Dental Phobia

My 11-year-old son is horrified of needles. I think he must have had a bad experience at some point. I took him to the dentist, and was amazed at the fight we had on our hands. We ended up getting only as far as the x-rays and cleaning. He needs work done. After his behavior, that dentist won't see him again. I think that was the closest I've ever come to really losing my cool with him. I have no idea what could have caused such a dramatic fear, and I have no idea how to overcome this problem. Please help if you can.

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One bad experience can lead to dental phobia. It might be helpful to determine if this is the cause of your son's reluctance to cooperate with treatment. If you could discuss the issue with your son and then discuss the findings of this conversation with a dentist, this may be helpful for all involved. Is your son afraid of needles in general or dental visits?

A two-year study was completed using specific techniques to reduce dental fear (JADA, October 1990, pp. 525-530). While all the following suggestions may not be available or practical in your situation, some techniques provided in this study may help your son. First, a dental fears questionnaire is completed by the patient. The answers on the questionnaire are then discussed with the dental assistant and/or dentist. This alone may be helpful to the patient as this opens discussion with the dental professionals and can be very revealing. If videotape depicting dental treatment is available for viewing, this modeling can be helpful for the fearful patient. The video (or even live modeling with another patient or a family member) can also show the patient listening to a tape and having control over the progression of the procedure. For example, if the patient wants the dentist to stop, he or she raises a hand, and the dentists stops treatment.

Relaxation exercises may also be helpful. These exercises include progressive muscle relaxation and guided imagery. Progressive muscle relaxation involves tensing and relaxing major muscles in the body. Guided imagery involves visualizing (perhaps with the help of a cassette tape) tranquil relaxing scenes, such as a beach scene, a calm summer's day, a forest, and a harbor at sunset. The patient should practice this technique at home every day for about a week prior to dental treatment. This allows the patient to remove himself or herself from the "stressful" situation. Some patients are more ready to receive dental treatment after these exercises.

If the patient is not ready, the next appointment may include filling out the fear questionnaire again (generally the patient will reveal less fear). If the modeling video is available, another viewing may be helpful. Listening to a relaxation tape for about 10 minutes can then reduce anxiety. Systematic desensitization may also be helpful. This exercise involves visualizing "dental" scenes, such as driving to the appointment, walking into the office reception area, etc., progressing from mildly fearful scenes to more fearful ones. Before progressing to a new scene, the patient takes a few seconds to visualize one scene and then uses a relaxation technique to reduce the fear reaction.

Some of these suggestions may be a bit complicated for children, but some simplified versions may be helpful. If some discussion with your son and a dentist (a pedodontist may be helpful in this case) does not prove helpful, perhaps some type of relaxation exercises and modeling may be beneficial. If necessary, some premedication with a sedative prior to treatment accompanied by use of nitrous oxide gas during treatment may be helpful.

I strongly encourage you to pursue discussion and treatment as soon as possible. If left untreated, dental disease may lead to pain and infection. This will increase anxiety.

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