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Dental anxiety in children

You bring your child to the dentist for the first time, and the child expresses signs of fear or anxiety. Do you wonder why this happens?

After all, it’s his first visit. He doesn’t even know what a dental treatment is; yet, he is afraid – why?



In general, fear is a normal reaction, an instinct of survival. Fear helps us mark possible points of danger and signals to us to be attentive. Feelings of fear appear in response to a specific source, as a reaction to the surroundings, such as a fear of the dark or a fear of dogs. Children experience different fears at different ages; for example, a baby develops a fear of strangers at approximately 8 months old – an important developmental stage. At elementary school age, children are usually afraid of the dark, of being alone, of imaginary characters or things, specific situations such as thunder or confrontation with animals. At the age of nine, children begin to fear physical injury. This fear appears, almost certainly, due to the parents warning their children to stay away from dangerous things, but also is influenced by conversations with friends or images seen on television.

Anxiety is a more abstract sensation, a feeling that something catastrophic is imminent; however, the anxious person cannot specify an exact reason for this feeling. These feelings may be physically expressed by a rapid pulse, sweating, difficulty breathing, weakness or stomach aches.

The “easiest” way of dealing with a child’s fears and anxieties is staying away from the cause of the fear (as was the way of dealing in the past with attention deficit disorders). Not dealing with the fear is likely to intensify the cycle of anxiety and avoidance.

Parents are very capable of influencing and calming their children. Parents who discern their children’s anxiety must try to understand, to support, to discuss it with the children and to express flexibility. In addition, they should encourage the child and help him deal with the anxiety without taking part in his/her attempts to avoid the threatening factor. Another important point is the level of the anxiety and the way the parents themselves deal with their anxieties. Parents should check and ask themselves how worried they are feeling in this situation, and to what extent they are transmitting this feeling to their children. A child who is always warned that “You’ll fall” and whose parents panic at the sight of any injury, might very well develop anxieties regarding falling and being injured. A child whose parents held his hand tightly every time they passed by a dog in the street may develop a fear of dogs, and so on.


What are the reasons for fear/anxiety regarding dental treatments?


Fear of the unknown – Remember that your child wasn’t born with a “fear of the dentist” gene. When the child comes to the dental clinic for the first time and is fearful or scared, this is usually due to fear of the unknown, in addition to information he has comprehended from his surroundings. Sometimes, these are horror stories heard straight from the parents, siblings or friends, and sometimes these are subliminal messages that the children has understood from his parents behavior, which expressed their fears. The parents feel the need to “prepare” the child for the meeting with the dentist, and use terms that actually may cause the opposite of the desired effect. For example, the simple sentence “Don’t be afraid” or “Don’t worry, it doesn’t hurt”, when the child hasn’t even arrived at the clinic or has just sat down on the examination chair will cause the child to understand that there is a possibility of pain or something frightening, and the fear will begin to mount.

Fears of penetration – Dental treatments require an invasion into the child’s personal space - not just physical contact, but even invasion of his mouth and body as he helplessly lies with his mouth open.
Fear of losing control – The child did not choose to come for treatment, rather was brought by his parents. The child lies in the chair with his mouth open and an authoritative figure is telling him what he has to do. This causes him to feel helpless and not in control of his situation.

Lack of trust – Trust is defined as a person’s expectation that a promise will be kept. If a doctor or dentist breaks a child’s trust, this can cause the child to lose trust in all doctors. Trust is also gained by the behavior of the parents and relatives, and exposure to statements overheard about trusting dentists. Trusting the dentist is an important factor in dental anxiety, both among children and adults.

Fear of pain – Even in modern dentistry, pain is something that can still be experienced during dental treatments, and therefore, the fear of pain is legitimate. Sometimes, the child will fear pain as a result of his experience or the experiences of others, or because of statements made which mentioned pain, even if they have negated the pain.



How should you deal with fear?


 Trust – Don’t lie to the children. If it’s going to hurt, don’t tell them that it won’t hurt. It is possible and preferable not to relate to this point when the parent “prepares” the child for the treatment so that the child will remain calm, but it is crucial not to promise things that cannot be kept (in short, don’t say things like “It won’t hurt”). A child who has lost his trust won’t ever again agree to dental treatments, no matter what. If you lie, they won’t believe you anymore, they won’t trust you anymore, and rightfully so. The dentist should help the child understand exactly what is happening, in detail, so that the child will feel that he is in control and familiar with his surroundings. Give the child the security of being next to him. If the treatment might be uncomfortable or painful, the dentist should explain this to the child in simple words in order to deal with the preparation that the child received before entering the clinic and to try to neutralize it. Let the child choose between different treatments (as logic and the child’s age permit). Agree ahead of time on a signal between the child and the dentist to stop the treatment when the child feels uncomfortable. Allow the child to ask questions or choose if he wants to hear explanations. It is important to remember that the level of control given to the child must be well monitored, and that sometimes, the proper amount of authority can prevent potentially traumatic situations.

 Changing the terminology – Sometimes, words said by the parents innocently, with the best of intentions, can cause the opposite effect. The best thing is to let the dentist explain to the child; you do not need to do any preliminary preparation at home. If you must – change the wording; for example, don’t use the word “injection”, but rather “sleeping drops for the teeth.” Don’t say “extraction” – the dentist will sometimes call this “E” for short or “to wiggle the tooth,” and so on…Let the dentist assist you and agree ahead of time on words to use.

 Gradual exposure – It is best when the first visit to the dentist is a positive experience. It’s not a good idea to come for treatment when there are already problems or pain felt in the teeth. At the first visit, the child will meet the dentist, the examination chair (“roller coaster,” “airplane”, “spaceship”…) and the different tools (“small mirror”, “vacuum” or “kiss giver” – instead of “suction”…). Of course, the visit will always end with a nice gift and a thank you to the child for helping out. If possible, begin the treatments gradually, from the easy to the complex, and give the child a chance to get acquainted with the dentist, the rules and the equipment.

 Remain optimistic and give positive feedback – Emphasize the pleasant and successful aspects of the treatment. Praise the child for his behavior – even if he was afraid but overcame his fear, this is excellent. Emphasize how proud you are of him for overcoming his fear and for his behavior. After treatment, it is recommended that you do something pleasant with the child, so that the unpleasant memories will be erased and only the positive ones will remain.

 Don’t get angry at the child – If the child is in pain or “feels funny” after the sedation, or simply has lost his patience, don’t express anger towards him. His physical difficulty will only be aggravated by the emotional difficulty - feelings of failure or frustration that he did not succeed and that he disappointed his parents.

 Don’t compare the child to other children who aren’t afraid – it is legitimate to be afraid. Emphasize the positive and not the negative.



Conclusion

The parent, child and dentist triumvirate have important roles in overcoming anxiety. Choose a dentist for your children whom you trust. Visit the clinic ahead of time, without the child, and become acquainted with the dentist and learn about his approach. Decide ahead of time who will come with the child to the treatment – the mother, father or both. Sometimes, the child will act differently in the presence of a different parent.
Decide ahead of time regarding the terminology and how to prepare the child. Don’t wait for the child to be in pain – bring him for an examination at an early age, before the problems begin, and continue to do so once every six months, at least. Tell the dentist of previous treatment experiences, about hobbies or things that make your child unique, or that your child especially likes (like a sports team, computer game, activity…) so that they will have a topic to discuss and the child will feel involved.

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