Dental anxiety and fear are common challenges faced by dental professionals treating pediatric patients. Sometimes characterized by negative emotions and resistance to care, dental anxiety can significantly impact the delivery of treatment, lead to delayed or postponed visits, prolonged chair time, avoidance of routine care, and ultimately have adverse consequences on a child’s oral and general health. 1–3
For many children, especially younger kids, the dental office can be an unfamiliar and overwhelming environment—one that provokes fear and sometimes refusal of care.1 In this article, we’ll take a look at why some kids feel anxious about going to the dentist, how that anxiety shows up, how common it really is, and what it means for the professionals trying to help. We’ll also share some practical ways dental teams can make visits less stressful and more positive for children and their families.
What is Dental Anxiety?
Dental anxiety or fear refers to a state of apprehension or distress related to dental settings or procedures. It can affect patients with or without special needs and can range from mild unease to severe phobia and may manifest in a variety of behavioral, emotional, and physiological responses.3 In children, this can be crying, refusal to attend appointments, reluctance to sit in the dental chair or comply with requests from the dentist or hygienist. Others may experience increased heart rate, nausea or panic attacks.1 Understanding a particular child’s anxiety is key to developing effective treatment strategies and behavior guidance for them and their parents.
Prevalence and Risk Factors
Estimates of the prevalence of dental anxiety vary, but a 2021 systematic review reported an overall global prevalence of 24% among children aged 3–18 years. This study also shows that younger children tend to be more anxious at dental appointments compared to older kids.2,4
| Prevalence of dental anxiety by age:2 | |
| Preschoolers: | 37% |
| School-aged children: | 26% |
| Adolescents: | 13% |
The development and severity of dental anxiety is influenced by many factors, including:4,5
• Age: Younger children have higher levels of dental anxiety due to limited understanding and fear of unfamiliar environments or procedures
• Parental Influence: Maternal anxiety, in particular, has been shown to influence a child's attitude towards dental care. Parental attitudes may influence the first dental visit, but a child's own experiences shape future attitudes
• Dental History: Children with a history of untreated caries often have higher levels of anxiety, potentially due to previous discomfort or the anticipation of invasive treatment
• Special Healthcare Needs: Children with behavioral, cognitive, or emotional conditions often exhibit higher levels of dental anxiety
• Previous Experience: A previous, negative experience at the dental office or undergoing a procedure under general anesthetic may contribute to future anxiety
• Socioeconomic and Cultural Factors: These may influence how families perceive dental care and access it, but there’s little evidence that it has a strong role in the development of dental anxiety
• Gender: Some studies suggest that girls may be more prone to dental anxiety than boys
• Environmental and Sensory Factors: Sights and sounds in the dental office may lead to an increase in dental anxiety
Why Dental Anxiety Matters
Dental anxiety can lead to a vicious cycle where fear leads to avoidance, and avoidance results in worsening oral health.4 This, in turn, necessitates more extensive and invasive treatments, which further reinforces the anxiety. For dental professionals, dental anxiety in their pediatric patients can result in:3
• Longer appointments due to the need for behavior management
• Higher rates of missed or canceled appointments
• Delayed diagnosis of oral health issues
• Increased emotional strain on both staff and caregivers
• Reduced efficiency and productivity in clinical settings
Managing fearful children requires patience, adaptability, and communication skills that extend beyond clinical competence.3 That’s why it’s essential to engage not only the child but also their parents or carers to create a trusting, supportive environment, both within the office and in the home. If dental anxiety isn’t addressed during childhood, it is likely to persist into adulthood, resulting in continued avoidance, deteriorating oral health, and psychological distress.6
Ways You Can Help Reduce Dental Anxiety
Start Them Early, Start Them Right:
The age a child first visits the dentist, and the frequency of those visits, are critical in reducing the development of dental fear. In research, these factors were shown to predict almost 45% of dental fear.7 Both the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend a child's first dental visit takes place by their first birthday or with the eruption of their first tooth. At this stage, if there is no previous pathology or symptoms, the visit can focus more on education, oral health promotion and the creation of a positive experience rather than on treatment. Early and effective preventive care leads to less dental disease, decreased treatment needs, and fewer opportunities for negative experiences. This proactive approach builds familiarity and the foundation of future trust. Therefore, it’s important to consider dental anxiety to prevent it becoming a barrier to care.7
Preparation and Predictability:6
Providing kids with information about what to expect during a dental visit will help to reduce fear. This can take the form of:
• Procedural information: Explaining steps such as “we’re going to count your teeth today”
• Sensory information: Framing sensations positively such as “you’ll feel something cool,” rather than “a sharp scratch”
• Videos and modelling: Showing other children calmly undergoing treatment can help normalize the experience
• Virtual Reality (VR): Used for pre-appointment familiarization or distraction, VR has been shown to reduce anxiety effectively
It’s not a scary place:1
A warm, friendly welcome from your team really sets the tone for the visit. A child-friendly waiting area with toys or games can help put young patients at ease—and those first impressions can shape how they feel about future visits.
