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Dental Fear and Anxiety Management in Children

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Dental Fear and Anxiety Management in Children

3 min read


Read the article to know how parents and dental doctors can help address these fears by instilling the proper behavior towards dental treatment.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At May 8, 2021
Reviewed AtNovember 24, 2023


Negligence on behalf of either the child or the parent, ignoring oral health at a young age can result in painful decay and other tooth or gum-related issues. Thus setting a standardized care regimen for the child apart from six-monthly to one-year regular visits to the dentist along with the right behavior management will be helpful in the prevention of dental diseases.

What Are the Common Dental Problems Faced by Kids?

1.Tooth decay:

Tooth decay is common in children and infants on a carbohydrate-rich and sweet diet. Prolonged bottle-feeding and poor oral hygiene may further worsen the decaying process. Also common in children with developmental disabilities and requires extra care in such cases.

2.Halitosis or Bad Breath:

Halitosis is caused by poor oral hygiene and poor periodontal health or gum disease.

3.Deleterious or Damaging Habits:

This includes thumb sucking, tongue thrusting, or lip biting. It can be a damaging and regular problem for children with disabilities and special needs. Appliances designed to prevent these habits will be advised accordingly by your dentist.

4.Teeth Grinding:

Children can grind their teeth unconsciously or consciously. It is also called bruxism, which is also a habit that is found in many adults, especially while sleeping. This increases the force unnaturally on the tooth and results in wearing out and generalized sensitivity of the enamel layer of the tooth.


Sensitive gums and painful infected teeth result mostly from decay or gum infection.

6.Mouth Ulcers and Canker Sores:

Mouth ulcers and canker sores are the most common red lesions seen in the oral cavity.

7.Over-Retained Primary Teeth:

Tooth eruption often depends on genetic factors, muscular action, movement of the facial muscles and jaw growth, and even on certain medications. If the tooth eruption is delayed or inconsistent, then the chances of primary teeth being retained (as they are not able to make way for the permanent teeth to erupt) are more.

8.Dental Fears and Anxiety.

What Are the Impacts of Tooth Decay and Gum Disease In Children?

1. Tooth-bound infections that affect the eruption of permanent teeth.

2. Tooth loss.

3. Pain in the infected tooth leading to emergency restorative or surgical treatment at the dentist's office.

4. Increased prevalence of dental disease in the adolescent age because of childhood risk exposure.

5. Increased vulnerability to infections in other parts of the body like the maxillary sinus, ear canals, and as a sequel of compromised oral hygiene infection, rarely spreading to the neurologic system.

Behavior Management In the Child:

The goals of behavior guidance are to establish patient and dental doctor communication effectively and at the same time address the child's health issues ensuring due cooperation and safety.

The Goals of Behavior Management Are:

  • Establish communication.
  • Alleviate the child's dental fears and anxiety.
  • Promote patient and parent awareness on oral health issues and dental hygiene.
  • Promote a positive attitude of the child towards oral healthcare.
  • Build a trusting relationship in an environment of safety (at the dental office or clinic).

The Most Commonly Used Behavior Management Techniques At the Dental Office Are Discussed Below:


By demonstrating the technique by which treatment is going to be done to the child, the dentist explains visually and verbally in the language of the child and alleviates the child's fear and anxiety about the dental check-up or procedure.

Positive Reinforcement and Modeling:

This is positive parental reinforcement and example at home and by the behavior of a parallel-aged child or elder sibling who follows the instructions given by the dentist. This process helps in cooperation and encourages the child mentally—the ideal technique for children aged between 3 to 5 years.


Moving the attention of the child away from the procedure temporarily by distracting them by speech, cartoons, music, or visually engaging them to forget the discomfort of the dental treatment. This process works in uncooperative children as well.

HOME (Hand over Mouth Exercise):

This process is done when the child has to cooperate during dental procedures and to establish cooperation when the child is distressed and resists the dental doctor. The hand is placed over the mouth till the child stops crying and removes it once the child is ready to cooperate. The hand should never be placed over the child's nose, and this is done only with parental consent to handle distressed and uncooperative patients on the dental chair.

Voice Control:

It is used to instruct the child in a voice of authority and to gain the child's attention to the importance of getting dental treatment done. This process is not needed in disabled or emotionally immature children.

Sedation and General Anesthesia:

Anesthesia is amongst the other accessory techniques which are employed only when the child consciously refuses to cooperate for the dental procedures.

Seeking Dental Guidance:

Starting from the age of three, it is imperative to seek dental guidance occasionally every six months. The dental surgeon will examine the child's teeth to find out reasons and solutions to tooth decay, misaligned teeth, tooth loss, or any other gum issues.

A healthy bonding between the child and the dentist is essential so that these tips can be followed both by the parents and the child.

1. Use a pea-sized amount of fluoride toothpaste and make sure the child spits after brushing.

2. Twice-daily brushing should be a daily regimen for two minutes at least.

3. To build good health habits in kids, start teaching your children how to floss regularly.

4. Remind the child to pay more attention to the posterior (back teeth-molars), especially in terms of toothbrushing, as they are more prone to decaying faster.

