Anxious or Phobic Dental Patients



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Children


T

he key to successful management of children during a dental visit is a true desire to accomplish a health service for the child. It is recommended that children start receiving dental care as early as one-year-old, thus it is critical that the dentist take the time to make first visits as comfortable as possible for all children even if their behavior is not at first attractive. It is very important for both the dentist and dental staff to mask their own emotions when children start to act up. Never show anger, even if provoked. Keep a sense of humor and try not to hold early bad behavior against the child at future appointments. Establishing a rapport with difficult children initially will help put them at ease for future visits.

Studies have shown that children often model parent's behavior. Assessment of the parent's level of anxiety is the first step in dealing with a child's anxiety. For example, if a parent is anxious about dental treatment, it may be easier to treat the child without the parent in the room. Conversely, if a child patient is uncooperative and the parent has a healthy attitude towards dentistry, it may be helpful to have the parent present during treatment. Traditionally, children preschool age and younger are more cooperative with a parent present while those over eight years old are more cooperative without (Koplik 1991).

It is also important to remember that too many people in the room can distract a young patient and lead to confusion and frustration. The child should be listening and responding to just one person, the dentist. If the parent is present during the treatment, suggest that he/she take the role of a passive bystander so the child can stay focused on the dentist and not be distracted. Children often look to their parents for reassurance, so it is helpful if the parent maintains a sense of calm. A child can sense worry in a parent which may trigger fear and anxiety in the child. As a dentist, keep in mind that some parents use threats in an attempt to frighten their children into brushing more. Unfortunately this puts Dental professionals on the same level as the 'Boogey Man' in the child's mind. If it seems that the child has irrational fears from such suggestions, it may be helpful to provide the parents with materials regarding appropriate verbalization and behavior in relation to Dentistry.


The Child’s First Appointment


A child’s first dental appointment can be as early as twelve months of age. Visits at this age are mostly a consultation with parents, addressing their concerns regarding care for the primary teeth, oral hygiene instructions, how to examine the baby’s teeth, fluoridation, and nutrition. Such appointments also provide an opportunity for the dentist to discuss proper verbage for parents to use when discussing dental treatment and office visits. This initial visit also provides the child with an opportunity to become familiar with the office and the dentist, exploring the dental chair, or letting the dentist count their teeth. Such visits are a good time to describe to the parents what types of behaviors are acceptable in the dental office and standard office policy for a misbehaving child.

Children’s Fears


In younger years, children are afraid of three basic things:

  • Separation from parents

  • The unknown

  • Being injured

Behavior


Behavior is learned at home. Children from permissive and undisciplined families often exhibit combative, defiant, and/or tantrum-like behavior. Children from an overprotective family will act shy and timid or sob when they are afraid - looking to the parent for comfort. Keep in mind that the child exhibiting fear may have had a previous experience with a doctor or dentist that makes them afraid. If the dentist takes the time to unravel the events that have lead to the child’s present behavior, it may be easier to reverse the trend. A little patience, understanding, and communication with the child and their parents can do wonders.

Be sure to reinforce good behavior with children. Remember to reward the behavior, not the child. Saying “very good” to a child does not tell the child what it was that he or she did that was very good. Saying something to the effect of, "You are doing a great job sitting still reinforces the good behavior and the child learns what behavior will be rewarded.

However, reinforcing negative behavior can only make the situation more difficult. Remain patient when a child acts out, let them know that their behavior is not acceptable and remind them what behaviors you consider acceptable. If you simply stop treatment and refuse to address the situation, the child learns that all he/she has to do to get out of a dental appointment is make a big scene. Every time that trick is successful, the negative behavior is reinforced. Thus, some children go from one dental office to another without receiving treatment because of poor behavior and never learning "good behavior."

Techniques for the Crying Crisis

Crying is a normal reaction to fear, however, most often, a crying child cannot be treated safely. If a child has a crying fit or temper tantrum at any point during treatment, it is necessary to stop treatment until the dentist can regain the attention of the child. Once the child’s attention has been gained, then and only then can the dentist teach the child behavior that is appropriate. In the following are behavioral techniques that are designed to “grab” the child’s attention during a dental visit. Sometimes if the parent is alright with it, the child tends to cry and act out less WITHOUT the parent in the operatory. It may stem from the child acting out simply to see if the parent will react. Some parents are insistent about staying in the operatory with the child but if the parent is willing he or she can test this theory by standing behind the operatory wall to peer over to see if the child becomes calmer. This way the parent still gets to observe if they are concerned.


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