Dental Anxiety — ORE Part 1 MCQ

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EasyPaediatric DentistryDental AnxietyORE Part 1

An 8-year-old child presents with dental anxiety and refuses to sit in the dental chair. He requires multiple restorations. His previous dental experience involved a traumatic extraction under physical restraint. What is the most appropriate first-line behaviour management approach?

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Correct answer: E — Tell-show-do technique with positive reinforcement

The correct answer is E. UK guidance (SDCEP and NHS England) mandates a graduated approach to dental anxiety, progressing from non-pharmacological behaviour management strategies (tell-show-do, positive reinforcement, desensitisation) before escalating to pharmacological interventions. Tell-show-do with positive reinforcement is the evidence-based first-line approach for anxious children. Option C (conscious sedation) and C (general anaesthesia) are reserved for children who fail non-pharmacological strategies or require substantial treatment under restraint. Option D is contraindicated: repeating physical restraint would re-traumatise this child who has prior traumatic experience of restraint. Option B (oral diazepam) is a pharmacological pre-medication, not a behaviour management technique and not indicated before psychological approaches. Even children with high anxiety can be helped to accept care through skilled behaviour management.

Reference: SDCEP Prevention and Management of Dental Caries in Children (3rd edition, 2021), Behaviour Management section, and NHS England Clinical Standard for Oral Health and Dental Care for Children and Young People (2023). https://www.childcaries.sdcep.org.uk/guidance/helping-the-family/behaviour-management/