Dental Anxiety: More Than Meets the Eye

Treating anxious patients is a daily norm in dentistry. I sometimes joke that I’m half dentist, half therapist. (Speaking of therapy, see my post on Motivational Interviewing for enhanced patient communication). But in all honesty, a large portion of our patients is terrified of the dentist! I have come to learn that different patients have their own, unique way of manifesting that fear in the dental chair.

I recently saw a new patient who had avoided the dentist for years due to multiple traumatic experiences. They even brought a stress ball to squeeze during their appointment! After years of neglect, they needed scaling and root planing (SRP) along with other extensive work. 

All things considered, the first appointment (to start SRP) went pretty well. When patients are terrified, their nervous energy seems to emanate through the operatory and put everyone on edge. It’s contagious. Nevertheless, I have done THOUSANDS of SRP procedures and we survived the first appointment!

The second appointment (to complete SRP) was last week. As I reviewed my schedule, I noticed in the appointment notes that the patient had called the office to report that a filling had come out a few days after their first scaling appointment.

Oh boy, I thought. They are going to be upset and, of course, it seems as though it’s all. my. fault. (In reality, no dental cleaning- not even a deep one- would cause a healthy filling to come out).

The night before the appointment, I dug up an old Dr. Greg (AKA “The Helpful Dentist”) email and practiced what I would say: “The only reason a dental filling would come out during a cleaning is that it was breaking down and ready to come out, regardless.” That night, I tossed and turned. This is the dilemma of being both a dentist and people-pleaser. 

The appointment finally rolled around. I was determined to be as chipper as ever. I greeted the patient with the biggest, warmest smile I could muster and told them how it good it was to see them again. I asked how they were doing (fully aware that they would be upset). Sure enough, they replied, “NOT GOOD AT ALL.”

I went on to examine the “missing filling.” As it turns out, the patient had broken natural tooth structure (a whole cusp), not a filling at all! I took an intraoral photo to show the patient, and we created a treatment plan for the tooth. I then began to set-up behind the patient.

I don’t typically eavesdrop on my patients, but this patient was just so testy and furiously typing away on her phone that I couldn’t help but glance at the screen. The email subject line read “Mom’s Burial Plot.” 

The words hit me like a ton of bricks. My patient was planning their mother’s funeral in the dental chair.

Dental anxiety is so common that it can easily be disregarded as a mundane, everyday nuisance. However, this appointment was an eye-opening reminder that our patients’ behavior may not always be a manifestation of fear or dental anxiety. Instead, we must approach each appointment with a fresh set of eyes and truly be present for every patient. 

What was initially a dreaded appointment became a meaningful wake-up call. It provided me with a renewed commitment to care for my patients with compassion and the benefit of the doubt. ❤️

Have you ever had a dental wake-up call? Comment below!


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