Fear - Anxiety, anger, aggression and claiming behavior

Fear - Anxiety, anger, aggression and claiming behavior
Anxiety is an emotion that warns you of danger. Fear helps you survive. So fear is useful when there is a real danger. In this section we discuss the common fear at the dentist. This fear can be specific (fear of one situation, action or object), but it can also be a panic disorder.



Anxiety is an emotion that warns you of danger. Fear helps you survive. So fear is useful when there is a real danger. In this section we discuss the common fear at the dentist. This fear can be specific (fear of one situation, action or object), but it can also be a panic disorder. You can also broadly apply the approach that we describe here in general practice and in pharmacies.


Types and causes, with whom, when

Many people are afraid of the dentist. The numbers differ considerably in different studies. The figures range from 25 to 65%. Some people are so scared that they only go to the dentist when it really can't be otherwise.


The people who are a little or rather scared can be treated well in normal dental practice. The first step in good care is to recognize and discuss specific fear of the dentist. The people who are very scared try to avoid the threatening situation and want to be reminded as little as possible of the fear. This is possible, for example, by not going to the dentist for years. Only when they have serious complaints (pain) or when others put pressure on them, do they get the feeling that they have to. But then the fear can be so great that they dare not make an appointment, cancel the appointment, do not show up or do not want to enter the treatment room. These people often require treatment in a Center for Special Dentistry (CBT). People with moderate anxiety can be treated very well in a normal dental practice when there is attention for their anxiety.


It is important to distinguish between specific fear of a specific situation or experience (intervention, pain, injection) or a panic disorder. In a panic disorder, panic attacks occur in various situations. In a panic attack the patient experiences all kinds of nasty sensations that intensify the anxiety: a feeling of tightness, as if the throat is closed, difficulty swallowing, a deaf feeling or tingling in the fingers or around the mouth, palpitations, dizziness, shaking, sweating, it get hot or cold. A panic attack usually lasts a few minutes to half an hour. The attacks not only occur at the dentist, but often also in other situations (a full bus, waiting in line at the checkout). This is different from specific anxiety (phobia). The fear of a panic disorder usually does not lead to extreme avoidance behavior, such as with a phobia.




You can suspect that people are afraid of the dentist if they have not been to the dentist for a long time and their teeth are not in good shape, if they always cancel appointments or do not appear at their appointment, or when they have come, but the dare not enter the treatment room. Sometimes you see physical symptoms of anxiety when patients are in the treatment room: wide pupils, muscle tension, shaking hands, rapid breathing, the smell of sweat (despite washing, clean clothes and use of deodorant).


If patients do not tell themselves that they are afraid, you can bring up fear: "Many people find such a visit or treatment exciting. I understand that very well. How is that for you? "


Show understanding and respect when the patient says he is scared. Ask exactly what he is afraid of or what he is most afraid of. Ask further so that you know exactly where the patient is most afraid: the idea of the anesthetic syringe, the pain of the anesthetic syringe, pain during treatment, the sound of the drill, pain, shaking in the head during drilling, silent have to lie down, have to swallow all the time and the idea that the dentist finds that annoying, the feeling of having no control, everything unknown during the treatment. Ask if he is also afraid in other situations (panic disorder).


Discuss with the dentist how the dentist will deal with the fear of this patient.



Dealing with people with fear / Specific fear

Here we discuss dealing with adults with specific fear of the dentist (fear of pain, of the anesthetic). The table below shows points for attention.


Points for attention with specific fear of the dentist

Basic rules

 - Make contact

 - Match your communication to the person and what happens in the conversation

General and reception
Cooperation and trust  - Ensure collaboration with the patient and work on trust; a patient who knows that you are consulting with him and that you will not attack him with pain or discomfort has positive experiences; thereby his anxiety can diminish and his confidence grow
Fear for ...

 - Know what the patient is afraid of; during treatment, the dentist can discuss the anxiety and ask what the patient is currently afraid of, what he finds the worst and what can go wrong

 - The dentist can make an appointment (again), for example about the stop sign or anesthetized if the patient indicates pain

In the consultation room, treatment room or at the desk
Agreements to build trust  - Make agreements and stick to them, so that the patient has positive experiences (which treatment, how long treatment at a time, which signal if it doesn't work)
Information  - Explain what will happen via the tell-show-do method; make the situation predictable for the patient, which gives him a sense of control

 - Explain that the dentist ensures a good anesthetic

 - Be honest if you are not sure that the treatment will be completely painless

Use of language

 - Use non-threatening words and avoid threatening words; say for example: "I'm going to clean your molar" instead of "I'm going to drill"

 - Avoid the word "try"; it reinforces the uncertainty

 - Avoid denials such as: "that doesn't hurt"; the word from that message that lingers is "pain"

During the treatment

 - Ask if the patient wants to watch with a mirror

 - Tell how far the treatment has progressed and what will happen next

 - Ask for pain; the dentist will not settle for: "I am fine", but will be stunned to maintain the confidence of the patient


 - Ensure that the patient experiences control over his situation; agree how long the dentist is treating now (seconds or minutes); in the interval, the patient can relax a bit, his mouth does not have to open, he can breathe, swallow and say something more easily

 - As an assistant you monitor time; you tell the dentist how many minutes or seconds he can still treat

 - Agree a stop sign with the patient, with which he can indicate that it is no longer possible; make sure the patient gives the stop sign and immediately report this to the dentist, who must stop immediately

After the treatment
Evaluation  - Ask how it went and how it was experienced: "How are you looking at it now that it's over?" "Was it as exciting as you had thought in advance?"



When the patient notices that he is in control of the situation and that the situation is not as scary as he previously thought, the anxiety often diminishes in some treatments. If that fails or fails, the dentist can refer the patient to a CBT.


Panic disorder

Sometimes the patient tells in advance that he has panic attacks. In other cases you notice great unrest and other signs of fear. It is important to interrupt the treatment (for a short time) and to discuss the anxiety ''Table below''.


Points for attention in a panic disorder

Basic rules

 - Make contact

 - Match your communication to the person and what happens in the conversation


 - Show understanding

 - Create a safe situation by interrupting treatment and letting the patient tell what is happening to him: "Do you want to tell what is happening to you?"

 - Recognize the patient's fear: "I find it very annoying for you to experience this"

 - Ask the patient what you can do for him Ask the patient what you can do for him

 - Help the patient relax

 - Explain that you are going to make a plan together to deal with the situation

Ask information

 - Ask if the patient feels an attack coming up (what symptoms)

 - Ask the patient how he can calm down in other situations: has he been treated for this? what techniques does he know / apply? are there specific things in practice (smells, actions) that evoke fear?

Appointment  - Agree a stop sign and how you will support the patient: alert him to his breathing and muscle tension; give relaxation instruction

 - Continue treatment as soon as the symptoms are over; if you do not, unwanted conditioning may occur (if I get symptoms, the treatment ends)

 - Encourage the patient during the treatment, mention that he is doing well, that he is breathing quietly, is lying relaxed

File  - Make a note in the file and note the agreements made