Have you ever had a patient remember the treatment plan differently? Dental anxiety may help explain why, especially when care happens in phases.
Print & Go GuidanceBy Genni Burkhart, Editor
A 2013 study of patients awaiting root canal treatment or extraction found those with higher dental anxiety recalled more threat-related words than positive ones. For dentists who treat high-fear patients, that finding offers a useful clue as to why a treatment plan can seem clear during the initial consultation yet different weeks or months later to the same patient.
For example, you and your team explained their immediate treatment only covered part of a larger, overall plan. However, financial limitations, timing, or other concerns meant postponing some or all of the recommended care. At the time, the patient appeared to understand that additional treatment would still be needed at future visits. Then, weeks or months later, you discover the patient is surprised to learn there's more dentistry to complete.
Pain, injections, surgery, cost, or simply getting through the appointment may demand much of a fearful patient's attention, all while you're asking them to absorb a treatment plan that can extend for several months. Understanding how fear affects what patients absorb and remember will keep them better engaged in their care and more likely to accept treatment plans after their most immediate issue has been resolved.
Where Does Attention Go?
A 2016 systematic review in The Journal of the American Dental Association examined 19 studies involving how adult dental patients understood and recalled treatment information. With conventional methods of presenting that information, measured comprehension ranged from 27% to 85%, and recollection ranged from 20% to 86%. However, most patients believed they had understood all or nearly all of what they were told.
The researchers also found instances in which dentists believed their explanations had been understood while patients later reported that they hadn't understood or didn't remember receiving the information.
Dental anxiety further complicates the situation. In a study of 42 patients awaiting root canal treatment or an extraction, those with higher dental anxiety recalled more words associated with physical and psychological threats than positive words. Dental anxiety scores also predicted how many psychologically threatening words patients recalled.
Additional research has found a similar attentional bias. A 2020 study of 53 people with high dental anxiety found that their attention was drawn disproportionately to dental threats. Earlier research involving patients with dental anxiety also found greater attentional interference from threatening dental information.
For sedation dentistry, that matters, long before any medication is administered. A high-fear patient can be alert, engaged in the discussion, and trying to absorb the treatment plan while anxiety is already competing for their attention.
Research outside dentistry helps explain why. In a study examining anxiety, distractibility, and short-term memory, anxiety was independently associated with reduced short-term memory performance, while worry was closely associated with distractibility.
This result, often seen in dental practices, can show up as inconsistent memory of a conversation that seemed clear at the time.
When Care Happens in Phases
Phased treatment creates an obvious place for that memory gap to show up.
A patient may understand during initial consult that immediate treatment doesn't complete the full treatment plan. Perhaps active disease is addressed first while restorative care is postponed, or the most urgent treatment moves forward while other recommendations wait.
Once the pain, infection, or problem that brought the patient to the practice has been addressed, the sense of urgency changes. Months later, the details of deferred treatment may no longer be as clear as they were during the original discussion.
For high-fear patients, completing that first phase also carries tremendous emotional weight. Someone who has struggled to seek dental care may understandably experience finishing treatment as a major accomplishment, even when the clinical plan extends beyond a single appointment.
That's where a dentist's recollection of “phase one is complete,” and a patient's impression of “my treatment is complete” can differ altogether.
Keep the Plan Clear
- Written summary: A written summary gives the patient something concrete to return to after the appointment, and as their treatment progresses. For phased or deferred care, it can identify what's already complete, what recommended care remains, and why those treatments are important.
- Tone and language: The tone you use deserves just as much attention as the information itself. Conversation focused on future failure, expense, or everything that could go wrong can add to the fear already surrounding their care. Clear, conversational language will best communicate the same concerns without making the situation feel punitive or threatening.
- Power of written words: Written information should match the conversation you had with the patient. If the practice has spent considerable time building trust and helping a fearful patient move forward, the follow-up shouldn't suddenly sound like a warning drafted for the chart.
For a patient who has worked through significant dental fear, completing one phase of care can feel like a major victory. Once the immediate problem is gone, however, the urgency that helped carry that patient into treatment may fade with it. Details about what comes next can become much easier to lose.
In Conclusion
High-fear patients may listen closely, yet they can still remember a completely different mix of details than you'd expect. Reinforcing the full plan in writing gives them a clear way back to the conversation, so the relief of finishing one phase doesn't become the mistaken belief that treatment is wrapped. For the dentist, that also means fewer surprises later and a better chance of keeping the patient engaged and willing to follow the treatment plan from start to finish.
Author: With over 16 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.
References
- Moreira NCF, Pachêco-Pereira C, Keenan L, Cummings G, Flores-Mir C. Informed consent comprehension and recollection in adult dental patients: A systematic review. Journal of the American Dental Association. 2016;147(8):605-619.e7.
https://doi.org/10.1016/j.adaj.2016.03.004 - Bodner E, Iancu I. Recalling the threat: Dental anxiety in patients waiting for dental surgery. Israel Journal of Psychiatry and Related Sciences. 2013;50(1):61-67.
https://pubmed.ncbi.nlm.nih.gov/24029113/ - Lapointe MLB, Blanchette I, Duclos M, Langlois F, Provencher MD, Tremblay S. Attentional bias, distractibility and short-term memory in anxiety. Anxiety, Stress & Coping. 2013;26(3):293-313.
https://doi.org/10.1080/10615806.2012.687722 - Johnsen BH, Thayer JF, Laberg JC, et al. Attentional and physiological characteristics of patients with dental anxiety. Journal of Anxiety Disorders. 2003;17(1):75-87.
https://doi.org/10.1016/S0887-6185(02)00178-0 - Siev J, Behar E, Fortune MR. Attentional bias and training in individuals with high dental anxiety. Frontiers in Psychology. 2020;11:1057.
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01057/full
