Dental anxiety and phobia are common conditions dentists have struggled with for decades. Still, the problem looms large with an estimated thirty million Americans who consider themselves to be afraid of going to the dentist. Many of these people can attribute their fear of dentistry to traumatic experiences as children.
I spent the first few years of my career practicing pediatric dentistry as I was trained in my residency program. I began to see that the techniques I was taught in my pediatric residency program for treating children were helpful for some children, but caused others to have unpleasant experiences.
Changing Treatment Methods
The behavior management methods traditionally taught and applied in pediatric dentistry for treating children involve a few techniques: tell-show-do, intimidation, physical restraint, and sedation. Use of fear-inducing behavior management methods often generate negative dental visit experiences that risk creating long-term memories of intimidation (voice control), suffocation (hand-over-mouth), immobilization (physical restraints), and humiliation (crying rooms). Sedation, another traditional alternative, doesn’t always work and sometimes a child can be difficult to awaken, which is unsettling. I knew there had be a better way.
The first step was realizing the child’s memory is more important than fixing the tooth, so I began by resolving to always put the child before the tooth. This meant abandoning use of traditional behavior management methods in favor of practical solutions that create positive dental visit experiences for children. It’s a critical, necessary shift for pediatric dentistry because negative dental office experiences in childhood can lead to dental phobia in adulthood. When children experience traumatizing dental visits, the potential for instilling intense fear of seeing a dentist exists. Such fear sets them on course for a lifetime of steadfast avoidance of routine, preventative oral health care, which can generate a host of ailments.
I’ve found much of this pain and suffering preventable by building a no-fear pediatric dental practice. Over the past two decades, I’ve developed and implemented techniques and fee structures within my private practice that facilitate taking the fear out of a kid’s dental visit. Coupled with instituting a no-force policy, I’ve established strategies for winning a fearful child’s trust, for building their self-confidence, and for gaining their cooperation.
Allowing a child to move forward at their pace may first require procuring the parent’s patience, cooperation and trust. Many parents take time off work, expecting the job to get done on schedule so they don’t have to reschedule. When a child is unable to provide the necessary level of cooperation to complete dental work, many parents may initially want to use traditional behavior management techniques. However, when they understand that there may be long-term unintended consequences of these techniques, they begin to see things differently. Parents are pleased to see their children develop the skills necessary to provide adequate cooperation for dental treatment.
Some parents understand this well; fearful themselves, their testimonials strike a familiar ring. Recalling memories of their own bad childhood dental visit experiences, they don’t want their kid falling subject to similar treatment. Yet, parents who’ve experienced traumatic dental visits can unwittingly project their fears onto their children. Children are impressionable and when anxious parents convey verbal and non-verbal cues indicating a dental visit is unpleasant, they catch the discordant tone and their guards go up.
Building Trust From The First Dental Visit
Setting the stage for a more harmonious beginning, my program includes tools parents find helpful, such as guidelines about what to say (and not to say) to a child before the dental appointment. At the office, I greet new patients in the lobby, during which time precursory behavioral assessments are made, then they are next ushered through a facility tour.
For a glimpse of what’s in store for our patients, imagine visiting an open pediatric dental clinic with happy children and parents where they can feed the gerbils and play with toys. This approach is preferable to crying rooms and restraining boards used previously. Children are allowed to handle the instruments and given opportunities to observe what the process entails before receiving treatment. We win trust and willingness by empowering our patients, by believing them when we’re told it hurts and by stopping treatment when asked. From the moment patients enter our dental office and every moment thereafter, we engage in building rapport, trust, confidence and moreover, positive memories.
Dental practitioners reading this may wonder how such techniques are financially sustainable, given dentists typically are paid only when billable treatment is delivered and completed. I address this and share several other key strategies in my book, Pediatric Dentistry: Building A No-Fear Practice. Here’s where you’ll learn about the nominal fee schedule I developed for keeping costs affordable for most families while also financially supporting a pediatric dental practice operating under no-fear methodologies.
Practical reforms in behavior management methods are imminent if we’re to deliver pediatric dental care that supports dental phobia prevention. Kids simply need not grow into adults who are terrified of seeing a dentist. If the no fear pediatric dental practice model were widely adopted, I believe the prevalence of dental phobia would fade in future generations.
Article by: Dr. Allan Pike
Dr. Allan Pike began practicing pediatric dentistry in 1965 when he accepted into the children’s dental program at OHSU. His son, Steven, followed in his footsteps and together they operate Dr. Pike Dentistry For Children in Portland, Oregon.