1. “To suffering, there is a
limit; to fearing, none”
Sir Francis Bacon

2. THE FRIGHTENED CHILD
DEEPTHI P. R.
PUSHPAGIRI COLLEGE OF
DENTAL SCIENCES

3. CONTENTS
• Introduction
• Misbehaving child dental patients
• Definitions
• Causes of fear of dentistry
• Management
• Conclusion
• Bibliography

4. INTRODUCTION
• Pediatric dentist- avoidance behaviors
• Frustrates ; guilt & anxiety, discomfort
• Management skills refined with time &
dedication
• Ways to manage-”embarrassment of riches” by
Dr. David Chambers in 1977

5. MISBEHAVING CHILD DENTAL PATIENTS
Can‟t or won‟t cope with the stimuli & behavioral
demands of the dental experience
Category I: The emotionally compromised
child
Category II: The shy, introverted child
Category III: The frightened child
Category IV: The child who is aversive to
authority

6. THE FRIGHTENED CHILD
• Formidable challenge to everyone who
encounters – dentist
• Intense, enormous cooperation
• Problem of fear is contended more

7. THE FRIGHTENED CHILD
• Study in the US by Agras et al(1969):
snakes>heights>storms>dental visit
• Fear of needles, handpiece, rubber dam
placement
• Fear of bodily harm
• Fear of the uncertain & strangers- infants &
toddlers
• Fear of separation- 3 year old

8. THE FRIGHTENED CHILD
• Misbehaviour is attributed to fear or other
cause- difficult
• Information, experience & common sense

9. DEFINITION
• Fear is an unpleasant emotion or effect
consisting of psychophysiological changes in
response to realistic threat or danger to one’s
own experience
• Fear & anxiety interchangeably used
• Anxiety is a vague unpleasant feeling
accompanied by a premonition that something
undesirable is going to happen
- Kent

10. CAUSES OF FEAR OF DENTISTRY
Intellectually unable
Not relieved even when educated
Chronologic age <36-40 months
Slow development

11. CAUSES OF FEAR OF DENTISTRY
Emotional upsets in life
Acute chaos at home
Abused children
Grieving close one‟s death
Other health problems
Self limiting
Resolve in time
Rigorous procedures- difficult to endure

12. CAUSES OF FEAR OF DENTISTRY
Acquired fears
„sold‟ to the child by peers, siblings or parents
Subjective Fears
Based on feelings & attitudes that have been
suggested by others
Not experienced personally

13. CAUSES OF FEAR OF DENTISTRY
Learned fears
Previous painful or difficult experience at
physician‟s or dentist‟s office
Objective Fears
Direct physical stimulation
of the sense organs
Not of parental origin

14. CAUSES OF FEAR OF DENTISTRY
Emotionally ill
Undiagnosed
Not noticed by the parents
Broken homes
Daily observing teacher
may notice

15. MANAGEMENT
• Easily identified except the emotionally ill
• Make certain-misbehavior is out of dread of
dentistry
• Parent & dentist obliged to avoid increasing the
anxieties
- postponing dental work
- using drugs
- perform under G/A

16. MANAGEMENT
• The most appropriate measures to be taken
regardless of :
-cost
-inconvenience
-loss of efficiency

17. MANAGEMENT
• Emotional illness:
-Refer to psychiatrist,
psychologist, counselor
-establish whether the child
is emotionally healthy to go
through dental appointment

18. CONCLUSION
• Misbehaving children encountered in pediatric
dental practice on a day to day basis
• A careful and intelligent identification of the
actual cause behind the behavior
• The management techniques to be adopted
• Reveal any unidentified psychological condition
suffered by the child.

19. BIBLIOGRAPHY
• Pediatric Dentistry- Infancy through
adolescence, Edition 4
-Pinkham, Casamassimo, Fields,
McTigue,Nowak
• Clinical Pedodontics, Edition 4-Finn
• Pediatric Dentistry, Edition 3
-Welbury, Duggal,Hosey
• Textbook of Pedodontics, Edition 2
-Shobha Tandon