Pediatric Patients During and Post-Pandemic

A dental appointment is often a source of anxiety for some of our younger patients. The changes necessitated by the COVID-19 pandemic may make dental visits even more stressful for these nervous patients, and may even inspire dental anxiety in children who previously experienced none. As dental hygienists, how can we make sure our pediatric patients feel safe in the dental office?

Alleviating dental anxiety in pediatric patients

A Cochrane review highlighted that dental anxiety in children is rooted in dread of what is to come, along with the feeling of having no control. The most effective tools we can use, then, will focus on alleviating that dread and restoring a sense of safety and security.

Explain the changes

Our young patients are coming into a dental environment that has undergone significant changes. Before your patient arrives, consider a video call to explain exactly what to expect and why, show them what may have changed, and invite them to ask questions. Use clear, simple language and frame your explanations positively. For example:

“We’ll all be wearing masks because it’s the best way to keep you safe and healthy. Here’s what my mask will look like. It might look a little odd or scary, but it’s just me behind here – see!”

Get parents on board too

Many parents are anxious about bringing their child to the dental office right now. Children look to their parents in uncertain situations and will often imitate the parent’s reaction, so reassure parents by taking the time to explain ahead of time the protective measures your office has put in place.

You can also ask parents to help you prepare their child before the visit. This might involve sharing positive experiences of their own dental care, or watching educational videos with their child to show them what to expect.

Communicate

Always communicate in a friendly, positive and calm manner, avoiding scolding or disapproving language. Speak to the patient and not just the parent, and answer all of their questions transparently using clear, age-appropriate terms. Remember that children pick up on body language cues too, so use lots of positive eye contact and friendly expressions.

Use the tell-show-do technique

Anxious pediatric patients can benefit from the tell-show-do technique of desensitization:

• Tell the patient what each step of the procedure will involve.
• Show the patient where the procedure will happen and any equipment you will use.
• Do the procedure exactly as described.

You might complement tell-show-do by pausing at each new stage of the treatment, reiterating what will happen next, and confirming that the child is comfortable and happy to continue. You should also use lots of praise to reinforce their co-operation. This may be:

• Verbal -- “Thank you for keeping your mouth wide open; that’s really helpful!”
• Non-verbal – an encouraging thumbs-up.

Establish signals

To help your pediatric patient regain a sense of control, establish non-verbal signals that they can use to communicate with you if their anxiety becomes overwhelming. For example, you might say:

“It’s important that you try to keep still, but if you need me to stop at any time, then just raise your hand like this and I’ll stop right away.”

To build trust, it may help to do a “trial run” to reassure your patient that you’ll respond promptly to their signal.

Provide a distraction

Distraction is a proven technique for soothing anxious patients. While the go-to toys and magic tricks are not an option in the current circumstances, we can still use non-contact distractions like cartoons and music. If you’re able to do so, ask your young patient for their favorite songs or shows beforehand and play them during treatment.

Try relaxation techniques

Encourage nervous patients to try controlled breathing exercises or guided visualizations, such as asking them to imagine their favorite place and describe it to you in detail.

For very young patients, the “snake” breathing technique works to calm the breathing and provides a fun distraction. You simply tell the child to breathe in through the nose, and then breathe out “like a snake” with a long, slow hissing noise.

With compassion, care, and creativity, dental hygienists can help anxious young patients maintain optimal oral health through the COVID-19 pandemic and beyond. You can find more techniques for helping children with dental anxiety in the Cochrane review. You may also find helpful this checklist from the American Academy of Pediatric Dentistry on returning to the dental office.