Another newbie here, advice please

[griffinej5]

Hi, I've been reading a bit, and I'm probably entirely too tired to be super coherent, but I thought I'd try to add a bit.
I recall being phobic since I was a young child. I have some recollection of what might have occurred, but not completely. At that age, I certainly wasn't going to talk about it. I'm 27, and I've only started going to the dentist last year after not going for I think 7 years or so. I will talk about it a bit now, but up until recently , I couldn't even be in the room when other people talked about the dentist. Someone presented something in which there was discussion about the dentist. I left the classroom during that presentation. I came back later and told the professor privately why I had walked out, and why I would walk out if discussion of the dentist occurred. Later on, she made me talk about it in an exam (explain it in terms of operant and respondent conditioning). I debated whether to take the lower grade, knowing I had passed, or go for 100.
That said, I disagree with the psychologist that people are willing to talk about it. I believe there was also an earlier time of my not going for a few years also, prior to the most recent one. There was a period of time where I was kicked out of the dentist, and then I didn't go there probably for a couple years. If at any point my parents tried to discuss it with me or get me to go, I think I screamed at them to shut up and leave me alone.
I think consequences might be useful, but only good consequences. Both reinforcement and punishment come with potential side effects, but the side effects of punishment are much trickier to deal with. She already doesn't like to go, so to add punishment to the mix, it may end up with her resenting the whole thing even more. If you are going to add reinforcement, make sure the things you are asking for her are achievable at that point in time. If it has to start with walk up and touch the door, but don't go inside, then that's where it has to start. Just don't hold at the same step too long. You have to keep moving forward. I have a punishment arrangement for myself involving calling the dentist, because I also have a fear of making phone calls, but I'm an adult and I chose to do that. I have a friend who will bug me to make the call if I tell him I need to do it, and he will follow up with me, ask when I am going, etc. If I don't do it, I send him money.
I gag and sometimes vomit when I things done at the dentist. They gave up on putting one of those dams in a few weeks ago because I said it wasn't happening unless they wanted me to throw up. I never had any problem with the mouth guards for martial arts. I always did mine myself at home, and just had the boil and bite type things, but if they did that to me at the dentist, I'd throw up. I may have been able to tolerate that because I wanted it. A few years ago, I got a flu shot at work in front of my coworkers. At this point I was so phobic of needles, I'd typically cry, hyperventilate, gag, and vomit at the doctor's office. They would just hand me a trash can when I was in there getting a shot. I asked for a specific nurse who had given me something before, but I certainly didn't cry or put the trash can beside me. Peer pressure can be quite powerful, but it took months of of regular minimally painful shots to be comfortable.

 

[Lucy's mum]

Hi, happy new year to everyone.

Many thanks again for taking time to post advice, it is v much appreciated.

An update: we had a lovely Xmas holiday and completely forgot about the dentist which was good. Now that we're back into the routine, I'd really like to spend however long it takes helping Lucy to feel more comfortable.

In hindsight, I don't think the psychologist was helpful. I think this is something I can help her deal with myself. Yesterday I popped into a local dentist's surgery that has been recommended on this site. I had a chat with the receptionist/nurse there. They specialise in phobic patients and she gave me loads of advice. She said patients should never, never be forced into doing anything they are not comfortable and both the dentists never put any pressure on. If a patient doesn't want to sit in the chair, open their mouth etc on that particular day, then that is fine. In essence, it's about giving them control and trust.

She suggested that I bring Lucy in initally just for a chat. She also said it was a good idea for me and my husband to register at the practice and bring Lucy when we have our check-ups. So no pressure for her, it's just for her to observe. I got a good feeling there anyway. And she said I shouldn't make it too much of a big deal. Maybe I have been worrying too much about this issue and she's picking up on that. Maybe subconciously she likes the attention that I'm worrying about her...?

Re the control issue: how much control should you let an 11 year old have? As parents, we have a duty to exercise some control over our children's lives for their own good, until they are old enough to make their own choices. And sometimes children NEED an adult to set boundaries and make them feel safe. So I am battling a bit with myself how much control I give her over this?

