“Psychological knowledge and techniques will save time, money and frustration in the long run”

When it comes to collaboration with psychologists in a dental setting, many clinicians think simply of writing referrals for patients with anxiety. Dental Tribune International spoke with Lena Myran, a clinical psychologist and PhD student who specialises in oral health psychology, about the profound impact that a working relationship with a psychologist can have on a dental practice. The following conversation is based on a recently published textbook chapter titled “Working in Partnership for Better Oral Health Care”. This and several other chapters authored by Myran can be found in the 2022 textbook Oral Health Psychology: Psychological Aspects Related to Dentistry, published by Springer.

Ms Myran, in your chapter “Working in Partnership for Better Oral Health Care”, your team acknowledged that teamwork between a dental practice and a psychologist could provide significant improvement in patient care. Could you share with our readers how your team initially identified the potential for psychological care within dentistry?
All of the chapter co-authors are psychologists working in dental healthcare or they have worked in collaboration with dentists for many years. In my country of Norway, I have been working specifically on a project offering facilitated dental care for people who have experienced torture or sexual abuse or who have odontophobia.

Anxiety, however, has many expressions. When anxious patients enter the examination room, tears, outbursts, avoidance or forced talkativeness is normal. These anxiety expressions might make the dental team insecure and lead its members to question how they can best understand the patient and handle the patient’s behaviour.

Psychologists working closely with dental teams and their patients can help make these behaviours understandable, explaining seemingly irrational behaviour in comprehensible terms. Effective treatment for anxiety has been well documented. In this respect, it is rewarding to apply exposure therapy and to see a client being able to successfully make progress in dental treatment.

Clinical psychologist, Lena Myran. (Image: Lena Myran)

For those who have not yet read the chapter, could you outline why understanding patient behaviour and psychological illnesses is so vital to successful treatment and also to running a successful practice?
For anxiety in general and dental anxiety in particular, the underlying mechanism that maintains and enhances the anxiety, is avoidance. Avoidance is the action that keeps the patient from turning up at dental appointments or prevents him or her complying to dental treatment. The cognitive psychologist Dr Scott Barry Kaufman put it well: “It’s perfectly human to fluctuate between fear and growth. However as Maslow said, ‘One can choose to go back toward safety or forward toward growth. Growth must be chosen again and again; fear must be overcome again and again’”. Avoidance, therefore, costs a considerable amount of money owing to missed appointments and prolonged treatment and causes frustration both inside and outside the dental practice. Even though psychological interventions and alliance-building conversations are costly, psychological knowledge and techniques will save time, money and frustration in the long run. Satisfied patients tend to come back for treatment.

The chapter talks about the benefits of building a multi-disciplinary team. As some dentists might not have previously considered involving a psychologist in patient treatment, what tips could you offer to a practice owner as he or she seeks out a good psychologist to work with?
I do not know how mental health systems are built in Europe, but many countries already have multi-disciplinary teams which include available psychologists or dental healthcare professionals with special training for dealing with dental anxiety. They are often happy to discuss patient-related cases with you or accept your request to short internships or collaborations. If you are really interested in developing your own practice into a trauma-sensitive specialised practice, contact general practitioners. They are usually updated on available healthcare services and thus will know where to find psychologists.

No one can manage all parts of dental anxiety treatment alone; we need each other to be able to provide the best service possible.

What would an ideal practice look like to you in terms of teamwork and the utilisation of a multi-disciplinary approach to both enhance patient care and build a healthy team?
One of the most important factors building a healthy team is the acknowledgement that we all have important roles and distinct competences. No one can manage all parts of dental anxiety treatment alone; we need each other to be able to provide the best service possible. Mutual respect is therefore of the essence. The role of the dental secretary, for example, is important to a practice because of their facilitating and sensitive contributions.

Another factor important to building an ideal practice is the establishment of a safe environment where it is normal for both patients and members of the dental team to experience strong feelings and make daily mistakes. Those feelings and mistakes should be addressed with curiosity and enthusiasm, and not as something to be ashamed of or scared of. Making mistakes is often the best way to learn new skills.

Working with abstract concepts like relationships and human behaviour makes it necessary to abandon the urge to make things perfect. The team should be trained to find success in every session. Did the patient use the stop signal more often today? Did the patient give more honest feedback? It can be difficult to recognise the successes during treatment, as it is never purely success or defeat. We should think in terms of degrees of success.

Do you have any other perspectives you would like to share with our readers?
Working in partnership with psychologists is important in the treatment of patients having severe dental anxiety. However, as famous clinical psychologist Dr Marsha Linehan put it, “A good professional relationship is one human being trying to help another human being”. Establishing an environment where your patients feel safe is half the job of getting dental treatment done with anxious patients. Reading this article makes it likely you already have a special interest in helping anxious patients. Trust yourself and your gut feeling. You will come a long way by being an authentic, accepting and empathic human who is using his or her knowledge to help another human being.


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