TELL/SHOW/DO

Appropriate communication alleviates the anxiety and fears of many patients simply for the reason that the unknown factor has been removed. The principals of Tell/Show/Do were initially designed for childrens’ dentistry, however it may be adapted for use with any age group. The TELL phase involves an age appropriate explanation of the procedure including descriptions of any instruments which may be used and for what reason. The SHOW phase is used to demonstrate a  procedure up to the point where the instrument is actually used. The DO phase is then initiated with the patient’s consent and the treatment is performed. The patient should always be made aware of the approximate length of the procedure. The very fact that the dentist is taking time to explain things and acknowledge any  anxieties or fears the patient has, the more relaxed they will become.

DESENSITISATION is when anxiety is reduced by a gradual acclimatisation to the object which causes fear. The principals are similar to TELL/SHOW/DO except that the TELL and SHOW phases are repeated over a few visits until the patient feels comfortable enough to proceed and DO. This technique is  especially effective with needle fears and phobias.

Click here for a ‘virtual’ dental needle desensitisation appointment.

MODELLING is mainly used with children and is based on the idea that people learn about their environment from observing the  consequences of other’s behaviour. If a patient is shown that it is possible for another to visit the dentist, have treatment and leave without undue stress, their anxiety may be reduced. In time the  patient may then be able to accept their own treatment. Good Models include mothers demonstrating to children “how easy it is” as demonstrated by Klesges and Malott (1984). Ghose et al (1969) used siblings whereby the younger sibling observed the older being examined and treated. The use of brothers and sisters is a commonly used technique in the dental surgery in an attempt to reduce anxiety from the very first visit.

PROGRESSIVE MUSCULAR RELAXATION is a technique whereby the patient is taught to control their muscle tension and breathing. By doing this an increased heart rate and sweating may be reduced therefore allowing the patient to become more relaxed. The patient is reclined in the chair and asked to control their breathing by taking deeper, longer breaths. They are then asked to tense and relax the major muscle groups of the body. For example by starting with tensing the muscles in the feet while breathing in,  and relaxing them while breathing out. The calf muscles may then be tensed, followed by the thighs, and so on until every muscle has been tensed and relaxed. This may take between 15 to 20 minutes. Lamb and strand (1980) showed a decrease of anxiety levels in patients receiving this relaxation technique. In a study by Corah in 1979 it was suggested that relaxation techniques may be more effective in women.

DISTRACTION is a basic behavioural coping strategy, highly effective especially helping patients dealing with brief stress. This may involve the dentist simply talking to the patient, however more  high tech options are beginning to grow in popularity. Examples of such techniques are the provision of a television screen positioned above the dental chair, a personal C.D. or cassette player,  computer games or Virtual Reality headsets. Corah (1979) suggests that distraction techniques may be more effective in men.