, in their own world where their imagination can run wild and can’t hear any of your soothing words. Why not hook their iPod up to your speakers and play their choice of music. It is important to provide guidance on this in advance, as it is known that even if they love heavy metal this will not lower their blood pressure or aid relaxation.

Frequent Breaks

Make frequent breaks part of your routine. Even if you don’t think the patient needs it, stop to offer a rinse, a chance to sit up and move around is always welcome. These offers help to convey your constant concern for the patient’s well-being and show that it is dentistry on their terms not yours. Even if it feels excessive your nervous patients will thank you.

Workflow management

Finally recognise that working with nervous patients who have recently joined your practice can be seriously hard work. But, like so many things in life, by giving first without expecting to receive, you will be pleasantly surprised when your early efforts are repaid. And if you help a patient overcome their fear you have a patient for life and someone who is very likely to tell their friends about your care.

It is critical that every nervous patient receives your very best efforts. Caring for this group of patients is, in my experience, massively rewarding as you see another human being overcome what was previously an insurmountable problem in their life. It is truly wonderful to see the personal growth that often follows when someone resolves a long standing dental fear.

Equally recognise that in helping, your clinical and communication skills will be tested to their limit. The early visits in particular can be emotionally draining for both patient and dentist. As such it is wise to try and manage your workflow to control the number of very anxious new patients that you are working with at any one time.

So there you have it, I hope you found something of value in the above article. Equally if you have ideas on how to do things better, please let me know as I would love to hear from you. I can be contacted at my practice on 0131 669 2114 or by e-mail Fraser [at] Craigentinny.co.uk

Craigentinny Dental Practice website: Dentist in Edinburgh – Dental Care for Nervous Patients

Comments

21 comments on “Top Tips for Treating Nervous Patients
  1. Gordon Laurie says:

    Hi great article and very helpful. One little thing, I always think you should go and fetch a new patient in for yourself rather than getting your nurse to do it. You can learn an awful lot about them on that short walk down the corridor and they get a chance to meet you on neutral territory.

  2. Tom says:

    I appreciate the “Talk, Talk, Talk” section. I was working with a patient today who had NEVER had any dental work done because she was scared. She is now an adult and needed to have a root canal done. I started out by telling her everything that I was doing, and what to expect. I think it helped build a relationship of trust.

    When she was done, she told me it wasn’t nearly as bad as she thought. I work with a lot of anxious patients, but this one was probably the most satisfying – I feel like together we are overcoming her fear of the dentist and I’m pretty sure she’ll be back.

  3. Fraser, this is quite a thorough guide to how prepare and deal with a nervous patient. Though you have addressed a generic nervous patient, in the specific instance he/she is a child, I would like to underscore one tip, which is that once a certain trust has been established, distractions can work well…Disney movies in particular are very effective, in my experience.

  4. Jenny pinder says:

    Excellent article .
    I emphasize to new patients that excellent pain control is something that is of the utmost importance to me.
    My nurse loves helping the patients and she sits in on the first interview. We advise the person that it’s so she can help, understand and support them. I introduce her and ask if they might prefer to speak to me alone. This will happen sometimes.
    She also goes through the treatment plan with them at the end of the appointment and makes sure they know what to do next .
    Often patients will tell her something important that they don’t feel able to say to me.

  5. Rob Endicott says:

    Great job with the article! This really should be required reading as so many patients need TLC and their fears taken seriously. Many thanks for writing down and sharing such great detail.

    All the best

    Rob

  6. CDA Karli says:

    This was a great article. I myself already do most of what the article talks about. I deeply care about how my patients feel. My problem is getting other people in my office to do the same. I think a good way to start is having them read this article, and others like it. if any of you feel that not everyone is on the same page at your dental office maybe you can try this.

  7. Denise says:

    Thank you for your information and help with the issue of “Dental phobia’s” I am a Dental asst and office manager and have been treating many patients lately with this problem. Your site has helped greatly.

  8. Thanks for the feeback on the article as well as the additional suggestions. Dentistry is a broad church and there are so many ways that we can do things better to help our patients. Jenny, you are absolutely right regarding pain control, only by delivering comfortable, pain free dentistry time after time can you slowly unseat the fears that past bad experiences have created.

    Good patient experiences really are dependent on having a great dental nurse working with you. By being attentive, chatty and participating fully with patients while carrying out the technical work of nursing they can make a huge difference to an appointment. I am blessed to work with a team of superstars who manage to make this this multi tasking look effortless. It is remarkable how often patients will choose to confide something relevant to their care to their dental nurse as a result.

  9. Stephen Murray says:

    Thanks for putting this list up. I think I relate to the paragraph about listening most – that’s what I have been adjusting myself to do most recently, and although it’s subtle, I do notice results. Not only in my patients’ reactions, but also it makes ME feel more confident when I am talking to them, because it concentrates in my mind what they need/want to hear.

    Stephen
    That Friendly Orthodontist
    http://thatfriendlyorthodontist.com

  10. Dr Philip Jacobs says:

    Great article! Many patients have a needle phobia, so I think the best invention ever for a lot of nervous patients is The Wand. We have recently acquired The Wand STA, replacing one of my original Wand units. The STA is even better than the original, as it allows you to make one tooth only numb, avoiding the whole face and lip being numb for hours after an injection. My tip is to embrace this new technology to make the dental treatment experience so much more comfortable. Most people don’t feel a thing when you give an injection using the wand, plus it looks a lot less threatening than a syringe.

    http://www.hopeislanddentalcare.com.au

  11. Fahad says:

    Excellent article, thumbs up.
    If I may ask, what are your thoughts on use of calming music in the room? I personally find it very helpful, a few patients have commented on it too, saying it helped relaxing them. But the nurses prefer to listen to radio 2 or something a bit more “upbeat”, which I find has the opposite effect to what we try and achieve with sedation.

