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