Resources
Research experts in paediatric dentistry, psychology and cognitive behavioural therapy (CBT) have come together to develop 'Your teeth you're in control' for dentally anxious children.
Our resources have been tried and tested on lots of children, aged 9-16, in different settings with excellent results. All of the children evaluated had reduced dental anxiety after using the CBT resource and this reduction was still present one year later. Proven to help parents and dentists understand their patient or child’s fears and anxieties, the resource is now being rolled out into the NHS.
For a closer look at the resources head to:
- - you can view our online resources here
- - you can purchase paper copies of resources here
About the resources
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Your teeth you are in control was designed to help child patients understand their worries about going to the dentist and guide them through the treatment.
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Dental team guide
The dental team guide explains the purpose of ‘Your teeth you are in control’ and how dental teams can support children with dental anxiety to ensure the best outcomes for them.
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Message to dentist
This form is made to be filled out by the child patient so the dental professional can see exactly what's worrying their patient and how they need to be supported.
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Parent's guide
It's important that parents understand what their child is going through. This guide helps parents through this process so they can support their child.
See bottom of the page for details of translations
How to use the 'Your teeth you are in control' guide
- The first stage of using 'Your teeth you are in control' is to identify the patients where CBT might be useful and introduce the guide to them, being sure to highlight that it was developed with other children and teenagers.
- Ask the child to complete the 'Message to dentist' for their next visit.
- At the start of each visit review the 'Message to dentist', recognise the patient's past achievements and discuss the worry/pain score.
- At the end of each visit provide specific praise for what they've achieved in this visit, complete the post treatment worry/pain score and plan for the next appointment with them by going through what the procedures will involve,
We've created a series of training videos to help you and your dental team use the resources as effectively as possible. The videos include more details on how to use the guide in the first instance as well as at follow-up appointments. We've also included an extra video on making a dental stressball.
Patient case studies
The case studies here demonstrate positive examples of the CBT guide supporting reduced dental anxiety and improved quality of life at an international scale. They provide some context and background to the challenges being faced by the patients and how the guides helped them.
- Ella's story
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Ella, aged 10, was referred to hospital dental service because her dentist thought she may have a decayed tooth. Ella had been too scared to let her dentist check her teeth, despite attending the dentist from a young age.
I'm scared of things dropping down my throat
Ella
1st visit to the dental hospital
On her first visit Ella kept her gloves on and hood up and wouldn’t speak directly to the dentist as she was feeling anxious.
The dentist explained that she didn’t need to look at Ella’s teeth until she was happy for her to, but she did want to help ella, who has severe social anxiety, feel less anxious about the dentist.
Ella was given the ‘’ guide and her parents were given the parents guide. She was asked to complete the ‘message to dentist’ sheet for her next visit. It was agreed that on her next visit, Ella would just brush her teeth without looking at the dentist.
2nd visit to the dental hospital
Ella had read the guide and completed the ‘message to dentist’ sheet. She agreed a coping plan and a stop signal with her dentist who reassured her, before brushing her teeth as agreed on her last visit.
The next step was to have a check up with a mirror and an xray on her next visit.
3rd visit to the dental hospital
On her third visit, Ella took her gloves off, put her hood down and made direct eye contact with the dentist for the first time. Before her check up, Ella wanted to see all the dental instruments. She also chose to do maths puzzles in her head to give her something else to think about.
Ella had the agreed check up and xray and the dentist noticed that her front teeth were protruding and that she needed to see an orthodontist to have moulds taken of her teeth. Ella was given the trays for the moulds to practice with at home so she wouldn’t worry about things going down her throat.
The dentist promised to introduce her to the orthodontist next time.
4th visit – to see the orthodontist (3 months later) at the dental hospital
Ella was much more confident on this visit. She’d brought the guide and message to dentists with her and her family had talked to her about the visit the night before. She happily accepted moulds and photos being taken of her teeth.
Ella’s scores of her own dental anxiety had reduced from 8/10 to 3/10.
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Leo's story
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Leo was referred to a hospital dental service because he needed some fillings but would not let his dentist give him an injection. His dentist felt that Leo might need to have a general anaesthetic to have his treatment because he was so scared of needles.
