Management of children's dental anxiety



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Understanding children's dental anxiety and psychological approaches to its reduction
Summary

Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services. This article will consider the prevalence, development and implications of children’s dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as Cognitive Behavioural Therapy aimed at the reduction of dental anxiety in children.


Introduction

This article will consider children’s anxiety in the dental setting and will describe the nature of dental anxiety and its implications for the child patient and the dental team. It will also describe a variety of psychological management strategies, based on a theoretical framework of anxiety, and discuss the potential for psychological approaches aimed at the reduction of dental anxiety in children. A wide spectrum of pharmacological regimens can also be used to manage dental anxiety, including various forms of sedation as well as general anaesthesia, however, this article will not evaluate the evidence base of these techniques. It has been proposed that much of the previous literature has focused on the pharmacological approaches to anxiety management . A large proportion of the paediatric dentist’s case-mix may include dentally anxious children, thus it is important that clinicians update their knowledge on the different psychological interventions available now and in the future. It is argued that those dental practitioners who use only narrow set of pharmacological or behavioural strategies may limit their success in treating dentally anxious children and may subsequently need to refer these children to specialist services .


Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence . Dental anxiety, dental fear and dental phobia are terms that are often used interchangeably, but actually indicate different types of dental anxiety. Dental fear represents a normal emotional reaction to a specific threatening external dental stimuli, dental anxiety represents a general state in which the individual experiences a level of apprehension and is prepared for something negative to happen and dental phobia is a severe type of dental anxiety which may result in avoidance or endurance of the dental experience with significant discomfort .
The sight, sensation and fear of pain from the needle and dental drill have been frequently shown to be the most fear-evoking stimuli for dentally anxious children . However, whilst children sometimes present with fears of specific treatments, other children report a more general anxiety associated with the dental setting/treatment . It is also to be expected that a proportion of child patients will display anxious behaviours which are not the result of ‘dental anxiety’ (e.g. generalised anxiety). Therefore, assessing the nature of a child’s anxiety is extremely important in determining the most appropriate and effective management strategy. Dental anxiety reaches a clinically significant level when a number of specific diagnoses are met such as avoidance or a significant impact on daily functioning . Studies suggest that just under half of children report low to moderate general dental anxiety and between 10% and 20% report high levels of dental anxiety (e.g. dental phobia) . However, it should be recognised that prevalence rates of childhood dental anxiety and phobia, as reported by different studies, will be influenced by the different measures and cut off points researchers have used to distinguish between those who are and are not anxious .


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