What is Dental Anxiety?
It’s scientifically proven that any child’s first visit at the dentist can develop some kind of anxiety and stress although this anxiety might not be manifested.
What makes children so anxious?
- Fear of needle, dental materials and tools, different smell as well as dental equipment
- Fear of unknown for possible pain, or fear of parent separation
From where does anxiety come from?
- Anxiety or fear that the parents have, more specifically the mother towards the dentist, can directly affect the child as this behavior can easily be transmitted even from the embryonic state!
- Very young children or emotionally immature for their age that are unable to understand the need of dental treatment
- Friends, school and company that many times can tell “scary stories” about dentistry, thus transferring fear to other children
- Past traumatic experiences of children in a dental office, hospital or with other doctors it is proven that they have a negative impact on the child’s behavior.
Generally fears that are developed from the immediate environment are usually more intense from the anxiety that is generated from a child’s visit to the dentist.
Management
Child’s approach:
The dentist that has specialized in Paediatric Dentisty uses different psychological techniques and specific vocabulary to describe the different steps as far as the dental praxis. The goal is to slowly introduce the child to an unknown environment making the visit as painless and stress less as possible. Thus the dental procedure can be easily accepted by the child. The dentist’s role is to quickly gain rapport of both parent and patient.
For the above reason the dental clinic set up has to be friendly and modified to the children’s needs.
Techniques:
- TSD (Tell, Show,Do)
- Desensitization
- Modelling
- Audiovisual aids
- Boundaries for the child behavior
In addition to the non-pharmacological approach mentioned above, there is also the pharmacological approach mentioned below
Pharmacological Approach
- Nitroxen oxide( laughing gas)
It is a mixture of gas (oxygen and nitrogen) delivered by a mask through the nose of the patient. While breathing through the nose, the child has a pleasant feeling of euphoria and relaxation. With the cessation of breathing, this mixture of gases disappears immediately and the patient will reach its physiological levels in less than 5 minutes. The analgesia induced by nitrous oxide reaches a light analgestic stage during which the patient is fully conscious. This procedure is approved by both the American and the European academy of Paediatric Dentistry.
When is it used?
When the psychological approach is not enough for the child to cooperate. In these cases the Nitrogen oxide- oxygen apparatus is the method of choice that helps the child to bypass the stress of the dental visit. It also minimizes the effects of gag-reflex.
How does the child feel when the mixture of air is breathed in?
Nitrogen oxide has a pleasant smell and makes the child feel relaxed and indeed does create a good mood, especially with those children that are annoyed by sound or and especially all the dental process.
Is it safe?
It is extremely safe. It’s the safest seductive used in dental praxis provided that the dentist has the knowledge, practice and experience to use it!
Before the procedure
- Little or no food should be given before the procedure
- The child should be able to breathe through the nose. Any difficulties with nose breathing limits the effect of nitrous oxide
- The dentist has to know if the patient takes any other medication
Are there any contraindications?
- In chronic obstructive pulmonary disease
- Inability to breathe through the nose
- Psychiatric disease
- In neuromuscular disease as myasthenia gravis
- In patients taking medication as bleomycin
- During the first trimester of pregnancy
- Patients with dental phobia
- Arachnophobia, agoraphobia patients
- Patients taking MAOI, SSRI or St. John’s Wort
- General Anaesthesia
This procedure is limited to children that cannot be managed with the approaches mentioned above. Children with dental phobia, special needs, too young as well as children who have lots of dental work.
Full mouth rehabilitation under general anesthesia is safe and takes place in an operating room with an anesthesiologist.
These cases are ambulatory cases where the patient comes in the hospital early in the morning and leaves the hospital during noon time.
The biggest advantage of this method is that the patient completes therapy during one visit.