Sally Hanks, associate professor of clinical dental education at Plymouth University Peninsula Schools of Medicine and Dentistry, highlights what is being done to train the dentists of tomorrow to manage children’s fear of the dentist
Shocking figures from the NHS have revealed that having teeth pulled is the most common reason why children are admitted to hospital. Figures from the Health and Social Care Information Centre show that for the year beginning April 2013 more than 25,000 children aged between five and nine admitted to hospital for dental treatments. Put into context, the next most frequent condition for the hospitalisation of children in this age group was tonsillitis at more than 11,000.
Many reasons have been cited for this, including: poor diet; increased consumption of sugar (with fizzy drinks identified as the main culprit); poor oral hygiene; and the failure of parents to take their children to a dentist, either because of cost or perceived anxiety – on the part of the child and the parent.
Certainly, all these reasons are troubling but they are addressable – we can improve diets, reduce sugar intake, get better at cleaning our teeth and maintaining good oral health.
But what’s harder to address, and of particular interest to me, is how we get over an almost ingrained fear of the dentist – especially for children.
Modern dental treatment
The days when ‘difficult’ children were automatically given a general anaesthetic whenever they needed dental treatment are, thankfully in my opinion, long gone. General anaesthetic has taken its rightful place as just one of a number of options – behavioural and pharmaceutical – that are available to modern dentistry.
At Plymouth University Peninsula Schools of Medicine and Dentistry, the way in which we teach our students to deal with anxious children has at its base the General Dental Council guidelines, Standards for the Dental Team of: ‘..taking a holistic and preventative approach to patient care, taking into account the patient’s overall health, psychological and social needs, long term oral health needs and their desired outcomes.’
The first action taken is to seek to understand more about the phobia and distinguish between true phobia and general anxiety. Is the child really frightened of dentistry and/or the dentist, or is it the unknown that is worrying them? Is it the parents who are anxious? Or is it the dentist’s anxiety about treating children?
Certainly there is a debate to be had about whether children are born with dental anxiety, or whether they pick it up from the environment around them. There is a poor public perception of dentists and dentistry, especially around the treatment of children, and this may be because as a profession there is perceived to be a lack of confidence about how to manage paediatric dentistry procedures – even though there are many protocols in journals and on the British Society of Paediatric Dentistry website.
Our students are shown that the management of anxiety in children (and by extension, their parents) is underpinned by exceptional communication.
Effective communication alongside excellent clinical standards will help to dispel anxiety and fear in the majority of anxious child patients. This, in turn, will encourage them to become lifelong, enthusiastic and regular dental attendees. Some people have a natural talent for empathy, building rapport and effective communication techniques, while others may have to work at it.
At Plymouth University Peninsula Schools of Medicine and Dentistry we teach in a primary care setting. Basic communication skills sit at the heart of what we do, and during their five years with us our students learn those skills in the classroom, with self-directed learning using case studies, the observation of others, inter-professional engagement projects, dental humanities sessions, and, most importantly, treating child patients themselves.
Such activities see them not only in clinical settings, but also in art and music studios and out in the community where they interact with people in schools, youth groups and many others, including groups for the elderly, the homeless and substance abusers. On the one hand our students bring to these groups dental hygiene education and advice and, in some cases, treatment via our dental education facilities, and on the other they gain valuable insight into how dentistry fits into the community as a whole and how to see every patient as an individual whole person.
Our students are also taught when to hand over to specialists, who should manage more complex cases. Such specialists can be found in either a community dental service, via specialist paediatric dental units in hospitals or in a specialist practice setting. True phobias might be managed in a variety of ways including positive reinforcement, ‘tell-show-do’, desensitisation, modelling, hypnosis, cognitive behaviour therapy (CBT) and conscious sedation.
Later in their studies students are given information about these more specific techniques of well established evidence based behavioural, psychological and chemotherapeutic regimes.
By using techniques other than general anaesthetic we can help children take ownership of the situation and overcome their anxieties via their own efforts which may have been having negative effects in other areas of their lives. Ultimately, the bottom line is being able to recognise fear and anxiety in children and making this key to the management of their treatment.
Add to that effective communication, excellent clinical skills and a pleasant environment and we are well on the way to helping children overcome their anxieties and, in so doing, creating loyal, appreciative and enthusiastic dental patients of the future.
And does it work? The last word goes to the parent of an anxious child treated by our students under supervision at our dental education facility in Exeter. She said: ‘My boy was very worried about coming to the dentist, but we need not have worried. The student dentists were great with him. They talked to him and gave him all the support and time he needed to calm down and let them treat him. I think the treatment we received here today bodes well for the future.’