I'd rather let them rot
Leo
1st visit to the dental hospital
Leo seemed ok at his assessment visit and was made another appointment to have his fillings and injection done with some sedation. So far so good.
2nd visit to the dental hospital
But when Leo came for his sedation visit, he would not put the mask on his nose. He said he would rather let his teeth rot. His mum became very frustrated, and felt Leo was just being difficult. The dentist tried to find out why Leo was so worried: he said it was because he didn’t want to feel out of control. He was given the guide and reassured that the next time he could just hold the mask and the dentist would turn the sedation gas off straight away if he felt he wasn’t in control. Leo completed a dental anxiety questionnaire and scored 26 /40 (where 40 is the highest level of fear).
3rd visit to the dental hospital
Leo had read the guide but said he hadn’t slept well for 3 days before his dental appointment, and this made him feel angry. He still did not want to try the gas.
The dentist talked to Leo about his thoughts, feelings and behaviours and reassured him that the gas could be turned off whenever he asked. He had a stress ball to squeeze and chose some music to listen to as a distraction. Leo asked his mum not to tell him when the next appointment was, until the actual day, so he wouldn't lose sleep worrying about it.
4th visit to the dental hospital
Leo managed to have an injection for his filling which he was very proud of. He was encouraged to reflect on what had gone well.
His mum said that she hadn't realised he was so anxious, she thought he was just being stubborn, and reading the parent guide had given her a better understanding of how to help him.
5th visit to the dental hospital
Leo coped really well with an injection for his second filling. When he completed the dental anxiety questionnaire again, it showed that his anxiety score had really reduced since his first visit (to 18/40). He was happy to return back to the care of his own dentist, and was reminded to use the coping skills he now had.
- Sam's story
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Sam, aged 9, needed to have an abscessed baby tooth taken out. He was worried about having this done and would not let his own dentist do it, so he was referred to a community dental clinic.
I’m scared the dentist will take the wrong tooth out
Sam
1st visit to the dental clinic
The dentist gave Sam and his mum the as well as the parent guide, and Sam was asked to fill in the ‘message to dentist sheet’.
Sam and the dentist agreed that on his next visit Sam would have an X-ray and let the dentist brush his teeth and put fluoride varnish on them. He also said he would test a squishy nose mask used for sedation during dental procedures.
2nd visit to the dental clinic
Sam had read the booklet with his dad and completed the 'message to dentist' sheet. He'd written down that he was worried about the treatment leaving him sore, the dentist taking the wrong tooth out and bleeding after treatment. Sam talked about a coping plan with his dentist, and then the dentist exlained everything to Sam like he asked. Sam wanted to squeeze the squishy ball and concentrate on his breathing to relax, he agreed a stop signal with the dentist.
Sam was sedated and his teeth polished and flouride paste painted on his teeth as planned. At the end he had some x-ray pictures taken and agreed with his dentist that next time he would have the baby tooth removed whilst sedated and under local aneasthetic.
3rd visit to the dental clinic
When Sam arrived, the dentist and nurse explained the plan for the visit. They both pointed out together which tooth was coming out and showed Sam in the mirror so her knew it was the right tooth. They agreed the stop signal again and during the treatment Sam concentrated on squeezing the squishy ball and doing his breathing exercises.
Sam managed well and had his tooth extracted with local anaesthetic whilst sedated. He was shown afterwards that his gum had stopped bleeding.
Overall, Sam's dental anxiety score reduced from 8/10 to 3/10.
Translated versions of the resources
In response to requests from dental professionals and psychologists around the world the resources, including ‘Your teeth you are in control’ and the ‘Message to dentist’ have been translated into many different languages. The following ‘Message to dentist’ forms are available here to download:
Thanks to our collaborators and Five Areas Ltd for their help getting these translated version appropriate for children with dental anxiety in so many different countries.
‘Your teeth you are in control’ has been translated into Arabic and Mandarin. Please contact Zoe Marshman Z.Marshman@sheffield.ac.uk to obtain copies.