5. Dental guidance and advice should be sought every six months in the dental office or clinic, even for a healthy child, to rule out the possibility of any infections or decay.


Hence behavior management is a key factor in supplying dental care for children. Dental issues need greater attention from the parent as well as the dentist. Emphasis on trust-building and inculcating confidence levels with good communication between the child and dental doctor is the best way to keep oral issues at bay.

Frequently Asked Questions


How to Help a Child With Dental Anxiety?

Children with dental anxiety should be dealt with carefully to prevent dental anxiety from progressing into adulthood and ensure proper oral care in children. Some of the ways to help with anxiety are:
- Bring a distraction during scheduled dental appointments.
- Let the child bring what they want.
- Practice relaxation techniques.
- Positive reinforcement with awards.
- Reassure the child of the parent's presence the entire time.
- Play games with the child.
- If the child likes music, music can be played during the examination.
- Use a quiet and reassuring voice while conversing with the child.


What Is the Cause of Dental Anxiety in Children?

Anxiety and fear of dental procedures may trigger in a child's psyche due to various reasons, including:
- Negative past experiences.
- Fear of embarrassment.
- Fear of needles or injections.
- Fear of anesthesia.
- Fear of pain.
- Fear of panicking or loss of control.


How to Handle a Patient With Dental Anxiety and Dental Phobia?

Dentists, especially pedodontists, are trained to handle children with dental anxiety and phobia. Some of the means are:
- Psychotherapeutic interventions - 
- Communication skills and rapport building.
- Behavioral management techniques.
- Relaxation techniques. 
- Hypnotherapy.
- Acupuncture.
- Tell-show-do technique.
- Positive reinforcement.
- Cognitive therapy and cognitive behavioral therapy. 
- Other techniques to manage such children include relative analgesia, anxiety-relieving medication, conscious sedation, and general anesthesia.


How Can a Dentist Manage a Fearful Child?

Some of the methods a dentist may use to manage a fearful child are:
- Creating a calm environment.
- Using kid-friendly language.
- Clearly explaining everything to overcome the fear of the unknown.
- Sedation and general anesthesia.
- Tell-show-do technique.
- Keeping short and morning appointments.


What Does Pediatric Dental Fear Mean?

Pediatric dental fear refers to the fear and anxiety seen in children developed towards a dental visit. The fear may be subjective (projection and manifestation of others' fear in children) or objective (due to personal experience). This is a significant challenge for the dentist and parents.


Is It Common Among Children to Have Dental Anxiety?

According to Diagnostics and Statistics of Psychic Disorders, dental anxiety is among the most common fears. One of the surveys puts the prevalence estimates at nine percent for dental fear and anxiety. Additionally, about 36 percent of the United States population have some fear of dental treatment, and about 12 percent with extreme fear.


What Can Be Done to Motivate a Child to a Dental Visit?

Some of the ways to eliminate fear and motivate a child toward dental visits are:
- Schedule appointments with a kid-friendly pediatric dentist.
- Start at-home awareness about oral health.
- Listen to their fears and answer their queries.
- Practice what is preached, as kids are great at mimicking.
- Involve the kids in small decisions.
- Do not keep the appointments a surprise; inform beforehand.
- Use positive words and reinforcements.
- End the visit on a positive note.


What Can Be Done to Promote Dental Health in Children?

The children and their parents must take a few steps to ensure proper dental health:
- Brush twice a day.
- Use of fluoridated toothpaste.
- Teach proper brushing techniques.
- Teach flossing techniques.
- The dentist can be asked to apply sealants to the tooth if required.
- Drink fluoridated water.
- Bi-annual dental checkups and interventions, if required.


How to Pull Out the Tooth of a Scared Child?

- Talk to the child about the need and importance of pulling out the loose tooth and ask the child to wiggle the tooth with the tongue. 
- Tell the child stories about the lost tooth, like tooth fairies and rewards. 
- Celebrate the loss of the tooth.
- Use ice to numb the gums.
- Use of topical numbing gels.
- Use a sterile gauge to gently pull out the tooth if the tooth is loose enough.
- Educate, motivate, and schedule a pediatric dental visit.


Can Dental Anxiety Be Considered a Disorder?

Dental anxiety is a subgroup under a larger group of anxiety disorders. According to listing in the Diagnostic and Statistical Manual of Mental Disorders, anxiety, and dental anxiety are considered disorders under specific isolated phobias.


How to Sedate a Child for a Dental Procedure?

Children may have to be sedated for some dental procedures due to the treatment's nature or to bypass their fear and anxiety. The dentist may utilize nitrous oxide (laughing gas) and oral or intravenous sedation.


Can a Dentist Prescribe Something to Soothe Anxiety?

Dentists may prescribe medications to soothe anxious children through oral anxiolytics. These are usually short-acting, small, single-dose medicines to be taken an hour before the appointments. Oral anxiolytics like Temazepam may be used.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



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