Dental fear in children: clinical consequences Suggested behaviour management strategies in treating children with dental fear

  • M. ten BergeEmail author


Aim: This is to present an overview of behavioural management techniques in the dental situation, and to prepare guidelines for the treatment of dentally fearful children, focusing on the behavioural management approach. Review: The literature related to the behavioural management of children in the dental setting was reviewed. Using this material a provisional set of guidelines for behaviour management strategies in treating children with dental fear was developed. Conclusions: Effective behavioural strategies that can be used by the dentist are discussed, from a theoretical as well as from a clinical point of view. In addition, available research studies are reviewed and suggestions for strategies and possible guidelines in dental practice are presented.

Key words

behaviour management dentistry children 


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  1. Arnrup, K, Broberg, AG, Berggren, U, Bodin, L. Treatment outcome in subgroups of uncooperative child dental patients: an exploratory study. Int J Paediatr Dent, 2003;13:304–319.PubMedCrossRefGoogle Scholar
  2. Azrin, NH, Holz WC. Punishment. In Operant Behaviour. WK Honig (Ed) Appleton Century Crofts, New York, USA. 1966, pp 380–447.Google Scholar
  3. Bandura A, Blahard EB, Ritter B. Relative efficacy of desensitization and modelling approaches for inducing behavioural affective and attitudinal changes. J Pers Soc Psychol 1969;13(3): 173–99.PubMedCrossRefGoogle Scholar
  4. Barrios, BA, O’Dell, SL. Fears and anxieties. In EJ Mash & RA Barkley (Eds.), Treatment of childhood disorders, New York: Guildford Press, pp 167–221. 1989.Google Scholar
  5. Beck, AT, Emery, G. Anxiety disorders and phobias: a cognitive perspective. Basic Books, New York USA, 1985.Google Scholar
  6. Casey, RJ, Berman, JS. The outcome of psychotherapy with children. Psycholog Bull, 1985;98, 388–400.CrossRefGoogle Scholar
  7. Corah, NL. Dental anxiety. Assessment, reduction and increasing patient satisfaction. Dentl Clinics North Amer 1988;32:779–790.Google Scholar
  8. Davey, GCL. Dental phobias and anxieties: evidence for conditioning processes and modulation of a learned fear. Beh Res Therapy, 1989;27:51–58.CrossRefGoogle Scholar
  9. Davidson, PR, Parker, KCH. Eye movement desensitization and reprocessing (EMDR): A meta-analysis. J Consult Clinic Psycholog, 2001; 69:305–316.CrossRefGoogle Scholar
  10. Dean SJ, Pittman CM. Self-punitive behaviour: a revised analysis. Lawrence Erlbaum Associates, Hillsdale NJ, USA. 1991, pp259–84.Google Scholar
  11. Do, G. Applying the social learning theory to children with dental anxiety. J Contemp Dent Practice, 2004;5:124–134.Google Scholar
  12. Eisneberg N, Fabes RA, Shepard SA, et al. Parental reactions to children’s negative emotions: longitudinal relations to quality of children’s socal functioning. Child Dev 1999:70:513–34.CrossRefGoogle Scholar
  13. Holst, A, Crossner, CG. Management of dental behaviour problems. A 5-year follow-up. Swed Dent J, 1984;8:243–249.PubMedGoogle Scholar
  14. Hout van, W, Emmelkamp, P. Exposure in vivo behandeling bij angststoornissen: procedure en effectiviteit (Exposure in vivo therapy in anxiety disorders: procedure and efficacy). Gedragstherapie, 2002;35(1):7–24.Google Scholar
  15. Jongh de A, Muris, P, Horst ter, G, et al. One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions. Beh Res Therapy, 1995;33: 947–954.CrossRefGoogle Scholar
  16. Jongh de, A, Oord van den, HJ, Broeke ten, E. Efficacy of EMDR in the treatment of specific phobias: four single-case studies on dental phobia. J Clinic Psycholog, 2002;58:1489–1503.CrossRefGoogle Scholar
  17. King, NJ, Ollendick TH. Annotation: Treatment of childhood phobias. J Child Psycholog Psychiat, 1997;38:389–400.CrossRefGoogle Scholar
  18. Kleinknecht RA, Mastering Anxiety: The Nature and Treatment of Anxious Conditions, Perseus Books Group UK. 2002 Ch.2, p 25–54Google Scholar
  19. Klingberg, G. Dental anxiety and behaviour management problems in paediatric dentistry: a review of background factors and diagnostics. Eur Archs Paediatr Dent 2008:9:11–15CrossRefGoogle Scholar
  20. Klingman, A, Melamed, BG, Cuthbert, MI, Hermecz, DA. Effects of participant modelling on information acquisition and skill utilization. J Consult Clinic Psychology, 1984;52:414–422.CrossRefGoogle Scholar
  21. Leitenberg, H, Callahan, EJ. Reinforced practice and reduction of different kinds of fear in adults and children. Beh Res Therapy, 1973;11:19–30.CrossRefGoogle Scholar
  22. Liddle A, Locker D. Changes in levels of dental anxiety as a function of dental experience. Behav Modif 2000;24:57–58.CrossRefGoogle Scholar
