Once again, a patient has asked me what they can do to get their spouse to make a dentist appointment. The spouse is not alone. There are many people nervous about going to the dentist. They know they need to, but won't.
Being nervous or apprehensive about dental treatment, or just disliking the experience, can make it difficult for some people to go for a checkup, especially if nothing is bothering them at the time. Unfortunately, not going means letting things get more extensive and expensive to treat.
I offered to see the spouse for an appointment just to talk. No examination. No cleaning. No treatment.
It would be a chance to meet each other, to discuss concerns and apprehensions, and to develop strategies to cope with treatment and overcome this barrier to a lifetime of dental health.
It's easy to be afraid of something you don't know about. A better understanding of modern dentistry can alleviate fears. Today, new techniques in dentistry make it virtually painless and more comfortable than ever. We could even talk by phone, but coming into the office is a big and important first step for an apprehensive patient to acknowledge their fears and be ready to overcome them.
What might be discussed at the first meeting with a nervous patient?
-- What are they most apprehensive about? The drill? The injection? Stories they have heard about some procedures? Is it just "the whole experience?" Once specific concerns are identified, patients are well on the way to developing strategies to cope with them.
-- What have past experiences been like? Most apprehensive patients have had a difficult experience or are intimately aware of the experiences of someone close to them. We will discuss what has been said or done at a past dental appointment that has made the experience particularly difficult.
-- What stories have they heard? Times and treatment methods have changed. These past experiences may or may not be relevant to the current situation. Getting the facts about their particular needs can save a lot of needless worry.
After that, we can begin to discuss coping strategies for dealing with treatment. There are many and varied ways of overcoming apprehension. Things such as time of day and length of appointments should be discussed. They may want someone to accompany them during treatment for support. It is important to develop a signal to use if they need to stop treatment when they need a break. Some patients find the more they know about their treatment, the easier it is for them. Others find the information upsetting and want to know as little as possible. These are just a few of the issues to be discussed before treatment begins to determine what will work best.
Will a pharmacological approach be required? Eliminating apprehension about going to the dentist is an admirable goal. It is an important step toward attending to immediate dental needs and ongoing preventive care. For some people, however, the barriers are too high and too difficult. Medications for relaxation or sedation may be needed to help.
It is important to discuss the cost of treatment. Fees for dental treatment are based on many factors, including time associated with strategies for coping with apprehensions. These may not be a benefit of a dental plan. For a variety of reasons, coming late and missing appointments is very common among apprehensive patients. Unfortunately, this can lead to treatment dragging out over time, a deterioration of the teeth and gums as active disease goes unattended -- leading to needing more treatment -- and fees for the lost and additional time. This can make a bad situation worse; a situation that is easily avoided.
People close to an apprehensive patient are best positioned to motivate them to take action. They must also be cautious not to say or do anything that will hold them back. The support and encouragement they can offer is essential. People who overcome their fear of dental care realize benefits beyond dental health. They can be justly proud of this significant accomplishment.
First, they must take that difficult first step, acknowledge their fears, be ready to overcome them and sit down with their dentist to begin the conversation.
Joel A. Antel is chairman of the Manitoba Dental Association's communication committee