Description
Topic: fear of the dentist
Therapeutic goal: abreaction, corrective experience
Age group: 9 years
Secondary target group: parents or other family members of a child with a fear of the dentist
Tertiary target group: carers, teachers, other relatives of the child, possibly members of the wider healthcare team involved in care
Form of work: individual
Brief content of the work (if it is recommended to work with only a part of the work – concretization of a specific part of the work for the given problem): fairy tale The Little Mermaid, p. 37 – 39, reading for continuation, at each meeting a different part of the work, more in Description of therapeutic work
Description of professional pedagogical/therapeutic work:
Non-pharmacological therapeutic-pedagogical intervention (educational program) with two patients who visited our therapeutic pedagogy clinic at the same time in October 2020 with the same problem – fear of the dentist.Meeting frequency: 1 hour once a week/4 meetings held
Content of meetings:
1. Introductory meeting:
first meeting with the child and parents, taking a personal, developmental, pedagogical, family, interest anamnesis including reading interests not only of the patient but also of the family, developmental and family history, way of spending time together, creating a feeling of trust, analysis of the problem, its beginning, development and overall history, analysis of risk and protective factors, explanation of the focus and methods of work of the medical and pedagogical clinic, drawing up an agreement on the provision of health care, instruction on the protection of personal data, finding out the next nearest visit to the referring dentist, agreeing on a method of cooperation with parents; observation of the patient in the context of the therapeutic educator’s communication with the parents and as part of the interaction with the parents, Family drawing as an offered game activity during communication with the parents, observing the child during work, assessing the result of the Family drawing product as a used orientation examination, establishing direct contact with the child through the Magnet Game (ideomotor techniques – see more details in the thesis author’s work on p. 101), outline of the goal, structure and focus of the next meeting
2. Second meeting:
Goal: to learn to overcome the fear of an unpleasant or unexpected situation, to promote courage and boldness, which can later appear in other areas of life
2a. Opening conversation: sharing the experiences of the last few days
2b. Preparatory therapy: Finger signaling – ideomotor techniques (for more details, see the thesis author’s work on pp. 102-103)
2c. Main part: reading the story for continuation (see the specific translated text in the author’s work in the appendices) – brief content of the read part: The mermaid longed to be human. However, during the three wishes, she forgot to wish for health as well, and so after a while in the human world, her teeth started to hurt a lot. Her new friend Kristínka will help her overcome fear and pain. He will teach her how it is at the dentist, what to prepare for. Finally, the mermaid overcomes her fear and visits the dentist.
2d. Expression after reading: We depict and imitate sounds using imagination and musical instruments in the ambulance, various sea animals, a storm at sea, wind… We also try to depict the emotions experienced by the mermaid. Then we look for a way for the child to calm down her friend while overcoming her fear.
2e. Relaxation: The goal was to learn to relax the whole body, to explain that something hurts less if a person is relaxed and vice versa. “Now we will sit down, take a few slow breaths, you may or may not close your eyes. I will now count from 1 to 10 and with each number take a deep breath of fresh air and exhale the used oxygen, etc.” We repeat the Magnets exercise.
2f. Conclusion of the meeting: thanks for cooperation, feedback from patients, sharing of experiences from the meeting, agreement on the next date of the meeting or voluntary homework (drawing a picture).
3. Third meeting:
Goal: is to learn more about ourselves, about the fact that we can control many things only with the help of thoughts, how the body reacts to conscious stimuli
3a. Introductory interview: situational
3b. Preparatory therapy: Scale of creative imagination (more details in Appendix No. 4 of the thesis author’s work, exercise 1)
3c. Main part: reading the story for continuation (see the specific translated text in the author’s work in the appendices) – brief content of the read part: The mermaid lives contentedly with humans, as long as the toothache does not come. My friend Kristínka helps to find out what it’s like to go to the dentist, what it means to go to the dentist. And so they start playing dentist, as it happens in reality. Kristínka calms her down, makes jokes until eventually the mermaid gets used to the idea of visiting the dentist.
3d. Expression after reading: We depict toothaches, we make sounds similar to a drill, a motorcycle, a swarm of flies, we create images of a car journey, how the person will be brought to the ambulance, how it will continue after the dentist’s bell rings. On this occasion, we talk about the prevention of tooth decay, how and when to brush your teeth properly. We discuss the topic of how to deal with pain or injury according to how we practiced before in preparation. Questions for patients: How did you feel in individual exercises? Have you ever encountered something similar? Which parts of the story were the most interesting for you? Which character or situation interested you the most and why? How else could the given situations be solved?
3e. Conclusion of the meeting: due to the relatively long introductory exercise, the conclusion of the meeting was limited to a minimum – thanks for cooperation, short feedback from the patients, agreement on the next date of the meeting.
4. Fourth meeting:
Goal: consolidation of experience from previous meetings, preparation for a real visit to the dentist, detection and elimination of possible hidden influences in the background that would affect the overall result in reality
4a. Initial interview and preparatory therapy: HRV biofeedback
4b. Main part: reading the story for continuation (see the specific translated text in the work of the author of the diploma thesis in the appendices) – brief content of the read part: The mermaid goes to the dentist with her friend. In this way, the fairy also gets to the clinic, where she sees all kinds of devices and can experience first-hand how it really goes at the dentist. In the end, she herself bravely sits in the dentist’s chair.