Positive Language and Building Rapport:6
Age-appropriate language, humor, and visual aids such as patient mirrors help build rapport. Using statements such as “you seemed unsure today—what helped or didn’t help?” can be supportive and promote a sense of inclusion. Reviewing their experience at the end of a session—regardless of the outcome—allows the child and clinician to reflect, plan for next time, and reinforce a sense of progress.
Tailored Distraction:6
Distraction strategies should be discussed with the family beforehand and aligned with the child’s preferences. Effective distractions can include:
• Audio-visual tools (videos, music, audiobooks)
• VR
• Conversational distraction
• Allowing the child to bring comforting objects, toys or engage in simple play
Distraction is most effective when introduced before emotions escalate. Once a child becomes highly distressed, soothing and validating techniques become more appropriate.
Relaxation and Imagery:6
For children in high distress, techniques such as muscle relaxation, guided imagery and safe place visualization can be effective. These methods tap into a child’s imagination and offer emotional escape during procedures.
Reinforcement and Reward:6
Positive reinforcement encourages cooperative behavior. Effective motivators could take the form of verbal praise, stickers, or small toys. Rewards should be:
• Specific: “You did a great job keeping your mouth open”
• Timely: Delivered as close to the desired behavior as possible
• Valued: Tailored to what the child enjoys or responds well to
Empower Families:1
Parents and carers play a crucial role in shaping their child’s attitude toward dental care. Encourage them to frame dental visits positively and avoid sharing their own anxieties. Providing information and strategies creates a supportive partnership and helps to build a consistent, reassuring message around dental care.
There’s Nothing Better Than Prevention!
Good oral health habits can significantly reduce the need for invasive treatment—a major cause of anxiety. Reinforce the idea to both kids and parents that a consistent oral hygiene routine at home will help prevent problems and future dental appointments will simply become “check-ups to see how well you’re doing”.
Along with your preventative care advice, why not suggest Willo as an additional aid to overcoming dental anxiety? It’s the fully automated toothbrush that provides consistent, effective oral care for your young patients. Willo promotes an easy, enjoyable and engaging toothbrushing routine for proven plaque removal that will help ensure future dental visits are short, pain-free, and focused on prevention.
Summary
Dental anxiety is a real issue for kids, parents and dental professionals. If left unaddressed, it can have lifelong consequences for oral and psychological health. However, when you take a patient-centered, preventative approach—emphasizing early exposure, preparation, empathy, collaboration and individualized preventative care—your dental surgery becomes a place of confidence rather than fear!
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References:
1. American Academy of Pediatric Dentistry (AAPD). Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:358-78.
2. Grisolia B, et al. Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses. Int J Paediatr Dent. 2021;31(2):168–183.
3. Peltier B. Psychological treatment of fearful and phobic special needs patients. Spec Care Dent. 2009;29(1):51–57.
4. Alasmari A, et al. Dental Anxiety in Children: A Review of the Contributing Factors. J Clin and Diagnostic Res. 2018;12(4):1–3.
5. American Academy of Pediatric Dentistry. Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:337-44.
6. Langridge M, et al. Supporting anxious children through dental care. Dental Health. 2023;62(6):42–46.
7. Carrillo-Díaz M, et al. How Can We Reduce Dental Fear in Children? The Importance of the First Dental Visit. Children. 2021;8;1167.
