Why communication is a clinical matter, not a courtesy

Most people's anxiety about the dentist is not only about pain. The Victorian Department of Health's Better Health Channel lists the causes as including “a traumatic dental experience or other healthcare experience”, “fear of loss of control” and “trust issues”, alongside the needles, drills and setting that are the obvious triggers. A great deal of it is about not knowing what is happening, not knowing what it will cost, and not feeling able to ask.

It is also common, and it has measurable consequences. In the 2002 National Dental Telephone Interview Survey (Armfield and colleagues, BMC Oral Health, 2007, n=6,112 Australians aged 16 and over), 11.9% said they were “very” afraid of going to the dentist and a further 5.2% “quite” afraid. Among the very afraid, 43.9% had last seen a dentist more than two years earlier against 29.1% of those with no fear; 27.6% expected to go only when they had pain or a problem against under 17% of everyone else; and they had significantly more teeth missing through decay. Better Health Channel has a name for that loop — the “vicious cycle of dental anxiety”.

Which means communication is not a nicety layered on top of the treatment. It is part of the treatment, and it determines whether people attend at all — which is why it belongs on the list of things to weigh up when you are working out what makes a truly great dentist.

Below is an illustrative walk-through of what good communication looks like across a single appointment. It is a composite scenario written to explain the approach — not an account of a real patient, and not a testimonial.

Before anything clinical happens

The environment does some of the work

A new patient waiting for a first appointment is usually asking themselves three things: what will this dentist be like, what will they make of the state of my teeth, and what will they recommend?

That second question carries most of the anxiety. People who have avoided the dentist for years are frequently expecting judgement, and it is the reason they keep avoiding it. See Dental Anxiety and Can I ease my anxiety about visiting the dentist?.

A calm, light-filled waiting area helps. So does being greeted by name, and introduced to the clinician rather than delivered to them — the clinicians and their qualifications are set out on Our Team and Dentists and Registered Specialists, so you can know who you are meeting before you arrive.

A handshake and an introduction

Small, and more significant than it sounds: being met as a person before being treated as a mouth. The tone set in the first thirty seconds shapes everything that follows.

The conversation before the examination

Talking first, examining second.

A good appointment starts with a conversation about your overall health, your teeth, and your concerns — with the clinician listening with genuine interest rather than waiting for a turn to speak.

The order matters clinically as well as emotionally. What you are worried about, what has hurt, what you have avoided and why are information no examination produces — a history of tooth pain that comes and goes, for instance, changes what the clinician is looking for before they look.

Your medical history belongs in that conversation too, including medicines you take, conditions you have, and allergies — several of them change what treatment is appropriate and how it is planned. Diabetes and pregnancy are two of the common ones, and both are worth raising rather than waiting to be asked.

If you are not sure what is reasonable to bring up, 5 questions you've always wanted to ask your dentist is a fair starting list.

Looking at your own images

After the examination and X-rays, the images are reviewed together on screen, with the clinician pointing out what is fine as well as what needs attention. The technology is only worth having if what it produces is shown to you.

Two things follow from this:

You can see the evidence yourself. A recommendation attached to a visible finding is a different proposition from one delivered as an assertion.

You hear what is healthy, not only what is wrong. Most mouths are largely fine, and saying so is honest rather than generous.

On imaging specifically, every radiograph should have a reason — it is reasonable to ask why this one, now, and what it will change. See How safe are dental X-rays? and when they become unsafe.

Options, not instructions

Each recommended treatment is explained in detail, along with the alternatives — including, where reasonable, monitoring rather than treating.

You should not feel pushed in any direction. If you do, asking for a second opinion is a normal request rather than an insult, and a clinician who is confident in the plan will not mind.

The underlying principle: you make the decisions about your own dental health, with the benefit of professional insight and support. Informed consent is a legal requirement — the Dental Board of Australia's Code of conduct carries separate sections on good care, effective communication and informed consent — but it is also just the correct way round, because the treatment is happening to you.

