A 2013 NIH study measuring the prevalence of dental fear among school children (ages 6–12) showed that approximately 47% of subjects reported being afraid of dental procedures. Because it’s extremely common for young patients to be apprehensive about getting their teeth cleaned, poked, prodded, and (especially) drilled, it’s important for dental professionals to know how to handle these youngsters and make their visits to the dentist positive and friendly instead of scary and unpleasant.
Do Your Best to Make the Visit Special: Dental hygienist Joanne M. Pasienza writes that her “main objective is to make this experience as wonderful as possible.” You never get a second chance to make a first impression, so if you have a new patient coming in for the first time, it’s vital that you make them as comfortable as possible, treat them with kindness, and earn their trust. If you do well with the first visit, the child is more likely to be cooperative and compliant at the appointments that follow.
Be Patient and Flexible: As critical as it is for a young patient to be obedient, it’s also important for their dental clinician to be equally accommodating. Becoming upset or impatient with the child will only make matters worse, so you must remain calm and avoid even the appearance of frustration. A child’s first visit to the dentist will most likely be rather short, which should make it easier to minimize the chances of a meltdown in the chair. However, by exercising patience and compassion, you’ll be able to gain the trust needed for longer and/or more complex examinations/procedures.
Explain Everything: Oftentimes, it is the unknown that causes the most fear within children. Luckily, this is easy to combat. As Greg Psaltis, DDS puts it in his article, The Reality of Working with Kids, “provide a running commentary to the child so that nothing comes as a surprise.” Use simple terminology and age-appropriate language to describe exactly what you will be doing. If there is any chance of discomfort, warn the child in advance so that they can be well prepared, and explain to them what each tool/instrument is for in words they’ll be able to understand (for instance, Dr. Psaltis recommends avoiding the negative connotations of “shots” by instead saying you will be “putting teeth to sleep”).
Relaxation Techniques: For children who show extreme anxiety in the dentist’s chair, the first thing to try should be deep breathing. This simple exercise works for the majority of youngsters, and if you have a tough customer who doesn’t want to cooperate, you can get the same effect by asking them to blow bubbles through a wand (this has a dual function of also distracting the child, which we’ll discuss further in a moment). Another approach – although it’s more time consuming – is to ask your patient to tense and relax each of their muscle groups, starting with their toes and moving up from their feet and legs to their fingers, hands, arms, neck, jaw, and scalp, culminating with breathing exercises that focus on the muscles in the chest and abdomen.
Distraction/Visualization: As touched upon above, distraction can be great for getting a young patient to let go of their dental anxiety, relax, and cooperate throughout their visit. The most common form of distraction found in dental offices everywhere is the use of toys. Many practices employ this strategy, and some offer television and video games for children to watch/play during their examinations. Obviously, this technique isn’t effective in all cases, and sometimes visualization is the best option. Encouraging a child to picture a positive experience (a recent birthday party or vacation, for example) can help them forget their fears. You can also assign them a task like counting ceiling tiles, naming the 50 states, or doing simple arithmetic (depending upon the patient’s age).
Praise/Positive Reinforcement: Liberal use of praise and positive reinforcement is key to ensuring a successful visit when dealing with kids who have a fear of the dentist. Focus on what is going well throughout the visit, and let the child know what they’re doing right. Give them specific feedback by saying things like “thank you for keeping your head so still” or “good job holding your mouth open and helping me to work quickly.” Another tried and true method is the prize box. This strategy has been used by many clinicians, and the principle could not be more simple: if the child behaves and cooperates, they are allowed to select a small toy from the prize box once their visit is over. Rewards such as these are great incentives to promote “bravery” at the dentist’s office.
Don’t Forget About the Parents: Kids aren’t the only ones who might be apprehensive about their trip to the dentist’s office. Sometimes parents can be a lot more difficult to deal with. Do your best to work with the parent; they should be partners in promoting good habits and long-term oral health. Talk with them prior to the child’s first visit, explain the scope of the examination/procedure, and go over any potential problems. Most children will feel more comfortable with their mom and/or dad in the room during the examination, so it’s imperative that the clinician and parent are on the same page. Finally, take into account that the parents are role models. If you are able to demonstrate a procedure on a parent before performing it on the child, not only will the youngster learn about what to expect, they will also see what constitutes appropriate behavior in the dentist’s chair.
Greg Psaltis, DDS – The Reality of Working with Kids
Joanne M. Pasienza, RDH – A Hygienist’s View of Children
Lisa Efron, PhD & Jeffrey A. Sherman, DDS – Five Tips for Managing Pediatric Dental Anxiety