Achieving the "Pot of Gold" with High Fear Patients

Published Date 04/07/2017

In the best-selling, classic book, entitled Three Feet from Gold,  by Napoleon Hill, a young man gives up on his dreams of becoming rich, while prospecting for gold, when he is a mere 3 feet from hitting a major gold vein.  Caring for the fearful dental patient can be a circumstance in which dentists often give up before digging deeper to achieve success.   Anxiety and dental fear can literally paralyze patients and keep them from seeking dental care. As dental care providers, we need to be able to uncover the cause of their distress , while building trust,  which is truly achieving the “pot of gold”.  Each part of the appointment is an opportunity to build the relationship and add to the level of trust and comfort the patient experiences while in our care. 


Roxanne is a patient much like ones that you might see every day in your own practice--one that expects high quality dentistry, while hoping that the appointment proceeds in an efficient and comfortable manner.  She is a 48 year old woman with many posterior crowns, due to breakage, bruxism, and years of dental neglect.  To complicate matters, Roxanne has high anxiety.  However, she has been steadfastly working to improve her mouth, since she became a patient in my practice 6 years ago.  She has completed the work in three quadrants so far, and today she presents to finish her dental restorative treatment in the lower left quadrant.


Several different products and adjunctive treatment modalities have been uniquely beneficial for me as I work on anxious patients (and non-fearful patients alike).  Each of these aid my team and myself in providing them the comfort and efficiency  they deserve during their dental appointments.

  1. 1)    Nitrous oxide and behavorial modifications
  2. 2)   EMLA (Eutectic Mixture of Local Anesthetic) topical cream—for supreme soft tissue comfort prior to anesthetic placement
  3. 3)   Isolite—quick and easy isolation of the area
  4. 4)   Seek and Sable (Ultradent) caries indicator—to ensure complete caries removal
  5. 5)   Reflectys (Itena) hybrid composite—butter-like consistency, esthetic and strong composite for buildups and anterior/posterior composite fillings.
  6. 6)   Dentocrown temporary material (Itena)--- esthetic temporary material with a durable finish
  7. 7)   Dentotemp temporary cement (Itena)— robust temporary cement for short preps or bruxers

Roxanne has deep caries, fracturing, breakage and large existing amalgams in teeth #18 and #19, and caries in the disto-occlusal aspect of #20 (Figures 1-3).  I have planned to do full coverage porcelain fused to metal crowns on #18 and #19, and a DO composite filling on #20.  The caries are very deep on the disto-facial aspect of #18, so I decided to proceed with porcelain fused to metal crowns for optimal strength.



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Dr. Kate Gross earned her Bachelor of the Arts in Human Biology at the University of Kansas and completed her Doctorate of Dental Surgery at the University of Missouri-Kansas City. She is a member of the American Dental Association, Academy of General Dentistry, and the Crown Council. She is an Achievement Award recipient of the American Orthodontic Society, and past president of the Salina Dental Society. She enjoys attending continuing education courses that present ways that patients can improve their quality of life and have a healthy, beautiful mouth and smile. Most recently, Dr. Gross has completed courses for Invisalign®, sleep apnea, and comprehensive orthodontics.


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