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Br Dent J. 1998 Aug 8;185(3):134-6.

Anxiety levels, patient satisfaction and failed appointment rate in anxious patients referred by general practitioners to a dental hospital unit.

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University Dental Hospital of Manchester.



To reduce the high failed appointment rate and anxiety levels among previously identified anxious new patients referred by general practitioners to a unit of restorative dentistry. A letter was drawn up which contained more explanatory information about the purpose and content of the initial dental appointment.


The study was a single centre, double blind trial.


Referrals of nervous/anxious patients from general practitioners to the Manchester Dental Hospital.


185 patients were randomly allocated to the control group (n = 94) who received the standard hospital appointment information and the experimental group (n = 91) who received the new more informative letter.


The effect of the new letter on patient attendance was recorded and anxiety levels were measured before and after seeing the clinician.


70 patients attended from the control group and 58 patients from the experimental group, giving 59 and 44 fully completed forms respectively. Both groups of patients were generally happy with the information that they were given. The attendance of patients in the experimental group and the control group were not significantly different. Preconsultation state anxiety levels were not reduced in the experimental group by the provision of the additional information but after the consultation both groups showed a significant reduction in state anxiety (P < 0.001).


The new more informative letter did not improve attendance among this group of nervous patients. Other strategies for increasing initial attendance will therefore need to be identified and evaluated. In this study, the most important factor in reducing anxiety levels during the consultation appeared to be contact with the clinician rather than preparatory written postal information.

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