Abstract
Childhood dental anxiety is not only distressing for the child and his family, but is also associated with poor oral health outcomes and an increased stress on the general and specialist dentists. This article will discuss psychological approaches aimed at reduction of dental anxiety in children, which in-turn insures a stress free practice for dentist.
Importance of Child Psychology
- To understand the child better
- To know any problems of psychological origin
- To deliver dental treatments in a meaningful and effective manner
- To establish effective communication with the child and the parent
- To teach the importance of primary & preventive healthcare to the child and parents
- To have a better treatment planning and interaction with other medical or dental specialities
Classification
Child psychology theories can broadly be classified into two groups: I) Psychodynamic Theories:- Psychoanalytical Theory by Sigmund Freud (1905).
- Psychosocial Theory by Erik Erikson(1963).
- Cognitive Theory by Jean Piaget (1952).
- Hierarchy Of Needs by Maslow (1954).
- Social Learning Theory by Bandura (1963).
- Classical Conditioning by Pavlov (1927).
- Operant Conditioning by Skinner (1938).
Psychosocial Theory by Erik Erikson
Erikson's theory of psychosocial development modified Freud's original psychosexual theory by incorporating both psychosocial and psychosexual factors that contribute to a child's personality development. The first stage, Trust versus Mistrust (0-1 years), is focused on the establishment of secure and stable relationships between a mother and her child. If this stage is successfully navigated, the child feels that the world is safe, predictable, and secure. In dental practice, this stage is relevant in the development of separation anxiety in children. To help alleviate anxiety during dental treatment, it is recommended to have the parent hold the child during procedures. The second stage, Autonomy versus Shame (1-2 years), involves the child's increasing mobility and locomotor skills, which form the basis for the development of independence and autonomy. In dental practice, this stage is characterized by the child moving away from their mother but still seeking refuge with her in threatening situations. Hence, the presence of the parent in the dental clinic is crucial to provide the child with a sense of security and comfort. Overall, Erikson's theory underscores the importance of understanding a child's developmental stage to effectively address their psychological needs in various settings, including dental clinics. Erikson's theory of psychosocial development also includes several stages that occur during childhood and adolescence. The third stage, Initiative versus Guilt (2-6 years), is characterized by the child's rapid expansion of language skills and increasing exploration and activity. To avoid feelings of guilt, parents and others must allow children to express their exuberance and enthusiasm. In dental practice, children can be encouraged to view dental visits as a new adventure, and they can be taught about various aspects of dental care in a positive and engaging way. The fourth stage, Industry versus Inferiority (6-12 years), focuses on schooling and peer relations. Successful children become literate, numerate, and socially integrated. In dental practice, cooperation at this stage depends on the child's understanding of what is required to please the dentist/parent, the supportiveness of their peer group, and whether desired behavior is reinforced by the dentist. The fifth stage, Identity versus Role Confusion (12-18 years), involves two major tasks: sexual identity and career identity. At this stage, external appearances are particularly important for establishing intimate relationships. Adolescents may seek orthodontic treatment to improve their dental appearance. Erikson's theory emphasizes the importance of understanding a child's developmental stage and meeting their psychological needs in various settings, including dental clinics. When it comes to orthodontic treatment, it is crucial to consider the child's desire for treatment and their ability to understand the implications of the procedure. Informed consent is essential, and both the child and their parent or guardian should fully understand the potential benefits and risks of treatment. By taking a holistic approach to dental care and considering a child's developmental stage and unique needs, dental professionals can help promote positive outcomes and establish a foundation for good oral health throughout the patient's life.Cognitive Theory by Jean Piaget
- Piaget believed that children progress through distinct stages of cognitive development, each characterized by a different way of thinking about and understanding the world. These stages include the sensorimotor stage (birth to 2 years), the preoperational stage (2 to 7 years), the concrete operational stage (7 to 11 years), and the formal operational stage (11 years and up).
- In the context of dentistry, Piaget's constructivist approach suggests that children learn best by actively engaging with their environment, and that practitioners can help facilitate this learning by providing hands-on opportunities for exploration and discovery.
- Piaget's concept of egocentrism refers to the tendency of young children to view the world from their own perspective, without fully understanding the viewpoints of others. In the dental setting, this means that practitioners should take care to communicate clearly with child patients and involve them in the treatment process, helping them to understand what is happening and why. This can help children feel more confident and comfortable during their dental visits.
- Children up to two years of age are considered to lack the ability to cooperate due to their limited cognitive development. Hence, general anaesthesia or delaying of elective treatment is preferred. General anaesthesia or restraints may be performed for emergency treatment.
- After eighteen months of age, communication, distraction and tell-show-do may be tried as the child begins to show some evidence of symbolic behaviour. However, the success rates of these behaviour management strategies are not good as the child’s language and cognitive skills are yet to develop.
- Tell-show-do with the correct use of euphemisms fit to child’s vocabulary (by 2 years - 250 words; by 5 years - 2000 words) Eg: slow piece handpiece may be called ‘uncle bumpy’ as the vibrations produced feel like bumps to the child, pre-visit imagery make them imagine how the visit would be.
- Tell-play-do; Pre and post-appointment games involving the child pretending to be a dentist with a toy dental kit helping in reduction of anxiety (pre-visit), reinforcing oral hygiene instructions (post-visit)
- To take advantage of a child’s egocentrism in the dental clinic, effective communication with the correct use of euphemisms as well as rewarding the child by praising them in front of their parents or peers is effective in developing a positive attitude.
- Allowing them to play an active role in the treatment process by asking them to perform seemingly important activities such as holding the suction tip or temporarily pausing the treatment when they raise their hand makes them feel involved and improves their chair side behaviour.
- Distraction; Use of audio-visual aids, virtual reality, and 3D glasses
- Aroma and music therapy for relaxation and distraction; Use of injection sleeves.
- Establish dentist as authority figure to be obeyed; Voice control
- Direct observation; Reinforcements (E.g.: notice board with photographs of ‘good’ children), parental presence/absence.
- Relaxation techniques including training exercises such as bubble breath exercises have been proven to effectively reduce anxiety during buccal infiltration injections. Other relaxation techniques including Jacobson’s progressive relaxation learning and computer- assisted relaxation learning, are also effective in reducing dental anxiety thereby improving chair side behaviour, attitudes and quality of treatment provided.
- Systematic desensitization or exposure therapy initially described by Wolpe is based on relaxation and encourages children to discuss their status of anxiety and fear in order to construct a hierarchy of their most feared dental situations and to gradually expose them to these situations from the least to most anxiety producing.
- Guided imagery has also been utilized successfully to give local anaesthesia to children as helping in reducing fear from the syringe and gaining better compliance from the child.
- Teach back technique for children in concrete operations has been observed to be beneficial for reinforcing patient education, improved follow-ups, and overall health outcomes.
- Distraction methods have been studied as effective in managing children in the concrete operations stage including virtual reality, 3D videos, and other audio-visual aids by various authors and researchers
Free for members
Keep reading — it's free
The rest of this article is open to DentalReach members. Create a free account, or sign in, and every article on the site opens in full.
