Tuesday, April 04, 2006

How Children Behave at the Dentist, What to Expect

Many parents expect their children either to act up or be little angels at the dentist. With children, you really never know quite what you are going to get. Here is a list of what I generally see with children at different ages and what to expect as far as behavior in the dental office. I have to say I have had one and two year olds who do better than teenagers. I also have seen parents in worse shape than their kids. The behavior is what I usually see for dental exams or cleanings. If they do have cavities or other treatment needs, I use the cleaning/exam appointment to evaluate their response. If I think they will be fussy for treatment, then we discuss how to make that better. There are always exceptions to what I am presenting here, but this is how it goes:

Babies-They usually do well for an exam or just cry a little. Give them their pacifier and they are as good as new.

One year Olds-they usually do quite well although if they are closer to two things can get a little loud.

Two Year Olds-They don't call this age the "terrible twos" for nothing. These kids are by far the hardest to examine. They almost always cry to be examined. I mean they really scream like there is no tomorrow. They fight too. This is the age that they begin to establish independence. This is especially true for the "headstrong" kids. They really don't like to lie down for an exam. I can look a little with them sitting up, but can't really do a complete exam. So, we have them lie down, the parent holds their hands, and I take a really quick look. I don't mind the noise, although the resistance can make the exam more difficult. I always hope the parents realize this kind of fussing is normal for this age. I don't want them to think the child is in any kind of real distress. I don't want them to be mad at me for just looking at their child's teeth. The parents I worry most about are the first timers. Parents who have more than one child often understand the normal reactions. I know the child is not traumatized for life just for counting their teeth. In fact these fussy two year olds often become model patients after a couple more years of regular visits.

Three Year Olds-this is a transition age. Some three year olds are just as fussy as the two year olds just bigger and stronger. Some are model patients who let you lay them down, clean their teeth, and often do fillings without protest. Even a particular three year old may respond differently depending on what side of the bed he woke up on that day. You know what I am talking about.

Four year Olds-I like four year olds. Most of the time they are the best patients. They hop up into the chair; let you take x-rays, fillings, whatever. They can't do this for long, but most do quite well. Again, there are exceptions. Some are as "head strong" as the two year olds.

Five through Eight-Regular kids. Most do quite well. I can communicate with these kids and can guide them through almost anything.

Eight to Eleven-Most do well, but these are the "needle-phobic" years. You can have a perfectly calm child who throws a giant fit if he thinks he is going to get a "shot". Read here for more info on that bad word: Pedo Lingo. After they have received appropriate anesthesia, they revert back to cooperative patients.

Teenagers--Most do well although some have typical teenager "attitudes". You have to take into account whether they are the "I'm too cool to care/whatever" type or (usually young ladies) who are extremely preoccupied with their appearance.

Special Needs Patients--If you take your child to a Pediatric Dentist, you will likely see other children around of all ages and temperaments. You also may see some patients who have medical or developmental conditions like Down's Syndrome, or Cerebral Palsy. These children are welcome in our offices. Some can be very loud or resistant to treatment. Even just an exam can be difficult. Others are some of the best behaved in the office. In other words, there is great variety in Pediatrics. You can expect lots of commotion and activity.

If you want more, go back to the home page or click here:Pediatric Dentistry

25 comments:

Anonymous said...

I have a two year old needing crowns on two front teeth, and a molar. I went to one dentist who referred me to another dental clinic where they do the dental procedure with laughing gas. I just went to another office where they want to do the same procedures, but just strapping her down. She will not be cooperative at all during the procedure, so I don't know what is better. A friend's child was strapped down, and I was told she got a little traumatized after. What are your thoughts/concerns/suggestions?

Dr. Dean Brandon said...

As you can read here-two year olds can be quite resistant to Any dental treatment even just looking.

Most two year olds with multiple procedures we do under general anesthesia or at least some premedication --there area few, and I mean a very few that can do stuff (but not much stuff) with just laughing gas. Even with medication a two your old can be resistant--then you either "hold and go"--or stop the procedure...Read more about premedication and other stuff on this blog here and you may get a better feel for the alternatives.

Kim said...

I have three boys, ages 5, 4, and 1. My 5 and 4 year olds are horrendous at the dentist. The oldest has had tonsils out, a frenectomy, and his adenoids removed. My 4 year old has had three trips to the ER resulting in stitches on his face and mouth. Could these past issues contribute to their apprehension? The dental staff just tells us "it's normal" to have to hold them down kicking and screaming for a cleaning. This has been the solution every six months for several years now, and I'm just concerned and wondering if this truly is "normal"? Thanks - great, helpful blog!

