How to help a child who is anxious about the dentist - Part 2

In the first part of this blog we discussed finding a child-friendly dentist and how to help your child before an appointment.

Maybe you have a dental appointment approaching. How can both you and your dentist make things easier for your child during their visit?

How can the dentist help my child?

Treatment room at Small Bites

• Taking things one step at a time will help to build up confidence. It is usually best to start with a check-up and simple cleaning before moving onto other treatment.  
• Young children are not able to sit still or concentrate for long periods of time, so visits are best kept shorter or have breaks when needed.
• The dentist may introduce a "stop signal," like raising a hand, that can be used so that your child can let the dentist know if they are not comfortable or need a break.
• Distraction can be used to give your child something else to think about other than the dental treatment. For example, music, cartoons on a TV screen or simply chatting about something else.
• A good dentist will explain things in a way that your child can understand as they go along. Long explanations and words may be confusing for your child. It is best to have a separate chat with parents while the child plays it the waiting room if required.
• The dentist can first explain, and then demonstrate any tools or materials before using them. For example, an instrument can be used on the back of the hand or finger nail before it is used in the mouth so your child knows what it feels like. 
• Although the dentist should be friendly with your child they may need to use a sterner tone of voice if a child is not listening and following instructions much the same as a schoolteacher would.

Certificate of Bravery

• Positive Reinforcement - when a child behaves and cooperates well they should be rewarded with praise, stickers, a small gift or "bravery" certificate.

Should parents stay in the room for dental treatment?

This depends on your child's age and behaviour. Young children (below 4 years) tend to experience separation anxiety and therefore it is usually advised that parents stay in the room. 

Some children "play up" to their parents and behave better when they are not in the room. One solution for this is to allow the parent or carer to stay in the treatment room whilst the child behaves well, but ask them to go to the waiting room if the child is not listening and following instructions.  

How can I help my child during a dental visit?

• In the previous post we discussed the importance of staying positive and encouraging your child. 
• For young children, you may need to help support your child on your lap while that dentist checks their teeth as shown in the picture.

• If your child makes a fuss try to remain calm. Dentists who treat children regularly will have seen their share of tantrums and be prepared for this. Allow the dentist to guide you on how to best support you child.  
• Some children will "act up" at the dentist to try to avoid treatment. If they are immediately taken out of the treatment room they are more likely to do the same thing the next time. Instead it should be explained to the child what needs to be accomplished in that visit. If cooperation is difficult it is better to achieve a lesser goal than planned, for example, placing a temporary filling, than abandon treatment altogether.

It is better to use rewards after the treatment is over than to promise bribes before hand. 

Show your child how proud you are of them for each new achievement.

Finally - Prevention is better than cure

Although, with some help, the majority of children can learn to cope with (or maybe even enjoy!) visiting the dentist the goal should be to prevent the need for dental treatment as far as possible.

It's a great feeling to take your child for a check up and be told that there are no cavities!

Here are some tips for preventing dental decay and gum disease:

• Thorough tooth brushing twice a day, morning and night. For more brushing tips see this post (click for link).
• Rinsing out the mouth with water after eating.
• Eating a healthy diet and making snacks and drinks, between meals, sugar free as far as possible. 
• Dental sealants are a coating placed on the biting surface of the back molar teeth by a dentist. They protect the narrow pits and grooves of the tooth which can be prone to decay. See this post for more information (click for link).
• Regular check-ups not only get your child used to visiting the dentist but enable any early signs of dental disease to be spotted and prevented from progressing into a bigger problem.

How to help a child who is anxious about the dentist - Part 1

Do you dread taking your child to the dentist? 

Are you worried about how your child will behave? 

Do you put off visiting the dentist until your child has toothache?

Maybe you are anxious yourself and don't know how to help you child overcome their fears?

In this two part blog we will look at ways in which you can make visiting the dentist less stressful, and maybe even enjoyable for you and your child.

Children are not born with a fear of going to the dentist. A small child visiting the dentist for the first time will not know what to expect, apart from what they have picked up from their parents and others around them. Therefore, it is important to try to give your child a positive view of dental health. Depending on your child's age, you can discuss or show them the importance of teeth and looking after them in an appropriate way. They can be encouraged to view the dentist as someone who helps them look after their teeth.

If you are anxious yourself, or have had a bad experience in that past, try not to talk about this in front of your child and advise other family members and friends to do the same. 


