Increasing patients' perceptions of control
Loss of control is one of the most fundamental drivers of dental anxiety.
A perceived lack of control is one of the most consistent drivers of dental anxiety. Patients are placed in a physically vulnerable position, often unable to speak easily, while procedures are performed in a highly sensory environment. For many, this creates a feeling of being “trapped,” which activates a threat response and amplifies both anxiety and pain.
One of the simplest and most effective ways to address this is through the use of stop signals - a pre-agreed, patient-initiated cue (such as raising a hand) that immediately pauses treatment.
Why stop signals work
From a psychological perspective, stop signals increase a patient’s perceived control, which has been shown to significantly reduce both emotional distress and pain perception (Loggia et al., 2008). Importantly, it is not just the ability to stop that matters, but the belief that stopping is possible.
When patients feel they have no control, their brain interprets the situation as more threatening. This increases sympathetic nervous system activation (fight, flight, or freeze), leading to:
Increased muscle tension
Heightened sensitivity to stimuli
Lower pain thresholds
By contrast, when control is restored, the nervous system settles, allowing patients to tolerate procedures more comfortably.
Research across healthcare settings supports this. Studies have shown that increased patient control improves coping, reduces anxiety, and enhances tolerance of medical procedures (Wiech et al., 2006).
Perceived loss of control in previous dental experiences has been identified as a key factor in the development and maintenance of dental fear.
The role of control in dental anxiety
Dental anxiety is strongly associated with previous experiences where patients felt:
Unable to stop treatment
Not listened to
Overwhelmed or rushed
These experiences often form powerful negative memories, which contribute to future avoidance. In fact, perceived loss of control has been identified as a key factor in the development and maintenance of dental fear (Armfield, 2010).
Stop signals directly address this by:
Re-establishing autonomy
Reducing uncertainty
Shifting the dynamic from passive to collaborative
How to implement stop signals effectively
The effectiveness of stop signals depends on how they are introduced and reinforced. A simple, structured approach:
Introduce the concept early
Before treatment begins, explain clearly: “At any point, if you’d like me to stop, just raise your hand and I’ll stop straight away.”
Frame it as genuine control
Avoid presenting it as a formality. Patients need to believe it will be respected.
Use invitational language
“Would you like to go ahead? You can stop me at any time.”
Respond immediately when used
Stopping promptly reinforces trust. Delayed or ignored signals can worsen anxiety.
Check in throughout treatment
Periodic check-ins reinforce ongoing control: You’re doing really well — just let me know if you’d like a break.”
Clinical impact
Stop signals are a low-effort, high-impact intervention that can:
Reduce anxiety before and during treatment
Improve pain tolerance
Increase patient cooperation
Shorten overall appointment time by reducing interruptions caused by distress
They are particularly valuable for:
Patients with previous negative experiences
Trauma-affected patients
Those with gag reflex sensitivity
Patients with generalised anxiety or panic tendencies
Beyond the signal: reinforcing control
Stop signals are most effective when part of a broader control-based approach, including:
Asking permission before starting
Offering choices where possible
Allowing breaks
Using collaborative language
Together, these strategies help patients feel like active participants rather than passive recipients of care.
The bigger picture
Stop signals may seem simple, but they address one of the most fundamental drivers of dental anxiety - loss of control.
By restoring even a small degree of autonomy, clinicians can significantly reduce perceived threat, improve patient experience, and reshape how dental care is remembered.
Over time, this contributes to breaking the cycle of dental fear, improving attendance, and building long-term trust.
References
Armfield, J. M. (2010). How do we measure dental fear and what are we measuring anyway? Oral Health & Preventive Dentistry.
Loggia, M. L., Schweinhardt, P., Villemure, C., & Bushnell, M. C. (2008). Effects of psychological state on pain perception. Pain, 136(1–2), 168–176.
Wiech, K., Kalisch, R., Weiskopf, N., Pleger, B., Stephan, K. E., & Dolan, R. J. (2006). Anterolateral prefrontal cortex mediates the analgesic effect of expected and perceived control over pain. Journal of Neuroscience, 26(44), 11501–11509.
Written by Dr Trent Davidson and Dr Helen Fisher from Mindset Dental in Brisbane, Australia 2026