Tips for Dealing With Dental Fear and Anxiety in Pediatric Patients

It is a natural human behavior to be fearful of the unknown. Adults deal with the fear of the unknown typically by asking questions, gathering facts, speaking with an expert on the topic, etc. These could be referred to as coping mechanisms or what we call in dentistry an informed decision-making process.

Part of making a treatment decision in dentistry is to ask questions, gather facts and discuss with the dental professional BEFORE you sign up! Adults have the maturity and capability of rationalizing the informed decision-making process, taking the information, and shifting the unknown to the known, so they know what they are signing up for. What about the pediatric client?

 

Tip 1: Let Them Ask Questions

The pediatric dental client has 100% reliability on the parent or caregiver for having advocated on their behalf the asking of questions, gathering of the facts and discussions with professionals. Supportive parenting will involve this approach. However, the parent/caregiver, as much as they know their child, may have missed something the child needs to know to alleviate their own fears of the unknown (or worse the myths from ‘stories’ heard by other children).

Within vulnerable populations of children, we can easily see how the child is even more disadvantaged with either no advocacy or partial advocacy. Regardless of the level of the child’s support, lack of support, and/or vulnerability the child may have their own questions. Hmmm, how about asking the child directly? Be prepared to answer any questions or concerns too in a way that they can understand.

 

Tip 2: Building Trust With a ‘Wow’ Experience

I am heading toward 30 years in dentistry where my first four years were spent being a certified dental assistant in a pediatric dental office. I loved it!!!! No that’s a lie, I absolutely LOVED it!!!! I felt it was my full responsibility as a dental professional to support every child in the way THEY needed the support.

In the specialty of pediatrics, there is typically a reason why the general dentist refers a child to their colleague. Such scenarios are medical health risks, behaviour issues, special needs, young age, the scope of treatment, etc. No matter the reason for the referral a relationship needs to be built with each specific child.

There is no cookie-cutter approach to any relationship, so why would we think in dentistry there is a certain list of rules for children in general? Albeit there are general do’s and don’ts, but the relationship will need to be tailored to each individual. Where we fall short in dentistry is not taking the time in getting to know each child BEFORE we deliver any type of treatment, even an exam.

Why? Because the clock is running and dentistry’s clock never stops. Working within a tight schedule is the nature of a dental practice. But why not structure that schedule to tailor to the needs of the pediatric client? After all, the experience from that first, second and even third visit will 100% dictate the way the pediatric client envisions dentistry. Should we not want to be part of shaping that experience so it's nothing short of magnificent?

We need to deliver a ‘wow’ experience at the very first encounter. In the robotic approach to dentistry, the pediatric client is booked for a new client exam. At the new client exam, we do an intro chat a bit and then expect the child to automatically hop in the chair, open wide for x-rays, a full exam by two strangers maybe three, scaling, polishing and applying fluoride. Yeah, that should go over really well!

We need to restructure the sequence of the new client exam. Their first visit should be a meet and greet, nothing more. I like to have every child come when their parents or siblings (if they have siblings) visit, BEFORE their own first visit. That gives the child the chance to come into the operatory and interact. There is a show and tell with the child who does not have an appointment.

A ‘goody bag’ is given with a dental bib, a piece of gauze, a dixie cup, a mask, gloves, and a saliva ejector for role-playing at home. Often the child will hold the saliva ejector for the parent. The child is asked if they want a ride in the chair. Some say yes if they can sit with the parent or a sibling. Some say no. I S. The child that takes me up on the fun ride by themselves is ready for the new patient exam. The child who declined is simply saying ‘Hmm I need to get to know you more first”, and guess what, that’s okay.

 

Tip 3: Take Your Time

Why should a new pedo client exam not be any less than 1 hour? As the first 15 mins will be a complete show and tell. Not just a here is what I am going to do, but bring the child to the counter show them the tray set up, let them touch the saliva ejector, fill a cup of water and let them suction the water out, spray the air water syringe in the sink, place their foot on the rheostat pedal to spin the prophy cup, feel how the prophy cup tickles (change the prophy cup of course before going intraoral), see how bright the light is before you shine it in their eyes and the list goes on.

In all the possible show-and-tell interactions there is an opportunity for the pedo client to ask questions. By doing this, the unknown is being removed and a beautiful rapport is being built via trust and patience.

Yes, there is a business management side to a dental office, but we cannot be so wrapped up with tight schedules that we lose sight of the importance and value in the role we play as dental professionals to make dental visits fantastic for THAT child. One of the roles of the dental professional is advocacy. For every client that sits in the dental chair, we must do what is best for THAT client. We are not meeting the pediatric clients' needs if there is no structure to their experience.

Will the office lose production with a full-hour pediatric visit that will most likely render a billing of a new patient exam and maybe radiographs if required? Not at all, the reverse will happen, and the office will gain production as you will be gaining a client for life. With my ‘vintage’ status as an RDH approaching 30 years, I have fully witnessed the investment come back as I now see third generations. The once-pedo client with whom I invested my time to tailor the experience to their needs is bringing in their own children and sharing how thankful they were for the time I took with them. That parent is so excited for me to meet their child and it's actually a very emotional moment.

Many kind words and heartfelt thank yous are shared with watery eyes. Just for having taken that time for them when they were a child and now again for their own child. Many parents are in complete awe that the same unforgettable positive approach they received is being shared with their own child. Then guess what else happens? That parent refers all the kids in their playgroups.

 

To Sum it Up

Managing dental fear in children can be challenging. In my about 30 years working in dentistry, I have picked up some tips to help alleviate dental fear in pediatric clients.

 

Tips for Dealing With Dental Fear and Anxiety in Pediatric Patients:

  • Let Them Ask Questions - Ask them directly if they have any questions or concerns.
  • Build Trust With a ‘Wow’ Experience - Let them explore the clinic and be hands-on.
  • Take Your Time - Don't lose sight of the importance and value of the role we play as dental professionals to make dental visits fantastic for every child.

Tailoring the structure of a pediatric dental appointment to fit THAT child may occupy an hour in your schedule with a low production return, but it will be the best time invested. It’s sending a message to the parent and child that you care. That message is received loud and clear, and you gain a patient for life with constant referrals. I believe that one hour is worth our time!

 

Sources:

    1. Julie L Lerwick. Minimizing pediatric healthcare-induced anxiety and trauma. World J Clin Pediatr. 2016 May 8; 5(2): 143–150. Published online 2016 May 8. doi: 10.5409/wjcp.v5.i2.143 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857227/

 

 

Michelle Aubé (Simmonds) RDH, maxill Dental Hygiene Educator

Michelle is a Dental Hygiene Speaker, Consultant and Educator with over 21 years of experience as a RDH and 4 years as a CDA. She has written dental hygiene articles for CDHA’s OH Canada professional publication and continues to practice clinically and teaches both clinical dental hygiene and practice management at Fanshawe College and the University of Western Ontario. She has served on the Discipline Committee at Algonquin College and held the position of a CDHO Quality Assurance Assessor for 7 years.