February 2008

The Whole Tooth and Nothing But the Tooth:
Preventing Fears and Tears at the Dentist

By Michael Gazori, DDS

“Nothing personal, Doc, but I hate you!” These words were spoken to me a number of times in my former career as a general dentist by new patients before I had even begun treating them. I understood that statements like this were based on anxiety. When I inquired further, I found that invariably my adult patients expressing such sentiments had painful dental experiences as children. I realized that in most cases, the attitudes, both positive and negative, of adults towards dentistry are largely shaped by childhood dental experiences. Many patients’ negative recollections were of the dentist continuing treatment while they cried that the process was painful.

The dentist who ignores a child’s cries may believe that the child is mistaking pressure, numbness or vibration for pain. However, if a child truly feels pain and is given no way to control that pain, she will likely begin to develop negative attitudes and a lifelong, heightened level of anxiety about dental care. This anxiety often leads to avoidance of preventive care and the subsequent development of dental disease requiring more extensive, and possibly more uncomfortable, treatment.

Prevention Is Key

The most important way to eliminate children's dental pain and anxiety is to prevent dental disease that requires extensive treatment. If dental problems can be eliminated, then debilitating anxiety is less likely to develop. Dental disease can largely be prevented with early intervention and care. When making recommendations to you, the dentist will consider your child’s risk factors for dental disease, including medical conditions, diet, oral hygiene, dexterity and fluoride exposure. Establishing good dental care, health and habits early in your child’s life will likely reduce pain and anxiety in the future because you have eliminated the need for more extensive treatment.

Parents can also help alleviate their children’s anxiety toward dental treatment. Modeling good dental habits and portraying a positive attitude will ensure that children don’t pick up on parents’ anxieties. Avoid words like “pain” and “needle.” Do not use fear of the dentist as a motivator to get your children to brush their teeth or to avoid candy. Not surprisingly, studies show that a heightened level of anxiety is usually associated with a heightened perception of pain.

Helping a Child Feel Comfortable

Pediatric dentists have a variety of ways to make a child feel comfortable during treatment. Using nitrous oxide (laughing gas), listening to music or watching movies can be helpful. Other methods, such as sedation and general anesthesia, may be advised depending on the treatment needs, medical conditions and the ability of the child to cooperate. These methods allow the dentist to complete most (in cases of oral sedation) or all (in cases of IV sedation and general anesthesia) treatments in one appointment, resulting in an immediate improvement in dental health and often less emotional difficulty for the child. This is particularly true for younger children with extensive treatment needs. The negatives of sedation and general anesthesia include increased health risk and cost and a possible delay in developing positive coping strategies for visiting the dentist. As one instructor during my fellowship at Children’s National Medical Center in Washington, D.C., said, “Sure, you can medicate every child who comes into your office until they’re 18 years old, but does that give them the coping skills they will need for the rest of their lives?” Although sedation and general anesthesia are great options for some kids, parents should feel comfortable with these options and understand all of the risks and benefits. If you are not comfortable with the recommendations of sedation or general anesthesia, seek a second, or even third, opinion.

Finding a Pediatric Dentist

When looking for a pediatric dentist for your child, find a dentist who enjoys working with children, with whom you both feel comfortable and who will respect your child’s complaints of any discomfort during treatment. Children must have some control over frightening or painful stimuli. Fear and pain are inextricably linked. The degree of pain we feel is often affected by our anticipation of pain and our emotional status. One study showed that children who felt a lack of control with a painful dental procedure were 14 times more likely to be highly fearful afterwards and were 16 times less likely to be willing to return to the same dentist. Another study showed that a dentist whose behavior lowered anxiety in patients also reduced the degree of pain reported.

Dentistry has changed a lot in the past few decades, particularly for children. Ask your child’s dentist for other tips to help alleviate pain and anxiety.

Michael Gazori is a specialist in pediatric dentistry. He can be reached at www.littlepearlsdentistry.com.