Guest Post: How to Manage Anxious Patients with Niall Neeson

I am so pleased that with this post we have Niall Nesson aka @thecalmingdentist talking about how to manage anxious patients...

“Oh I hate the dentist…I’m going to be your worst patient ever”

One in three people have a fear of the dentist. That is a lot of people!

This is why managing dental anxiety is a part of our day to day job as a dentist.

As dental anxiety is something we encounter so frequently, there can sometimes be a tendency in the profession to simply accept it as something we have to work around. A mild inconvenience to the smooth running of our day. As health professionals, I think we can do better than that. We can, and should be able to show empathy and compassion to people and their emotions.

The vicious cycle of dental fear describes the typical pattern of behaviour where dental anxiety leads to avoidance of the dentist. This inevitably leads to deterioration of the dental health. The resulting condition of the teeth can lead to powerful negative emotions of guilt, shame, embarrassment. These emotions compound the anxiety further and the cycle continues to spiral.

With true dental phobia, this spiral can result in a knock-on effect on people’s day to day life. It may affect their confidence, social interactions, their working life, relationships. The impact of phobia is far-reaching and goes way beyond the state of someone’s teeth.

Dental anxiety is a big, big deal for people.

Do you know what though? This means we have the power and ability to have a positive impact on people’s overall well-being. How cool is that?!

Why are patients anxious of dentistry?

There are many factors that can contribute to dental anxiety including
  • Negative or traumatic dental experiences
  • Genetic or personality factors
  • Influence of family or peers
  • A history of trauma or sexual abuse
  • Mental health
There are often a number of factors contributing but the thing to remember is that everyone has an unique background as to what’s contributed to how they feel about a dental visit. Our job is to find out how best to help them as an individual.

Top tips for managing dental anxiety in General Dental Practice

Things we can all do!

No lectures!

They already know they should have been here 10 years ago. They know you’re meant to brush your teeth twice a day. We can’t change the past. But we can change the future.

Welcome them. Even better- congratulate them for making it in the door! By doing so they’re breaking that vicious cycle of dental fear and it gives us a chance to reverse that cycle to a more positive spiral of good dental experiences, building trust, improving dental health and reducing dental anxiety.

Set the tone

Think about the music, ambience and smell. Consider how your surgery looks to an anxious patient and what can be done to make it more welcoming and less threatening. Adapting the environment with slow, relaxing music and essential oil vapourisers can help create a calm environment and reduce patient tension and apprehension.

Respect the biology of the fight or flight response!

We’re all from a scientific background and understanding. We all know the sympathetic nervous system leads to tachycardia, sweating and shortness of breath. Other symptoms can affect communication and an actual, real, biological increase in pain perception. Simply having an understanding and appreciation of this can reduce our frustration and stress levels. So the next time a petrified patient asks you the same question for the third time just bear this in mind. And teach this to receptionists and nurses- their attitude has the power to make it or break it for nervous patients!

Provide a sense of control

Research shows the importance a sense of control has for the anxious patient. A simple but clear stop signal goes a long way. Lifting the hand can work fine. I like to use a button clicker- psychologically it gives them a sense of having the power to stop us ‘in the palm of their hand.’ Believe it or not I even use the type that are used to train dogs! Not very glamorous but patients love it.

Slow breathing techniques

I like to encourage people to focus on diaphragmatic breathing. If you’re into yoga, mindfulness or meditation, you’ll be familiar with this. If not, it may seem a little bit silly the first few times you use it but give it a go- trust me, it works really well. 

Something along the lines of “one way of helping to feel more relaxed is to take big, slow deep breaths in, right down into your tummy…(you inspire)…and then really slowly release and relax on the outbreath (you expire)…Allowing the outbreath to last longer than the inbreath makes it even more effective…So counting to 4 on the inbreath and 6 on the outbreath is a really helpful pattern.”

It brings their attention to something helpful rather than anxious or catastrophic thoughts about what is about to happen. At the same time the control of breathing actually slows down the physiology, reduces the sympathetic nervous system response, reducing heart rate and allowing the patient to feel more calm.

It’s something they can return to again and again throughout the visit. So simple but so helpful!

What other options are there for anxiety management?

If you enjoy this area you may consider training in additional techniques that can help to treat people with dental anxiety:

Intravenous sedation

A superb technique using anti-anxiety medication such as midazolam that allows treatment to be completed in a comfortable manner for the patient. Has an amnesic effect so people usually can’t recall the visit. Patients lend to love this memory loss but it may limit the progress in improving the actual phobia.

Inhalation sedation (nitrous oxide or ‘happy air’)

Reduces anxiety, reduces gag reflex and importantly, the patient can recall the experience which can help build trust and confidence with dentistry. Excellent for kids but requires good cooperation and has its limitations which more extreme levels of dental anxiety.

General anaesthetic

Despite the risks associated with GA, for some this is the only way to access dental care. Choice to use may depend upon extent of anxiety, the necessary treatment and someone’s medical history or degree of cooperation. It allows treatment to be completed but has been shown to be ineffective for reducing levels of anxiety.


Can reduce dental anxiety, improve cooperation and help with building confidence. I found my training in hypnosis to be invaluable at improving my communication skills and use of language. Really useful techniques to combine with nitrous oxide inhalation sedation also. Has some limitations and some people are more hypnotizable than others.

CBT (Cognitive Behavioural Therapy)

A psychological talking therapy that has been shown to be very effective at treating the actual phobia, with long lasting benefits. Includes systematic desensitisation and gradual exposure. Wonderful results and can even benefit overall mental health. There is a growing body of research and support for more use of CBT in dentistry.

I always remind dentally anxious patients that it’s ok to feel nervous. That’s completely understandable. The thing that’s helpful for them to know is that we have loads of things we can do to help. There are plenty of options. We just need to sit down with them and figure out the best pathway forward for helping them as an individual.

Let them know that the way people think and feel about the dentist can change. It can evolve over time into something more positive, more healthy. By attending, they have started that journey. Remind them to focus on the huge benefits they can enjoy in the future!

Being part of that journey can also be some of the most satisfying and fulfilling work we can do as dentists. So it’s also helpful to remind yourself of the benefits of embracing dental anxiety and genuinely helping people. We can make such a difference!

Niall is a GDP in Ireland and established the ‘Dental Fear Solutions’ service in Boyne Dental Navan. Niall shares videos and content to help support people with dental anxiety as ‘The Calming Dentist’ on Instagram/ Facebook.

He’d really appreciate if you give him a follow and help spread these positive messages about dental anxiety!

What are your top tips for managing dentally anxious patients? Please leave them in the comments below. 

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