Providers' Assessment and Management of Dental Fear: A Qualitative Analysis

Little is known about how providers assess and manage dental fear in private practice. Objectives: As part of a qualitative study, dentists were asked how they identify and manage patients' dental fear. Methods: Dentists were interviewed by telephone regarding their experiences in treating fearful patients. Two groups of dentists in the Seattle area were recruited: providers who used “gentle” techniques or similar terms in their telephone directory advertisements, and members of the Dental Organization for Conscious Sedation (DOCS). Providers were asked about how they recognize and manage fearful patients. Results: Nineteen private practice dentists (22% female; 56% “gentle” dentists) participated in the telephone interviews. One provider was removed from analyses because he did not identify as belonging to either provider group during the interview. Percentage of fearful patients in the practice varied substantially among providers, ranging from 2-80%. Most reported that they ask directly about patients' fears during the initial examination; over half include a question about fear on health history forms. A greater proportion of “gentle” dentists reported using these direct methods of fear assessment, compared with behavioral observation used by half of the “DOCS” dentists (and one third of “gentle” providers). Most providers noted that “personal experience” and “trial by error” were the primary means by which they learned to manage fearful patients, while fewer than half indicated that they received formal training in fear management. The majority of providers noted that treating fearful patients is often “stressful,” “tiring,” or “challenging,” although some noted it could be “rewarding” as well. Conclusions: While most providers in this study took steps to assess and manage their patients' fears, few reported receiving formal training in fear evaluation or management. Additional instruction in working with fearful patients may decrease provider stress. Funded by U54 DE 14254 and T32 DE 007132.