Dental Appointments

Bringing your child to the dentist can be hard, I mean really hard. A trip to the dentist can invite overwhelming fear for children and teens, lead to noncompliance with treatment, and evoke high levels of stress for everyone involved. So how can we make dental appointments easier? 

I’m a Certified Child Life Specialist (CCLS), a pediatric psychosocial professional, who works to reduce the risk of children and families developing negative psychosocial impacts in the midst of difficult medical procedures and heavy emotional experiences.

Here we’ll talk about how you can promote positive coping in your child who is fearful of the dentist, empower them, and advocate for them while navigating through anticipated stressful appointments.

Preparing Your Child
How can we make this unknown, scary experience, more familiar and less threatening? We can normalize it. Preparation is a great way to normalize dental appointments, connect with your child, and evaluate their needs. It’s helpful in determining where certain fears might be coming from and which coping strategies could help.

What Information to Give
Children will often cope better when they understand what is going to happen and why. As the expert on your child, you can decide what information might be helpful for them to know and what parts would only cause them more worry, recurrently assessing your child’s emotional state for changes. 

• Sensory Experiences
  • Exposing your child to the sensory experiences anticipated can reduce stress and anxiety about the unknown. It can be an effective way to desensitize and familiarize them with the procedures and materials.
    • This might look like using your fingers to massage their gums, having them try on sunglasses during play, or using a toy water squirter inside their mouth.
• Order and Purpose of Procedural Steps 
  • Providing sequential information about expected procedural steps can be helpful in reducing fear. When children don’t have all of the information, they tend to fill in the gaps on their own, which can lead to increased anxiety and confusion, as it is likely inaccurate information. Preschoolers and early school-aged children are most likely to have misconceptions about the purpose of medical procedures.

You may not know what the procedural steps will be, and that’s okay. We will talk about ways to advocate for your child by partnering with your provider later in this article.

Nonthreatening Ways to Introduce Information
The hope with preparation is that your child will cope better at the dentist after they have been introduced to the stimuli in a nonthreatening way. It also allows for opportunities to form positive associations.

• Play - Engaging in pretend dental play is a great nonthreatening way to introduce information. You and your child can reenact procedures and rehearse coping strategies. You can take turns being the dentist. If your child doesn’t want you to pretend to check on their teeth, ask to check the teeth of a stuffed animal or figurine. When we create more distance from a stressful stimulus, it can feel less threatening. 
  • You can play with toothbrushes, flashlights, or pretend tools for checking and counting teeth.
  • You can also check out the Be with Me Playseum in Ridgedale Mall. It is a place for young children to learn through play with over 20 different themed pretend play areas, called Cityscapes, including a dentist’s office.
• Books - Reading stories that portray the dental experience in a positive way can be helpful. There are many great picture books, some suggested ones are listed at the bottom of this article. 
• Songs - Singing songs can be a great way to introduce information and practice steps of the procedure. For example, it might be helpful for your toddler to practice holding their mouth open. You could sing a song that encourages them to repetitively do that. When you sing that song again at the dentist’s office, it can also serve as a form of distraction.
• Art - Your creative child might enjoy learning about the dentist by doing art or playing with playdoh. There are a lot of great ideas for “teeth arts and craft” on the internet.
• Diagrams - Some children might be interested in seeing illustrated diagrams of the mouth and teeth or pictures of certain materials used, like cleaning tools or imaging equipment.

Consider Your Language

• Unfamiliar vs Familiar
  • It’s best to use words that your child already knows and understands.
  • Dentist → tooth doctor, dental hygienist → doctor’s helper.
  • X-ray → a machine that takes pictures of your teeth, it can see the parts of your teeth that are inside of your gums.
  • Nitrous oxide (laughing gas) →  silly/calm air. A type of medicine that you breathe in that helps your body feel calm and comfortable. You might feel silly too. You will breathe in through a small mask on your nose, or a tube that goes under your nose.
• Hard vs Soft
  • Needle → A small silver straw. It gives your body medicine (or gives your body a drink of water, or takes a small amount of your body’s blood). 
• Humor
  • Children don’t understand adult humor so it’s best to try and avoid statements such as “Maybe on the X-ray we will see your breakfast stuck between your teeth.” Those types of statements can make children feel vulnerable, uncomfortable, or ashamed.
• Honesty
  • If your child asks if something will hurt, it’s best to be honest. Redirection can also be an appropriate response. You could say something like “Some people say it does, and other people say it doesn’t. Why don’t you let me know how it feels for you?”
  • Try to avoid telling them that it is almost over, or giving them a timeframe. If it ends up being inaccurate, it can lead to increased fear and distrust.
• Other Suggestions
  • Things to Say
    • “I know this is hard, I’m right here with you.”
    • “I hear that you’re scared, it’s okay to be scared.”
    • “I am going to be here next to you the whole time.”
  • Best to Avoid
    • “It’s okay, you’re fine!”
    • “When I was scared, this is what I did…”
    • “See? That wasn’t even bad, I knew you’d be fine.”
    • Excessively apologizing.

Advocating

• Partner with Your Provider
  • Ask to speak to the healthcare team about your child's needs prior to your visit. 
    • See if they can give you a step-by-step process on what will happen during the appointment, or if they have any educational resources available.
  • Request a tour of the office. 
    • A tour allows your child to get familiar with the space, the staff, and (if possible) the equipment and materials. If a tour is not possible, ask if they have any photos.
  • Don’t be afraid to ask questions or make requests. You deserve to know how to best prepare your child and set them up for success. 

