A patient with post-traumatic stress disorder attends anxious about dental care, but the condition is not described as severe. What is the most appropriate INITIAL approach?

Correct answer: B. Explain in advance, step by step, exactly what will happen at each visit and agree a stop signal

• A. General anesthesia is disproportionate for non-severe anxiety and does nothing to build the tolerance needed for routine ongoing care.
• B. CORRECT. Loss of control and unpredictability are the core triggers in PTSD, so the first-line intervention is BEHAVIOURAL: full advance explanation of what will happen, tell-show-do, a pre-agreed stop signal that you always honour, short appointments, and allowing the patient to control the pace. Predictability plus genuine control restores a sense of safety and is effective for the majority of these patients.
• C. Working fast and saying little is precisely wrong: it maximises unpredictability and removes the patient's control, which is what provokes the response.
• D. Pharmacological sedation may be a useful ADJUNCT if behavioural measures prove insufficient, but starting with a benzodiazepine skips the intervention that actually addresses the mechanism — and benzodiazepines carry dependence risk in a population with high comorbid substance use.

Note: Ask what specifically triggers the response — supine positioning, the mask, the sound of the handpiece, someone standing behind them, being unable to speak. Many triggers can simply be designed around once you know them.