6 Ways to Ease Pediatric Dental Anxiety

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

Whether it’s your own child begging to skip his next dentist appointment, or the child of a friend who’s deathly afraid of the dental chair, I’m sure you’re aware that dental anxiety in children can be very real.

And what’s worse is that failing to address this problem can cause it to worsen over time, making it difficult to maintain your child’s oral and dental health. But it doesn’t have to be that way.

It is possible to ease your child’s dental anxiety—no medication or sedation required.

What is dental anxiety?

Put simply, dental anxiety is “fear related to seeking or receiving dental care.” But before we dive further into this topic, what exactly does dental anxiety mean?

Many people don’t particularly like to go to the dentist, but they’re not necessarily afraid to go. Dental anxiety, meanwhile, steps into the territory of fear.

Anxiety is actually a multisystem response of the human body to a perceived threat or danger. It reflects a combination of biochemical changes in the body, the patient’s personal history and memory, and the social situation.

Anxiety appears to be a uniquely human experience. Although other animals clearly know fear, human anxiety involves an ability to use memory and imagination to move backward and forward in time—an ability that animals do not appear to have.

Put simply, we are prone to anxiety because we can remember and imagine, and we can extrapolate potential outcomes that cause fear. This is often the case even if those outcomes have never actually happened to us personally (or are unlikely to happen in the future).

The anxiety that occurs in posttraumatic syndrome indicates that human memory is a highly complicated mental function and that a large portion of human anxiety is produced by anticipation of future events, regardless of their likelihood.

For example, your child may have a friend who’s had multiple cavities. One day at school, your child’s friend explains his last dental visit, during which he had his teeth drilled and filled. It was horrible and painful, he says. Now, even though your child’s teeth are in great shape, he is now nervous about visiting the dentist and having a similar experience.

It’s important to distinguish between anxiety as a feeling or experience, and an anxiety disorder resulting from a psychiatric diagnosis. A person may feel anxious without having an anxiety disorder. Likewise, a person facing a clear and present danger or a realistic fear is not usually considered to have an anxiety disorder.

So, to sum this up, dental anxiety is fear of the dentist that causes varying degrees of stress-related responses of the human mind and body. It could be as simple as excessive sweating or as severe as an anxiety attack at the thought of a dental procedure. For children, that anxiety can manifest itself as “acting out,” crying, tantrums, refusal to cooperate, or a myriad of other responses.

Why is my child afraid of the dentist?

In order to ease your child’s dental anxiety, it helps to understand the causes. Then, equipped with that knowledge, you can more effectively deal with and ease his fear of the dentist.

I want you to have the tools you need to make a trip to the dentist a pleasant and rewarding experience for both your child and you, just as I utilize the tools at my disposal for the same purpose.

Fear of Obstructed Breathing

Although you may not hear much about it, the first cause of dental anxiety I would consider is your child’s fear of having his airway blocked. Whether it’s the rubber dam, the instruments, cotton roll, or the dentist’s fingers, the airway is somewhat restricted during normal dental procedures. This elicits a primal fear.

Children are good at vomiting, gagging, and coughing because these are all ways to remove obstructions to breathing. Without this basic fear, we could not survive more than a couple of minutes. For children who are mouth-breathers, this gag reflex is even more accentuated, since it is their survival instinct basically saying, “Get out of the way, I can’t breathe.”

For children who do not breathe well through their nose, this can be very frightening, but it can also be frightening for children who do breathe through their nose. In fact, this innate fear is what makes waterboarding effective for activating an extreme fear response.

Fear of Pain

For many children, pain is also at the root of their dental anxiety, and at one time, it wasn’t completely unwarranted. Dentists used to believe that baby teeth had no nerves, so procedures were performed with only a little nitrous oxide gas, just to calm the child down and keep him from fidgeting.

