Our approach to working with fearful children.
Here at Kidstown Dental we love in treating children who are fearful or anxious about visiting the dentist. With our extensive experience working with such children, we have devised a set of practices to make their visits as comfortable and positive as possible. Here we’ll explain the techniques we employ, and how our approach may differ from what are familiar with.
Working with very young children
Ideally, a child’s first visit to the dentist should be around 6 months after their first tooth appears, or 1 year old. According to the Centers for Diseases (CDC), it is becoming more and more common for children aged 2 to 5 to have cavities – in fact, a recent report, found up to a 22% increase in the incidence of cavities in the youngest age group. Therefore the ADA recommends that first dental examinations happen early in the child’s life, so that problems can be prevented before they become more serious. Problems like cavities, enamel defects or demineralization can start as soon as the teeth erupt. If they are identified early at age 1 or 2, more invasive interventions, like general anesthetic procedures, can be avoided. Prevention is always better than catch up.
Because there are only around 6,000 pediatric dentists currently working in the US, many young children end up being seen by a general dentist for their first visit. The general dentists willing to see young children are very needed, but very, very few general dentists have any training on children under 3. Because the training in most dental schools is lacking in this very young age, rarely do they have experience working with children under 5 or those with behavioral issues. This is not ideal as these groups of patients require a different approach to make them comfortable with visits to the dentist.
Why children are afraid of visiting the dentist
Believe it or not, going to the dentist is a learned fear. Vertical transmission, ie. parents inadvertently pass on their own fears (children a very perceptive) is probably the most common reason kids come to their first visit already feeling fear. Often, children are afraid of visiting the dentist because they have had a prior bad experience with a dentist. Dentists who have not had extensive behavior management training or child psychology education that is part of Pediatric Dental Residency, can run into lots of pitfalls. Some may try to “push through” a procedure when the child is in pain, causing the child a lot of distress. Some practitioners have the attitude that children just have to deal with the pain and “suck it up”, however, this only means that the child will be more resistant to visiting the dentist in the future and be harder to work with. Others may hold the belief that the medical community used to believe, that children don’t feel pain like adults. In the old days, dentists didn’t think it hurt to drill on baby teeth. In these cases the dentist may not believe that the child is having pain, but just that they are “misbehaving.”
Helping children love coming to the dentist is very important to me. I love being able to give kids their first experience, and avoid fear altogether. I really enjoy (though it might sound weird) helping kids who have already been traumatized in a dental setting, overcome that fear and actually look forward to visits. Why… My first visit to the dentist was VERY traumatic. I remember my grandmother (who took me) being told I had cavities, to wait in the waiting room and they would be fixed. The solid white door closed. The brunette “nurse” held my hands as the white-haired, old man dentist (with big hands) proceeded to come at me with (what seemed a very large) needle. I blacked out after that and don’t remember much more. I know they filled “many” cavities that day, and I was petrified of the dentist from then on.
Now that I head my own practice, I can choose how it is run, and I want dentistry to be as fun and easy as possible for children and their parents. I also am a bit of a perfectionist, so I care that the work is excellent, beautiful and long lasting. I work to establish trust with the children, and show them that dentistry doesn’t have to be painful or scary. Often, once I’ve established this trust with a child who was previously fearful, they will be the best and most dedicated patients and their parents will be grateful for helping their child overcome the fear of the dentist. We hear parents saying that they wish that they could have visited a practice like ours when they were children, because it’s so much more positive than their experiences were.
How We Make Going to the Dentist Easy and Fun
Every visit to Kidstown Dental starts with us showing patients around the dental office so they can see what goes on here. They get a tour to see all the areas and ask questions. Then any person on the team that sees the child, an assistant, a hygienist, or the dentist will spend a little “no gloves, no mask” time to get to know and warm up the patient. They start at the children the tooth brushing station and the learning lab, allowing us to get acquainted with the child and do some fun activities together before starting any of the “clinical” stuff. Even in the case of an emergency appointment, it’s still important to take the time to make a connection with the child before beginning any procedure.
We make use of the “Tell, Show, Do” model, in which we first tell the child what will be happening – “This is my super cool laser. It gives your tooth a cool shower, and it washes away the sneaky germs that have been hiding in there,” for example – then shows what will be used, “would you like to see how it feels on your hand first?” By doing this, the child doesn’t deal with fear of the unknown, and can see that the laser for example, doesn’t hurt at all. (That is why we can do no shot fillings and crowns…see below!) We also use distraction techniques like singing to the child, placing a sticker tattoo during their filling, playing games with them, or having a TV above them which they can watch, so they have something to focus on other than the procedure. Another important aspect in working with children is not to berate a child or harp endlessly on a behavior – “Stop closing your mouth!” – but rather to praise them for their efforts – “Thank you for holding your mouth open so well!” It’s funny, but when you do something as simple as saying thank you for holding your mouth open (instead of don’t close, don’t close…) even when they were closing, they open wide.
