Seven-year-old Annika came to my clinic, hiding behind her mother’s skirt, crying. It’s her first dental visit and she is very scared. What, with all the stories she has heard from her classmates about how painful it is to go to the dentist, Anika was not going to let a dentist touch her at all!
Sound familiar? Fear of the dentist, as we know, can only lead to problems in the future – your child will forever be scared to go to dentist and he /she not learn how to take care of his/her teeth.
Maybe this is one of the reasons why I went into this specialty in the first place – not only to learn how to handle these cases, but also to help these children get over their fear and not be scared of the dentist. Mind you, some dentists who are not trained to treat children may actually be more scared of treating your child than your child is!
The following are the different approaches we do to help the child cope with his/her fear. In employing these techniques, we never lie – we always tell the truth to the child to gain her respect and for her to know who the authority is.
Tell-Show-Do
One of the sources of a child’s fear is the fear of the unknown. If she does not know what is going to happen, then her overactive imagination will start to work and picture the worst. But if the procedure is explained to the child in simple terms that she can understand, and then she will start t relax.
For example, a simple oral examination can be explained to the child that the dentist will just count her teeth (This is the “tell” part.), then we get our instrument and show her how to count using her fingers (This is the “show” part), then we do the actual oral examination.
Voice control
This is employed for children who misbehave. Dental treatments can be a little painful especially when the child knows what’s going to happen. Then the child will cry, disrupting the treatment. Voice control is the modulation of the voice of the dentist in a low, controlled tone – like a teacher – just to remind your child who has the authority in the dental clinic. This will grab your child’s attention and will compel him to stop crying and listen to what the dentist has to say. We have to rely on the child’s maturity to understand the procedure, as the dentist explains it to her again.
Hand-Over-Mouth
For a child who is hysterically crying and combative, a hand is placed over her mouth, and she is told that the hand won’t be taken out unless she stops crying. This is from a premise that there is no point in reasoning with a child who can’t even hear your explanation above her cries. Once she stops crying, it is time again to talk logic into the child using voice control. Some parents find this technique radical. This technique is not employed unless you agree to it.
Parental Absence or Presence
A parent’s absence or presence in difficult times is, most of the time, crucial to a child. And dental treatment is considered a “difficult time” for the child. She will want her parent to be with her. She will be more confident with the treatment, with the knowledge that her parent will not let anybody hurt her. The parent may be used as a bargaining tool for the child to behave on the chair “If you want Mommy beside you, you have to stop crying.” But if the misbehaviour continues, the parent really leaves the room or goes out of the sight of the child, as proof of the authority of the dentist. It shows that it is the dentist who is the one who is in control of the clinic, and not the child.
Distraction
This is a very effective technique for children and adults. Storytelling, singing and playing music are examples of distracting the patient so her mind is not on the high-pitched sound of the drill. Some children just need a good amount of distraction for the whole dental treatment so they will be able to cope.
Watching the dental procedure through a small mirror is a good distraction for the child.
It is important to understand that these techniques will only work if the child has enough maturity to understand these procedures. For toddlers, these techniques may not be effective since they do not yet know that the dental procedures is FOR THEIR BENEFIT, and that they are not being punished. Pharmacologic techniques are usually employed for toddlers in need of extensive dental treatment. They can also be used on older children when the parents feel that their child may not be able to cope with the “pambobola” techniques stated above.
What is essential here is you know that you have choices. You can choose to have your child treated with the techniques stated above, if you know that she can do it, without any effect of trauma on her. But if you feel your child is not ready for that, then you always have the choice of having her treated with sedation techniques. You, as a parent know your child best. You, together with your pediatric dentist can plan for the best treatment approach for your child.