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Case No. 03 The House of Hygiene · Interactive CE

The Anxious
Patient

A Case-Based Approach to Dental Fear

Patient Management Professional Development · Self-Study ~35–45 Minutes Interactive Case
Course information & CE accreditation details →
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Course Information · CE Accreditation

Case No. 03 · The Anxious Patient

Course title
Case No. 03 · The Anxious Patient
Description
Recognizing and managing dental anxiety, SSRI oral-health implications, and evidence-based communication.
Provider
The House of Hygiene
AGD PACE Provider ID
Pending — national AGD PACE application in progress
Instructor
Belinda Marsh, RDH — BS in Dental Hygiene, Idaho State University (2022); practicing clinical dental hygienist
Educational method
Self-instruction · web-based, interactive
Intended audience
Dental hygienists and dental team members
Prerequisites
None
CE credit (pending)
1 CE hour
AGD subject code
153 — Psychosocial: Anxiety & Fear in Dentistry
Cost
Complimentary
Release date
July 1, 2026
Last reviewed
June 2026
Expiration date
June 30, 2029 (reviewed at least every 3 years)

Learning objectives

Upon completion, the participant will be able to:

  1. Identify verbal and non-verbal signs of dental anxiety using evidence-based screening tools.
  2. Connect SSRI use to specific oral health implications: xerostomia, elevated caries risk, bruxism, and platelet effects.
  3. Apply evidence-based communication techniques including Tell-Show-Do and patient-controlled stop signals.
  4. Differentiate between pain and anxiety responses during clinical instrumentation.
  5. Develop an appropriate high-caries-risk treatment plan including recall adjustment and fluoride protocol.

Commercial independence & conflict of interest

Belinda Marsh, RDH, the sole instructor and content author, has no relevant financial relationships with any commercial interest to disclose. This course was developed independently, is free of commercial bias, and is not sponsored or influenced by any commercial entity. The provider retains full control of content, scientific integrity, and faculty selection.

References & resources for further study

This course cites current peer-reviewed literature and clinical guidelines throughout, and provides a consolidated reference/evidence-base section within the course for further study. All clinical content is reviewed for scientific accuracy and currency at least every three years.

Participant support & mastery

Ask the author / participant interaction: Questions about course content may be sent to bbomarsh@gmail.com; we respond within two business days.
Technical assistance: bbomarsh@gmail.com.
Mastery & credit: Completion requires viewing the full course and passing the end-of-course assessment. CE credit reflects the estimated time to complete the instructional content and does not include time spent on the assessment.
Refund / cancellation: This course is complimentary; see theRefund & Cancellation Policy. Attendance records are retained for seven years.

Course evaluation

The House of Hygiene is a self-instruction continuing dental education provider. AGD PACE national approval is pending; this course does not yet award AGD-recognized CE credit and makes no claim of accreditation. Statement and credit details will be finalized on approval.

New Patient · Today's 9:15 am
M
Maya Chen
Graphic Designer · Age 34
Chief ComplaintJaw pain; referred by PCP for routine cleaning
Last Dental Visit7 years ago Notable
MedicationsListed on intake form — review with patient
Medical HxSelf-reported "nothing major" on intake
InsuranceDelta Dental PPO · full coverage for prophy
Learning Objectives
  • 01Identify verbal and non-verbal signs of dental anxiety using evidence-based screening tools
  • 02Connect SSRI use to specific oral health implications: xerostomia, elevated caries risk, bruxism, and platelet effects
  • 03Apply evidence-based communication techniques including Tell-Show-Do and patient-controlled stop signals
  • 04Differentiate between pain and anxiety responses during clinical instrumentation
  • 05Develop an appropriate high-caries-risk treatment plan including recall adjustment and fluoride protocol

You have 60 minutes for this appointment. Maya is currently in the waiting room. How you approach the next hour will matter more than you might expect.

Trust
Schedule
Scene 1 of 5
Waiting Room
M
Maya Chen
visibly anxious
💊 Sertraline flagged
💧 Xerostomia signs
⚠ Attrition noted
What do you do?
Learning Moment
Knowledge Check · Scene 1 Question 1 of 5
Final Assessment Question 1 of 8
Assessment Passed
—
—

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A note: These courses are offered as professional development and self-study. They do not carry formal CE credit. Your certificate confirms course completion.
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References & Evidence Base

Superscript numbers throughout the course correspond to the sources below. All clinical statistics and recommendations are grounded in peer-reviewed literature or regulatory text.

  1. Humphris GM, Morrison T, Lindsay SJE. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health. 1995;12(3):143–150. MDAS cut-off · 5-item structure
  2. Keene JJ Jr, Galasko GT, Land MF. Antidepressant use in psychiatry and medicine: importance for dental practice. J Am Dent Assoc. 2003;134(1):71–79. SSRI oral effects · xerostomia · ~32% salivary flow reduction · bruxism
  3. Chu FCS, Yip HK, Leung KC, et al. Caries experience among psychiatric in-patients: the impact of psychotropic medication. J Dent. 2017;57:54–60. DMFT 9.39 vs 6.48
  4. Haas AN, Santos ZB, et al. SSRI use and platelet serotonin depletion: clinical implications during periodontal instrumentation. J Periodontol. 2018;89(4):449–457. 80% platelet serotonin depletion · spontaneous bruising
  5. Cordeschi T, Ferracuti N, Ierardo G, et al. Effectiveness of a 4-month vs. 8-month recall interval for high-caries-risk preschool children: a 30-month clinical trial. Int J Paediatr Dent. 2026. doi:10.1111/ipd.70032. 2.5× cavitation risk at 8-month vs 4-month recall
  6. Fee PA, Macey R, Walsh T, et al. Recall intervals for oral health in primary care patients. Cochrane Database Syst Rev. 2020;10:CD004346. Risk-based recall recommendation
  7. Featherstone JDB, Chaffee BW. The evidence for caries management by risk assessment (CAMBRA). Adv Dent Res. 2018;29(1):9–14. Xerostomia = HIGH caries risk · 3–4 month recall
  8. Colorado State Board of Dental Examiners. 3 CCR 709-1, Rule XIII: Limited Prescriptive Authority for Dental Hygienists. Effective June 30, 2015. Colorado Secretary of State. Colorado RDH Rx authority
  9. Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta-analysis of behavioral interventions. Community Dent Oral Epidemiol. 2004;32(4):250–264. Stop signal efficacy · pain amplification · TSD outcomes
  10. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35–50. 36% dental anxiety prevalence · perceived control evidence