phobia of wobbly teeth

[nss]

HI, i am a dental therapist in UK. I am currently seen an 8 year old lad who has the most severe phobia of wobbly teeth, which has led to a general fear of teeth/dentistry/toothbrushing. He has gross deposit of calculus & generalised gingivitis. I have now seen him 3 times and have managed to scale just one tooth & give OHI. He is also seeing a mental health worker to try & tackle his fears. I have experince of treating phobic patients & generally have success. BUT I am really struggling with how to progress with this lad. Does anyone have any suggestions?? I would be very grateful.

 

[brit]

Hi nss
I'll move this to dentistry questions in the hope an actual dentist might more easily see it. It certainly sounds like a difficult case.
I am not qualified in any way, but have you chatted to him about what his actual issues are around wobbly teeth? What is he afraid will happen when you clean his teeth? What would he need you to do for him to accept treatment? Does he need you to guarantee that you will cause him no pain? Does he want to take frequent breaks (stop signal)? Does he want reassurance that his teeth won't fall out except when they are supposed to be replaced by the adult teeth?

Has he had parents extract his baby teeth against his will and is this his trigger...i.e. a wobbly tooth means being forced to get the tooth out asap or the parents will intervene. I know it sounds weird but I can recall several posters whose parents caused their dental fear by insisting on wiggling out their wobbly teeth for them.
Remember treating the person is more important than cleaning the teeth - however long it takes it is better to do it with his full permission than to force it on him in anyway. You are in UK so will already know this - not so everywhere alas.
Let us know how it goes. There must be a reason he feels this way and talking it through and what he needs to help him (even outside the norm), may work.

If he has a lot of cleaning required, it might be best to get a dentist with painfree injection technique to numb him up one quadrant at a time...by Q4 he'd probably be a lot happier. Do you also use the topical gels like oraquix?

 

[comfortdentist]

I really need to more about this person before I could recommend how to approach him. I would absolutely spend time discussing normal maturation of his dentition and how is is going up. How is roots are eaten away packman style so they fall out easily. He might be a candidate for some type of sedative at first followed by frequently recalls appointments for awhile. I don't have enough information though.

 

[nss]

Further information on this lad ... is that he knocked his upper A's when younger & they were extracted & although mum said this wasnt at the time a traumatic experience, it triggered this phobia about wobbly teeth/cleaning/dentistry. Then mental health worker has been giving him coping strageties for when he comes to see me. He also brings a toy mouse which he squeezes when he wants me to stop. since my first post, I have seen him twice more & have only managed to part scale two teeth. His mum is now thinking a GA would be better, as she has two days of worry & tears with him prior to coming. I worry that a GA might cause him more trauma, plus not actually dealing with getting him over the phobia.
Thanks for any further advice you can give me!

 

[Gordon]

It's not really within our training to deal with this, has the mental health worker got a psychiatrist they can refer on to? What does your dentist think?