This patient form was developed by people with lived experience of dental anxiety. It is designed to highlight specific fears as well as to help identify victims of abuse or trauma.
Feel free to use it in your practice. Or have it available on your practice website, so patients can complete the form prior to their appointment.
You are also welcome to adapt it to your own needs.
For Children and Teens
‘Your teeth you are in control’ is a programme designed to help child patients understand their worries about going to the dentist and guide them through the treatment. Experts in paediatric dentistry, psychology and cognitive behavioural therapy (CBT) have developed these resources for dentally anxious children.
You can find out more on The University of Sheffield’s School of Clinical Dentistry website: Your teeth you are in control
The patient form and parent summary are available as a free PDF download:
Or you can buy the full-colour version (£2.50 for 20 sheets) from the University of Sheffield’s School of Clinical Dentistry online shop. You can also buy the workbooks for children (£0.69), the parent summary sheets (£2.50) and the guide for the dental team (£0.69) there:
Child Dental Anxiety Guides – Online Shop
See this page on Dental Anxiety Scales if you are looking for scales which are commonly used in research.