Going to the dentist can be nerve-wracking for anyone, even kids. Research shows about 9% of kids and adolescents have fear about going to the dentist. The younger the child, the more likely they are to get anxious about a cleaning or procedure.
Dental anxiety isn’t just uncomfortable — it can also impact dental health. It can be difficult to drag anxious children to the dentist’s office in the first place. And squirmy or noncompliant kids can interfere with how a dental procedure goes.
Luckily, there are tactics that parents, dentists and dental office staff can use to make kids feel more comfortable before and during the visit.
To start, the office environment can play a big role in easing kids’ anxiety about dental procedures, says Dr. Anna Forsyth, a clinical assistant professor of pediatric dentistry at the University of Washington School of Dentistry. Most pediatric dental clinics use warm communication and body language from the moment the child enters the office.
But the office environment isn’t the only factor. When it comes to calming kids’ nerves, Forsyth says many clinics follow guidelines from the American Academy of Pediatric Dentistry and refer to evidence-backed research about what actually helps kids stay calm in the dentist’s chair.
Here are some of the most frequently used techniques to help children with dental anxiety.
Educational videos and apps
Helping kids understand what to expect at the dentist can be an effective way to calm fears. Many pediatric dental practices create or buy videos about going to the dentist, Forsyth says, which they share on their websites for parents and children.
Parents can also prep their kids for dentist appointments with educational videos from YouTube and apps designed to alleviate dental anxiety. A study published in 2021 found that dental video songs and a mobile app called Little Lovely Dentist, a game that allows kids to play “dentist” on fictional characters, were two effective methods in reducing kids’ anxiety.
In the study, kids who viewed the music videos and played the game prior to a dental procedure had lower heart rates and less anxious facial images than the control group.
Tell and show
Many pediatric dentists use the “tell-show-do” technique to help ease children into the appointment.
“With kids, we explain what we’re doing in appropriate language, show them what we’re talking about in a non-threatening way and then do the procedure,” Forsyth says. For example, if the dentist wants to apply sealant to a patient’s tooth to prevent tooth decay, they might explain the process, demonstrate it on the child’s fingernail, then encourage the child to open their mouth.
While the tell-show-do method is common, evidence about its effectiveness is mixed. In the 2021 study cited above, researchers found that when the dentist used the tell-show-do method, pediatric patients had a higher heart rate than the group that watched videos; their anxiety levels were similar to the control group.
A 2019 study found tell-show-do was more helpful when kids could try out the procedure themselves on a Play-Doh model of a mouth. Coupling the tell-show-do method with smartphone games about dentistry also resulted in better child behavior during dentist visits.
The American Academy of Pediatric Dentistry encourages dentists to use positive reinforcement to help kids develop positive associations with the dentist. Dentists often do this by praising kids before, during and after dental visits. Forsyth says she might tell a child that she loves how they’re sitting still during an exam, for example. Before a visit, she might remind the child how well they did last time.
Giving post-visit prizes like small toys is another way to decrease anxiety and motivate kids to come back to the dentist. One study found preschool kids had less anxiety about dentist visits if they earned a prize afterward, but research also shows not all prizes are equal. Kids might be more motivated if they have a choice in their post-visit prize — for many, a toy is a better incentive than a sticker.
Distracting kids is another way to reduce anxiety. If she’s working with young children, Forsyth says she often sings songs or tells them stories. Some kids benefit from a sensory distraction, such as holding a string of beads or popping bubble wrap.
While every patient’s preference is different, evidence suggests videos are one of the most effective tools for distracting kids and increasing compliance. One study of 80 kids found that ceiling-mounted TVs were the most helpful, followed by chair-mounted screens. Audio-only distraction didn’t help as much, but it was better than nothing.
Researchers have also studied virtual reality as a distraction tool. One small study from 2018 found kids and adolescents experienced less pain and fear during potentially anxiety-provoking dental procedures, such as fillings or tooth extractions, when they engaged in immersive, interactive VR using VR goggles during their procedures.
Does parental presence or absence matter?
You might think having a parent nearby would reduce a child’s anxiety and drive positive behavior, but there’s not much evidence to suggest a parent in the room makes a difference. Some dentists may attempt to keep anxious kids compliant by inviting a parent in, then threatening that the parent will leave if the child doesn’t cooperate, Forsyth says.
But that method isn’t particularly effective: A 2018 study found parental presence or absence was no more likely to encourage compliant behavior than other methods. Another older study had similar findings: Kids’ behavior at the dentist wasn’t driven by parental presence or absence. (Plus, Forsyth says, making threats isn’t a great way to build trust with a scared patient.)
While some anxiety-reduction methods show more promise than others, there’s no silver bullet for addressing child anxiety. It’s more important for dentists and parents to shape their strategies to address kids’ specific fears, Forsyth says.
“Every child is different, so you want to make sure you’re tailoring your methods to their needs,” she says.