Dental anxiety is commonplace among children. Nearly 20% of school age children are afraid of dentists. 1 Treating children with dental anxiety presents a real challenge to dental clinicians. It has been reported that many dentists consider the anxious and fearful child to be one of the most problematic types of patients.

Dental anxiety is not only a challenge for the clinician, but it also has a detrimental effect on the patient and interferes with receiving optimal dental care. Outlined are several behavioral strategies that should prove beneficial in managing the child with dental anxiety.

INFORMATION

In general, children tend to do best when they are informed in advance what to expect. Providing information in advance is particularly important in the case of an anxious child. The clinician should consider describing step by step what he or she will be doing describe the type of sensations the child may experience (eg, types of noises, vibrations and taste).

Young children may have difficulty understanding particularly complicated verbal explanations; for them, actual demonstration or role-play is a more beneficial strategy to adopt. The tell-show-do method is a good way to reduce anxiety in the child. Specifically, the clinician tells and shows the child what will happen in appropriate language, taking into consideration of the child’s age.

The clinician can then show the child how the procedure will work by demonstrating on himself / herself or on an available model.The treatment can then start once the child understands what is about to happen and his/her anxiety levels have reduced.

RELAXATION – Reduced Anxiety

For the child who is visibly anxious relaxation strategies are quite useful. Anxiety levels are different in every child and some children will benefit following a simple deep-breathing exercise, which involves deep inhalation and slow exhalation.

Another approach involves progressive muscle relaxation. Specifically, the child tenses and relaxes each muscle group in the body. The child lays back in the dental chair with arms by his / her side and closes their eyes. The child then tenses and relaxes each group of muscles in order, starting from the left toes and progressing to include the left heel, ankle, calf, knee, thigh, and finally the hip. The exercise is then repeated on the right side of the body. The arms are then tensed and relaxed, followed by the shoulders, neck, jaws, cheeks, forehead, eyes, and scalp. Finally, the child is told to focus on his / her tensing and relaxing the muscles in the chest and abdomen.

DISTRACTION

Distraction can be useful in reducing dental anxiety. There are many methods of distraction for the clinician to consider. If the child is playing with a toy whilst in the waiting room, it should (if possible) take that toy with them to help distract them whilst in the dental chair. Another method is simply talking to the child, engaging him / her in a pleasurable topic should distract the child and reduce dental anxiety. simple dialogue with the clinician may serve to distract a child. Once the treatment has begun this will obviously become a challenge.

Another way to cause a distraction is visualization.

The clinician should ask the patient to visualize a favourite experience, such as a recent holiday or party. This strategy is only really effective if the child re-experiences the event. To do this the clinician should ask for a s much detail about the event as possible. Another exercise to reduce anxiety would be asking the child to do simple arithmetic sums, or counting the tiles on the ceiling.

REINFORCEMENT

The clinician should make available rewards for the child in the form of stickers, collectible cards or small toys. This can be a very useful incentive for cooperation and for particularly “brave behavior.” Reinforcements can be issued frequently, and are dependant on the child’s age. There is no such thing as too much reinforcement but it must be realistic and not appear ‘over the top’.

The clinician should ensure that the incentives being offered are actually something that the child really values, otherwise this strategy will be ineffective. The clinician should prepare in advance for every scenario, perhaps by having a box of small gifts suitable for girls and boys of all ages.

It is a good idea to talk to parents about what toys or gifts might work to reduce anxiety with their child. In time the dental surgery should be equipped to deal with all possible scenarios.

PARENTAL INVOLVEMENT

There are many ways in which the parent can be involved and helpful in dealing with anxious children. If a child is experiencing anxiety the clinician should ask the parent for assistance. The child has probably exhibited anxiety in other contexts, and the child’s parent is likely to have some experience dealing with such anxiety. some strategies that may be most effective with the child. It is certainly controversial having the parent present, but can be a great help in dealing with the child’s anxiety.

It is also important to consider the role of parents as a model for their children. The clinician maybe able to model a procedure on the parent. The child in turn will know what to expect from the procedure and the parent can demonstrate any expected behaviour necessary. This should certainly reduce anxiety levels as the child feels safe with their parent.

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