Dr. Dean Brandon said...

You raise a lot of complex issues. Simply as I can here...I do see this from time to time. Kids who have, say hospital experiences, tend to be a little more anxious at the dentist, but usually only for a visit or two, then there seems to be no long term effect. Now, many times behavior has to do with something called temperment-the general way a person reacts to things. Lots of other factors too. I usually see things improve with age.

Anonymous said...

I have a 2 year old who will be going to her first dental appointment for a cleaning. My friend's little girl went and did fine. I'm really anxious about the appointment and I don't know what to expect. I don't want her to be strapped down, but is that realistic? What should I expect?

Dr. Dean Brandon said...

Well, you can see my post here is pretty thurough. Of course, the dentist/staff should do nothing you do not approve of. Most of the time just holding hands of the child (yes sometimes that is restraint) is all that is needed to get a quick look. If something other than an exam is needed, like fillings, then there are lots of good ways like sedation that might be available for that kind of thing. (read more under general topics behavior management on the sidebar).

A good dental visit for a two year old usually consists of some fussing, a quick exam (usually not a cleaning unless it is pretty fast) and a nice toy and a smile afterwards.

Anonymous said...

Your site is really helpful!! Thank you so much for putting it up.There is not much that isn't covered and I appreciate that. Your advice makes me feel at ease, Thank you!

Anonymous said...

great

Kelowna Dentist said...

To avoid this certain unwanted behaviors of our children we must always stress the importance of brushing and flossing to their children and monitor their compliance at home.

steph said...

My now 7 year old used to be just fine going to the dentist. Even had a filling done and was a pretty good patient. When we went back for our next visit/cleaning she was So scared and has been ever sense. She feels like she's going to throw up she says because she's scared and when they lay her back it gets worse so now I'm having a hard time just getting a cleaning done and there might be a new cavity. How do I get her back to comfortable?

Dr. Dean Brandon said...

steph--

Each child is different and different from time to time. I would suggest first go to a pediatric dentist. Now things will not likely change right away, we still have kids that are anxious. However, as a child continues to visit the dentist and mature, things most often get much better. Medications can help as well depending on what is being done.

I have seen some some "good" kids who have had their tonsils out and are anxious at the dentist for their next visit even though it has nothing to do with the dentist. After a short while, they are just fine and back to great behavior.

Anonymous said...

My 8 year old son just had to have 5 fillings in between teeth from not flossing good enough. They gave him some laughing gas and when they poked him with the needles to numb his mouth he freaked and was not cooperative after that. We ended up getting him back on the chair and used the velcro board to hold him down and get it done. The whole time he was yelling and crying and saying it hurt. I started to think that maybe it really did hurt and he wasn't numb. Does getting fillilngs really hurt? I'm stressing cause that was the worst experience ever as a mom and now my 3 year old is going in for a crown on one of her teeth. We have definitely changed the way teeth are taken care of at our house. I vow to never have to put my babies through this again.

Dr. Dean Brandon said...

Gosh, I know that must have been a difficult experience for him and for you. I have seen kids get upset even after numbing. Often kids react to things like noise and vibrations not necessarily anything that you would think is that bad. Why is it that one child has a difficult time and the next (who might be a 4 year old) does just fine doing the same exact thing? It seems to do partially with individual variation and what we call "temperment" or personality styles. Some are very verbal or vocal, others very laid back. Anxiety can cause some kids to say it hurts and all we are doing is placing a cotton Q-tip in their gum. There are kids who do not even need numbing and others that seems to be reactive even with lots of numbing and just small procedures. Often we use medications to reduce the anxiety as you can read here on the blog. There is a small number of kids (usually 9 -12yr old boys) that seem to be very very anxious about injections, and will resist suddenly and violently, but after the numbing is over, they usually do just fine. The key things are 1. that we do everything possible to make things as easy as possible for these children, 2. Each child reacts differently and differently on different days, 3. Anxiety management is an important consideration and is often mitigated by medications as benign as laughing gas or sedation or even general anesthesia.

Anonymous said...

