The User Experience of Going to the Dentist
Photo by Caroline LM on Unsplash
I am going to start by confessing that I am very very anxious when going to the dentist. It makes me feel incredibly vulnerable to sit immobilized in a chair with my mouth open while someone with very sharp instruments drill into my teeth, the tool vibrating with high-pitched whirring in my ears. To say it is incredibly uncomfortable is quite an understatement. Yet I voluntarily subject myself to this experience two times each year, and actually pay for it! This is because I live in America, and in America, good teeth is kind of a requirement. Turns out, I am not alone. According to a survey by DentaVox, 61% of those who responded reported having fear of dental procedures. Of those who dread going to the dentist, the fear of pain is the biggest contributing factor to the anxiety in the dentist chair.
Since starting my User Experience Design training, I have begun to think more deeply about some of my less-than-positive user experiences, and going to the dentist, with all of its figurative and literal pain points, really tops the list. As always in good design thinking, I also have been pondering ways that would help make the act of getting teeth cleaned a bit less harrowing for people with anxiety, and, if possible, even border on the pleasant side.
I didn’t always hate going to the dentist. My anxiety was built up over years of painful experiences at different dentist offices, and more recently, getting braces as an adult. I feel like my mouth has developed more sensitive nerve endings in recent years so that each rough move by the hygienist would send shockwaves that make me jump, which is the exact opposite of what the hygienist needs me to do. But of course I am always at the mercy of the person holding the weapon instrument and can’t communicate very well in the moment. Typically the torturer hygienist would stop and ask me to not move and just raise my hand if I feel discomfort. If I did that, it would just mean raising my hand the entire cleaning session. I mostly end up just bearing through the whole hour (no gritted teeth allowed). You could suggest that I should just look for a new dentist office and you would have a good point. However, you should also know that I have tried this already and the thought of having to look for another new dental practice that may or may not be better is not on my list of ideas for fun.
To understand the process that someone like me goes through at the dentist, I decided to look at my user journey:
Enter office
Receptionist may or may not be friendly depending on the number of phone lines ringing or people waiting
I am instructed to sit in the waiting area where all others are looking down on their phones
Someone comes through a door and shouts my name, which may or may not be butchered
I get up and follow that person through a door down the hallway
Sometimes that person introduces themselves
I enter a small cramped room taken up largely by a reclining chair with a big lamp attached at the top
I am instructed to sit and make myself comfortable, at which point I notice my hands are unconsciously in a clenched position
I am told I need new X-rays and it makes me anxious because I remember gagging the last time I had to bite down on the x-ray sensors. Also, the plastic coverings on the sensors have sharp corners that cut the inside and the corners of my mouth
A weighted vest is put on me before the x-ray and the heaviness of the vest offers a temporary calm for my overwhelmed sensory system
I clamp my teeth down on the sensor, careful to avoid the sharpness of the plastic coverings that cut my mouth last time and trying not to gag
I hear a high frequency beep that indicates the x-rays are done and breath a sigh of relief that I can move again
The sensor is pulled out of my mouth like ventilation tubes in the medical TV shows like Gray’s Anatomy
I am given a blue crepe paper bib with plastic backing to clip on to my chest as the chair descends to full recline
I am given sunglasses to protect my eyes from the bright light that is now piercing into my skull
The sunglasses are one-size-fits-all, which means they only fit people with large faces so that as my head rests on the headrest, the glasses pop off of my ears
I am given child-size glasses because my Asian face is too small for one-size-fits-all adult sunglasses
I am told to open my mouth and trust the person holding the pointy and sharp metal wand
I am not being told what is happening or what comes next. I just have to keep my mouth open. It is difficult to swallow
The pointed metal wand is scraping around my gums and teeth, sounding and feeling exactly identical to nails on a chalkboard
At some point a nozzle is inserted into my mouth and suddenly very cold water comes rushing out of the nozzle while another tube is inserted into my mouth to suction the water out. Sometimes the water will splash onto my face or spill out of my mouth and onto my waterproof crepe paper bib, meaning the water will roll down my neck and get my shirt wet.
A soft-tipped drill is inserted into my mouth with some paste squeezed into the gaps between my teeth. I know it is polishing my teeth but the whirring noise can be nauseating and the paste stuck in between my teeth is uncomfortable
More cold water is suddenly spritzed into my mouth, sending shock waves through the sensitive parts of my mouth
The long clear tube comes in to suck out all the excess water. I close my mouth around the tube and it seems to want to suck out my tongue or the side of my mouth through the tube
The dentist comes in suddenly to do an exam. She looks at each of my teeth and rattles off a series of numbers to the hygienist, who types them into the computer.
The dentist is happy with the state of my teeth and leaves the room
I am asked if I wanted watermelon or mint flavored fluoride to paint onto my teeth. I pick mint
The painted fluoride is sticky and my lips now want to be glued shut
I am told the cleaning is over and make an appointment for six months later
After going through the user journey, I have found some areas for improvement for me in this experience.
Introductions Make a Big Difference: First impressions make a lasting difference. A friendly and open environment will set the tone for those who are anxious and help them prepare for what is to come. Even though I have seen the same hygienist two times in a row now, I cannot tell you her name because I don’t believe she has introduced herself. I believe the limbic part of my brain goes into hyperdrive and makes learning and memory difficult. Sure, it’s not like we have a relationship since we only need to see each other for one hour twice per year. But what if it was different? What if the receptionist and hygienist made you feel like you were a valued customer, that you were at the office visiting old friends? That would definitely help me feel less anxious. Perhaps they thought that I’d already been there six months before and therefore, introductions or friendly greetings were no longer necessary. I feel like the opposite should be true.