Finding Ways to Provide Choice
Every child is different, so there is no perfect solution that works for de-escalating all children, but if there was… I think it would be choice. Choice is powerful in a lot of ways. Choice gives some level of control back to your child in a situation where they don’t have a lot of control. It also allows for the exertion of power and empowers them to make decisions. There is no choice that is too small. Even asking your child if they want to open or close their eyes during the next step can be effective. 

Choosing Coping Strategies 

• Younger Children
  • For our little ones who are exploring the world through their senses, sensory coping could be helpful. That might look like swaddling them, massaging their hands or feet, playing soft music, or providing a calming smell.
  • Provide visual distractions like a glitter wand or a light spinner. 
  • Bring a comfort item like a weighted blanket or a stuffed animal to direct focus away from their mouth to their hands. A small item where they won’t move too much is best, like a stress ball or pop-it.
  • Try out different positions (if possible) and encourage your child to look at you and not the staff.
  • Tell your child a story or sing songs to them.
  • Give them a job. Their job could be to keep their body still, hold their mouth open, or if possible, hold a tool like the dental suction device that removes saliva and water.
• Older Children
  • Have them create an “I need a break” signal they can use during high-stress moments, like a hand gesture. This allows you to advocate for a break or intervene to prevent anxiety from escalating to a point where it is hard to recover and return to the procedure. Regularly checking-in with them could be helpful, too. 
  • Engage them in conversation, talk about their interests.
  • Play calming music or an audiobook they like. Offer to let them wear headphones, if possible.
  • Choose an alternate focus in the room. This could look like playing iSpy, counting all the circles or squares in the room, or looking at a relaxing picture.
  • Provide guided imagery, walk them through a cool nature walk or a day at the beach. Give them ideas of calming things to think about.

Create a Coping Plan

• Talk to your child about how they might cope best, then come up with a plan.
• Consider creating an All About Me sheet about your child’s needs and interests. This is a fast and easy way to let the staff know about your child’s preferences. You could include a list of topics your child likes to talk about, or a list of things that help them feel calm, or things that make them feel scared. 
• Pack a bag of items that will help them cope and feel safe and calm. You could include items like a comfort item, a joke book, a fidget, or headphones.

Meeting Their Chaos with Your Calm
Uncertainty can be uncomfortable, and the unknown can feel really scary. There are a whole lot of unknowns in a child’s world. When children have overwhelming fears about things that we deem small or unimportant, we should remind ourselves that this is a real fear for them, no matter how small we might think it is. 

• Use a slow, low voice to engage with them.
• Provide reassurance that you are here to listen to them and support them. 
• Acknowledge and validate their feelings.

Debriefing 

• After the appointment it might be helpful to debrief with your child. Ask them how it went for them. What part was the hardest? Was it different than they thought it would be? What was helpful to them?
• Provide specific praise.
  • “You did a great job because you held your body still even when you wanted to move.” 
  • “I am so proud of you because I saw you taking deep breaths.” 
• If the appointment didn’t go as planned, you could try engaging your child in more preparatory activities and revise their coping plan.

Managing Appointments when Dental Visits Don’t Go as Planned

• Try to make their appointment during the best time of day for them, keeping their sleep and eating schedules in mind.
• Develop a dental care routine at home together that is engaging and fun.
• Ask about having more frequent appointments with smaller goals instead of one long appointment.
• Consult a Certified Child Life Specialist (CCLS). CCLSs are clinically trained psychosocial professionals who can provide individualized interventions. Local CCLSs in private practice are listed at the bottom of this article.

How a CCLS Can Help 

• Engage your child in individualized and intentional therapeutic play to help meet their emotional needs. 
• Familiarize your child with the unfamiliar setting, dental procedures, and anesthesia or nitrous oxide processes. 
• Desensitize your child from the equipment and tools by introducing information in a nonthreatening way.
• Assess and enhance your child’s understanding of the procedures by providing dental health education using developmentally appropriate language.
• Provide strategies to support your family in maintaining oral health and improve your child’s compliance by providing parenting support and addressing any behavioral issues.
• Offer creative ways to facilitate compliance and help with limit-setting.
• Teach and practice coping skills with your child to help them process their experiences and develop new positive associations.
• Identify and address issues such as fear of the unknown, oral sensitivity, and misconceptions.
• Empower you to advocate for your child by providing education on things like nonpharmacological pain management strategies and comfort positions.

Resources 

• Be with Me Playseum, Minnetonka (inside of Ridgedale Mall) has a Dentist’s Office pretend play area.
  • 12401 Wayzata Blvd, Minnetonka, MN 55305
• Local Certified Child Life Specialists
  • Sara McCarthy, CCLS
    • Sara, our MK Plymouth publisher, is not taking clients right now, but you can reach out to her at SaraM@MacaroniKID.com with questions.
  • Children's Coping Connection - Laura Sufka, CCLS and Carin Hanson, CCLS
    • https://sites.google.com/copingconnection.care/home/home
  • Empowered Kids - Shannon Meland, CCLS and Sam Schackman, CCLS
    • https://www.empoweredkidsmn.com/families
  • Child Life on Call - Katie Taylor, CCLS
    • Katie is not local, but offers an informative app and website to help parents through their children’s healthcare journeys.
    • Website https://childlifeoncall.com/parents/
    • Support Spot App https://childlifeoncall.com/supportspot/
• Books and Videos 
  • Sesame Workshop: Teeth
  • Going to The Dentist by Anne Civardi
  • Daniel Goes to the Dentist by Alexandra Cassel Schwartz
  • Ninja’s Go to the Dentist by Mary Nhin
  • Going to the Dentist: A Toddler Prep Book by ReadySetPrep