  12. trudy says:

    i am one of these patients . i get so stressed out about going to the dentist . have had bad experiences in the past with dentists . looking for a dentist at the moment . article you have written is very helpfull .

  13. Mary says:

    Thank you, Doctor Hendrie! I was looking at this because my friend’s aging dentist doesn’t seem able to freeze his teeth properly anymore, so my friend got curious about the situation and found the page which led to your tab. I found it very helpful myself as I work with nervous university students who need help with their exam taking because of various disabilities. Too bad my friend can’t come over the pond and go to your surgery! My friend also has Central Sleep Apnea, so I’ve been wondering if his failure to get his teeth frozen is connected to that condition. He also couldn’t get to sleep last night after his appointment in the afternoon; the freezing doesn’t help the pain and then it takes ages for his freezing to come out. Weird, don’t you think? Cheers! Mary

  14. vicky says:

    great article, I am one of the dental phobic people. The two things that have helped me most is 1)they let my boyfriend stay in the room and I could hold his hand

    2)The dentist also squeezed my shoulder and told me I was doing a good job

  15. Linda says:

    Great Article, find myself wishing you worked down in wirral, I am so anxious and terrified of the dentist I cannot bring myself to even telephone one, my teeth are really bad now, actually not many left and 2 at the front loose, I don’t smile any more but just can’t find a dentist here who I think I may be able to go to.

  16. Claire Hill says:

    I wish my dentist would read this………. The practice where he works boasts about being accredited for nervous patients (which is why I chose it), but despite having been 4 times now (in the past 8 months) for various fillings, he just doesn’t really “get it”. I had a fantastic dentist for 14 years beforehand, but we moved out of the area, hence the new dentist. I have had a few chats with him about how important it is for me not to feel rushed and to be kept informed about what’s going on, yet he’s still swooping down on me with the needle before I’ve even had chance to settle properly in the chair! At every appointment so far, there has been unnecessary pain of some sort and, coupled with the lack of communication, I don’t have any rapport with him and don’t feel any trust. This is the first time I’ve had a private dentist and I’d naively assumed that it would be even better than an NHS one……. I long for my old dentist, who went to great lengths to put me at ease – although at the time I just thought that all dentists were like that! I’m now thinking I should try and find a new dentist.

  17. Tom Shrill says:

    Talking to your patient is indeed a good way to help relax them. Ask about their day, then give them the chance to answer. Some may not like when you ask questions, but most do.

  18. JJ says:

    Hi.

    I just want to thank you for this article. I’m an extremely phobic patient myself. I just recently found a dentist who does all of these things. He’s very caring, patient and gentle. For me an important thing is the ‘stop signal’ and numbing. I’ve had dentists in the past who just flat out ignore the stop signal. It’s traumatized me greatly. I’ve also had problems getting numb and getting top ups on anestetic often times.

    Thanks for the article. It’s a very good resource.

    JJ

  19. Paula says:

    What a great article…I had a phobia od dentists since a young teenager in the 50’s, when I had to have my four teeth removed after a hockey stick accident, which broke my teeth. My Dentist ( who I have since learned was an Alcoholic) gave me no option, and said I would need a plate with the teeth on to give me a ‘bite’ even though one tooth was not really affected.

    It took me years to trust a dentist again, and I eventually found one who then moved from NHS to Private practice, which I was unable to afford. I tried to find another who dealt with anxious patients locally, and it was not easy. I have now a lady dentist who I trust, but my problem now is my denture causing my gums to swell due to the pressure of the teeth at the front pressing on the gums. This is especially bad against my incisor. I have been advised the only way to avoid this is to have implants, but again, I cant afford them. I have now to have the gum tissue removed at the hospital, which I am not looking forward to. I just wish I did not have false teeth, which had it been now a days, they could have been saved.

  20. HR says:

    The biggest problem for me is that most dentists seem frustrated or inconvenienced by my tension/gag reflexes. When I needed my wisdom teeth out my dentist thought there was no way I could take it without general anaesthesia. I didn’t want that and went to a clinic that operated as part of a drug company trial (testing pain killers). The surgeon was top notch as extracting wisdom teeth was all they did (and turns out it my case was a little complicated) but also really down to earth. They let me choose what radio station I wanted and the nurse *held my hand* during the procedure (they did that for everyone). It was one of the best dental experiences I have had. I learned later that I got the placebo pain killer. I wanted to write my regular dentist and tell him “See? I don’t need general anesthetic.”

  21. Amanda Flowers says:

    Positive reinforcement is huge for me! I feel like I’m being a “bad” patient or somehow annoying them, but being reassured that I’m doing well helps so much. Until my current dentist, none of them had done that and her encouragement makes appointments so much nicer. Not to mention she reads eyebrows like a pro.

Leave a Reply

Your email address will not be published. Required fields are marked *

*

Join ISDAM!

ISDAM is a new charitable society for dental and mental health professionals who are interested in helping people overcome dental fears. It will include access to a members-only discussion and support forum, a newsletter, and live and online training courses.

Dental Fear Central

Dental Fear Central is the Dental Anxiety Network's sister website for people who experience dental phobia or specific dental fears.