Consent means hearing the risks as well as the benefits, and "what happens if we do nothing" is a legitimate option that should be on the list rather than omitted from it. See Understanding Your Treatment and General Dentistry. Where the plan involves a registered specialist, the same standard applies to their part of it — see Why would I need to see a dental specialist?, and, where several of them are involved at once, Complex Dental Cases, where the coordination between clinicians is itself a communication problem.

Where the work is cosmetic, the conversation can be made literal: the proposed result can be modelled and shown to you before anything irreversible is done. See The Mock-Up Reveal and why you should see your new smile before any treatment begins.

Costs, before you commit

Appointments made, prices discussed, and payment plan options explained — at reception, before treatment begins.

This is where a good deal of dental distress originates, and it is entirely avoidable. It is also not discretionary for the clinician. Writing to practitioners in its position statement on teeth whitening, the Dental Board of Australia sets the standard plainly: “before any treatment, you must ensure the patient has reasonable expectations and understands the risks”, and “you must have and document their informed consent, including financial consent”. Cost is part of consent, not a separate conversation at the desk afterwards.

A written quote covering the whole course of treatment — not just the first appointment — is a reasonable thing to ask for, and a reasonable thing to expect.

Ask for the item numbers with it. Reading those to your health fund is the only reliable way to establish your gap before you start. See Price Guide, and, on how finance has changed the conversation in dentistry generally, Patient Dental Payment Plans.

The test of whether it worked

The measure is not how the appointment felt in the moment. It is whether the patient comes back in six months — and whether they arrive without dread. On what that interval should actually be for you, see How often should I go to the dentist?; in practice much of that recall is with a hygienist rather than a dentist.

That is what communication buys: not comfort for its own sake, but continuity of care. The Armfield survey above is the reason that matters — fear tracks with avoidance, and avoidance tracks with more teeth lost to decay. Better Health Channel is blunt about the trajectory: “adults who are anxious about dental care tend to remain anxious throughout life”, which is an argument for addressing it rather than waiting for it to fade.

What you can ask for

If communication has been the problem in your past dental experiences, these requests are all reasonable:

• "Please explain what you are going to do before you do it."
• "Can I see the X-ray or photo?"
• "What happens if I do nothing for now?"
• "What are the alternatives, and what would you choose?"
• "Can I have the full cost in writing before we start?"
• "I'm anxious — can we agree a signal for stopping?"

None of these should be awkward to ask, and the answers tell you a good deal about the practice.

On that last one specifically, a stop signal agreed beforehand returns control to you, and knowing you can stop is often enough that you do not need to. “Fear of loss of control” is on Better Health Channel's list of causes of dental anxiety, and the signal is the direct answer to it. See A comfortable injection is possible, and Sleep Dentistry where more than that is needed.

In an emergency the same rules hold, compressed — you are still entitled to know what is being done and what it will cost before it happens. See Emergency Dentistry.

For a child, the same principles apply in a different register — see First Visit to the Dentist, Children's Dentistry and Combating dental anxiety in children.

Common questions

I have put this off for years and I cannot point to anything that caused it. Does that make sense?

It does, and the research says so explicitly. Armfield and colleagues, discussing their Australian survey, note that while dental fear often follows a bad experience, “cognitive factors are suggested by findings that many highly anxious people can not recall an aversive event which might explain the origin of their dental anxiety”. You do not need a story to justify the feeling, and you are not required to produce one to be taken seriously.

The avoidance pattern itself is well described in the same study. Of the people who said they were very afraid of the dentist, 29.2 per cent fitted the full profile of delayed visiting, dental problems and going only when symptoms forced it — against 11.6 per cent of people with no dental fear. Adjusted for sex, whether they still had their own teeth, employment and household income, the odds of a very fearful person fitting that profile were 3.33 times higher (95% confidence interval 2.67 to 4.15).

So it is a recognised clinical pattern with a measured size, not a personal failing. The practical consequence is worth saying plainly: the longer the gap, the more there tends to be to deal with, which makes the next appointment harder to face — which is the cycle. Saying “it has been a long time and I am dreading this” at the point of booking gives the practice the information it needs to plan the visit differently, usually by starting with a conversation and an examination and nothing else.