 

[evsgal82]

Hi, sorry if this has been suggested already as i didn't read all the replys, but have you tried taking her to your own appointments?? perhaps if she comes along and sees you and your partner having check ups etc she would see there was nothing to be scared of?? Just a thought Hope all goes smoothly eventually for her and for you.

Best Wishes

 

[jjh6ytrh]

One of my 3 kids is special needs and my youngest daughter is what you would call "strong-willed" and there is no better word to describe her! I think one of the downfalls of the forum style chat is that there is quite possibly a lot of information, important information, that does not get included into the mix. I am not a professional psychologist by trade, so to speak, but have seen the gamut and studied a lot on my own about adolescent psychology and behavior issues. That, coupled with my own anxiety and panic disorder over the past 12 years makes me approach this situation a little bit differently.

First and foremost, one of the questions (that I am not sure was asked, at least I didn't see it) was does she have any other anxiety-type issues at home, school, generally outside of the dentists office? Is she generally a strong-willed child (moreso than most adolescent girls are, lol)?

Hi, happy new year to everyone.

Re the control issue: how much control should you let an 11 year old have? As parents, we have a duty to exercise some control over our children's lives for their own good, until they are old enough to make their own choices. And sometimes children NEED an adult to set boundaries and make them feel safe. So I am battling a bit with myself how much control I give her over this?

I am glad that you wrote this, because for a minute there I was starting to worry that this child was just simply given too much freedom to make ultimate choices that sometimes we as parents need to make for them. I understand this is a tender subject in the forums as it relates to dentistry, but hear me out everyone. I think that our culture has become one where the kids are in control and it has caused NOTHING but problems at every turn. I am not some strict authoritarian, but I do know when it is appropriate to make my kids do things that they might not otherwise want to do and that makes them uncomfortable. Most all kids have some anxiety at the dentist and the one thing that we cannot (or at least try not to do) early on is give into those fears by letting them "escape" the situation. Escape from irrational fear only intensifies and and solidifies our bodies natural reaction to it. (i.e. I am scared of this, leaving the situation makes me feel better so subconsciously your body thinks "hey, that must really have been something that I need to avoid at all costs). It sounds harsh and please note that I am NOT condoning restraint at all, lol...that lends to much worse problems later one. However, when kids are little, we should introduce them to dentistry as early as possible AND expect they are not going to want to do it and also have a plan to help them do it. My little girls first cleaning at 4 was certainly an ordeal and if she had the choice, she would have bolted for sure. However, I knew that was not going to help, so we struggled through it. Then she of course got prizes and while she still has anxiety, she realizes it is "worth" it for the surprise. Now, that obviously does not help you with your 11 year old. Just more putting it out there for parents of younger children.

If this were me, I would approach the situation as follows:
1.) Find a dentist that YOU are comfortable with. Trying to find one that she is comfortable with will not ever happen based on what you have said.
2.) Talk with your daughter and let her know that sometimes we all have to do things that we do not like doing, but the benefits far outweigh the bad stuff (kids can understand this if explained properly).
3.) Explain that this is going to happen, regardless. That she is not going to get out of going because as a parent it is your responsibility to ensure good dental hygiene to protect her from the horrible nightmare that is improper dental care. (Sometimes, depending on the kids personality, it helps to even talk about and sometimes even show them images of really poorly taken care of teeth. This is not so much scare tactics as it is creatively using different things to help THEM make the decision. BTW, I do not recommend this step unless you feel it would help and not scare her even more, only you know your child.)
4.) Tell her that not going and not getting it done is not an option but that you want her to feel as comfortable as possible. Present the scenario as such: instead of asking why she is scared, which usually lends to "I don't know", ask what WOULD get her through an appointment. What can you do as mom, what can the dentist do, what would the situation look like to her. If the requests are reasonable, then you can work with them to give her that feeling of security and control. ALL anxiety and phobias are related to control issues. Those of us with anxiety and panic disorder will tell you that we are control freaks! Not in a bad way though, lol...just in every situation we experience symptoms is usually one where we feel control slipping.

