Managing expectations to give better treatment

People are surprising and rarely behave like the textbooks! I was reminded of this again today whilst working on a patient who was terrified of dentists.

We often carry out anxiety assessments on our patients. We use the Modified Dental Anxiety Scale and then the Index of Sedation Need to decide if we can help them with sedation.

It is very tempting though to see a high MDAS score on a patient form and think “they are massively nervous, it’s going to be difficult to carry out treatment on them”.

Looking back at my data over the last few years, comparing patient compliance scores  with their MDAS scores I’ve found no correlation at all. There is actually more of a correlation with anxiety medications and recreational drug use.

Yes, to my medical colleagues this is very low grade anecdotal evidence with some numbers, but I think I know why quite often the patients who report the most anxiety are often easier to treat.

I believe it’s all down to expectations. A patient who is petrified has often done most of the hard work before they get into the chair. They have summoned up the courage to phone, booked in for a checkup, found out what needs doing, booked the appointment and arrived on the day. That’s a huge thing for someone who really doesn’t want to go!

Quite often people believe it’s going to be nerve wracking, awful, painful and expecting the worse. I’ve seen that in my own patients but also through the comments people put on our facebook forum. The vast majority of the time they are completely surprised by how straightforward it was.

So the anxious patient may have low expectations when they arrive on the day. When even a small amount of sedative is administered, that fear starts to subside and they start to enjoy themselves. It was way better than they thought, they didn’t care as much, didn’t feel anything and don’t remember most of the treatment.

I have found it’s quite often the patients who expect to be “asleep” or the patients who are mild to moderately nervous who can present a challenge.

If their expectations are that they will be completely “out of it”, they’ve been told that by the dentist or by their friends or family, they will only be disappointed if they become even slightly aware of being in the chair.

Managing this expectation is important. I get asked by many patients “so you can guarantee I will be asleep?” Of course my answer is “no, it’s called conscious sedation, you are awake but afterwards you will think you’ve slept”.

It is crucial that patients aren’t given a false sense of oblivion, that the idea of conscious sedation is to make dentistry easier for them, not to be a “general anaesthetic”.

By far the vast majority of patients really enjoy even a long session of dentistry under sedation!

If you are a patient, you can visit us at or join our facebook group Dental Phobia UK.

If you are a dentist and want to provide sedation to your patients, visit

Happy dental-ing!