What if my child has a phobia?

Recently, the BBC reported on a tragic story that revolved around a case of dental phobia. An eight-year-old girl, who suffered from a severe dental phobia, was so traumatised by dental work that she later starved to death. It's was a shockingly extreme response to a fear we are all familiar with – after all, none of us likes to visit the dentist. But how do parents cope when their child is so distressed that they are prepared to harm themselves rather than visit the dentist?

Even for those who dread dentists, eight-year-old Sophie Waller’s response to treatment is hard to understand and come to terms with. Once, during a check-up, a dentist nicked her tongue and drew blood. This event led her to becoming dentophobic. So when one of Sophie’s milk teeth became loose, she refused treatment.

This involved a complete refusal to eat or talk. The only option that medical professionals were left with was to remove the tooth under anaesthetic in hospital. At the same time, her dentist removed several other teeth that would have caused Sophie a return trip to the dentist in the future. While the dentist assumed it was the sensible approach, Sophie was so traumatised when she woke up that she steadfastly refused to eat. A month later, she died.

Thankfully, this kind of case is extremely rare. The question is, should parents and dentists be doing anything different?

What do we know about dental phobia?

We know that dental phobia affects about 10% of the population. Sometimes, the causes of dental phobia are linked into wider mental health issues and are part of more deep-seated, complex phobias. Usually, these need to be dealt with by a mental health specialist such as a psychiatrist or child psychologist.

Other causes of phobia are similar to those identified by Sophie’s parents: a bad experience at the dentist causes the person to develop an irrational fear. In Sophie’s case, this irrational fear was so powerful and overwhelming that she could not even find a way around it after the treatment had finished.

We also know that the vast majority of phobias can be treated. With the right kind of support and careful treatment, most patients can overcome their phobia.

What role can the parents play?

We’re all afraid of the dentist to some extent. Therefore, parents play a hugely important part as role-models for their children. Often, if the parent is nervous or apprehensive about visiting the dentist, this nervousness will transmit to the children.

Therefore, parents are vital in ensuring that their children understand what visiting the dentist involves. For many children, one of the most traumatic elements of dental work is they do not really understand what is happening or why it is happening to them. Parents can help from the outset, encouraging their children to see a visit to the dentist as a positive, healthy activity. Knowing your teeth are being looked after by an expert should provide peace of mind, not anxiety and tension – of course, the reality of a phobia is that it is never that straightforward.

What role can dentists play?

Nowadays, most dentists have specialist training in dealing with nervous or phobic patients. The majority of undergraduate courses will include teaching on things like distraction techniques and behaviour management. These are particularly helpful when dealing with children.

The most important aspect for a child is a fear of the unknown. If they aren’t sure what to expect in the dentist, and they see their parents acting nervously, then their imagination will run wild and paint all sorts of pictures. Therefore, just as they would do with adults, dentists need to ensure that their younger customers are comfortable, relaxed and that they know what is about to happen.

Parents will often find that some dental practices are simply more child-friendly than others. In fact, some surgeries now market themselves as being ‘gentle dentists’ or a ‘specialists in treating dental phobics’.
Practices that are more child-friendly will often have toys in the waiting room, televisions in the surgery, plus other ways to make children feel relaxed enough to cope with treatment. Similarly, the attitude of everyone from the receptionist to the dentist makes a big impression.

It may sound obvious. But how many of us ever think to shop around for the right kind of dentist? Not many. Most of us expect the patient experience to be the same whichever dentist we visit. But it isn’t. No two practices are the same. No two dentists are the same. And, of course, no two patients are the same either.

What if it doesn’t help?

Some phobias (perhaps one in ten) are too deeply ingrained for the person to overcome them. This is unusual in a child, where the phobia is most likely to be a knee-jerk reaction to previous pain. However, a severe phobia in children is not unheard of.

If you think that your child has a more severe form of phobia, your first step should be to speak to your dentist and your local GP. Sometimes, treatments can be managed using sedation techniques or through approaches and procedures that minimise the pain involved. Alternatively, some form of counselling can often help.

For many people, counselling and therapy is often viewed as a last resort. People are afraid that labelling their child as phobic is the first step towards accepting their condition, rather than resolving it. But it is wrong to look at it that way. For sufferers of dental phobia, one of the most important elements in getting treatment is their ability to build a patient-practice relationship that fosters two-way communication. For children, in what is essentially an adult environment, this communication can be difficult. Counselling, therefore, is simply another avenue for communicating – another way of building trust between your child and people in the dental profession.

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