Dental Fear in Children

An interview with Dr. Fred Margolis

Fred, as a pedodontist, what percentage of your patients are referred to you by general practitioners because of behavioral problems? 

About 25% of my patients are referred to me by professionals to provide dental care for children and adolescents with physical, mental and/or emotional problems.  Many of these patients have behavior problems as well.  I also treat adults with disabilities and some of these patients also have behavioral problems.

What are the causes of dental fear in children?

There are two main types of fear: objective and subjective fear.  Objective fear is one that you experience directly.  If, for example, you had a painful dental visit while having a tooth extracted; the next time you needed a tooth extracted you would be fearful because of this prior experience.  If you told your friend about the bad experience and he needed a tooth extracted, and he had fear, this would be subjective fear.  The other types of fear are inborn: we are all born with the fear of falling and the fear of loud noises.  When I am placing patients back in the chair I will gently hold their hand or place a hand on their shoulder to reassure them that they will not fall.  Oftentimes, when the dentist turns on the suction device or drill, the child will begin to cry because of the loud noises.  Fear of the unknown is common among all of us, including children.  We use the “Show, Tell and Do Technique” in allaying the child’s fears. The dentist can show the child an instrument, then tell the child what is going to be done with the instrument, and then use the instrument.  This procedure works for children as well as mentally and physically challenged adults.

Is fear of dentistry decreasing as time goes on?

During the past 27 years as a pediatric dentist I have seen the fear of dentistry decrease somewhat.  About 10-15% of my patients are truly phobic, another 35% have some fear but are able to cope with  no outside help, and the remainder are comfortable in going to the dentist.

What role do parents play in your patients’ dental fears?

I send a welcome letter to the parents prior to the first visit.  In this letter we tell the parents what will occur at the first appointment.  We also tell the parents what to say and what NOT to say to the child before the first visit.  We advise them to tell the child they are going to meet a new friend, their dentist, who is going to count their teeth, clean their teeth with a special toothbrush, and make sure their teeth are healthy.  We advise not using statements such as: “If you’re good it’s not going to hurt”, or “ Don’t worry, they won’t hurt you if you behave.”   These phrases may scare the child.  Don’t use the words “hurt” or “pain”.  This makes the dental visit an unwelcome one.  Only say positive things!

Any advice to parents before they bring in their child for the first visit to a dentist?

 Go to the library and get books on going to the dentist.  I don’t recommend the Berenstein Bears books because I do not feel that talking about extractions and fillings is necessary prior to the first visit.  Mr. Rogers has a good book and there are several that the librarian can suggest.

Do you allow parents to stay in the treatment room while you are seeing their child?

Parents are invited into the treatment room during the first visit.  Most young children feel more comfortable and secure having a parent or sibling in the operatory.  However, if one of the parents has dental fears I suggest having the other parent accompany the child to the first visit.  Children easily pick up your discomfort and fears about dentistry.  After the first visit when dental work is being done, the child may do better with a “one on one” with the dentist.  Many children act up with the parent present and actually behave better without a parent in the treatment area.  It is a good idea to discuss this issue with the dentist before your child’s visit.

What should a parent do or not do while in the treatment area?

 The parent should only be a casual observer and only participate in the conversation when asked.  Remember, your child can only listen to one person at a time.  Dental professionals are better trained and have more experience in these situations than do most parents, so let them do their job.

What new techniques are available to make a child’s dental visit easier than in the past?

 I don’t think it is easier today!  Today’s parents are reluctant to say NO to their children.  They want to be “friends” with their child.  I suggest that NO is sometimes a necessary word.  Also, if the dental personnel ask you to not accompany your child into the treatment room, please understand that many patients do better without you in the room.  Don’t be afraid to ask questions of the dental personnel prior to your child’s visit.  Good communication is important.  Finally, there are medications that are safe and effective for your child to take prior to his/her dental visit to calm them.  Please discuss these alternatives with your dentist.

At what age do you see children for their first visit?

The Academy of Pediatrics and the Academy of Pediatric Dentistry suggest seeing the child when the first tooth erupts or age one, whichever comes first.  This is to inform the parents how to begin preventive dentistry for their children, discuss oral habits, fluoride uptake, nursing and bottle use, etc.  Our goal is the same as every parent:  to have a child free from dental disease--gum disease and tooth decay--their entire life.  Also to provide interceptive orthodontic procedures to lessen the amount of time a child is in braces or prevent orthodontic treatment entirely.  Routine first visits, with professional cleaning, fluoride treatment and examinations, begins at age 2 ½ years old.

Looking into your crystal ball, what do you think the future will bring to children’s dentistry?

 1.      Preventing tooth decay.  Fluorides mandatory in every incorporated community in the United States. 

2.      Sealants applied to all permanent molars and bicuspids on all children needing them.

3.      Lasers being used for cavity preparations by all dentists, alleviating the need for local anesthetic for routine restorations in most cases.  This will be less noisy, less painful, with less vibration and will make for happier, less fearful child patients.

4.      Orthodontics will continue to begin at earlier ages for children to lessen the time required and money spent for braces in most cases.

Thanks, Fred, for taking time from your busy schedule to participate in this interview.  I’m sure your information will be useful to visitors to dentalfear.com.

 It was my pleasure and it was great meeting you at the Academy of Laser Dentistry meeting in Tucson.

Dr. Fred Margolis received his B.S. and D.D.S. degrees from Ohio State University and certificate in pediatric dentistry from The University of Illinois.  Dr. Margolis has been an assistant professor of pediatric dentistry at the University of Illinois College of Dentistry and is a clinical instructor at Loyola University’s Oral Health Center.  He has lectured for over 25 years and is a nationally recognized speaker on pediatric dentistry and dentistry for the disabled.  Dr. Margolis is in private practice of pediatric dentistry in Buffalo Grove, Illinois.  He can be contacted at (847) 537-7695.  His web site address is wemakefamiliessmile.dentistryonline.com.