Dentistry And Mental Health
Estela Vargas, CRDH CEO Remote Sourcing
"Supporting both the physical and mental health needs of dentists, across their lifespan, continues to be an important area of focus for the ADA," said Jim Hoddick, D.D.S., ADA Council on Dental Practice chair. The pandemic created panic in many ways that affected countless people to the point that many have not returned to their “normal” and probably won’t ever. Those that fought the demons of mental health issues before the pandemic continued to fight but now had a new opponent, COVID-19. "COVID-19 has created unique stressors. Every day, I see people stressed out to the max and overworked."
The percentage of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, according to the ADA's newly released 2021 Dentist Health and Well-Being Survey Report, spurring the ADA and ADA Council on Dental Practice to take action on supporting the wellness of dentists.
Not only has the frightening statistics affected dentists, their teams, and all health care workers, but our patients are feeling it too and bring those fears, anxiety, and trepidation to their dental appointments.
Studies and research show alarming statistics involving patients with mental health issues such as depression, avoiding oral hygiene at home, and subsequent professional dental care.
Scheduling and the office environment
Proper patient scheduling is vitally important to the patient and the team. The pre-pandemic double or overlap scheduling may bring higher productivity but, in the long run, will scare patients and staff away from the practice. With COVID 19, paying particular attention to social spacing and allowing time for the newer mandatory sterilization is critical.
You don't want the following to be an everyday occurrence in your practice: An adult male patient was waiting to be seen in the reception area. He suffered from acute anxiety triggering his need to "run." he started fidgeting and getting up and down. Suddenly he bolted out the door and didn’t come back. The Office Manager called him and said he was sorry but that he became unhinged listening to the sound of the dental drill and had to leave.
Scheduling and office ambiance can play a significant role in reducing dental anxiety. From the reception area to the dental treatment area, anxious patients are aware of all they see, hear, and smell. In some cases, this can worsen a patient's mental state.
It is often recommended to schedule patients with dental anxiety in the morning, as afternoon appointments leave them more time to worry and only serve to increase their pressure. Seat the patients as quickly as possible to avoid the patient fretting in the reception area and avoid leaving a nervous patient alone in a treatment room for an extended period
Regardless of wait time, patients with dental anxiety will still be unsure as they enter the office. Creating a calm, inviting office environment can help reverse the effect of the sound of a drill and chemical smells.
The sound of phones ringing off the hook and busy; stressed-out staff members can trigger a patient to leave or postpone future dental care.
Some environmental additions to calm the team and the patient include the following:
- Soft, natural light, avoid fluorescent lighting
- Exit doors and windows so the patient doesn’t feel trapped
- Soft background music or calming nature sounds like ocean waves
- Artwork that portrays peaceful, happy scenes in nature
- Massage chairs in the treatment rooms
- Access to music with headphones
- Television monitors on the ceiling and choices of movies to watch
- Diffusers to mask unpleasant dental smells
- Beverages or bottled water
- Extra attention or TLC from friendly staff
Approaches to relaxation and proper breathing
Helping patients physically relax, in addition to mentally, is another strategy for those experiencing dental anxiety. Proper breathing techniques are one of the most fundamental ways to encourage physical relaxation. Diaphragmatic breathing, for example, relies on the use of the diaphragm to reduce tension in the chest and provide more oxygen for the body per breath. Muscle relaxation can be done simultaneously by tensing a specific set of muscles during inhale and relaxing them during exhale.
Guided imagery is focused relaxation or meditation that involves concentrating on a specific object, sound, or experience, promoting a calm state through relaxation. Patients are taught to develop a mental image of a pleasant, tranquil experience—complete with specific, concrete details such as sound, smell, and colors—that guides their attention to achieve relaxation, thereby reducing anxiety.
Studies have shown that guided imagery is effective in treating distress, mood, and anxiety symptoms associated with chronic pain, social anxiety disorder, attention deficit/hyperactivity disorder, and cancer pain. It is also relatively easy to learn, teach, and use daily dental practice.
In extreme cases of anxiety, patients may have to be sedated (which requires special training and licensing) or given specific prescribed drugs to ease symptoms so that care can be provided. Sedated patients must be carefully monitored and have a responsible adult accompany them to their appointments.
Conclusion
Dental anxiety is a severe concern for the dental team and the patients. Dentists and the team must be proactive and take the necessary steps to improve the dental environment so that it is a pleasant place for both the team and the patients. When patients and the team feel safe and relaxed, both will be more willing to engage with the goal of improved dental health and mental wellness in both the short and long term.
