How to Handle the Anxious Patient

We've all had that one patient. The patient who refuses radiographs. The patient who tells you fluoride is toxic and is used in atomic bombs (yes, I’ve actually heard that one). The patient who shows up 15 minutes late but needs to be done in 20 minutes, and hasn't had a prophy in 3+ years.

And finally, the anxious patient. 

I like to say that there are two types of anxious patients. Type 1: the one who brought it upon him/herself, and Type 2: the "I just want to sit and cry with you because I feel so bad for you" patient. Yes, there are two. And in my case, I normally only feel bad for one type.

Just last week, I had what I would call my most anxious patient EVER. He started out as a classified Type 1 anxious patient, but I quickly realized he was a Type 2. I think as clinicians we are sometimes numb (pun definitely intended) to our patients’ feelings. I know I am guilty. I do the same thing over and over at least eight times a day.

The appointment started off just as you would imagine. He immediately sat in my chair with his sob story on how he is terrified of the dentist and that is what has kept him away for 10+ years! Of course, I immediately thought, "hello SRP," without even hearing him out.

So without even asking, I went along with my routine. I explained the etiology of periodontal disease, how it happens, how we treat it, and the consequences of non-treatment. I suddenly looked up to a 43-year-old (very masculine) man with tears streaming down his face. [Insert guilt.]

He proceeded to tell me he that was held down without any anesthetic as a child and has been terrified to come back to the dentist. He also told me while he almost didn't come today because he was so scared, he had also taken the whole day off to prepare himself.

He begged for us to go ahead and do something today because he wasn't sure if he would have the nerve to come back. He said he even had a dental office turn him away because he couldn't sit still. 

So, what do you do in this situation? How do you handle it?

First off, I recommended nitrous. I explained the benefits and how he would be much more relaxed. We talked about Valium (however, he would have to come back a second time if he went that route), and also in-office sedation. After much conversation, he decided to go ahead with the nitrous and we would see how he did.

We went ahead and got him numbed up and I started scaling. Immediately he started jumping in the chair because of the noise. I could tell he was very still anxious. About every 5 minutes, I would stop and have him take two deep breathes through his nose to help relax him a little more (with the help of the nitrous of course!).

Luckily I work in a wonderful office with awesome coworkers who suggested the lead apron! Have you heard of the weighted blanket trend? It is an immediate anxiety reliever, and yes it worked! By the end of the appointment, the lights were off, weighted blanket was on, along with headphones, a pillow, and he held a stress ball we keep in the office.

WOW! You would think I would have rolled my eyes 100 times by then. Nope. Not this time. This time was different for me. Why? Because I opened my ears to listen to him and not just hear him. So many times I only hear these types of patients, but I don't actually take the time to listen. 

Every story is different and every patient is different. What I learned from this experience is to stop going through routines. Open up your ears and listen to their story. I promise it will be worth it.