Childhood fears are common and often occur within specific developmental periods. Common fears for children which tend to pass with time include fears of the dark, animals, insects, separation and visits to the doctor or dentist. Many children and adolescents perceive visits to the dentist as worrying. This may be due to a number of stimuli in the dental setting. For example, meeting new adults (who often wear coats and masks), seeing unfamiliar equipment and sharp implements, hearing unusual sounds, tasting unpleasant tastes, lying down in a chair and having objects put inside their mouths that can be uncomfortable or painful.
Dental anxiety is a fear of going to the dentist and experiencing a number of the above worries specifically associated with the visit to the dentist and dental setting. Dental fear can arise after experiencing painful or unpleasant experience or procedures, however these are not necessary for children to develop dental anxiety. A child’s personality and temperament including shyness and nervousness, a child’s resilience as well as parents’ own attitudes about visiting the dentist or medical professionals and parenting behaviours can influence the development of dental fear.
In dental anxiety, children and adolescents fear that something negative, unpleasant or traumatic will occur when visiting the dentist. This fear tends to result from their perception of what ‘going to the dentist’ entails rather than their actual experience. Children or adolescents will frequently avoid going to the dentist and will often behave in fearful, distressed and challenging ways to delay having to go to the dentist. Refusal behaviours, acting out, crying loudly, screaming/shouting or physical behaviours can be common in children with dental anxiety. Some children may become silent and passive or may present with other common physical symptoms/complaints such as:
- Stomach aches
- Nausea or vomiting
- Dizziness or fainting
- Muscle tension or body shaking
- Body ‘freezing’ or clinging
- Cramps or muscles aches
- Heart racing/palpitations and associated over-breathing, sweatiness, over-heating (e.g., hot flushes, red face/cheeks, clammy hands)
When children’s dental fears exceed what is typical for their age and developmental level, are persistent, and interfere with oral health and regular attendance at appointments as well as a child’s everyday functioning, a diagnosis of ‘specific (dental) phobia’ is usually considered and intervention is recommended.
General strategies to reduce fear when your child is going to the dentist
- Provide your child with some information about the dentist, the setting and the steps involved. Providing enough detail about what the child can expect and will be required to do will help with predictability and can reduce anxiety.
- Point out the dentist’s location when walking or driving by in a casual and relaxed way.
- Answer simple questions with age-appropriate language and in a matter-of-fact tone. Avoid too many details which may fuel further questions/anxiety and escalate your child’s seeking of reassurance.
- Allow the dentist to answer more specific questions and call ahead to perhaps discuss the questions so the dentist can be prepared with ‘child-friendly’ answers.
- Talk through the benefits of having healthy teeth and general oral care.
- Validate your child’s feelings of worry with the experience (i.e., let them know that you understand what it feels like for them).
- Talk about your own involvement – e.g., if they will be separated from you and where you will be, or that you will be there together.
- Talk through some strategies that the dentist may use to help them feel more comfortable (and share this with the dentist). e.g., chatting, telling stories or jokes and praise.
- Have a discussion about the realistic sensations that they will experience – e.g., a few minutes of discomfort as their teeth are cleaned.
- Avoid discussions about injury.
- Avoid discussion regarding other family members’ unpleasant dental or medical visits.
Treatment for Dental Anxiety / Phobia
Research has demonstrated that Behaviour Therapy and Cognitive Behaviour Therapy (CBT) are the most effective intervention models for Anxiety Disorders, including dental phobia in children.
These therapies will often include teaching strategies or techniques to the child and parent(s) such as:
- Education about anxiety in general, and dental anxiety more specifically. Identifying triggers and factors which might be maintaining the child’s worries and fears is important.
- Emotion discussions: Talking opening about anxiety and other feelings, up-skilling parents or caregivers to do this effectively through listening, validation and problem- solving.
- Behaviour management: Anticipating worries and behaviours as well as reassurance-seeking and questioning is helpful. Giving the child information about what to expect when going to the dentist will make the experience more predictable, give the child a sense of control, and thus help to reduce anxiety. Putting limits in place around the child’s repetitive questioning and reassurance-seeking can be helpful. Stating clearly how you expect them to behave, modelling ‘coping’ behaviours and problem-solving is also beneficial.
- Coping strategies: Teaching children to relax using breathing, muscle relaxation and focused-attention strategies can be helpful (e.g., focusing on an object/point in the room). Practical strategies like holding the child’s hand, encouraging the child to chat with the dentist or yourself, counting, listening to music or watching a cartoon/clip may be helpful.
- Rewards and behaviour charts: to encourage coping and brave behaviours as well as reinforcing coping efforts and ‘facing-fear’ goals (see the ‘exposure steps’ below).
- Thought challenging and self-talk: helping children to identify worried thoughts and to put these into words. Challenging thoughts based on evidence and probability, and encouraging more realistic thoughts and self-talk can be beneficial. For example:
- “This is good for my teeth and gums”,
- “It will be over soon, I will look at the mirror and be brave”,
- “The dentist is helping my teeth and is not hurting me”.
- Exposure to dental situations: helping children gradually face their fears in a step-by-step approach which involves exposing them to situations and triggers which cause them to feel anxious. When small, realistic and achievable goals are set, children learn to sit with their anxiety and cope with it. They may also learn that their fears often do not come true or that they were not as bad as they had thought they were. Each step is practised frequently and consolidated before moving on to a more difficult step.
An example of a possible exposure ‘step ladder’ for dental anxiety (starting with the most achievable goals to the most difficult ones, with the parent present for each step):
- Visiting the dental surgery
- Visiting the dental surgery and meeting the dentist
- Sitting in the waiting room and talking with the dentist
- Sitting in the waiting room with parent and going into the dental office
- Going into the dental office and sitting in the chair
- Going into the dental office, lying in the chair and practising holding mouth open
- Lying in the chair and practising holding mouth open and looking at some of the dental tools and
listening to suction tool
- Lying in the chair and holding mouth open and dentist practising using a tool of child’s choice
- Lying in the chair and holding mouth open and dentist using a tool of his/her choice
- Lying in the chair and holding mouth open and dentist completing use of a tool and suction
Please also read our page about general phobias in children here.
If you would like to find out more about our treatment for dental phobia or other phobias, or to book an appointment with one of our child clinical psychologists who provides treatment for these conditions, please email or call the clinic on 02 9438 2511.