Dental Fear and Anxiety in Children and Adolescents
For a significant proportion of children and adolescents, dental fear and anxiety (DFA) is a severe issue.
The prevalence of DFA in children and teenagers ranges from 5 to 20 per cent in many countries. In some certain cases being listed as a dental phobia (severe DFA).
When it comes to dental checkups, children and adolescents with DFA are frequently uncooperative, making treatment difficult or impossible.
Such behaviour jeopardises treatment outcomes, causes workplace stress for dental personnel, and is frequently a source of friction between dentists and patients or their parents.
Fearful children and teenagers may try whatever means imaginable to avoid or delay treatment, causing their dental health to deteriorate.
DFA may induce sleep issues, influence one's daily life, and have a poor impact on one's psychological functioning in addition to its effects on dental care.
DFA acquired as a child can remain into sexual maturity and is a significant predictor of adult dental avoidance.
This emphasises childhood as a critical period for preventing and intercepting DFA, allowing people to safeguard their oral health in the future.
Previous DFA research relied heavily on quantitative tools such as questionnaires and psychometric scales.
However, because these instruments are largely based on professionals' assumptions, they may not capture the full range of respondents' perceptions and views.
Furthermore, quantitative methods that are primarily concerned with generating statistics and testing hypotheses may be incapable of uncovering complex mechanisms.
As a result, qualitative research is regarded as an important complement to quantitative methods, particularly for gathering detailed information on human behaviour and the reasons for such behaviour.
Although qualitative research does not seek to give data that can be statistically extrapolated to a large population.
It can reveal a diverse range of perspectives and experiences in the context of people's own words.
Current Research in DFA
Although a few qualitative studies have yielded some insightful insights, there is currently a scarcity of research using qualitative approaches to better understand DFA.
Abrahamsson and colleagues found that individual vulnerability and traumatic dental care experiences produced dental fear in adult patients
They were often locked in a vicious cycle of fear and negative expectations about treatment, after conducting thematic in-depth interviews with 18 patients.
They also discovered that a number of psychological and social characteristics, such as self-respect, well-being, avoidance, willingness to act, and ambivalence in coping, influenced how adult patients dealt with their anxiety and how it affected their everyday lives.
Three themes explaining children's refusal to submit to dental treatment were identified through semi-structured interviews with mothers of 14 children who were uncooperative during dental treatment.
Recent Medical Studies
Recent medical studies, on the other hand, have demonstrated the potential of using public uploads on Internet social media sites like YouTube as a valuable source of qualitative data to understand health behaviours and perceptions.
A study, for example, reported the personal narratives of cancer survivors through an analysis of 35 YouTube videos, enriching our understanding of the psychological impact of a cancer diagnosis on patients' personal and family lives.
The outcome will support professionals in better dealing with cancer patients and their families. It will also provide better treatment to cancer patients.
However, the potential of Internet social media in dental research is mostly untapped. Knösel and colleagues recently published an interesting study in which they carefully evaluated educational films on YouTube linked to dentistry.
Search for Dental Fear on YouTube.
YouTube is a video-sharing platform by Google and it was launched in 2005. It receives over 3 billion daily views and 800 million monthly users.
YouTube provides a completely unconstrained space for people to tell their tales and express their emotions in real-time.
It allows people to talk about difficult topics or express their thoughts without fear of embarrassment or negative judgement, which is typically a concern in face-to-face interviews.
In principle, the candid in-depth testimonials and reports on YouTube could be valuable data sources for analysing DFA.
Personal narratives and spontaneous sharing uploaded to YouTube by patients and the general public add a rich context to our existing knowledge of DFA.
Furthermore, some new or previously unexplored themes may emerge, deepening our understanding of DFA.
This study used a qualitative research approach and YouTube as a platform to profile the manifestations, impacts, and origins of DFA in children and adolescents from the public's perspective..
1. Immediate Physical Reactions
A trip to the dentist can be a daunting experience for children and adolescents.
Their immediate physical reactions, such as pitiful crying, forceful screaming, and uncontrollable shivering, were frequently seen in the videos.
2. Psychological Responses
Worry, upset, panic, feelings of powerlessness, uncertainty, hostility, and hatred toward dentists were among the psychological responses to DFA.
Some teenagers showed concern and panic about dental treatments in a few videos..
"I'm still cautious about wearing braces." I'm afraid I'll choke in this situation. "What if they start drilling a hole through my teeth?"
The needle freaks me out because I have a severe horror of needles. It was a total anxiety attack, and it was awful."
Wisdom tooth extraction was a nightmare for several teenagers who had undergone or were about to face the treatment.
A juvenile girl discussed her many fears the night before her scheduled dentist visit, shivering and smoking in front of the camera.
She couldn't stop worrying about "breaking[ing] bone down" during the surgery and having both of her cheeks swollen afterwards.
After hearing the terrible stories of his close friends who had a wisdom tooth extraction, a teenage boy was overcome with a strong sense of helplessness and insecurity, according to a video.
The fear had infiltrated him so deeply that he declared that he would rather not turn 18 just to avoid the possibility of wisdom tooth extraction.
This fear, combined with his sympathy for his friends, grew into a hatred for dentists.
3. Lack of cooperation
Pediatric patients who were afraid of the dentist sometimes refused to sit in the chair or open their mouths for an oral examination.
