A fair number of the children I treat have already refused treatment somewhere else. The parents arrive apologetic, sometimes embarrassed, usually braced for another failed appointment.
A number of the children I see have already had a difficult appointment somewhere else, and my aim is to treat them in the chair here rather than send them on for a general anaesthetic. There is no trick to it. What there is, is more time, no surprises, and a willingness to end an appointment having achieved less than we planned.
Fear is usually narrower than “the dentist”
The first thing I do is find out what the actual fear is, because “scared of the dentist” is almost never the real answer.
In children it is usually one specific thing. The noise of the suction. The feeling of water pooling at the back of the throat. The bright light in the eyes. Lying flat, which for some children is the entire problem and has nothing to do with teeth. The smell of the room. Someone who once held their head still. A sibling who told them something.
When a child can name it, we can often deal with that one thing and skip the rest. A child terrified of the suction sound can be shown it, allowed to hold it, allowed to suck up a cup of water with it, and be finished with the fear inside a minute. A child who cannot lie flat can be treated at 45 degrees. That is not a compromise on the dentistry.
Children who are too young to name it tell you anyway, by what they flinch at. Watch what your child reacts to at home when you brush, and tell me. Parents notice things they do not think are relevant, and they usually are.
What I ask of parents
Three things, and the first one is the hardest.
Do not tell them it will not hurt. A child who has been promised no pain and then feels a pinch has learnt that you cannot be relied on for information about this room, and that costs us years. Say instead that you do not know exactly what will happen, and that the dentist will tell them before doing anything. That is a promise I can actually keep.
Do not use the dentist as a threat. “If you do not brush, the dentist will drill your teeth” is a sentence that arrives in my chair about once a fortnight, and it works exactly against what everyone wants.
Keep your own history out of the room. If dentists frighten you, tell me quietly at the start and I will not raise it in front of your child. Children read a parent’s body language in the chair far more accurately than adults expect. If you are gripping the armrest, they know.
During treatment, let me do the talking. Two adults narrating at once is how a settled child becomes an unsettled one. You are there to be seen and held onto, which is more useful than commentary.
How the appointments are structured
I book differently for an anxious child. Usually short, and usually more of them.
The first visit often contains no dentistry at all. Sit in the chair, ride it up and down, count teeth with a mirror, choose a show on the ceiling TV, leave. The point is that nothing bad happened. The second visit might add a polish. The third might be the treatment. That looks slower on paper and it is faster in practice than three failed attempts at the same filling.
Everything runs on show, tell, do, in that order and without deviation. I show the instrument, I say exactly what it will feel like, and then I do precisely that and nothing else. If I said I would count to ten, I stop at ten even if I am not finished. A child who catches you doing something you did not warn them about will not trust you again for a very long time, and that single moment can undo a year of work.
We agree a stop signal, usually a raised hand, and I honour it every time including when it is obviously being tested. It gets tested twice, then it stops.
The ceiling TVs matter more than they sound. The child picks the show, not us, and older children often choose their own music instead. A child staring at a fixed point above them keeps their head still without anyone holding it, which means faster treatment and no restraint.
Autistic children and special-needs dentistry
For autistic children and children with intellectual disability or sensory processing differences, the anxiety approach above is the starting point rather than the plan. What changes is the preparation.
We plan the sensory environment in advance. Tell us what the triggers are before the appointment, not on the day. Overhead light, the taste of prophy paste, latex gloves, the vibration of the polisher, the smell of eugenol, the noise level in a waiting room. Most of these we can change. Some we can remove entirely. Noise-cancelling headphones with your child’s own device are welcome, and I will tap your child’s shoulder to signal rather than speak over them.
We use the first appointment as a desensitisation visit. No treatment. For some children we do three or four of these before anything happens. This is normal, we expect it, and it is not wasted time.
Send us photos of the room to use at home. Social stories work, and they work better with photographs of the actual room, the actual chair and my actual face rather than generic ones. Ask reception and we will send them.
Book the first appointment of a session. No waiting room, no running late, no unpredictable delay. Say when you book that this is what you need.
Bring the routine. The same clothes, the same comfort object, the same parent, the same time of day. Consistency across visits does more for cooperation than anything I do in the chair.
For children where dental treatment is genuinely needed and cannot be completed awake even with support, happy gas is the next step. Where a child cannot manage the nose mask either, an oral anti-anxiety premedication taken before the appointment is sometimes the answer. We will discuss both, with the medical history and any paediatrician involved.
Happy gas, and its honest limits
Happy gas is nitrous oxide mixed with oxygen, breathed through a small nose mask. The child stays awake and can still talk and put a hand up. It does not numb anything, so if a filling needs local anaesthetic, it still needs it. What the gas does is change how the child feels about the injection.
It works well from about five, and it is unreliable at three, mostly because young children breathe through their mouth when they are anxious and vent most of what they are given. It also does nothing at all if the nose is blocked, so a cold or hay fever means we reschedule rather than push on.
We do not offer general anaesthetic. There is no theatre here. Happy gas and oral premedication cover the large majority of children who need restorative work, but not all of them, and if your child genuinely needs hospital care I will tell you that at the assessment and refer, rather than let you pay for two failed attempts first. Note that the Child Dental Benefits Schedule does not cover general anaesthetic, though it does cover inhalation sedation under item 88943, benefit $77.60.
We also do not do orthodontics of any kind, so nothing here concerns braces or aligners.
Cost, so it is not another thing to worry about
We bulk bill under the Child Dental Benefits Schedule. Eligibility is age 0 to 17 for at least one day of the calendar year where the family receives an eligible payment such as Family Tax Benefit Part A. The cap is $1,158 over two consecutive calendar years, or $1,132 if your child’s window opened in 2025. A bulk-billed CDBS service cannot carry a co-payment.
Smile Squad covers every Victorian government school student, with no card and no Medicare requirement. Public dental covers children 0 to 12, free with a concession card and otherwise a flat $40 per child capped at $160 per family. We have HICAPS on site for private extras and are an HCF preferred provider under More For Teeth.
Booking
Say when you book that your child is anxious, or autistic, or has had a bad experience elsewhere. It changes the appointment length, the time of day and who your child sees.
We are at 129A Canterbury Road, Blackburn, with on-site parking. Consultations are available in Mandarin, Cantonese, Teochew and Shanghainese as well as English. Call (03) 8838 8820, or text 0435 025 318 if a phone call is difficult.
More on our approach to dental anxiety, on happy gas, and on children’s dentistry generally. See also happy gas for kids by age and what happens at a first visit.