Another thing we think is very important is to always keep things positive. Lets be honest, some children, sometimes will not be able to handle a given dental procedure without some sort of sedation. Lets take a young 4 year old who might need a lot of work and some of it quite extensive. This child could still be in the pre-cooperative cognitive stage of development, and thought they love coming to the dentist, are happy, etc…just can’t open wide enough and stay open for the procedure. We would likely try, because some can, but if they aren’t able to, we will praise them for trying something new, for being such a good helper. We will tell them that was a great practice for the day, and then step back to discuss other options with the parents. We do believe restraining the child yelling at the child, telling them “if you don’t do it today you’ll have to come back and get a shot” or other similar negative approaches help us or the child in the long run.
I have found, it is imperative that the dentist never lie to a child, and should not hurt them. We have a system where children are told to raise their left hand if anything bothers them or even if they just need a break, and it’s vital that the dentist honors this and stops the procedure if the child raises their hand. This is how the dentist can build trust with the child.
The aim of all these techniques is for each visit to be a happy one. For a very fearful child who is too anxious to go through with a procedure on their first visit, we make sure to praise everything that we have achieved in the session, such as them sitting in the chair or rinsing their mouth. We emphasize to them the important of practicing, just as you would in a sport like soccer. This makes the child feel good, and helps them to get comfortable with the dentist so that more procedures can be undertaken on their next visit. Our policy is that no child should leave the office feeling like they failed, disappointed us or distressed.
Technology we use to make procedures easy and comfortable
At Kidstown Dental, we have five lasers in the office for dentistry, which allow us to perform fillings, crowns, and even nerve treatments without having to give the anesthetic shots which many children find painful or upsetting. Laser treatments are not painful, unlike traditional dental drilling. When you use a drill on a tooth, it creates heat and friction which sends a pain signal to the brain, so pain signals need to be blocked with local anesthetic. Also, drilling can create problems like micro fractures, which can cause recurrent problems. Lasers uses water and light energy instead, so there’s no heat or fiction. It feels like a cool water spray on the tooth, with no pain. It eliminates the bacteria and the tooth is healthier and free of micro fractures. (It is a superior way to prepare a tooth for a filling or crown.)
For any surgery involving gums or soft tissues, we use lasers too. The lasers seal the nerve endings as you go, greatly minimize bleeding (sometimes none) and make healing faster and often without any scarring. For many surgeries with the laser, we only need to use a topical gel anesthetic, i.e. no shot!
A common fear patients, even adults have, are bitewing x-rays. They can hurt and make some people gag. For a child it is very scary and for anyone, gagging or throwing up is embarrassing too. Being sensitive to this issue, we use a simple technique we call “no-gag x-ray technique”. It is a small thing for us, but a big deal for our patients.
How parents are involved in our procedures
Finally, one of our unique policies is the way in which we manage parental interaction during procedures. Studies have found that children behave more poorly when parents are in the room with them – for example, one study found that children behave 800 times worse in the presence of their mother! If parents are in the examination room with their child during a procedure, they can inadvertently make the child more afraid. An example is, lets say the child is getting a shot for an extraction. We know we can explain the procedure and give the injection completely painlessly (technique!), but the parent leans over and starts rubbing the child’s let and asking if they are okay. Child goes into red alert….and they can become nervous because they can tell something is happening that is making Mommy nervous for them. If a parent is nervous – especially if they are afraid of going to the dentist themselves – then they can transit this fear vertically down to their children. (But don’t stop here, we know you want to be with your kids…)
However, it’s understandable that parents feel protective of their children, particularly if they have had bad experiences at the dentist, and they want to be in the room with their child. So we have found a balance of parental involvement which we call the “silent partner policy”. This means that parents have the procedures explained to them and are invited to come into the room with the child, but are asked to sit in a chair and to let the dentist take the lead in interacting with the child. This allows parents to see how the child copes with the procedure, while building trust between the child and the dentist. We have found parents love this. They get to see first hand all our cool techniques for helping their child and at the same time, their child really having fun while getting treatment done!
Conclusion
It’s very common for children to be afraid of visiting the dentist, but it needn’t be that way! If your child is anxious about dental work, then let us help with our extensive experience and advanced techniques for making fearful children feel comfortable and safe. Contact us at 281-542-4521 to make an appointment.