We now know differently, though. There is pain associated with dental procedures, and if a child indicates the dentist is “bad,” “makes me hurt,” or isn’t “nice,” these may be indicators of undue pain the child has experienced from a dentist who was not properly concerned about giving the child a pain-free experience that would make future dental care more likely.

Adults who’ve experienced legitimate pain as children in a dentist’s chair often remain extremely anxious about visiting a dentist into adulthood. This can lead to a lifetime of rare dental visits, cancelled appointments, and poor dental health.

Fear of Powerlessness

Fear of losing control is a cause of dental anxiety that is related to the fear of pain. A child knows that the big person with the pointy instruments is in charge. If there’s pain or discomfort, the child may very likely feel that he or she has no control over it. This can make him very anxious even if he’s never been to the dentist before.

In my office, we utilize a number of tools to help minimize this kind of anxiety, such as giving the child complete control of the TV remote. No one will take that from him—not a sibling, the staff, or the parent. He’s in control of that remote.

Also, we help the child to understand that if he raises his hand, we will immediately stop. This gives him more control and makes for a less anxious visit. We also give the child a stuffed white dog to hold onto that further helps to minimize fear.

Vicarious Fear

When adults suffer from dental anxiety, they may transfer that fear to a child through vicarious learning. As an example, when a child hears a horror story about a dental visit, he will likely experience the fear of that visit himself.

Children want to copy adults they love and admire, so if someone important has a fear of the dentist, it will be more difficult to ease that child’s dental anxiety, even if he hasn’t personally experienced a problem. In fact, in a study of Scottish children age 13-14, a high predictor of dental anxiety was the number of people in the child’s life who were afraid of going to the dentist. (1)

Too Much Time Between Visits

Another high predictor of dental anxiety in the above study is the length of time since the child’s last dental visit. Although not seeing the dentist does not necessarily mean a child will develop cavities (more on that in a moment), children may assume that infrequent visits to the dentist will result in more problems when they do finally do go. And more problems, in their minds, equals more discomfort, pain, and increased anxiety.

Injections, drilling, and scaling were the highest anxiety-inducing procedures for 13- to 14-year-old participants in the study. Additionally, in many cases, children who are sporadic in their dental visits finally agree to a visit due to pain, which is often cause for a filling or extraction.

Not surprisingly, drilling and extraction are also associated with anxiety, and anxiety resulting from these procedures will likely produce a vicious cycle leading to long term dental anxiety problems. (2)

Fear of the Unknown

Finally, your child’s dental anxiety may be rooted in fear of the unknown.

For some children, fear of the dentist is born out of little more than their imagination of what a dental visit will be like, laced with snippets of information gleaned from media or stories they may hear. They have little or no experience to base this fear on, and sometimes the unknown is quite scary to a child.

Although studies show that the majority of five-year-olds that experience dental anxiety no longer experience it at nine, just under half of the five-year-old study participants were still anxious by the time they reached their ninth birthday. During the follow up period of the study, more than 11% of the non-anxious five-year-olds had developed a fear of the dentist by age 9. (3)

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Consequences of Dental Anxiety in Children

A significant problem for the dental profession is dental anxiety and the subsequent avoidance of dental care and deterioration of oral health. (4)

If dental anxiety becomes a long-term issue, the consequences can include a lifetime of avoiding needed dental procedures, which could lead to a marked deterioration in overall oral health. The cycle then continues as new dental issues due to poorly maintained teeth and gums lead to other anxieties.

Not going to the dentist doesn’t automatically lead to cavities, since the development of cavities is actually a diet and hygiene issue, and it is possible to heal cavities naturally, on your own.

But the risks increase with sporadic, rare, or non-existent visits to the dentist. This is especially the case when people aren’t taking the proper supplements or eating the right foods to maintain the health of their teeth, gums, and oral microbiome.

Avoidance of dental treatment often results in a higher incidence of cavities, which has been found to lead to more missing teeth and unfilled, but problematic teeth. (5) This can also lead to feelings of inferiority and shame, which in combination may lead to greater anxiety and further avoidance of dental care.

