Dental anxiety in a child — ORE Part 1 MCQ

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ModeratePaediatric DentistryDental anxiety in a childORE Part 1

A 6-year-old child needs a small restoration but becomes tearful when dental instruments are shown. There is no acute pain or infection, and the parent reports that a previous dentist's approach was frightening. The child remains cooperative when calm and can follow simple instructions. What is the most appropriate initial management?

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Correct answer: B — Use tell-show-do with gradual acclimatisation and positive reinforcement

This child presents with moderate dental anxiety following iatrogenic conditioning—a common, treatable scenario in UK primary care. The child demonstrates partial cooperation (sits in chair, follows instructions when calm), indicating readiness for non-pharmacological management. UK NHS guidance mandates a graduated approach, starting with the simplest and safest anxiety management technique likely to succeed. Tell-show-do with acclimatisation and positive reinforcement is first-line: it allows the child to contextualise instruments and procedures, reduces fear through predictability, and has high parental acceptance. Option E (general anaesthesia) is inappropriate for limited treatment scope without exhausting behavioural techniques first. Option A (restraint) risks psychological harm and worsens future dental anxiety, contradicting UK behaviour guidance. Option D (discharge) abandons a cooperable child, allowing anxiety to entrench. Option C (home sedation without guidance) skips the graduated approach and is unsafe without professional supervision. Answer: D.

Reference: NHS England (2024). Clinical Standard: Dental Anxiety Management. https://www.england.nhs.uk/long-read/clinical-guide-for-dental-anxiety-management/; NHS England (2024). Clinical Standard: Oral Health and Dental Care for Children and Young People. https://www.england.nhs.uk/long-read/clinical-standard-oral-health-dental-care-children-young-people/