I have a 3 year old daughter and she just came from tha dentist a couple of hours ago she got an x- ray and i was told that she has like 6 or 7 cavities and i was actually shocked like OMG and he explained to me how she was going to have to get sedated to get crowns and Im just really worried and scared. I just want to know how this is going to work and what to expect???

Dr. Dean Brandon said...

The younger they are the less reliable medications can be. I'd discuss with your pediatric dentist. Also, there is a lot here on the blog about sedation and behavior. Kids are unpredictable as far as behavior. With three year olds I often say it depends on which side of the bed they wake up on. Not surprising to have a three yr. old with cavities though. They often start in between the teeth where we can't see till we get an x-ray or it gets large enough to see.

Sarah Oakshott said...

My 3 year old has white discolouration on her teeth at the bases of most of them and a small cavity on her second to front tooth at the top I took her to the dentist today but all she did was scream and wouldnt even allow the dentist to see her mouth let alone inside it If she continues like this at appointments what are the options for treating her successfully?

Dr. Dean Brandon said...

Not uncommon for a two or three year old to protest. Read more here on the blog about behavior management, sedation, and hospital dentistry. Treatment (and behavior management) options should be discussed with your pediatric dentist.

Anonymous said...

I have a 7 year old that is in the beginning stages of braces and she had to have a mold done and was unable to tolerate it due to her Extreme gage reflex. We had to hold her down and fight with her and she vomitted all over the dentist and asperated. She will have to have more molds of her mouth taken any suggestions how to make this better or what to do different. Normally she is very cooperative at the dentist.

Dr. Dean Brandon said...

A gag reflex especially for impressions is not a situation exclusive to children. Adults occasionally have a hard time too with that. Still, I do not usually start orthodontic treatment on a very young child unless first it is indicated and second that they are fairly cooperative. Depending on what is being done sometimes an impression just for diagnostic models is not necessary or possible. If an impression is needed to fabricate an appliance like a simple expander (something sometimes done on younger kids), they you have to decide if it is possible and how far you want to go with that. Mild sedation can help or just nitrous oxide (laughing gas) can reduce a gag reflex. All this has to be balanced with what you are trying to do how time critical it is and if it is worth all the fuss. Sometimes it is just best to wait till the patient is older (however, no guarantee a gag reflex will improve (although it can with age).

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Anonymous said...

My one year old had two cavities on the upper teeth; the dentist said to wait until he's older to treat. Now at almost 2, his two front teeth have cavities also. First, what do u think about a fluoride filling ( don't know the name) that might last 3-6 mo , in order to prevent further decay? The dentist suggests Valium , laughing gas, and a jacket; my 2 yr old will be upset- very. Is it worth it for just a temp filling in your opinion ?
Also do these fluoride fillings give off a lot of fluoride in general which could effect the perm teeth?
Thanks!

Dr. Dean Brandon said...

Well, decay progresses on unless it is taken care of. I don't know what you mean by fluoride fillings. I suspect they mean glass ionomer restorative material. That does release fluoride in very small amounts--no problem at all. Unless the decay is totally removed, any restorative material is a temporary measure. Some dentists lightly scoop out some decay and place a glass ionomer (which can be an acceptable restorative) to buy time till there is more cooperation. YOu can read here when that might be...

RekhaD said...

My 10 year old daughter is scheduled to get 3 teeth pulled on Friday. Our dentist refered us to an oral surgeon. The oral surgeon saw my daughter once and has recommended IV sedation for the procedure. My daughter is generally calm and not usually afraid of shots or needles. His office keeps saying that the shots given in the roof of the mouth are painful and therefore she will be more comfortable with the IV sedation. I am more nervous than she is about the IV sedation. She is very petite weighing only 52 lbs. How concerned should I be about the actual IV sedation and her recovery afterwards? They're telling me she will be "out of it' and may vomit later. I don't like the sound of that. They have also said that I can't be present in the room for the procedure. I would like to be there while they get the IV started. Is that a reasonable request - to be there when she falls asleep and to be there when she wakes up? Thank you for your time.

Dr. Dean Brandon said...

We use in-office oral sedation almost every day. These kinds of things should be properly diagnosed, dosed and done in accordance with [roper guidelines of monitoring, health status etc. Read more on the blog here about sedation and general anesthesia. Oral surgeons often use IV sedation or even general anesthesia.

In our office we allow parents back, but it is understandable if an oral surgeon wants to maintain the surgical suite differently, an controlled environment--kind of like an operating room. It's always ok to ask.