CE Course 10 - Figure 5

Figure 5

  1. Be aware that patients may be fearful or distrustful. Learn to recognize signs of fear. When in doubt, ask the patient in a tactful, nonjudgmental manner about possible fear. Questions or comments on prior oral health experiences may indicate distrust.
  2. Explain procedures and their rationale and obtain the patient’s permission before beginning each procedure. For some patients, explanation and permission may be advisable even for such actions as lowering the back of the dental chair.
  3. It is much more important that the patient return for the next appointment than it is to complete a predetermined amount of therapy at one appointment.
  4. Schedule short, simple procedures first to give the patient a good experience; work up to more difficult procedures as the patient can tolerate them.
  5. For many fearful patients, control over what happens in the dental chair is very important. If a patient indicates fear or distrust, STOP and listen to the patient. If the patient appears unassertive, as the oral health care professional, should schedule rest breaks, elicit the patient’s feelings about the treatment in progress, and respond appropriately. Review principle no. 3.
  6. Patients who have trouble receiving oral health care are not all the same. For distrustful patients, provide lots of information. Don’t be rushed into treatment decisions and ensure that you have all necessary information. Distrustful patients often find simple reassurance disquieting, but are impressed by personnel who make careful, informed decisions about their care in consultation with the patient. Reassurance can be helpful for patients who are primarily anxious. Techniques of relaxation, distraction, and stepwise progression at the patient’s pace can be extremely effective.
  7. If the patient complains of pain, believe the patient and respond accordingly. Inadequate pain control can cause dental fear. Patients with a history of significant substance abuse may require more anesthetic than other patients.30 Recognize that when drugs for pain control are used in a controlled medical or dental setting, they are unlikely to lead to substance abuse.
  8. In 10 to 15% of fearful patients, pre- and post-medication can facilitate care and comfort, but it is preferable to teach and use cognitive-behavioral techniques to give the patient a means of control that can be applied in the oral health care setting and elsewhere.
  9. If presenting problems seem beyond the oral health care staff’s level of expertise, refer the patient to a dental fears clinic or consult with a psychologist or other mental health practitioner skilled in work with phobic clients.
  10. Remember, phobic and distrustful patients may require much patience and stepwise care. But if trust can be gained, they can become some of the best patients.
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