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DENTAL COMMUNICATION


Treating the fearful child H


Paediatric dentist Fiona Hogg offers advice on dealing with dental anxiety in young patients


ANDS UP who has experienced a little stress when managing an anxious child patient. Okay, maybe more than a little stress. Treating


the fearful child can be one of the most difficult challenges we face in dentistry and is experienced by both general dental practitioners and paediatric dentists alike. Is this stress avoidable? Despite improvements in children’s dental health,


caries continues to affect around one third of young children in the UK and with this challenging situation comes the need to consider how we can best manage treatment for the anxious child.


Establishing trust From the first appointment, the dental practitioner should aim to establish a positive relationship based on trust with the child and parent. Te triad of communication between dentist, parent and child can become complicated: young children tend to concentrate on only one individual at any given time. A smiling, welcoming dental team who show empathy to parent and child is the best start to the initial appointment. Always make eye contact with the child, use their


name and talk to them as opposed to talking over them – and aim to say something that will make them smile. Tese simple suggestions are excellent


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rapport builders and can help ensure a child is more likely to co-operate with treatment plans.1


It will


come as no surprise that fear experienced in previous unhappy dental visits has been related to poor behaviour at future visits, and there is certainly merit in parents bringing children for routine dental exams from infancy so that the surgery environment becomes more familiar.2


Managing anxiety Dental anxiety is common and occurs as a result of the reaction of the patient to perceived danger – known in physiological terms as the “fight-or-flight response”. Dental phobia is essentially a stronger reaction to the same fear, where the symptoms of the fight-or-flight response occur even when just thinking about the threatening situation. Children with a vivid imagination can create an overwhelming physical response by thoughts alone.2 Dental anxiety can be initially addressed when


taking a child’s dental history. Ask questions about previous dental pain and reactions to past dental treatments. In children over eight years, a validated scale such as the Modified Child Dental Anxiety Scale (MCDAS) can be a useful assessment of the child’s level of anxiety and helpful in planning appropriate treatment strategies. Te MCDAS


SUMMONS


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