4c. Expression after reading: We show the journey to the dentist again, step by step, how he sits in the waiting room, the dolls and the medical educator represent patients waiting for treatment, after changing roles, the medical educator represents the dentist and the patient the nurse. During the game, we take turns and try to switch roles. I like the role of dentist the most.
4d. Relaxation: Music-word relaxation with the intention of removing the last remnants of fear of the dentist.
The results:
Case no. 1: One hour after the end of the intervention, she visited the dentist in the same polyclinic building as the medical pedagogy clinic. She sat down in the dentist’s chair with practically no problems, and the medical pedagogue together with her mother “remained as extras in the waiting room”. The examination at the dentist was successful, the child passed the examination at the dentist without any problems and it is assumed that he will not have a similar problem in the future.
Case no. 2: The visit to the doctor took place 2 days after the end of the last of the meetings. Unfortunately, the result was not successful – the girl refused to enter the clinic. We try to provide an explanation in the discussion.
Discussion:
The use of fairy tales in therapy and other methods helped to overcome barriers in the first case, and several times in the intervention we used the fact that the patient was not afraid of other activities, which we used as supporting examples of her own coping resources. The child “came out of his shell” after a short time of meeting, was spontaneous and appeared relaxed throughout the meeting. Regarding the same procedure applied in the second case, the child became a little more withdrawn during the last meeting together, apparently with the feeling of an impending stress-inducing event, and the results of the HRV biofeedback from that day showed a slight increase in nervousness and anxiety, a deterioration of self-control and indicated failure . This was also strengthened by the fact that the parents proactively came to the waiting room of the dental clinic half an hour earlier than we had originally agreed, and after the arrival of the medical educator in the waiting room, the child was no longer able to go to the chair. It can be assumed that a certain role was played by the father, who from the beginning preferred “hard” anesthesia for the child. Whether it could have been prevented is really hard to say.
Conclusion:
Information from the unsuccessful case points to other deeper causes and reasons for the child’s fear than just the contact with the dentist requiring more individual work and the need to work with the family in the area of communication with the child. However, the implemented project demonstrated that the self-help bibliotherapy package can be acceptable for dentists and in the short to medium term can improve the well-being of dentists in contact with patients to eliminate the patients’ fear of contact through education in a different “practice” safe environment adapted for this. The results of a selection of eight studies with 979 participants and the finding that treatment bibliotherapy was significantly more effective in reducing symptoms of depression or anxiety than control conditions without therapy point to the potential of bibliotherapy as an educational tool. According to research findings, bibliotherapy may be more beneficial in treating depression in adolescents, but shows less strong effects on anxiety in children. According to the authors, further well-defined clinical studies should be conducted to confirm these results (Yuan, S., Zhou, X., Zhang, Y. et al. et al., 2018 – see the thesis author’s work for exact reference) .
Reference:
Babka, Vladislav. 2021. The word as a tool in therapy. Pp. 99-106. Thesis. Bratislava: Comenius University in Bratislava, Faculty of Education, Department of Therapeutic Pedagogy. Head of thesis Kotrbová Kvetoslava. Author’s place of work: Private health facility of therapeutic pedagogy clinic PaedDr. Anna Babková, B. Bullu 13, 036 08 MartinContact to the author: vladobabka@gmail.com Phone: 0949 131 221
The card of the recommended procedure according to the mentioned literary source was created by:
PhDr. Kvetoslava Kotrbová, PhD., MPH, Workplace: Faculty of Education, Comenius University in Bratislava, Slovakia Date last updated: October 23, 2022
The card of the recommended work from Slovak to English translated by: Mária Trechová, Workplace: PRO SKIZP – Association for support of Slovak Chamber of Physicists, Laboratory Diagnosticians, Language Speech Therapists and Therapeutic Educators, c. a. Bratislava, Slovakia
It has not undergone language editing!
Recommended citation procedure:
Babka, Vladislav. 2021. From the experience of applying bibliotherapy – case studies – fear of the dentist. In Kotrbová, K. et al: Biblioterapia.sk. Bratislava: PRO SKIZP – Association to support the development of the Slovak Chamber of Clinical Physics, Laboratory Diagnosticians, Language Speech Therapists and Therapeutic Pedagogues, 2023. ISBN 978-80-974667-0-1 Available on: https://www.biblioterapia.sk/en/publikacia/casuistics-example-of-good-practice-story-the-little-mermaid/
This article was created thanks to the support of the the program of the European Union Erasmus+, Key action 2 – Cooperation among organizations and institutions, KA210 – Small-scale partnerships for cooperation in the field of vocational education and training. Project title „Prototype of the on-line study tool for bibliotherapy”, project number 2022-1-SK01-KA210-VET-000082483. It represents the opinion of the author only and European Commission is not responsible for any use of the informations contained therein.
