Interview: “Helping patients begins with recognizing the anxiety”

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Interview: “Helping patients begins with recognizing the anxiety”

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Prof. Peter Milgrom treating a dental patient. (Photograph: University of Washington)
Iveta Ramonaite, DTI

By Iveta Ramonaite, DTI

Mon. 2. September 2019

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Being in a dental setting may often make people feel uncomfortable. As dental anxiety increases, patients may intentionally miss dental appointments and neglect their oral health. Dental Tribune International spoke with Dr. Peter Milgrom, Professor Emeritus of Oral Health Sciences at the University of Washington. Milgrom has recently published an article on dental anxiety and shed some light on the issue in this interview.

Prof. Milgrom, how prevalent is dental anxiety today?
Clinically significant anxiety rates in the U.S. are found in 15% to 20% of the population. The rate has stubbornly remained the same for 30 years or longer.

What causes dental anxiety?
For the most part, dental anxiety can be the result of a poor experience or interaction with dental providers, or a manifestation of underlying anxiety or a mood disorder. Dental providers should acknowledge the fact that a poor experience is defined by how the patient, and not the dental provider, perceives the appointment. Thus, experiences or procedures that are seemingly innocuous to the provider may be very upsetting to the patient.

What are some indicators of dental anxiety?
Dental anxiety is a cognitive or thought disorder. The dysfunctional thoughts are largely manifested in how people behave. What they say, or physiological changes, such as a very high heart rate and sweating, are also good indicators. Changes in any one or all of these dimensions indicate anxiety. However, sometimes people deny the fact that they are thinking fearful thoughts, since they are embarrassed or do not want to trouble the dental provider. As the appointment progresses, the fearful thoughts or behaviors become worse if unrecognized.

How could dentists help patients overcome or reduce their dental anxiety?
Helping patients begins with recognizing the anxiety. The best way to recognize anxiety is by asking patients to complete a simple screening questionnaire in the waiting room. After they have completed the questionnaire, the receptionist should personally hand it to the dentist in front of the patient, saying something similar to: “Doctor, here is the questionnaire Ms. Jones completed about how she feels about the dentist or the dental appointment. It contains some information that our office needs to be aware of.” The treatment then needs to be structured in such a way that the anxious patient can cope with it and not be overwhelmed by negative thoughts. Some say that it takes as many as seven good experiences to replace a single bad one.

In your opinion, what is the role of U.S. dental schools and the dental research community in reducing dental anxiety in patients?
The training programs, such as dentistry, dental hygiene, dental therapy and dental assisting, are all seriously negligent in not providing skills training experiences in this area for all students. This is not something you can learn from reading an article or a chapter in a book. Every extensive training program should have a specialized clinic for anxious patients, and every student should be required to have meaningful clinical training experience with these patients led by a knowledgeable clinician. The current programs in the U.S. often rely on treatment with sedative drugs. These treatments have been proved ineffective in obviating dental fears. A skilled clinical psychologist or clinical social worker needs to be part of the treatment team. Most of the high-quality research on dental anxiety is currently conducted outside of the U.S. The dental schools in the U.S. have failed to maintain the capacity to conduct such research, to the detriment of the public and trainees.

Editorial note: The article, titled “Dental anxiety: A persistent problem in dentistry,” was published in the August 2019 issue of the Journal of the California Dental Association.

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