Pain & Anxiety Management In Pediatric Dentistry

“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 patients I had never even seen before. I understood statements like this had their basis in anxiety and when I inquired further I found that invariably the patients had painful experiences as children. I realized that in most cases the attitudes (both positive and negative) of adults towards dentistry were largely shaped by childhood experiences.

A common thread ran through the patients negative recollections. As children they remembered telling the dentist a procedure was painful and yet the dentist continued. Its possible they were feeling sensations other than pain such as pressure, vibration, or numbness and the dentist believed they were unable to distinguish these sensations from pain. Its also quite possible they were feeling pain and when given no way to control the pain, developed negative attitudes and a heightened level of anxiety about dental care.

The three most important ways to eliminate dental pain and anxiety in children are prevent, prevent, prevent. If you are fortunate enough to prevent dental problems in your children, especially when they are younger, they are not likely to develop debilitating anxiety. Studies have shown that as children get older, their ability to cope and accept painful procedures improves. Early intervention and care will also help lessen the possibility of pain and anxiety by decreasing the need for more extensive treatment.

Find a dentist who enjoys working with children, who will acknowledge their complaints of discomfort, and with whom you feel comfortable.

Children need to feel some control over painful stimuli. 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 dentist behavior that lowered anxiety reduced child pain.

Another way to help your children is to model good dental habits and portray a positive attitude (even if that means faking it a little.) Children pick up on their parents anxieties and in many cases will adopt them without firsthand experiences themselves. Avoid words like “pain” and “needle” and never use fear of the dentist as a motivator to get them to brush better and eat less candy. Studies have shown that a heightened level of anxiety often times is associated with a heightened perception of pain.

Nitrous oxide and distraction with music or movies can be helpful. There are other methods like sedation and general anesthesia but make sure either of these choices is the right fit for you and your child. To paraphrase one of my instructors at Childrens Hospital in D.C., “Sure, you can medicate every kid who comes into your office until theyre 18 but does that give them the coping skills they will need for the rest of their life?”

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