03:22am Friday 28 February 2020

Treating Dentist Phobic Children

The Peninsula Dental School is the first new dental school for 40 years, and we break new ground every time we introduce innovative clinically based learning. The way in which we teach our students to deal with anxious children has at its base GDC guidelines, and addresses the following points:

  • To have an awareness of the need to limit interventions to the minimum necessary to achieve desired outcomes;
  • To have knowledge of inhalational and intravenous conscious sedation techniques and the role of conscious sedation in dentistry;
  • To be competent at managing fear and anxiety by using behavioural techniques.

The first action taken is to rationalise the phobia and distinguish between true phobia and general anxiety. Is the child really frightened of dentistry and/or the dentist, or is it the unknown that is worrying them? Is it the parents who are anxious? Or is it the dentist’s anxiety about treating children?

Certainly there is a debate to be had about whether children are born with dental anxiety, or whether they pick it up from the environment around them. There is a poor public perception of dentists and dentistry, especially around the treatment of children, and this may be because as a profession there is a lack of confidence about how to manage paediatric dentistry – even though there are many protocols in journals and on the BSPD website.

Our students are shown that the management of anxiety in children (and by extension, their parents) is all about communication.

Effective communication alongside excellent clinical standards will dispel anxiety and fear in the majority of anxious child patients. This in turn will encourage them to become life-long, enthusiastic and regular dental attendees. Some people have a natural talent for empathy, building rapport and effective communication techniques, while others may have to work at it.

At the Peninsula Dental School we teach in a primary care setting. Basic communication skills sit at the heart of what we do, and during their four years with us our students put those skills to the test via plenaries, self-directed learning using case studies, the observation of others, special study unit reports, and, most importantly, treating child patients themselves. Such activities see them not only in primary care clinical settings, but also out in the community where they interact with schools, youth groups and many others, including the elderly and drug users. On the one hand our students bring to these groups dental hygiene education and advice and, in some cases, treatment via our Dental Education Facilities, and on the other they gain valuable insight into how dentistry fits into the community as a whole.

Later in their studies they are given information about more specific techniques of well established evidence based behavioural, psychological and chemotherapeutic regimes.

Our students are also taught when to hand over to specialists, who should manage true phobias. Such specialists can be found in either a Community Dental Service, via Specialist Paediatric Dental Units in hospitals or in a Specialist Practice setting. True phobias are managed in a variety of ways including positive reinforcement, ‘tell-show-do’, desensitisation, modelling, hypnosis, cognitive behaviour therapy (CBT) and conscious sedation.

By using techniques other than general anaesthetic we can help children take ownership of the situation and overcome their anxieties via their own efforts. It has been found that, when this happens, children are proud of their achievement and ultimately become more confident in and enthusiastic about their abilities in other areas of their lives.

Ultimately, the bottom line is being able to recognise fear and anxiety in children and making this key to the management of their treatment. Add to that effective communication, excellent clinical skills and a pleasant environment and we are well on the way to helping children overcome their anxieties and, in so doing, creating loyal, appreciative and enthusiastic dental patients of the future.

And does it work? The last word goes to the parent of an anxious child treated by our students under supervision at our Dental Education Facility in Truro. She said: “My boy was very worried about coming to the dentist, but we need not have worried. The student dentists were great with him. They talked to him and gave him all the support and time he needed to calm down and let them treat him. I think the treatment we received here today bodes well for the future.”

Peninsula College of Medicine & Dentistry

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