I feel for you in having to go through this, but as a parent of an ODD kid, one of the things that I have learned about parenting is that we have to sometimes be tough but also be compassionate and fair at the same time. Kids will take every bit of "mile" they can; however, kids (in general) are more resilient than we are as adults. So long as it is not torturous and inhumane, do what you think you need to do as it is for sure in her best interest at the end of the day.

Mike

 

[carole]

I have to totally disagree with you on this one Mike, this girl has been to the dentist since she was young and been restrained, ever so gently by her parents but so far nothing has worked.

Lucy's mum, as a phobic but with the right dentist nervous patient I think this dentist sounds as if they could be really good for your daughter. If it takes one appointment a month for the next few months even if it was just for a drop in visit for say 5 mins, where she gets to see the dentist as somewhere social to go that you get work done eventually. I think at 11 she is old enough to put up a very strong fight, she was more than capable of doing this when she was very young. It shouldn't be a fight, I think she should be allowed to make here own choice and move at her own pace, it might be an idea for the receptionist/nurse to see her and have a chat for a few minutes if this can be arranged. Then if she feels she would like to make an appointment to see the dentist that can be done at this time. Maybe the receptionist can humanise the dentist and make your daughter curious enough to want to see him/her. If they have a room that your daughter could go into with the nurse and have a couple of minutes talking in there the next time she goes and gradually get her into a room with the dental chair in, where she could sit and talk there, eventually being so comfortable that the dentist can be introduced as soon as possible and they can talk.

It sounds long winded, but I really strongly believe that it has to be her choice, not to go to the office but to decide what happens.

It is so hard for you and I wish you good luck I think with a patient dentist this can be beaten. How does she feel about seeing other peoples mouths, and teeth? Would going with you make here worse. I ask because I cannot see anything that is going on either to me or anyone else. So it may make her worse if she goes in with you. I would find out how she handles looking at dental things. If I saw any tools I would run for the hills and I cannot be looking in anyone else's mouth. I don't like to see my own x rays or teeth too close either. So please before she goes in with you, make sure it won't make her worse.

Maybe when you or your husband go she may feel more comfortable waiting in the waiting room talking to the receptionist/nurse rather than going in with you. This will hopefully desensatize (sorry spelling) her to the practice. Even if she does manage to see the dentist I would take her when you go so that she has frequent visits there. If she would like to go in with you, good.

 

[gettingthere]

I really like Mike's point 4 - reframing the question from "what scares you?" to "what would make it better?"

With regard the issue of control and boundaries, I think a distinction has to be made between the concepts of control and freedom. It is certainly possible to provide the former and limit the latter and this is what needs to happen, I think, when helping this, or any, child through an anxiety-triggering situation.

It is the parents duty to set boundaries for the safety and wellbeing of the child and this cannot be underestimated when dealing with distressing problems like this.

I'm really glad the festive period went well and was not dominated by the dentistry issue - if ever there is a time to forget your worries and eat lots of chocolate, nuts and puddings christmas is it!

The new dental practice sounds excellent. I really like the fact that you had a good feeling about it yourself and that the rest of the family may also register there so that it "normalises" appointments for Lucy. Again, if it is a place that you really like, your enthusiasm may come across to Lucy when talking about it - better than the "forced cheerfulness" that some people adopt, albeit often subconsciously, especially when talking to children. I think it is difficult for people who have never experienced the fear themselves to understand what makes a standard dental environment so fear inducing to others BUT practices at either end of the spectrum do stand out. One of my former colleagues who does know about my dental phobia once told me that she always saw dental practices as not particular pleasant but fairly ordinary and clinical and not overly fear inducing either, until she visited one establishment which she said was dark, dingy and staffed by really bad tempered people - she said she could understand why that place could provoke anxiety and left without attending her appointment. I think it is the same with "good" practices that make you sit up and think "well this is nice!" and I hope Lucy will also notice the difference between this and what she has been used to. I particularly like the fact that they are already talking about not applying any pressure and allowing Lucy to observe and go at her own pace. I really hope this place is the answer!

As Carole has said, you cannot allow Lucy the "freedom" to neglect her teeth/health but you can provide safe boundaries by finding a place and person that is likely to gain Lucy's trust and you can give her control over the pace of the appointments and treatment and guidance on making choices from the options that you and the dentist present to her, as long as she knows she can turn to you to talk these through if and when necessary.