Beyond being talked through it kindly, does anything actually reduce dental anxiety?

Some things do, some widely offered things do not, and a 2024 systematic review in the Journal of Anxiety Disorders (Steenen and colleagues) is the most careful attempt to separate them. It screened 173 randomised controlled trials, pooled 67 of them covering 6,038 participants, and graded the certainty of each result.

What it supports. For long-standing (trait) dental anxiety, cognitive behavioural therapy — moderate certainty. For anxiety during oral surgery, hypnosis (standardised mean difference −0.31, 95% CI −0.56 to −0.05, moderate certainty) and benzodiazepine sedation (−0.43, 95% CI −0.74 to −0.12, low certainty). The authors describe both of those as having “comparably small effect sizes”, which is an honest framing rather than a dismissive one.

What it does not support. With moderate certainty, the review found that virtual reality exposure therapy, virtual reality distraction, background music, acupuncture and pre-operative video information did not alleviate anxiety during treatment, and with low certainty that aromatherapy did not either. Music, for instance, came out at −0.10 (95% CI −0.23 to 0.03) once an outlier trial was removed.

That is contested rather than settled — the same paper notes it “contradicts a recent network meta-analysis” which did find a benefit for music and virtual reality, and argues the earlier analysis was undermined by statistical heterogeneity. Worth knowing if a practice offers these: they are pleasant, they are not risky, and the best current evidence does not show they reduce anxiety.

One finding is directly about the subject of this page, and it cuts against an easy assumption. Replacing a conversation with a pre-operative video made no measurable difference (−0.04, 95% CI −0.19 to 0.12, across 7 trials and 605 participants). Information delivered is not the same thing as being listened to.

The authors' closing instruction is the most useful sentence for a patient to borrow: “clinicians should ensure that interventions match their purpose — managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies”. Sedation handles the appointment. It does not treat the fear.

If talking is not enough, what are the sedation options — and who is allowed to provide them?

The consumer terms and the clinical categories do not line up, which is why this is worth setting out. The Australian Dental Association's policy defines four levels, and none of the marketing phrases appears in it:

• Minimal sedation — “a drug-induced state of diminished anxiety, during which patients are conscious and respond purposefully to verbal commands or light tactile stimulation”, using a single low-dose oral medicine or inhaled gas. Nitrous oxide sits here, and the ADA classifies it as minimal sedation or anxiolysis. It is not “sleep dentistry”.
• Moderate sedation — depressed consciousness, but patients “retain the ability to respond purposefully to verbal commands and tactile stimulation”. This is the level that “includes the use of intravenous sedation”.
• Deep sedation — patients “are not easily roused and may respond only to noxious stimulation”.
• General anaesthesia — “controlled unconsciousness accompanied by a partial or complete loss of protective reflexes”, including the inability to maintain an airway independently.

Who may provide what is a registration fact you can check. The ADA's position is that dentists with sufficient training and experience may use minimal sedation techniques, but that to provide moderate sedation “a dentist must be endorsed by the Board and have completed a Board approved program of study”, with a mandatory two-year period in general practice before seeking that endorsement. An endorsement appears on the Ahpra register, so “we offer IV sedation” is a claim you can verify rather than take on trust.

Two cautions, both from the ADA's own policy. “Both general anaesthesia and conscious sedation procedures encompass risk” — a page that presents sedation as risk-free is contradicting the national professional body. And sedation in a practice is not a substitute for hospital care where that is what is needed: “availability of Conscious Sedation services cannot replace the need for access to general anaesthesia services in hospitals for dental purposes”.

What can I ask for during the appointment itself?

Better Health Channel publishes a list of coping techniques, and every item on it is something you can simply request:

deep breathing; meditation; distraction (such as listening to music or the use of devices); guided imagery; progressive muscle relaxation; agreeing with your dentist on a signal to stop during the treatment for a break (such as raising your left pointer finger or hand); using a weighted blanket (bring your own); hypnosis.

