approaches that can be taken with patients with
What are some
of the options for outside help?
Systematic desensitization is
an effective behavioral strategy for helping people overcome fears and
phobias. It involves identifying responses a person might learn that
are opposite to his fear responses, such as becoming relaxed. The
individual is then taught to engage in those responses when gradually
being exposed to the precise situations that produce
Desensitization is a gradual exposure technique that relies
on the behavioral principle of shaping. Shaping involves teaching a new
behavior (such as relaxing) gradually, by practicing
and reinforcing its application in small steps of increasing exposure
(approximations) to the full fearful situation. The first step is to
work with the patient to establish a fear
hierarchy. This is a list of
fear-producing situations ordered from “least amount of fear” at the
bottom to “most amount of fear” at the top. Through any number of
methods, the patient should learn to relax on cue, releasing the
tension in muscles while taking slow, deep breaths.
Once the patient can relax, this response is applied during
exposure to the fearful situations on the fear hierarchy, starting at
the bottom – approximations to the end goal - and working towards the
top. Patients need lots of positive reinforcement and support as they
work through their fears. This approach should
be tailored to the specific ability of the patient to understand and
We are acutely affected by all of our senses:
hearing, sight, smell, touch and taste. Here are some tips for reducing
sensory-related anxiety in each of these areas.
Voice Control: Many patients are overly sensitive to the
sound of our voices. Using quiet and smooth tones (voice control) is
more relaxing than allowing yourself to use a voice that is hurried and
Noise generated by dental equipment: Sounds produced by the
suction, dental handpiece or amalgamator can cause stress. When
possible, clinicians should relate these items to familiar and
non-threatening objects. For example, the suction can be referred to as
a loud straw or Mr. Thirsty; the handpiece as a tooth tickler or dust
buster; and the amalgamator as a filling machine.
Music: Some patients enjoy listening to relaxing music such
as soft instrumental, rain or water sounds. Others may choose to bring
in their own music and listen to it on headphones. This allows them to
drown out extraneous noise. A few patients will prefer to have no music
playing, as they find the background noise too distracting.
cleaners and disinfectants have strong odors. Try to find alternative
cleaners that don’t contain these additives.
clean-smelling air fresheners
It may be
necessary in some instances to eliminate all odors as best as
Touching firmly but gently will reassure the patient.
Unexpected touch can be difficult for patients who are
sensory defensive. Approach the person from the front and provide a
warning before touching.
It may be helpful to allow patients to touch some of the
equipment. Once they have felt some of the tools they seem less
concerned about them.
Allow patients to help by holding the saliva ejector, using
it when they want to. They may enjoy being your helper.
Place a small bean bag chair or pillow on top of the dental
chair to help make the patient feel more secure.
Leaving small children in their stroller is another
Patients with autism often have a sensory integrative problem
with balance and movement, and with proprioception. They may even like
being wrapped in the pedi-blanket or papoose wrap. Several companies
design and produce equipment for this purpose. This topic is covered
more in depth later in the module.
Some patients are very sensitive to strong
tastes. Ask the patient, or a parent or care provider, if they know of
a preference, such as fruit bubble-gum or mint flavor. In some cases
you may find it more suitable to use a toothpaste brought from the
Rinsing or wiping out the patient’s mouth
quickly can eliminate an unpleasant taste.
Seeking Outside Help
What about patients whose problems are more extensive than
what you may be able to manage? Several resources such as the ones
listed below are available:
mental health clinic
college or university psychology department
staff of your local hospital
courses, workshops and other forms of short-term specific instruction
for your dental staff
dental school with a special treatment clinic for dental