Parenting / 7 June, 2019 / John Roberts
Some children learn to dread a trip to the dentist. Paediatric Dentist Dr John Roberts delves into some of the reasons this could be and how, as a parent, you can ease their fear and anxiety before their next dental appointment.
Children will come to the dentist with a set of learned coping strategies that have served them well, either to get rewards or else to avoid unpleasant situations. Some of those coping strategies fit well with being a dental patient, and others do not; as paediatric dentists we aim to encourage dentally-appropriate behaviours such as sitting still with hands in lap, and other behaviours we aim to discourage, such as struggling, crying and refusal to sit in the chair. To encourage and strengthen those behaviours that allow us to do our work, is where the techniques of classical conditioning, positive reinforcement of appropriate behaviours, desensitisation and modelling are brought into play.
Specialist paediatric dentists receive training in the management of child dental behaviour and are in a good position to help their patients deal with associated fears. This should make the dental experience more pleasant for all concerned.
Dentistry for children was developed in the early decades of the twentieth century, at the same time as behavioural psychology, and so the specialty naturally adopted the behaviourists’ theories of learning, including Pavlov’s classical conditioning, Skinner’s contingency management, Wolpe’s desensitisation, and Bandura’s social learning theory. Later, with the growing influence of Carl Rogers, the role of empathy assumed greater importance in dental behaviour management. More recently neuro-linguistic programming theories have stressed the importance of the words that parents and dentists use, in the acceptance of the dental experience by children.
We try to understand dentistry through the eyes of the child patient, because it is that view which is determining the child’s behaviour. When he or she comes into our consultation room for the first time, accompanied by the parent, we might say “you look pretty scared, I wonder if you think something awful is going to happen to you? Well, we are just going to chat with mum for a while, then go into my other room where I’m going to count your teeth and perhaps take some pictures of them. It should be very easy for you, and if anything bothers you, just lift up your hand and we can talk about it”. Of course, the actual words we use depend upon the age and development of the individual child. In this way we aim to let the children change their own behaviour by adopting a more favourable view of the dental experience, which although at times can be uncomfortable, is something they feel able to cope with. This revised perspective of dentistry will allow the children to behave in a way that enables the paediatric dentist to achieve the very best work, and hopefully they will take this coping ability into other aspects of their lives
From a parental perspective it helps to avoid emotive language when telling your child what to expect, even when you are trying to be helpful; “it will not hurt at all” introduces the possibility of pain, and also leads to mistrust of the dentist if in fact there is an element of discomfort. Specialist paediatric dentists aim to give realistic expectations to their patients by explaining fully at each stage just what will happen, how long that stage will take, and most importantly what feelings to expect. In that way trust can be built.
It has been shown many times in research that children cope best in the dental situation when they come from homes where the parenting style includes the following:
These are exactly the aims of the specialist paediatric dentist. Almost by definition the dentist gives the child 100% attention. We will let the child know just what is and is not allowed – “you must not grab my hand”. We actively look for opportunities to reward behaviours –“thank you so much for keeping your mouth open wide, it makes it so much easier for me to mend your tooth”. At the end of the visit, behaviours are rewarded by tangible rewards such as stickers and balloons. We try not to let inappropriate behaviours become negatively reinforced. Sometimes we will raise our voice to let the child know that what they are doing is not acceptable.