The stop signal is the one to insist on. It is also the one the clinical literature backs indirectly — the American Academy of Pediatric Dentistry notes that “giving the patient a short break during a stressful procedure can be an effective use of distraction before considering more advanced behavior guidance techniques”. In other words, a pause is a treatment step, not an inconvenience.

Two named techniques are worth asking for by name, because they are formally described methods rather than bedside manner. Tell-show-do explains, demonstrates, then does, using verbal and non-verbal communication and positive reinforcement; the AAPD lists its indications as “use with any patient” and its contraindications as “none”. Ask-tell-ask adds a second check afterwards: asking how you feel about a planned procedure, explaining it in non-threatening language, then “again inquiring if the patient understands and how she feels about the impending treatment”.

And where the anxiety is long-standing rather than situational, Better Health Channel is direct about the referral: “referral to a psychologist can be helpful too. Short, targeted therapies including cognitive behavioural therapy can be very successful.” That is consistent with the review above, which found CBT the best-supported option for chronic dental anxiety.

If the communication does break down, how do I raise it, and with whom?

Start with the practice, in writing, and ask for a specific outcome — an explanation, a revised plan, a corrected estimate, or your records. Most of what goes wrong is recoverable at that stage, and a practice that handles a complaint well is usually worth staying with.

If that fails, there is a statutory route. Ahpra explains that the national health practitioner boards are responsible for “managing complaints and concerns (notifications) about the health, conduct or performance of practitioners”, and that the pathway differs by state: in New South Wales notifications about health, performance and conduct are handled by the Health Care Complaints Commission and the Health Professional Councils Authority, and in Queensland jointly by the Office of the Health Ombudsman with the National Boards and Ahpra.

A separate channel exists for advertising — misleading claims, prohibited testimonials, before-and-after images used contrary to the guidelines. Those are managed under Ahpra's advertising compliance and enforcement strategy, using the complaint form on the Ahpra website; Ahpra's own material gives 1300 419 495 for information about making one.

What a complaint is not for: a clinical outcome you are unhappy about is often better addressed first by an independent examination and a written second opinion, because that produces the evidence any later process would need anyway. See Second Opinions & Corrective Dentistry.

Is any of this different for a child?

The techniques are more formalised, and the stakes are different in a way that is worth knowing. Better Health Channel draws the contrast directly: “children who have had bad dental experiences can likely overcome their fear if they are supported during further dental visits”, whereas “adults who are anxious about dental care tend to remain anxious throughout life”.

So a child's fear is usually reversible with support and an adult's usually is not, which is the whole argument for spending time on a child's early visits rather than getting the treatment done quickly.

The methods have names and published indications. Alongside tell-show-do and ask-tell-ask, the AAPD describes systematic desensitisation — “a process that diminishes emotional responsiveness to a negative, aversive, or positive stimulus after progressive exposure to it”, where a child is exposed gradually across several appointments to the parts of a visit that worry them, sometimes beginning with a preparation book or video reviewed at home.

In practice that means the first appointment may deliberately achieve very little, and that is the point rather than a waste of the fee. See First Visit to the Dentist and Combating dental anxiety in children.

Related reading

• Is it important to have a family dentist?
• Finding a dentist online in Australia
• The Smile Solutions Experience
• Why Choose Us

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Full details on Contact Us, and getting here is covered on Location.

Payment plan options are available. Where a plan is advertised as interest free, that describes the plan term only — a deposit may be required, an establishment fee and ongoing account fees may apply, and charges can apply if the balance is not cleared within the agreed period. The applicable terms depend on the provider and the amount financed, and are set out in writing before you commit — ask what the deposit and the establishment fee are, in dollars, and what the total will be by the end. See Payment Plans.

Published 1 July 2013. The scenario described is illustrative, written to explain an approach; it is not a patient testimonial. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit. Sedation definitions and the endorsement requirements quoted in the questions above are the Australian Dental Association's, and effect sizes are from the cited 2024 systematic review; neither is a statement about what any individual practitioner provides — check the Ahpra register and ask. General information only.

Smile Solutions trades under ABN 28 193 514 103.