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Dental anxiety in children – why does it happen and what can we do?

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  Posted by: The Probe      17th August 2019

Why are children scared of the dentist? Adult dental anxiety is a topic that is covered often; nearly 40 per cent of adults self-reported ‘moderate’ anxiety in the last large-scale survey.[i]If, on any given day, you asked patients in your waiting room if and why they were feeling anxious, you’d get reasons like “Because I think it’s going to hurt” and “I’m worried about what the dentist might find.” Some people are uncomfortable with the intimacy (for want of a better word) of a dental examination. Having a stranger in close quarters, poking around in their mouth, can make them feel extremely vulnerable.

A dental practice is not somewhere most people visit often; the NHS advice for people with good oral health is to go once every 12 to 24 months.[ii]But even if adults suspect a problem, they may ignore it or take pain relief until they can’t avoid the dentist any longer. Or, they may have struggled to access services. So it’s understandable that anyone would feel nervous when making a rare visit to the dentist, especially if they suspect they need further treatment.

The psychology around dental anxiety is interesting and it seems that past dental experiences are often the key to unlocking a solution. Modern dentistry is a world away from what most people remember from childhood; practices are now more welcoming and advancements in equipment and techniques have made the dreaded drill almost obsolete. Dental hygienists and dental therapists are doing wonderful work in prevention too; this kind, gentle, holistic approach wasn’t widely adopted years ago.

So, to return to the original question, why arechildren scared of the dentist? They have no past experiences to draw on; is it a case of parents’ anxiety filtering down? An adult who remembers only bad things about going to the dentist will need to think carefully about how they describe an upcoming appointment to their child.

If the visit is for treatment, rather than routine, both parent and practice should work together to create a positive atmosphere. Think about the emotional impact on a child having an extraction because of neglected oral hygiene (most extractions for children aged 0-5 in 2017/18 were due to preventable decay[iii]). Care should be taken to avoid shame or embarrassment, while supporting child/parent to do better in the future.Rather than saying, “If you don’t look after your teeth, this will happen again,” say instead, “This is how we can now help you have good teeth forever.” See it as an opportunity to get to know the family– empathy and positive reinforcement is key to changing their preconceived ideas about the dentist and dental treatment. One study showed how children who’d had a tonsillectomy ‘misremembered’ howpainful it was because of how their anxious parent had responded at the time.[iv]

There are lots of other things that practitioners can do. A child walking into a room full of equipment and ominous looking (and tall!) strangers will likely feel a rush of panic, even if their parent has sold the experience as simply a visit to see some friendly people whose job it is to look into mouths. Although small children usually sit on Mum or Dad’s lap while in the chair, older children who will need to sit on their own may sometimes feel ‘separated’ from their parent even if they know they are nearby. This can be a scary experience for the child. The light can also be uncomfortable and intimidating, as can keeping their mouth open for prolonged periods of time.

We read about child-friendly ‘character’ dental chairs and the use of audio and visual distraction methods, but there is no substitute for eye contact and talking to your youngest patients on their level and with respect. Rather than distracting children, let them understandwhat you are doing, using child friendly language. Oral health education is lacking in the UK; a YouGov survey found that less than one in three British children aged between five and 16 are given lessons about the importance of good preventive oral care.[v]There are reports of practitioners reaching out to local schools, but this isn’t enough. Education can be as straightforward as a chat about the basics, like good brushing, and the part that diet has to play in avoiding oral health problems. Show children and parents what to do – use brushes that are easy to hold and manipulate, such as brushes from the TANDEX range – and let them experience how nice a clean mouth feels.

Managing dental anxiety from an early age is key to reducing its impact in later life and for maintaining a lifetime of good oral hygiene. Just because a child hasn’t demonstrated nerves, don’t assume they aren’t intimidated by the unfamiliarity and ‘seriousness’ of a dental practice. Help create a friendly, positive environment, be proactive in your appointments and you may even ease the fears of an anxious adult too!

 

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References

[i]Adult Dental Health Survey, 2009. Heath & Social Care Information Centre, 24 March 2011. Found at: http://content.digital.nhs.uk/pubs/dentalsurveyfullreport09(accessed April 2019).

[ii]NHS, Live Well, Healthy Body, Dental Check-ups. Link: https://www.nhs.uk/live-well/healthy-body/dental-check-ups/(accessed April 2019).

[iii]Gov.UK. Almost 9 out of 10 child hospital tooth extractions due to decay, 6 March 2019. Link: https://www.gov.uk/government/news/almost-9-out-of-10-child-hospital-tooth-extractions-due-to-decay(accessed April 2019).

[iv]Pavlova M, Graham SA, Jordan A, Chorney J, Vinall J, Rasic N, Brookes J, Hoy M, Yunker WK, Noel M. Socialization of Pain Memories: Parent-Child Reminiscing About Past Painful and Sad Events. Journal of Pediatric Psychology. 2019 Mar 7.

[v]Oral Health Foundation. UK schools bottom of the class for oral health education, 22 March 2019. Link: https://www.dentalhealth.org/news/uk-schools-bottom-of-the-class-for-oral-health-education(accessed April 2019).

 

 


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