Management of children's dental anxiety

Psychological management of children’s dental anxiety

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Psychological management of children’s dental anxiety

There is emerging evidence that psychological therapies can be used to address the patient’s dental fear and anxiety with reasonably good success, though, the majority of studies have focused on adult patients . Psychological strategies can be used to enhance trust, increase feelings of control and develop coping skills in children with dental anxiety . Clear explanations and procedural information, ‘Tell-show-do’, stop signalling methods/devices, positive feedback during procedures and positive reinforcement are all techniques which can be used to help build up trust and increase patient control and treatment predictability . These strategies are regularly employed by paediatric dentists, with ‘Tell-show-do’ being the most commonly used behavioural strategy . The use of these basic psychological techniques during dental treatment have been found effective in the reduction of children’s dental anxiety .

Whilst these techniques may be adequate for children with mild levels of dental anxiety, children with more pronounced fears may require additional psychological interventions to help them overcome their dental anxiety/fears. It is important that psychological interventions delivered by dentists are evidence based, however, there has been a lack of high quality research (e.g. randomised control trials) investigating the effectiveness of interventions in the field of dental anxiety . There are, however, a number of Empirically Supported Treatments (ESTs) for the management of anxiety problems in children, which are largely based on a Cognitive Behavioural Therapy (CBT) model . CBT is a problem–focused psychological intervention, which seeks to teach patients skills for the self-management of their anxiety. Williams and Garland developed the Five Areas model of assessment and management, which represents a new way of communicating CBT (see Figure 1).

Identify and target life situation (e.g. significant events, parental anxiety) aggression)

Identify and target altered thoughts (e.g. ‘I won’t be able to breathe’ ‘The dentist will be angry with me’)

Identify and target altered emotions (e.g. fear of specific stimuli, generalised dental anxiety, embarrassment)

Identify and target altered physical feelings/ symptoms

(e.g. fainting, physical tension, agitation)

Identify and target altered behaviours

(e.g. avoidance of dental encounter, reliance on pharmacological interventions)

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