  23. Lieberman, DA. Learning and the control of behaviour: some principles, theories and applications of classical and operant conditioning. Holt, Rinehart and Winston, New York, USA. 1974.Google Scholar
  24. Meichenbaum, DH. Self instructional methods. In: Kanfer FH and Goldstein AP (Eds.) Helping people change. Pergamon Press, New York, USA, 1975.Google Scholar
  25. Melamed BG, Hawes RR, Heiby E, Glick J. Use of filmed modeling to reduce uncooperative behaviour of children during dental treatment. J Dent Res 1975;54(4:797–801.PubMedCrossRefGoogle Scholar
  26. Melamed, BG, Weinstein, D, Katin-Borland, M, Hawes, R. Reduction of fear-related dental management problems with use of filmed modeling. J Amer Dent Assoc, 1975;90:822–826.CrossRefGoogle Scholar
  27. Melamed B, Williamson, D. Programs for the treatment of dental disorders. In: Sweet JJ, Rozensky RH, Tovian SM, (Eds.) Handbook of clinical psychology in medical settings. Plenum Press, New York, USA. 2000; pp.539–560.Google Scholar
  28. Murray, P, Liddell, A, Donohue, J. A longitudinal study on the contribution of dental experiences to dental anxiety in children between 9 and 12 years of age. J Beh Medicine, 1989;12:309–320.CrossRefGoogle Scholar
  29. Patterson GR. Behavioural t4chniques based upon social learning. In Behavioural Therapy. CM Franks (Ed). McGraw-Hill, New York, USA. 1969, pp341–75.Google Scholar
  30. Pavlov JP. Condioned reflexes. Dover Publications, Mineola NY, USA. 1926, pp26.Google Scholar
  31. Poulton, RG, Thomson, WM, Davies, et al. Good teeth, bad teeth and fear of the dentist. Beh Res Therapy, 1997;35:327–344.CrossRefGoogle Scholar
  32. Prins, PJM. Self-speech and self-regulation of high- and low-fearful children in the dental situation: an interview study. In: Ollendick TH, King NJ and Yule, W (Eds.) Handbook of phobic and anxiety disorders in children and adolescents. Plenum Press, New York, USA. 1985.Google Scholar
  33. Rachman, S. Neoconditioning and the classical theory of fear acquisition. Clinic Psychology Rev, 1991; 11:155–173.CrossRefGoogle Scholar
  34. Schouten, BC, Eijkman, MAJ, Hoogstraten, J. Dentists’ and patients’ communicative behaviour and their satisfaction with the dental encounter. Commun Dent Health, 2003;20:11–15.Google Scholar
  35. Shapiro, F. Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. J Anxiety Dis, 1999;13:35–67.CrossRefGoogle Scholar
  36. Shapiro, F. Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. Guilford Press, New York, USA, 2001.Google Scholar
  37. Skinner B.F. On operant analysis of problem solving. In B. Kleinmutz (ed) Problem solving, reseach, method and theory. Whiley, New York, 1966.Google Scholar
  38. Solomon RL. Punishment. Amer PsycholoI 1964;19:239–53.CrossRefGoogle Scholar
  39. ten Berge M. Dental fear in children: prevalence, aetiology and risk factors. PhD Thesis. Amsterdam: University of Amsterdam, The Netherlands, 2001.Google Scholar
  40. ten Berge M. Dental fear in children: assessment, prevalence and etiology. In: Gower, PL (Ed.) Psychology of Fear. Nova Science Publishers, New York, USA, 2004.Google Scholar
  41. ten Berge M, Veerkamp JSJ, Hoogstraten J. The etiology of childhood dental fear: the role of dental and conditioning experiences. J Anxiety Disorders, 2002;16:321–329.CrossRefGoogle Scholar
  42. ten Berge M, Veerkamp JSJ, Hoogstraten J. Dentists’ behavior in response to child dental fear. ASDC J Dent Children, Jan–Feb, 1999;66:36–40.Google Scholar
  43. Weerheijm, KL, Veerkamp, JSJ, Groen, HJ, Zwarts, LM. Evaluation of the experiences of fearful children at a Special Dental Care Centre. ASDC J Dent Child, 1999;66:253–257.PubMedGoogle Scholar
  44. Weinstein, P, Getz, T, Ratener, P, Domoto, P. The effect of dentist’s behavior on fear-related behaviours in children. J Amer Dent Assoc, 1982;104:32–38.CrossRefGoogle Scholar
  45. Weinstein, P. Child centred child management in a changing world Europ Archs Paediatr Dent 9(1)2008;6–10.Google Scholar
  46. Weiss, B, Weisz, JR. Relative effectiveness of behavioural versus nonbehavioral child psychotherapy. J Consult Clinic Psychology, 1995;63:317–320.CrossRefGoogle Scholar
  47. Weisz, JR, Weiss, B, Han, SS, Granger, D, Morton, T. Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. Psycholog Bull, 1995;117:450–468.CrossRefGoogle Scholar
  48. Wolpe, J. Psychotherapy by reciprocal inhibition. Stanford University Press, Stanford, USA. 1958.Google Scholar

Copyright information

© Adis Internationals 2008

Authors and Affiliations

  1. 1.Dept. of CriminologyNetherlands Institute for Forensic Psychiatry and Psychology (NIFP), and Erasmus University RotterdamRotterdamthe Netherlands

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