A recent routine check-up at the dentist for my two little girls triggered some pretty deep-rooted fears for me. As I watched my daughters lie back on the check-up tables, I felt my heart begin to race, my palms started sweating, and I found myself staring at the rise and fall of their chests. I was watching to make sure that they were breathing normally and not gasping, crying, or holding their breath in fear.
My little one laid back, arms resting gently on the exam table beside her, legs splayed out, totally relaxed. She might as well have been watching a movie or taking a nap. Her hygienist went to work, quickly, efficiently, and what appeared to be painlessly. I never had a dental experience like that when I was a kid. My experiences were filled with injections, blood, tears, angry words, and pain. My childhood dentist cultivated a dentaphobe.
What is Dental Anxiety?
Dental Anxiety is the fear of something terrible happening in relation to dental treatment. It is characterized by marked and persistent anxiety in relation to the dental tools, procedures, the dentist and/or hygienist, or the dental setting in general, and is coupled by a sense of losing control. Dental anxiety can be experienced by children, adolescents, and adults with or without history of an actual negative dentistry-related experience. Believe me when I say that I had several actual negative experiences.
Our oldest child, Lily, has never had a single negative experience with the dentist but suffers with dental anxiety. I am one of those moms who scheduled prenatal visits to check out potential doctors and dentists before I ever gave birth. I wanted to make sure that my kids did not have the same experiences I did as a child. I asked a ton of questions such as, “What do you do when a child is afraid of you?” and “Am I allowed to accompany my child to the examination area?” My husband and I chose carefully and have been extremely happy with our choices of medical providers for our girls. Still, Lily has anxiety when it comes to doctor and dental visits.
What Can Dental Anxiety Look Like?
Anxiety can manifest in a variety of different ways and varies from person to person. Some tell-tale signs of dental anxiety can include: the child becoming withdrawn when they are told about the appointment; asking about the appointment repeatedly or refusing to talk about the appointment at all; tantrums that have no other cause; the child saying that they don’t need to go to the dentist or that they have a headache or tummy ache; the child withdrawing at the dentist office; insistence on bringing a lovie to the appointment (even after they have given up the lovie in other situations); tightly balled fists; stiff body posture; refusal to lie back on the exam table; clamping the mouth shut; holding their breath and gasping; shaking or trembling; dizziness; choking sensations; and, in extreme cases, loss of bladder control. Some children even try to tell the dentist what tools they can and cannot use, which is where the desire to retain a measure of control comes into play. Some children experience emotional exhaustion after the dental visit. Dental anxiety is visceral and can prevent children from getting the dental care they need.
What Can Parents Do?
First, parents should understand that fears and anxieties are not always rational. Anxiety can be experienced over vague or unknown threats or even the possibility of a threat that has not occurred. Fear is the body’s response to an actual threat. Fear and anxiety are closely related and symptoms of both can be felt with either fear or anxiety. Anxiety can cause fear and fear can fuel anxiety. Simply telling a child to calm down is not an effective way to handle dental anxiety.
Meet the Doctor - Before scheduling a dental visit, schedule a meet and greet for your little one. Many dental practices are well versed in dental anxiety in children and have procedures in place to help calm the child. Allowing the child to see the dentist’s office in a non-threatening way first, before the actual checkup, can decrease fear and give the child a sense of control. Our hygienist allows her patients to handle example dental tools before using them, and has even done some pretty cool tricks with the sucky straw!
Make the Visit Predictable - Have your child close their eyes and visualize the dental visit as you talk them through what might occur. “First, we will check in, then you might have x-rays and wear the funny apron! Then, they will polish your teeth and make them so shiny! Remember, the dentist’s toothbrush can be a little loud.” Reading books about visits to the dentist can be a big help! Have your child point out similarities and differences between the story dentist’s office and their own.
Self-Advocacy and Trust - Talk through and practice what a stop signal might look like for when your child needs a break during the dental visit. Encourage the child to self-advocate when they need a break and make sure to follow through. Failure to follow through with the self-advocated break can lead to distrust and can exacerbate dental anxiety.
Distraction - For some children, being given something to think about other than the dentist’s tools in their mouth can be very helpful. On our recent visit, I told Lily a story about the time her aunt accidentally bit the dentist when we were little. When she interrupted the story for a break, my little one and the hygienist asked me to finish the story! I continued the story when Lily continued her cleaning. Other distractions can include music played through headphones, a stuffed animal to hold, or talking about what you will do after the visit.
Watch Your Words - Children are brilliant little sponges and will soak up whatever we say! With my own extreme dental anxieties, I have to make a conscious effort to not speak about or show my anxieties about dentistry around my children. At their appointments, I am calm and happy on the outside, even if I am secretly conjuring my happy place on the inside! As far as my girls are concerned, going to the dentist is fun and always ends in a new toothbrush and stickers!
Sedation Dentistry - The first time I experienced sedation dentistry I was super anxious that the medication wouldn’t sedate me. When I later realized that the procedure was over, I laughed euphorically. I’m not sure if I was happy about the medication or that the procedure was over, but I certainly didn’t feel anxious! This is an option that we use when Lily needs a more extensive procedure. I was nervous at first, but so happy when her experience went well and she was calm and breathing easily. Different medications can be used to achieve different levels of sedation, from conscious sedation where the child can respond to questions to full sedation with no memory of the event. After a visit using sedation dentistry, plan a relaxing day at home as the effects can take a while to fully wear off.
As with any fear or anxiety, patience is required! Find a patient, dental anxiety friendly dentist by asking friends for recommendations or making a visit to the office before bringing your child. Ask questions and feel free to shop around before making your final choice. The more comfortable you feel, the more comfortable your child will feel!