#21 – Helps calm fearful clients

No one enjoys going to the dentist. Some may be VERY frightened, but everyone is at least a little anxious. Here are some thoughts on fear of dentistry.

1. Most clients have some fear of dentists.
2. Severely frightened client are almost always otherwise mental healthy
3. Spending extra time with fearful clients is not a waste of your time. In fact, once we gain the confidence of a dental phobic, it will be the most satisfying part of your day.
4. Many dental phobics only come in for emergency care, but if we get their confidence, they can accept complete treatment.

Here are some general ideas to reduce this general anxiety – after all, some people hide their fright very well, so all our clients will benefit from these ideas.
1. When a client is within hearing, you can talk with another staff member, but be sure to include them in the conversation.
2. Don’t discuss their treatment where other clients could hear.
3. Answer their questions, but don’t dwell on negative examples
4. If you want a private conversation with another staff member, make sure no clients are within listening distance.

Between 20 – 35 million people are extremely afraid of dentists. These people develop this fear through:
1. Negative previous experience(s) with dentist(s).
2. Hearsay – frightening stories told by friends, relatives, or even strangers
3. A general, non-specific anxiety

These people avoid us at all costs. Occasionally, one is forced to see us. Usually they come in extreme pain needing extensive dental treatment.

You won’t have trouble recognizing most of these clients. They’ll tell you. When they tell you how afraid they are, don’t dismiss their feelings, deal with them professionally. The first step is to acknowledge their fear and show compassion.

Ask them to tell you why they are so afraid of dentists. It will really help them to tell their story to a sympathetic listener. This will take some time, but it’s important time if you care about people. Many people say the needle, the handpiece, or thinking about the past visits, stories from others.

Next, ask what about the appointment today they really fear. See what you can do to offer ways to reduce those specific fears and improve your client’s comfort.

Each person in the office has a responsibility to help these people in need. Let’s carry them through their first meeting with us.

Secretary

The first step phoning the office is the most difficult for the fearing client. The secretary must reinforce that the feelings are ok and it’s important to make the appointment.

Be helpful, caring, and supportive. Sometimes this fear will show as anger, so be ready for it. Tell the client how much we care and that many fearing clients are referred to us because we are usually very successful with helping them.
Make note of any specific fears on the chart. Often the fearing client won’t hear everything you say. Make sure s/he understands. A thorough new client exam is the best way for fearful clients to start with us.

A thorough new client exam is the best way for fearful clients to start with us.

When the client arrives, greet them by name, give them a health questionnaire to fill out and ask them to be seated. Don’t let them spend too much time in the reception room

Chairside Assistant

As soon as possible, go to the client in the reception room. Introduce yourself and offer to shake hands. This first personal touch is very important.

Guide them to a treatment room. Offer the clients a cotton blanket if they are cold. Don’t judge these people. Try to put yourself in their shoes. You may be very busy, but spend the extra time to actively listen to these clients. This can be a very good part of your day if you win over a frightened client.

Get the information and run tests, etc. that you need. Excuse yourself from the client only long enough to process an x ray, etc. The fearful client should be left alone as little as possible. Let them get to know you as a person. Warn your dentist what to expect.

Fear control includes a number of concepts:

1. Tender loving care
a. show compassion without being condescending or parenting
b. offer lots of “warm fuzzies”
1. blanket
2. headphones/music
3. movie

2. Offer N2O – it not only helps relax, but can be used in place of a “shot” for small fillings
3. The wand- present it as a computer controlled device to make “shots” more comfortable

4. Topical anesthesia
a. dry the injection site
b. apply – takes 90 seconds for the best results

Hygienist

Occasionally the fearful client will try to have their teeth cleaned. Usually they will have gum disease and decay. Be kind. They will be embarrassed, usually gag easily, apologize for the condition of their mouth, squirm, hurt, and generally tax you to the limit.

Don’t criticize them. Accept what exists and plan for the future. Again, while you are reviewing their history, have them tell you about past bad experiences, their feelings, and what they feel would help them be more comfortable during the appointment. Say something positive about their mouth bone support, bite, solid teeth, color of teeth something to help them maintain their self-esteem.

Discuss beginning with soft tissue management. This is a non threatening beginning that can help solve some of the underlying problems. A thorough new client exam is also a good start.

When you are planning to clean their teeth, offer them everything, nitrous oxide, headphones, and topical anesthesia. Make sure your first touch is on their shoulder. This is a reassuring, non-threatening touch. Tell your client to let you know if they are uncomfortable at any time. Help your client to feel that s/he is “in control” of the appointment and you are only there to serve them.

If your client is extremely apprehensive and has trouble getting through the appointment, your doctor may give the client oral sedatives before the next appointment.

Children

Occasionally a child will not be able to accept dental treatment. In some offices its not uncommon to see (and hear) a child crying while the dentist is providing treatment. This will never happen in our office.

If a child can’t accept our treatment, the doctor will stop treatment (usually the injection) remove the nitrous oxide nosepiece and sit the child up. While facing the child eye to eye, the doctor will say “________, I really like you, but I need your help if I’m going to be able to help you. Can you help me?” If the child won’t answer etc., the mother or father is called in. “Mrs. ________, this is just too hard for ______ today. I have a friend of mine who is a specialist in treating children who can’t help us. ______ you need to have your teeth filled so you won’t have any toothaches later. If you can help me, I’d like to help you. If you think it would be too hard, then I’ll call my friend and he’ll help you better than I could. The fillings will be done. Which of us would you rather have do them?

If the child can’t cooperate the doctor will reassure the parent that the child’s behavior is okay and that we will continue our regular preventive care in six months. The doctor will leave. The assistant will escort the parent and child to the small conference room and call the children’s specialist. The assistant will describe the dental problems and the child’s inability to “help us.” The assistant will then give the phone to the parent to make the appointment. Provide the parent with pen and paper to write down the time of the appointment and directions to get there.