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a woman in her 70s drove up to the tire shop where she had purchased snow tires a year or so before. She knew only the location and didn’t realize that the tire shop had been replaced by a Nordstrom. The woman said she wanted a refund for the tires. Despite the fact that Nordstrom doesn’t sell tires, the Nordstrom service representative accepted the snow tires and fully refunded the woman the price of the tires! People still talk about that act of customer service to this day, making it one of THE most valuable decisions Nordstrom has ever made. Think about it ... The woman probably told locals about Nordstrom accepting her tires. People had to be impressed; they’re still impressed! They likely remained loyal Nordstrom shoppers for years, praising the customer service and attention to detail in the store. (Keep this power of “word-of-mouth” referrals in mind as you keep reading.)
And that brings us to step No. 2.
powerful. If they are still feeling anxious when they get to the office, then offer them 0.125–0.25 milligrams more. Unless you have advanced training, this should be the limit you offer patients. By communicating with your patient, you can gauge their level of anxiety. These patients will be able to converse with you and share their feelings. This is a key step in this process because if you lose verbal communication with a patient, then you have gone too far in taking the edge off their anxiety. Instead, you have a bigger concern with their airway and other possible issues. Due to the benzodiazepine, the patient will be unable to swallow and their mouth will likely try to close on its own as well. You can aid in this by propping the mouth open, which will take away the protective reflex that causes the mouth to close. A throat pack and oral suctioning in the back of the pharynx will prevent choking. This strain can be painful for patients as they come out of the fog and recover from their procedure, and that’s what leads us to our third step.
STEP 2: USE ORAL BENZODIAZEPINES
EDITOR’S NOTE: Before offering any level of sedation to your patients, be sure you fully understand and are in compliance with your state board’s regulations and that you have met all educational and safety requirements. Dr. Mahoney’s recommendations are only to raise your awareness of the possibilities and are not a substitute for appropriate sedation continuing education. In addition, prior to introducing sedation to your practice, consult with your attorney and inform your malpractice carrier that you are offering sedation. Regardless of how careful or gentle you are, the entire process at the dental office is going to feel like one long horror show for someone who has dental anxiety or is not in a mental state to understand common dental practices. That’s where the use of oral benzodiazepines comes into play.
Now, imagine if you could offer that same quality in your dental practice?
According to Dr. Mahoney, it’s more than possible, especially when treating those with dental anxieties. From the minute your patient walks through the door, approach them with empathy, compassion, and kindness. Ask if there’s anything at all you can do to make them comfortable. Immediately walk them back to their chair while continuing to offer the highest level of white-glove VIP care that you can. Once they are in the chair, offer them a down pillow, a comforter, or other cozy item (with appropriate disposable or washable cover) that will diminish the harsh, sterile environment of a dental room. You may pride yourself on the comfort in your dental chair, but all someone with dental anxiety notices are the sharp tools and loud machines. Go that extra mile to ensure they are comfortable. Finally, turn the lights down, play soft music, and continue talking to them. Do not let their mind wander to what could happen or to get lost in their fears. In addition, if they have already taken an oral benzodiazepine, they will need you and your team to continue talking to them so you can monitor their level of consciousness and dosage.
"This isn’t a vacation; it’s an opportunity! You cannot stick your head in the sand and wait for this rain cloud to pass. Get to work ON your business so you have a business to return to when this does end."
STEP 3: FIRST-CLASS POSTOPERATIVE RECOVERY
You want to make sure your phobic patient’s care exceeds even the best care you have ever offered. After their procedure, continue this level of care. Dr. Mahoney recommends offering your patient something to drink to soothe the mouth after it’s been open for a long period of time. Massaging the masseter muscle can also be a powerful relaxant as it soothes the patient and the sore muscles that had to be propped open. Congratulate them on completing the procedure and let them know they did a great job. This boosts the confidence they need to continue seeking dental care and reminds them that they played an active role in their own care by taking this very big step. Continue this level of comfort all the way to the door to ensure they return and tell others about the fantastic work you do. Remember,
You want to bring your patient to a state where they feel comfortable with you and your staff. Those fears may still be there, but the benzodiazepines can muffle the noise that anxiety is causing in their mind. It brings them to a level of general comfort, making your actions and care measures that much more effective. Provide your patient with 0.25 milligrams of triazolam about an hour before their appointment. (They will need someone to drive them to the appointment.) This will relax them, making the soothing, comforting patient service you offer when they walk through the door all that much more
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