A recent study showed that parents' attitudes towards dentistry are often passed on to their children. Children are often listening in on our conversations with others, even while we think they are playing or doing something else. They even pick up on anxieties that we do not speak about by our expressions. If you have fear of the dentist you may find this 4 part blog (click for link) helpful for advice on overcoming your own anxiety.

Finding a child friendly dentist

Of course, it is important to find a dentist who is good with children. Not all dentists are good at, or enjoy, working with children. Find a practice where the dentist and their support staff relate well to your child and work to gain their trust so that your child can feel comfortable with them. The environment is also important in putting your child at ease and the decor should be fun. The waiting area should have toys, books or some form of entertainment to make waiting easier. 

Ask around for recommendations from friends and family or look at reviews from other parents. You can ask dental practices about their experience and expertise in treating children. Pediatric Dentists (or Pedodontists) are specialists in children's dentistry and usually have 3 years further training in Pediatric Dentistry after dental school. If you are in Bangalore, Small Bites in Indiranagar provides exclusive dental care for children. Here, we believe that every child deserves a good start in life with the best preventive dental care.

How can I help my child at home before a visit?

• Try to schedule the appointment at the best time for your child. Small children especially do not do so well if they are tired and hungry. 
• If you or your child are anxious, try to choose a time when the dentist is less busy to minimise waiting and so that there will be more time to discuss any issues and concerns. Even if this means that you have to take time off work it may be worth it for a first visit.
• Be positive. If your child is anxious, listen and show them you understand their concerns but express confidence that they will be okay. 
• Do not use words or scare stories that may upset your child. Even if you say "it's not going to hurt" the main word that your child will hear is "hurt", even though this may not have been in their mind before. 
  
• For young children, you could "play dentist" at home. You and your child can take it in turns to "be the dentist" and check each others teeth. Also try using your child's favourite soft toy or a puppet and "check their teeth." You can buy small plastic mouth mirrors for this, or just use your toothbrush. 
• If your child has a sibling, cousin or friend who is good with the dentist it may be helpful to visit the dentist with them first.
• There are many good children's books and videos available which can help children to understand about going to the dentist.
• If your child has had a difficult time at the dentist in the past, ask them about their concerns. Discuss these with your dentist to find ways to help your child before the next appointment.
• If one parent is particularly anxious, it may be better for the other parent, or another close relative, to bring the child for their appointments.

Ideally, a child's first experience at the dentist should not be for treatment. If at all possible, try to take your child just to see the dental practice and meet the dentist, or at most have a quick check-up, before they have any problems. This will help them to feel comfortable with the environment. 

At Small Bites we also have children's activities (advertised on our Facebook page - click for link) held in the clinic. This is a chance for children to get used to the environment and have fun on a separate day from any appointments. 

If your child, already has pain or problems before they have visited the dentist, don't worry. A good dentist will aim to alleviate the pain at a first visit but do further treatment as your child increases in confidence and cooperation.

Regular visits for check-ups will help your child. It is much better if they do not need treatment every time they have an appointment.

In the second part we will discuss ways that you and your dentist can help your child during their visit and some tips for preventing dental problems.

Root Canal Treatment for Baby Teeth - Pulpectomy

What is a Pulpectomy?

Pulpectomy is the name given to root canal therapy for baby teeth. This is required when decay or injury to a tooth has caused infection of the nerve. The aim is to keep the tooth until the correct time for it to fall out. 

I have been told my child needs a pulpectomy - why can't he just have a normal filling?

It is possible to place a filling in cases where the decay is only affecting the first two layers of the tooth - the enamel and the dentine. 

Diagram is of an adult tooth but illustrates the same stages of decay

Once there is infection within the nerve of the tooth this needs to be dealt with properly. If this is not done the nerve will eventually die and an abscess can occur when the infection spreads outside the tooth. Apart from causing severe pain, dental abscesses can cause fever and other health problems. As adult teeth develop close to the roots of baby teeth untreated infection can spread to and affect the normal development of the permanent teeth.

It's just a baby tooth - wouldn't it be better to pull it out?

Although they are lost early in life, primary teeth, also called baby teeth or milk teeth, are essential in the development and placement of the permanent teeth.

Baby teeth maintain the spaces for permanent teeth to erupt into. If baby teeth are lost too early other teeth may tilt into or take up the vacant space, forcing permanent teeth to come in crooked. 