One size fits all does not fit anyone: It is a nice gesture to provide sunglasses to prevent glare from the bright light while reclining in the dentist chair. It would be even better if there were different sizes that matched the frame of the client. For the anxious client, having sunglasses that pop off just adds one more obstacle to the already apprehensive client.
Sanitary Practices Should Not Hurt: While keeping plastic wrapping over X-ray sensors is definitely good practice for sanitation reasons, more research should be done to find materials that fit comfortably inside clients’ mouths. Each time an instruments causes pain, makes a client gag, cuts up a client’s lips, it lays down negative memories that over time, become added medical trauma. Trauma may be a harsh word to define these seemingly small unintended infractions but we cannot negate what someone feels. Fear and anxiety at the dentist is real and every small action taken to minimize the fear and anxiety is worth taking. What if there was an alternative to hard plastic coverings that cuts up the roof of one’s mouth when biting down? What if the X-ray sensor was a different shape or size so it would not trigger gag reflex each time scans are needed?
Knowing What Comes Next Decreases Stress: Some people want the dental appointment over with as quickly as possible and do not want to know what is happening. Some may want to have a big mirror to see what is going on each step of the way. There needs to be enough individualized attention paid to the different preferences of each client. For me, I prefer knowing what is happening and what is coming next. I used to make picture schedules for my kids to help them get ready in the mornings. Maybe I don’t need a picture schedule for the dental procedure but having an outlined schedule will really help me understand the steps for the appointment. Perhaps as an adult, I should have remembered the procedure from my previous appointments. Unfortunately, I forget easily due to anxiety during the appointment and I imagine there are others like me. I also appreciate when someone tells me before they’re about to spray me with very cold water, start the high-pitched drill, or suck out the contents of my mouth. Such small acts make a very big difference in calming fears of the entire experience.
Prevent sensory system overload: A dental appointment involves all of our seven senses: tactile, olfactory, auditory, visual, and gustatory are pretty self explanatory. The movement and body senses (vestibular and proprioceptive) are activated when we are reclining in the chair or told to turn our heads or open wide. When someone is anxious, their sensory processing may be heightened, making some of the sensory experiences very sensitive, disorganized, and skewed toward fear. A light shining in the eyes may become unbearable, the sound of the whirring drill induce distress, and the sudden rush of water unsettling. Understanding each client’s sensory profile will be important to tailor the cleaning experience to ensure the least amount of discomfort. Some ideas might be to use warmer water to rinse mouths, to introduce clients to all of the sharp instruments ahead of time, to explain what the machine noises are, or have a sound machine to drown out the unpleasant noises. A little bit of extra work from the dentist office goes a long way to help the client feel less anxious and improve the experience. Every person has a unique sensory profile so being adaptable and offering different plans for each individual will really help optimize the experience.
Distractions for the nervous user: Sometimes the sensory overload becomes too much to bear and the best way to cope with the unpleasant but necessary procedure is to become distracted by something else. Studies have found Virtual Reality to be effective for reducing fear, anxiety, and perceived pain management as well as increasing efficiency in dental procedures. Other calming strategies that would be helpful include TV screens in the ceilings for movies, headphones for calming music, or meditation guides. Offering the clients choices will empower them to feel more in control during the procedure and be much more at ease. Many pediatric dentists are very good at this part, providing all kinds of strategies to help children associate dentist offices with fun instead of fear. For some reason, however, the strategies seem to stop once we get to dental offices for adults but there is no reason these strategies need to stop. Why shouldn’t dentist offices for adults be fun too?
Think about Neurodiversity and Inclusion: Inclusion does not only mean thinking about the racial diversity or neurodiversity of the clientele, but also socio-economic diversity. Dental procedures are expensive in the US and thus is a huge barrier for many people to maintaining healthy teeth. It will be important for dental offices to be mindful of this and avoid judgement when a client comes in with issues that maybe should have been addressed much earlier. The off-hand comments that maybe were not meant to be judgmental, can perpetuate the harm done to someone who might already be traumatized from the dentist offices. This means it will be important to think more about having a trauma-informed practice, to not ask questions like “Why are your teeth this way?” “Why didn’t you get braces as a kid?” “Why did you not come in earlier?” I speak from experience as someone who at one point had difficulty accessing proper dental care, but then once I was able to access regular dental procedures, had difficulty coping due to not only fear, but also feeling judgment from the dentists. I am no longer in the lower socio-economic bracket but I carry the scars still. I am sure I am not alone, and I hope not only dentists, but other practitioners in client-facing professions can keep this in mind.
Next Steps: Thinking more deeply about my user journey has helped me reflect about some of the causes of anxiety of going to the dentist. For me, the reasons are complex and multi-faceted. I know I do not represent the population, but with dental phobia and anxiety affecting a large percentage of the population, it would be informative to conduct more qualitative research into people’s fears in order to guide best practices that will lead to happier customers.
References:
https://www.statisticstats.com/health/dentophobia-statistics-of-dentist-fear-and-anxiety/
https://www.dentalproductsreport.com/view/study-finds-more-60-percent-people-suffer-dental-fear