 

[brit]

Mike
I>M>O> Where your thinking is faulty is in approaching dentistry 'as an ordeal' which no one would willingly undergo. Simply not true. Painless empathetic dentistry is not a big deal provided you have a relationship of trust with the skilled provider.
Any 11 year old child who has had a previous bad experience and thereby developed a fear, can only overcome it by starting again and doing it properly with someone she initially warms to upon meeting and then grows to trust.
If she had seen an empathetic provider who was in no rush in the first place, there would likely be no issue. Yes, parents can insist on regular dental visits and I also would want to do that as her parent (rather than let problems become serious) but I would make her feel like she were totally in control. At age 11 she has to be allowed to choose between dentist A or dentist B (both of whom are deemed to have experience of successfully helping children with fears without sedation) as even for adults choice of dentist is such a varied personal thing anyway.

Depending on severity a special needs child may need a cleaning if their parents are unable to brush their teeth daily but the average 4 year old whose teeth are brushed to some degree NEVER really needs one. Sometimes less is more with kids.
The regular cleanings for 4 year olds is to some extent an insurance driven/profit thing in the USA. Of course the UK NHS system takes 'less is more' a bit too far when it comes to adults as well and tries to deny them regular cleanings too lol hence why I always suggest private is often better for adults. Severely affected special needs children tend to be treated under GA in hospital in UK and restraint is always an ethical 'no no'.
Despite having the same dentists and a clued-up Mum (me) one of my children was more dentally anxious than the other...what worked was seeing the same dentist for 5 years and him never pushing anything. He seems to not like stuff being done in his mouth for gagging type reasons, he is now ok with it at age 11 because it was never imposed. This dentist was also my dentist and of the extremely painless variety. He did the kids hygiene so they did not need to see two people although they do now and it's fine as pre-vetted again by me lol.
Trust me when I say that with (rough) dental hygienists there can be a greater danger of causing dental phobia than with dentists...so I think what I am saying is let child choose dentist, skip the cleaning and just verify that there is no decay to fix. (BTW that can be left and observed for longer than you think until a child is better able to cope).
Best of luck to OP and her daughter.

 

[brit]

ALL anxiety and phobias are related to control issues. Those of us with anxiety and panic disorder will tell you that we are control freaks! Not in a bad way though, lol...just in every situation we experience symptoms is usually one where we feel control slipping.
Mike

Mike, dental anxiety is also often about (real) fear of pain and doesn't necessarily have anything to do with being a control freak. It is also not irrational if your fear is based on negative real experiences. The good news is that rather than having to endure, you can find competent caring practitioners who make it easy for you.

The OP hasn't clarified the nature of her daughter's reluctance and actual past negative experiences but what she has outlined sounds like a good way forward. She thought her daughter's original dentist was a good choice and used her herself but it didn't work out. This is why the daughter now needs to be involved in the choice based on 'meeting for just a chat', the dentist has to sell themselves to the daughter even though Mum is paying the bill .

 

[Lucy's mum]

Hi, just checking in, thanks again for all your helpful advice.

Mike, in parenting terms I actually agree with much of what you say. I like to think I'm a fairly old school parent and I can totally see how damaging it can be to give a child too much choice.

What worries me a lot about this issue is the huge personality shift in my dd. She's normally a happy child who will speak openly about anything that's bothering her. With the dental phobia, I WISH she would say 'mum I'm really scared, I don't like it when he does x, y or z, or whatever. But she completely closes up, doesn't tell me what she's thinking/feeling or gets silly or giggly as a way of changing the subject.

My dh and I think it's best that we start with this new local dentist who is used to phobic patients. As an initial visit, I want dd just to pop in to the waiting room, meet the receptionist and then leave. I told dd this was going to happen tomorrow afternoon on the way to her ballet class. So she starts getting silly, saying she would be late for ballet, it would take ages to park and she might 'refuse'. So I told her she's not going to refuse or she wouldn't be going to ballet. Our next step is to make check up appointments for our 2 younger daughters and she comes along to observe. But she asked me if she could stay at home and I said no. Bearing in mind neither of these visits involve any treatment or even going into the surgery, is there an element of teenage rebellion and she is just digging her heels in? How much, if any, choice should I give her?

