Feeling Afraid?

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How to address children’s dental fear?

The best way to address children’s fears is to introduce them gradually to the dentist’s office at an early age for regular preventative check-ups. The common question I am asked is: “when should I bring my child to the dentist for the first time?”. The Canadian Dental Association encourages the assessment of infants by the dentist, to determine possible special risks, by one year of age. This visit is extremely important in order to inform and guide the parents (anticipatory guidance). If there are visible cavities or pathology, they need to be addressed. Possible special risks include medical and social history, feeding patterns, oral hygiene practice, fluoride availability, etc.

For a child under the age of 3, the goal for the dentist is to be able to do a visual inspection to ascertain if the eruption of teeth is within normal limits for the age, if the oral hygiene is satisfactory and if there are any visible cavities or pathology.

The routine preventative in-office polishing of teeth in most children starts around the age of 3. At this age, the children become interested, cooperative and receptive to instructions.

Ideally, the child should be exposed to the dentist’s office as an observer when one of the parents or sibling has a non-invasive procedure done (cleaning, not a filling, not root canal, extraction). It triggers the child’s interest and indirectly tells them that “it’s ok” to be in a dental office. Some children are comfortable and intrigued; some others feel strongly protective towards the parent and will start crying. This does not mean that the child will be “afraid to go to the dentist” in the long run. In a majority of cases, the same child will react completely differently at a later time, under the same circumstances. There is no innate “fear of the dentist”.

The parents need to reinforce gently and consistently the oral hygiene rules and the positive outcome of going to the dentist (“to prevent cavities” not the negatives of the experience “you’ll be in pain, get a needle”, etc). Some children will experience a “dentist fear” which may begin at school due to what they hear from other children. It is not unusual for a child that was comfortable in a dental office to start being apprehensive around school age (“I heard at school that going to the dentist hurts”). The stage is usually short and temporary. If you, as a parent, have anxiety about going to the dentist, you can be assured that, despite the popular belief, this anxiety is acquired not inherited. In addition, the health of your teeth is less related to genetics than it was believed in the past .While genetics matters to a certain extent, there is no doubt that oral hygiene and diet are the key factors that will determine a person’s oral health in the long run.

If the child has cavities at an early age due to various causes (for example diet, lack of preventative efforts due to parent’s lack of information, etc) and a gradual exposure to the dentist’s office is not possible, the child can be given sedation which can range from a mild sedative to general anaesthetic depending on the severity of the problem. Once the acute problem is resolved, the child can return at a later time for the gradual approach of preventative dentistry. Also, in the current culture, regular dental visits for a child through teenage years are necessary to address the specific challenges that come with the every age (exfoliation of baby teeth, eruption of permanent teeth, wisdom teeth, diet that varies with the age and habits, etc). Also, with careful observation from the dental team and parents it is possible to identify that sometimes the fear is being triggered in some children by specific things in the dentist’s office. For example: small children under the age of 3 sometimes are afraid of gloves, masks, light, words like “doctor” or “dentist”. In later years, the child may have some anxiety if he or she has experienced pain or discomfort during an earlier visit.

A very small percentage of children do have a fear that cannot be overcome and they will need sedation on a regular basis. However, these are the rare exceptions.

How to address adult’s dental fear?

If you have fear about dental treatment it is important that you let me and my team know about your anxiety right away and let us know if there are any specific things that trigger your fears, such as past traumatic experiences, needle apprehensiveness, sound of drill, gag reflex, medical health problems, etc.

The most common sources of anxiety in adults are:

  • negative childhood dental experience
  • needles
  • the sound of the drill
  • a pre-existing gag reflex that makes the procedure difficult for both you and the dental team
  • the sight of blood
  • being a “mouth breather” which makes it very difficult for you to keep the mouth open for longer periods of time
  • anatomically small mouth
  • sleep apnea that reflects in your oral health and reduced ability to keep mouth open for long
  • fear that some existing medical health problem will be worsened by dental treatment
  • fear of a possible panic attack or history of panic attacks
  • in rare cases, some people have general anxiety without any of the triggers mentioned above.

The key to successful treatment is careful observation by both the dental professional and patient, to try to get to the root cause, if possible. If you have had negative childhood experiences, you may need occasional reminders that dentistry has changed drastically since your childhood-both in its technical aspects as well as the philosophy guiding the approach to treatment. Technically, the size and capabilities of needles has changed, dentists now routinely use topical gel or spray to minimize the impact of the needle, the drills are much improved, the use of modern technology such as laser and ultrasonic instruments contributes to minimize the stress of dental treatment. New products and technology are regularly introduced into practice to continue to increase comfort and reduce anxiety and stress.

A fundamental change has occurred in the philosophical approach to dentistry in recent decades: the concept of “no pain no gain” is obsolete. With modern anaesthetics, it is in the best interest of both the patient and dental professional to get the work done with minimum pain and stress. We find that, too often, patients tend to forget that both you as a patient and the dental team are human beings who share the same goal –we all want the work done efficiently ,comfortable and with minimum stress. Our dental team will do everything we can to create an experience for you to receive the best oral care uneventfully.

We can adapt our work to help reduce your fears. For example, the sound of the drill can be blocked with an earpiece; if you have a gag reflex we can work to minimize it with careful observation and specific techniques. If you have anxiety at the sight of blood, we can minimize your exposure if we are aware of your fear.

If you have a small mouth, are a “mouth breather” or unable to keep your mouth open for long, we can provide a longer appointment and can find various ways to adapt to the circumstances.

Patients with existing medical health conditions need to provide a very detailed medical history to the dental professional. Our office team takes care to get detailed information when we review the medical history and update it. If we know the status of your medical health and medication that you take, we will make sure that you receive safe treatment in our office. We ask that you provide complete information and not reveal only what you consider relevant to your teeth. Many health conditions and medication can interfere with your dental health in ways you may not be aware.