Impacts of dental anxiety include negative thoughts, crying, aggression, sleep disturbances, disturbed eating habits, and greater self-medication. Impacts on social interactions, performance at school or work, self-esteem, and confidence levels have also been reported.

How to Ease Your Child’s Fear of the Dentist

So, how do you ease your child’s fear of the dentist? Let’s take a look:

1. Choose the Right Dentist for Your Child

Earlier, I mentioned a few ways dentists can minimize dental anxiety in their young patients, based on techniques I use in my practice. Thus, it is very important that you seek out a dentist who is attentive to the needs of children in order to help ease your child’s dental anxiety.

Dentists who have children of their own, for instance, are more likely to be tuned in to the needs of children and may be more sensitive to the things that may potentially induce fear.

2. Don’t Keep Upcoming Visits a Secret

Children need predictability in their life, so letting your child know of an upcoming dental visit in advance will give him time to mentally prepare for the visit. Allow your child to ask questions and express his fears. Answer his questions with straightforward, to-the-point answers while limiting the amount of details you include. Talk to your child about the importance of maintaining a healthy mouth and the rewards and benefits of regular dental care.

3. Teach Your Child How to Find Calm

You can employ relaxation techniques such as deep breathing exercises to slow down your child’s physical reaction to anxiety (i.e. increased heart rate, etc.). Emphasizing the positive aspects of proper dental care and regular dental visits will also help ease your child’s dental anxiety.

4. Set a Good Example

You are a role model for your child. Your thoughts, concerns, and attitudes will affect how he responds to anxious situations, and your involvement and calm will translate to security and calmness for your child.

I must make an important note, however: I advise avoiding bribery. Bribing the child to “not make a fuss, so you can get a treat” may actually increase his anxiety as he wonders what’s so bad about the dentist that he might want to cry or make a fuss. Sugary treats as a bribe also contradict the good dental behaviors you want to reinforce.

5. Start Early and Be Consistent

The earlier your child begins regular dental visits, the better. (I recommend scheduling your child’s first dental appointment around 6 months, or by his first birthday, at the latest.)

You decrease your child’s risk of developing dental anxiety if visiting the dentist has become a regular part of his life and earliest memories. You may even want to have a pretend visit with your child before the actual visit to lessen the strangeness and anxiety of the event.

If you’re still concerned that your child is anxious, try reading dentist-related storybooks to your child before a visit.

Additionally, once your child has his first dental visit, be sure to schedule regular follow-ups. Building a rapport with the dentist and the other clinicians, becoming familiar with the atmosphere of the office, and becoming more familiar with the rewards of regular dental visits will go a long way toward alleviating some of your child’s dental anxiety and preventing it from developing in the future.

6. Be Cautious When Taking Your Child to the Dentist With You

Most experts agree that taking your child to your own dental visits may be a very bad thing.

Instead of instilling calmness, your own unrealized anxiety, along with the sterileness of the adult dental environment, may have the effect of increasing your child’s dental anxiety. So if you want to take your child to the dentist with you, make sure you are free from fear of dental procedures yourself.

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Your child’s oral health is important to his long-term well being, so establishing good habits early will translate to a lifetime of healthy teeth and gums. And, of course, seeing the dentist on a regular basis is one of the best habits to establish.

In order to make this an anxiety-free activity for your child, you’ll need to be proactive and sometimes creative. To recap, six ways to ease your child’s dental anxiety include:

  1. Choosing the right dentist for your child
  2. Not keeping upcoming visits a secret
  3. Teaching your child how to find calm
  4. Setting a good example
  5. Starting early and be consistent
  6. Being cautious when taking your child to the dentist with you

You can ease your child’s dental anxiety by making the activity a fun and enjoyable part of his normal life.

Learn More: Pediatric Dentistry: How to Find the Best Dentist for Your Child