I like to describe fear of the dentist as ‘Fear of the Unknown’. Adult patients will relate a bad childhood or past experience and sit in the waiting room, quiet and pale-faced. A child that has never been to a dentist before will be crying profusely in the waiting area and there have even been instances where the child will refuse to go into the surgery.
From the slightest discomfort to the most excruciating pain in your mouth, coupled with a terrible headache, patients often describe dental pain as more severe than tearing a ligament. With that said, their first reaction is to take some pain medication and hope for the best.
Sometimes they’ll have antibiotics from an incomplete batch that they’ll also take to self-medicate (this is never a good idea and can be dangerous), not forgetting the toothache essence or use of kitchen cloves to numb the area. After a few days of all these remedies, upon not being able to sleep properly or waking up in the middle of the night in agony – the time to finally make that dreadful call to the dentist dawns upon you.
Adult patients often replay their bad or painful experience several times and with each time, their fear of the dentist increases. The children who have never been to a dentist have either had a painful experience at another medical practitioner or were probably in a lot of pain at the time they visited the other doctor and they replay that memory for all doctors or related medical facilities.
Children may also be told the horrific dramatised experiences of their friends at day cares or schools, and often parents project their fears onto their children subconsciously.
My personal experience with a dental phobic child was early in my career. The child presented very happy; he was talking, interacting and engaging in conversation. He even hopped onto the chair by himself and was confident until the button on the chair was pressed and the chair started moving. The terrified child started crying and refused to be treated. I had to assess how a co-operative child had become scared of this moving chair.
As adults, we take things for granted. Children have curious minds and are able to perceive and understand clearly if shown and explained. Children need to feel welcome from the time they enter the practice; the receptionist/s should greet them with warm smiles and engage, greet and speak to the children to put them at ease. Having a play area in reception is also a good distraction, as the child will usually focus on the toys.
A dentist calling the child by their name, asking them their age and even complimenting them on the lovely T-shirt or dress they have on, all impacts on the receptiveness of the child in the surgery. The mannerisms of the dental assistant are just as important. They should also greet the child and tell them their name, setting the tone for a lighter atmosphere. Both the dentist and dental assistant should have ‘an act’ that they play out for children.
While the dentist listens to the parent’s reason for the visit, they can create a bond with the child by engaging with them and holding their hand. This is also a way to gains the child’s trust and acceptance.
Many adults avoid the dentist based on past experiences, as well as the ‘Fear of the Unknown’. It is, in fact, more difficult to persuade adults than it is children, as adults are more set in their ways. Although we live in the age of the internet, not everyone has access to watch online videos to prepare them for potential diagnoses, such as when the dentist says “this tooth needs a root canal”.
For many patients, a root canal is considered the most painful procedure in dentistry. I find that by explaining and showing the patient on their X-rays what is causing them discomfort and what exactly we will be doing during their next visit, they better accept the idea of completing a root canal instead of extracting the tooth (saving teeth is definitely the first option).
“A dentist calling the child by their name, asking them their age and even complimenting them on the lovely T-shirt or dress they have on, all impacts on the receptiveness of the child in the surgery.”
Take your time with the initial consultation, even if it means just explaining what you are going to do during the next appointment. Tell the patient what they can expect and about the contra-indications. Communication is key when engaging with the adult patient. Creating a colloquial (jovial, smiling, even joking) environment instead of a professional one takes the patient’s mind off their fear and enables them to develop a good develop relationship with you.
Tips for parents
- Before your child’s visit to the dentist, show them videos such as Peppa Pig: The Dentist.
- Role play dentistry with your child and tell them what to expect: “Open your mouth” then put your finger in their mouth; have them count their teeth and brush them, etc.
- Use positive words when speaking to the child.
- Some children are more co-operative if a reward system is in place (this should not include sweet things).
- Ensure that you do not transfer your fears of the dentist to your child.
Tips for adults
- Dentistry has advanced drastically over the last 20 years ago and is not as painful as it used to be.
- Ask your dentist to explain everything to you, especially the things you’re uncertain about.
- Request the dentist to apply numbing gel/spray before an injection.
- If you are anxious, you can request a sedative that you can take prior to the consultation.
IV conscious sedation – An option for the phobic patient
As a last resort when an adult or child’s fear is intolerable, you may consider IV conscious sedation. This is usually an in-chair procedure, where you are managed by an anaesthetist who puts you into a deep sleep so that the dentist can complete your dental treatment.
Tips for dentists
- During the consultation, take the time to educate and explain thoroughly to patients your advised treatment plan.
- Show the child and adult patients the needle, if need be.
- Establish a safe signal with your patients. For example, if they feel pain or sensitivity and would like you to stop, they should raise their hand.
- Use positive words and praise every child – “You’re the best patient ever” – to build not only confidence in the dentistry but also their self-confidence.
- Tell patients that you’ve seen thousands of patients with the same sort of fears and share a story with a positive outcome to put them at ease.
It is imperative that dentists keep the profession alive and explain the importance of good oral hygiene care to their patients, as well as how taking care of their mouth affects their overall well-being. Doing their best to educate and inform patients of the latest developments in dentistry and having the latest equipment in their dental practices will help in soothing the fears of the phobic dental patient.