Five tips treating anxious patients

In this series, we’re exploring how we can adapt our practice to meet the needs of different patient groups. This time, we’re looking at the issues to consider when treating severely anxious patients.

You might be nervous when you meet your patients for their first time, but many of them will be even more worried at the prospect of a dental appointment, and a few will be so anxious that they find it difficult to cope.

Dental phobic patients can be challenging to treat successfully, and a bad experience could entrench their fear and make it even harder for them to seek necessary treatment. At the same time, the GDC expects you to “treat patients with kindness and compassion” and says, “you should manage patients’ dental pain and anxiety appropriately.” (Para 1.2, Standards for the Dental Team)

Here are our five top tips for making patients feel more comfortable during appointments.

1. Show empathy

Try to put yourself in the patient’s shoes. Someone who is visibly anxious could also be feeling exposed and vulnerable, but you can make them feel safer and gain their trust by showing that you understand and want to help. The best strategy for building a rapport is to listen and acknowledge the patient’s anxiety and the reasons for it, rather than trying to tell them they have nothing to worry about or trying to make light of the situation.

Remember that no one is at their best when they are fearful. An extremely anxious patient might be experiencing physical symptoms such as sweating, nausea or panic attacks, but they might also behave in ways that are out of character, such as becoming tearful or irritable. Try to give them the benefit of the doubt, although you shouldn’t tolerate aggression or abuse.

2. Communicate clearly and avoid jargon

Think about how you interact with the patient and your language. Patients find it harder to recall healthcare information when they are anxious, which has implications for dental phobic patients. A breakdown in communication could make it harder for you to meet the patient's needs, while feeling in the dark about what you have said during the appointment is likely to make them even more anxious.

First impressions count, so greet the patient with a smile, pay attention to your tone of voice and body language, remove your mask and sit beside them to take a history rather than towering over them while they are in the dental chair.

Try to be an active listener: make eye contact and acknowledge what the patient is saying through eye contact, nodding or saying "I understand" occasionally, but try not to interrupt or put words into their mouth. Avoid dental jargon when explaining your diagnosis and treatment plan. For example, patients are unlikely to understand terms like amalgam or paraesthesia, so use alternatives like metal filling or tingling sensation.

Demystify the process by explaining what you are going to be doing during the examination or procedure and look out for signs of confusion or ask questions to check their understanding. Take time to give reassurance and further explanation when needed and consider providing written information for them to read at home.

3. Explore reasonable adjustments and support

There is no universal way of managing dental phobic patients, as much will depend on what approach feels comfortable to you, their level of anxiety, the type of treatment and what practical steps you can take to support them in a practice setting.

Talk with your tutors about the best way of assessing anxiety, from a patient questionnaire using the Modified Dental Anxiety Scale (MDAS), which ranges from 5 to 25, to a more in-depth conversation with the patient about their specific triggers, such as an injection or the sound of the drill, as well as the tools that might help.

These might include:

• patients raising their hand to signal that they want to pause which can give them agency
• listening to music through headphones to drown out the noise of dental instruments
• breathing techniques
• a longer appointment time so you can take things slowly
• staging treatment over several appointments
• or requesting that a friend or relative is present for moral support.

We advise you to use your judgment about the last option. Although it’s standard practice for parents to attend with their children, it can be counterproductive to have a third-party present who doesn’t like going to the dentist and transmits their feelings to the patient.

4. Work in partnership with your colleagues

A dental phobic patient will be feeling anxious from the moment they step into a dental environment, so everyone has a part to play in making the appointment a positive experience. A friendly receptionist with good communication skills can help make the patient feel welcome and that everyone cares about their well-being. And if a patient confides their anxiety to the dental nurse who escorts them from the waiting room, the nurse can ensure you are aware and reassure the patient while they’re in the dental chair. You may also have colleagues with skills and experience in supporting anxious patients – often dental therapists - or with training in Cognitive Behavioural Therapy (CBT) techniques that can help the patient manage their dental phobia.

Effective teamwork is also essential, so patients are given clear and consistent information about waiting times, the next available appointment and what to do in an emergency. Mixed signals can be stressful: for example, if you tell an anxious patient to book the next available appointment and the receptionist says there is nothing available for eight weeks.

5. Know when and how to refer patients for conscious sedation

Ultimately, there may be some patients with extreme anxiety who need specialist interventions to cope with dental treatment, such as conscious sedation or even treatment under general anaesthetic in hospital (if extensive treatment is needed such as multiple extractions).

As a newly qualified dental professional, you’ll need to refer patients for treatment under sedation because this requires additional postgraduate training, experience and needs to be carried out in a suitable clinical setting.

If you’re considering a referral to the local NHS Special Care Dental Service or a private clinic, you should first explain the process to your patient, discuss alternatives and obtain and record their consent. When making a referral, follow your practice procedure and provide all the necessary information.

____________________

Fear of the dentist is a common problem and a significant barrier to care with 19% of adults giving this as a reason for infrequent attendance in the Adult oral health survey 2021. Much of this fear is rooted in past experiences or an outdated “drill and fill” image of dental practice, which means you have a chance to show them that things have changed.

There will be few things more rewarding in your dental career than successfully building a rapport with your anxious patients and transforming their oral health.

Further resources

• Clinical standards for dental anxiety management  -  NHS England
• The Society for the Advancement of Anaesthesia in Dentistry (SAAD) - dental charity dedicated to advancing knowledge of pain and anxiety control
• British Society of Special Care Dentistry (BSSCD) - Dental Specialty providing preventive and treatment care for people with physical, intellectual, medical, emotional, sensory, mental or social impairment.

 

The DDU is here for you as a student and throughout your dental career. Visit the join DDU pages to explore the benefits of membership now and beyond graduation.  

 

 

This page was correct at publication on 12/11/2025. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.