If the baby tooth is getting close to being pushed out by the adult tooth that replaces it, a pulpectomy may not be advised. This can be judged by looking at an x-ray of the teeth. In this case the baby tooth can be left to fall out naturally or, if there is spreading infection, may need to be extracted.

How is a pulpectomy done?

1. An opening is made through the top of the tooth. If the nerve is not completely dead, local anaesthetic will be required to numb the tooth first - click here for more information on this.
2. The decay and infected nerve are removed. The root canals are cleaned and shaped using small files and then washed and dried. 
3. The empty root canal space is then filled with a paste which is able to resorb as the tooth root loosens to make way for the new adult tooth.
4. A filling is then placed in the top part of the tooth. An x-ray will be taken to check the root filling.

Most teeth with pulpectomies will require a crown (cap), as when the nerve is dead or removed the tooth is more brittle and more likely to fracture. For baby teeth near the back of the mouth a pre-formed metal crown is most often used. This may be done or the same or the next visit.

Will the procedure be difficult for my child to cope with?

Pulpectomies do require slightly more cooperation from your child than for a simple filling. However, as baby teeth have shorter, wider and less complex root canals than adult teeth the procedure is less complicated and takes less time than for root canal treatment in adult teeth. There should be no pain, as long the tooth has been numbed where this is required. Your child might feel a slight tugging sensation while the canals are being shaped using the files. The procedure is usually completed in one visit of approximately half an hour, but make take two visits if the nerve is very infected.

What is the success rate for pulpectomies?

Clinical studies have shown a 78 to 96% success rate with the latest materials use for filling root canals in baby teeth. 

Are there any precautions that should be taken after treatment?

• Avoid eating and drinking for the first 20 minutes.
• If your child had local anaesthetic to numb the tooth they will need to be careful not to bite their lip or tongue until the numbness has worn off.
• On the day of treatment it is best to stick to softer foods that don't require a lot of chewing and avoid very hot food and drinks.
• There is sometimes some mild pain or discomfort as the tooth settles down. This can be relieved using children's paracetomol. (Calpol or Crocin).
• Your child should avoid biting heavily on the tooth until it is restored with a crown, as it may be brittle and prone to fracture.
• The teeth should be brushed normally.

How you can influence your child's dental health

Children learn by copying important adults in their lives. This is a natural process by which children learn about the world around them. 

Your behaviour, expressions  and reactions will usually have a greater impact on your child than what you say to them. 

Parents have a unique position of influence in their children's lives, as a role model and first teacher. This influence can have either a positive or negative effect. How can we use this influence in a positive way to improve our children's oral health?

• Parents choose what babies and young children eat. Parents usually introduce children to the same foods that they eat.  If children are given a healthy, balanced diet at an early age they are much more likely to choose a healthy diet themselves when they are older. 
• If you are constantly snacking on high fat and high sugar snacks your children are likely to do the same. When shopping, plan your meals and also think about healthy food to keep in the house for snacks when you or your children get hungry between meals. 
• For more information on a diet that is good for you teeth see this link.

• Give your children a good example to follow by letting them see you brushing your teeth regularly. 
• Teach your child about the importance of looking after their teeth. There are books and videos which can make learning fun.

• You will need to brush your child's teeth until they can learn to do it effectively for themselves from around six years old. Older children will still require encouragement and supervision. Also see post on top toothbrushing tips.
• Children whose parents regularly visit the dentist are more likely to do the same.
• Take your child to visit a dentist before they have any pain or problems. Find a dentist who is good with children. Regular check-ups enable the dentist to assess your child's risk for developing decay or gum disease and give preventive advice. Any problems can also be seen early and treated or prevented from progressing.

Did you know that children whose parents are anxious about visiting the dentist are much more likely to become anxious themselves? A recent study showed that parents' attitude towards dentistry are often passed on to their children.

Children look to their parents to learn how to respond  to a new situation and can pick up on their parent's anxiety. This means that some children are very anxious even before they first visit the dentist.

We will look at ways to help anxious children in a future post. For help on overcoming your own anxiety, see this blog (click for link)

Even if you are anxious, try not to let this show to your child. Avoid making negative remarks about the dentist in front of your children.

Once children get interested in looking after their teeth they can be encouraged to see the dentist as someone who helps them to stay healthy.