Parents and dental teams must work hard to persuade or encourage their children to collaborate.
A mother stated that her daughter had finally overcome her fear of the dentist, but that she had to "battle" with her daughter to convince her to go to the clinic in the first place.
Dental Fear and Anxiety: What Causes It?
1. Personal experience and parental or peer influence
Some children's DFA may be induced by the irregularity of their dental visits, as evidenced by a mother's testimonial who blamed her son's dread on his occasional dental visits.
He is apprehensive about visiting the dentist. I'm not sure if it's because we're going on a real visitor because it's been a while since we've been.
Careless words from parents can instill fear in children. A video depicted a young girl's destructive behavior after she refused to be examined in the clinic.
Her mother finally convinced the dentist that she was acting aggressively and uncooperatively because her father had taunted her that "the dentist would pull your teeth."
The influence of peers on adolescents should not be underestimated. For a teen who was adamantly opposed to going to the dentist, his friends' stories about their negative experiences initially instilled fear in him.
2. Dentists and Dental Auxiliaries
Patients' DFA may be caused by professionals' terrible manners, as seen in the case of a young child treated by a dentist.
Despite the girl's protests, the dentist raced through the operations without attempting to calm her down.
Throughout the appointment, the child struggled to follow the dentist's directions. Impatiently, the dentist flashed the lamp into the child's eyes, forcing her to close her eyelids. Here are the dentist's orders, which he delivered loudly, harshly, and impatiently.
Close your eyes for a moment. Keep it shut. Squeeze your eyes as tightly as you can. Keep your eyes shut. You're about to open.
[shimmers the light] Close your eyes... Keep your eyes closed until I tell you to open them again. Okay? We're not going to be able to do it.... Close your eyes and imagine... What can I do...?
Another cause of DFA could be a professional's lack of clinical skills. A teen girl who had been treated by an incompetent dentist expressed a mixture of fear and rage.
It's numb all the way up to my eye and all the way down to my chin. And they gave me... I don't know, six shots of something numbing and three shots of local anesthetic gel. And I burst out crying in my chair. It was excruciating... He slashed my lip.
DFA may be exacerbated by the dental team's poor work ethic. This happened to a teen who did not feel respected by a dental auxiliary.
The dental surgery assistant looked at him as if he were "a little cuckoo" as he chose the "hot pink" separator for orthodontic treatment.
He felt humiliated and upset as a result of the response.
Furthermore, as indicated by an irritated teenage lad, tardiness can irritate patients and exacerbate their nervousness before sitting in the dentist's chair.
First, I waited, and then I waited, and then I waited, and then I waited, and then I waited, and then I waited, and It seemed to take an eternity. Finally, my name was called, and I was ushered into the death chair.
3. Dental Setting and Procedure
Besides the human factors mentioned above, the physical environment of the dental clinic could provoke fear to pediatric patients.
Aside from the human aspects described previously, the physical atmosphere of the dentist's office may cause dread in children.
Many things at the clinic might cause fear, from big dental equipment like the dental chair, which a teenage guy dubbed the "death chair," to seemingly insignificant items like dripping sounds from the tap.
Dentist chairs can be excruciatingly unpleasant...
The sound alone is enough to make a person flee.
Furthermore, certain dental procedures (for example, injections) were the primary causes of DFA in some pediatric patients.
It was excruciatingly painful. The needle! I freaked out because I have a needle phobia.
Similarly, anticipating pain and discomfort (for example, choking) can lead to DFA.
This is how I'm going to be choked...
She twisted and turned all of my braces before tucking them into my teeth. It was excruciating... My braces will be extremely painful at 6 p.m., according to what I've been told.
She predicted that the brace would be excruciatingly painful for the next three days.
So I think I'll fall in love with Mr. John [a pain reliever] because I'll be taking it a lot. Overall, the experience was dreadful.
Adolescents place a high value on having a pleasing look. A teen guy undergoing orthodontic treatment was concerned that the metal bars would alter his appearance. His apprehension about the upcoming surgeries stemmed from his aesthetic worries.
I'm expecting the braces to change the way I look... I had an expander for a year, which basically expanded my jaws... If I keep going like this [giggles], it will ruin my appearance.
DFA in children and adolescents has a variety of symptoms, effects, and sources, according to this qualitative study. Some of the themes are only obvious when using social media on the internet.
The free sharing platform provided by YouTube, the candid in-depth testimonials in the videos.
The use of qualitative analysis, which allows the interpretation of the informants' deep meanings, are all factors that contributed to the discovery of novel and previously overlooked themes in this study.
Our findings added real-life narratives to some of our existing knowledge on DFA and revealed some missing puzzle pieces that could be confirmed in future studies involving in-depth interviews with patients and parents.
The profound effects of DFA on children and adolescents support the notion that managing DFA should be the first step in patient management.
DFA could be better prevented and intercepted if dentists, dental assistants, paediatric patients, and their parents worked together to prevent and intercept it.
Thoughtful approaches prior to, during, and after the dental visit, all contribute to a pleasant and productive dental experience.
Successful DFA management not only paves the way for a positive clinical outcome and improved oral health, but it also instils confidence in paediatric patients and may help them regulate their emotions when faced with other life challenges.