 

[carole]

Not knowing your daughter and looking at this situation from the outside, no emotions involved here. I would insist that she calls in on her way to ballet as you have said, also I think it is a good idea for her to attend when her younger sisters go for their check up. That way she see's that they are okay and there is nothing to fear from this dentist.

She needs to know that she needs a dentist, and that she is going to have to go. But without saying in so many words to her that she can choose how quickly things move in terms of treatment. It is probably the case she isn't going to need any work done, but let the dentist talk to her.

I don't know how it will be done on the dentists part, but I would as the dentist acknowledge her in a pleasant manner but all the attention would be on her sisters as they are the patients that day. I would also invite her to sit in the chair and let me have a quick look. With an okay that's fine maybe another day, if she doesn't want to.

There may be a bit of retaliation, but I didn't know what part of the dental visit I was actually worried about, I did for a lot of years think it was everything, when in fact I am not keen on the injections but there are ways around that one, but I hate the drill with a passion. That is harder to overcome, but a good dentist can help with that too.
She may get giggly or silly because she doesn't know how to deal with this, she may not have the words, I didn't for a long time. She may try to put it at the back of her mind and not want to talk about it. It is a complex phobia as any phobia is, but the dentist should be able to help, they are aware of the problem with your daughter and I am sure they have something they can pull out of the bag to help her.
Even if she won't let them look in her mouth continue to insist that she calls in before ballet and other things that she does as you are able. Also every time someone in the family has an appointment she can go along as it is going to become a family outing.

Hopefully as she gets used to the dental practice and becomes familiar with the staff she will manage to get a check up. If her sisters like the dentist they could have little talks about the dentist and how nice he is, that way she may feel left out and want to be more involved which would mean her seeing the dentist too.

I wish you all the luck with this one, I really hope it works out, I think it will in time. It must be exhausting for you with the worry and trying to scheme and plan how to get her treatment. For this reason I send you and best wishes.

Please as you have time let us know how you get on with the dentist yourself and how you other girls get on and of course how the nervous daughter Lucy gets on too.

 

[jjh6ytrh]

Honestly, having panic and anxiety disorder myself (and now under control without any meds) what you are describing is a very classic case of anxiety to a particular stimuli. I say that because if she does not have these feelings toward any other situation then the good news is that it is only relegated to this one, which is great. However, if not handled appropriately, it could lead to worsening symptoms (i.e. anxiety and avoidance of other things as well). I know it sounds ridiculous, but I am not sure if your approach will be as effective as you would like it to be. Yes, exposure therapy in my mind is absolutely without a doubt the one true way to change our thinking about a situation and allow us to finally realize there is nothing to be worried about and we can get through it. I have studied a lot on this topic, actually have been healed (mostly) from my anx/panic disorder with this method, and have even been on a Weather Channel Documentary covering this topic (because one of my main triggers was severe weather and fog). Anyway, what you are planning is a great idea, but if her anxiety is such that even the thought of the visits starts causing the anxiety then what is happening in your plan is merely exposure, which is missing the therapy part. In a way it is attempting to put her in the situation and "hope" that by doing it enough times it will lessen the anxiety.

Speaking from experience, this is merely putting her in a situation where she is feeling anxiety and challenging her to essentially last as long as she can. Now, this IS part of exposure therapy but is moreso not letting her avoid the situation. However, the therapy part comes in where she has someone with her (like a therapist, etc - not the dentist or even yourself as neither are qualified to provide the therapy) who goes with her into the situation and talks her through it, gradually working its way up to more and more anxiety-causing situations.

I do not have time to read through all the posts at the moment so I do not recall if you have ever taken her to see a psychologist (who specializes in anxiety disorders and is familiar and practices exposure therapy). It literally saved my life when I thought all hope was lost....and during the therapy I was a mess and it was so hard, but looking back it actually wasn't as bad as I thought.

Good Luck

Mike