When It’s Hard to Open Up
Getting a child who is fearful of the dentist’s chair to submit to an exam or procedure requires a compassionate, thoughtful approach.
Those who have mastered the art of calming nervous kids have often completed an additional two to three years in their pediatric specialty beyond the requirements for practicing general dentistry.
The reasons for a child’s fear can be irrational, but anxiety can also spring from a bad experience with a dentist or hygienist who did not have a gentle touch. Kids who are shy or intellectually disabled present additional challenges.
At Little Jaws Big Smiles pediatric dentistry in DeWitt, the initial approach to any child with chair anxiety comes down to three main ideas: Tell, show, and do.
“Every kid is different,” says Tansy Schoonmaker, a pediatric dentist at the practice. “But the parents let us know ahead of time, or our assistants can spot (fear) right away. When they walk in, we already know what to do.”
The dentist immediately tells the young patient what she is going to do, which always starts with having a look inside the mouth. Then she demonstrates on a puppet with teeth, using a mirror to get a closer look inside the puppet’s mouth.
“Half of the time,” Schoonmaker says, “that works right away.”
The dentists also allow a child to sit on his parent’s lap if he is afraid to get into
As with many pediatric dental practices, there are televisions on the ceiling at Little Jaws. The distraction helps ease anxiety. If X-rays are taken, all of the images are shown and explained to the child, Schoonmaker says.
When it comes time for a procedure, the practice offers a range of options to keeping the patient calm, from headphones for listening to music, to scented nitrous oxide medication (bubble gum and fruit are choices).
“It’s like they are dreaming, but they can wake up,” Schoonmaker says. “About 70 percent of our patients who have anxiety are treated by that method.”
If nitrous oxide doesn’t work, then parents can consider sedation options. For the most extreme cases, a child may need to be completely asleep. That would require an outpatient facility that can provide general anesthesia. Little Jaws does not offer sedation, but personnel there can work with parents to find a provider and facility that fits their needs, Schoonmaker says.
Aside from the initial tell, show, do approach and the drug options, pediatric dentists are trained to communicate differently with anxious patients. They often talk very quietly, so the patient has to listen more carefully, and calms down in the process.
For autistic patients, the main concept is repetition. The child might visit the dentist’s office and walk around a few times before he or she is eventually relaxed enough to get into the chair.
“Our goal is to have all of our kids leave here comfortable and happy,” Schoonmaker says.
She says the demand for pediatric dentists
is growing locally and nationally. The use of sippy cups, nighttime bottles for infants, and snacking between meals have all played roles
in that trend.
“It’s frustrating because they have found that snacking can be good for metabolism, which is obviously important in dealing with obesity issues. But it is also bad for our teeth,” Schoonmaker says.
According to the American Academy of Pediatric Dentistry, more than $40 billion is spent in the United States annually treating cavities. In its annual “State of Little Teeth” report, the AAPD indicated that tooth decay, if left untreated, can result in life-threatening infections, significant pain, chewing difficulties, poor speech articulation, poor sleep habits, low self-esteem, social ostracism and poor school performance.
The report also said putting off a child’s first visit to the dentist until they are toddlers is a mistake: Research has found that kids who have not had an oral examination until age 2 or 3 are more likely to require restorative and emergency visits. Between 5 percent and 10 percent of U.S. children under age 3 have oral health issues, and about 60 percent of U.S. children have had at least one cavity by age 5. That includes 40 percent of children who have had a cavity when they enter kindergarten.
Early education and intervention are key to preventing cavities, the report says, but one of the major impediments to improved oral
health nationally is, in some areas, a shortage
of pediatric dentists who accept Medicaid. Currently, about 70 percent of pediatric dentists
see Medicaid patients. At those practices, Medicaid beneficiaries represent about 25 percent
of the patients.
The number of practicing dentists, whether
general dentistry or pediatric dentistry, is growing in the United States, according to the report.
The AAPD forecasts that by 2020, about 5,600 dentists will be graduating from training programs annually, or about 800 more than
There are about 6,100 pediatric dentists practicing in the United States right now, and the acceptance rate of credentialed dentists applying to pediatric training programs remains at about 60 percent.
In addition to their ability to communicate with anxious young patients and render anesthesia, pediatric dentists also play a valuable role in educating parents about better oral health and dental care, the report says. At the first visit, for example, parents may learn about the dangers of fruit juices and other sugary drinks, resulting in a change of dietary habits that will benefit a child over his or her lifetime.
Aaron Gifford is an award-winning writer who lives in Cazenovia with his wife and two children.