Four: No Surpises, No Sudden Moves
Dental World Second Supplement
No Surprises, No Sudden Moves
Surprises have their place in life, but during treatment, knowing what to expect is wonderful. Knowing they will get a chance to process, adjust, and ask questions at each step takes removes the fear from an otherwise uncertain situation over which patients have no control.
Psychologically speaking, only trust counteracts fear. Predictability is what allows a person to build trust.
Predictability comes from narrating the process, explaining what comes next, setting expectations, and generally helping the patient anticipate, prepare for, and understand everything they will experience.
The Big Idea: Manage Their Imagination
We’re their eyes. We understand teeth and gums. They don’t want to be freaked out. If they have to interpret things on their own, they will. Help them manage their imagination.
Narrate Everything
Start small, and start immediately: As you take the patient from the waiting room, inform them how far they are going, for example: “We’ll be walking all the way to the end of the hall, on the left.” This sets up your role as a guide, and sets a precedent that all expectations will be handled.
Give them Permission to Speak Up
We are trained from an early age not to be a problem and not to make a fuss. Many patients won’t feel comfortable speaking up without permission. First, ask them to let you know if they need anything, but also, give them words to use, and regularly check to see if they are feeling something you think they might be.
Don’t leave it up to them. We can see what’s happening and understand the implications. In short, they need us to help interpret their experience. They can only feel and guess.
Expectations: Words for Feelings
When there’s a buzzing or a pinch, the patient has no idea what happened. They don’t have any visual information, and they know they’re in a place where blood flows and teeth are drilled.
As far as stress signals go, the fear that a sensation represents permanent damage is near the top of the list. We have to help them interpret their sensations, before they occur whenever possible.
Part of helping to interpret their sensations is giving them concepts to grasp and words to use. Without introducing ideas and words like temperature, vibration, pressure, or sensitivity, they will only filter these sensations as discomfort or pain. Using words like these as we explain what the patient is likely to feel is very important.
Expectations: Are We There Yet?
As we narrate, we positively orient them in the process. We let them know how far into the process we are, or how close we are to the end. Introduce the idea of quadrants to them, and that you do both sides of each quadrant. This way, as you move through scaling, they have their own sense of where they are. This helps them pace themselves.
One of the Four Fears patients have is about losing control of their time, so respecting this helps them feel considered and cared for.