Part 1. Dentist, cartoons and clowns

The experience of the little patient at the dentist is a complex experience, which is always intended to be an anxiety-free experience. And this can only be achieved on the basis of the right communication, the right language and the creation of a friendly environment for the visit to the dental office. In the first instance, in communication and creating a positive experience at the dental office, this article aims to briefly mention some communication and entertainment tools, designed to create a comfortable space for the little patient, a space where the dental experience is not seen and felt as a traumatic one.

Cartoons and audiovisual entertainment. Anxiety regarding the visit to the dentist is manifested in school-age children, with multiple behavioral, cognitive and psychological dimensions. One in five children in this category is afraid of the dentist, but also 5-20% of adolescents and young people, with some cases manifesting themselves in the form of real phobias. There are studies that show that audio-visual distraction (television, video games, for example) minimizes the perception of pain during invasive medical treatments. In particular, according to a recent study in the Acta Odontologica Scandinavica (2016) on 56 children during dental treatments while watching cartoons on a Merlin I-theater system, showed that they had a lower level of anxiety, reduced pain during dental treatments, but also a high level of cooperation (during anesthesia, for example). The study concluded that this technique is effective in calming small patients and providing them with the necessary dental treatment. Audio distraction through music or complex audiovisual distraction during pediatric dental treatments (including extractions) according to the Journal of Indian Society of Pedodontics and Preventive Dentistry (2007) or audiovisual distraction according to Quintessence International (2010) through wireless audiovisual glasses and audio headphones during repair dental treatments along with conscious sedation are also used as techniques to minimize discomfort in the dental chair with remarkable results, mainly when this sensory stimulation is both auditory and visual.

Dental clowns. The concept of medical clowns has been significantly addressed in specialized publications in recent decades, as this role has manifested its usefulness around the benefits generated by activities focused on humor and entertainment and their therapeutic interventions. A study published in Social Work Healthcare (2010) mentions the role of medical clowns in creating a welcoming climate, promoting interpersonal relationships, alleviating feelings of frustration, anxiety and hostility in a medical setting. At the same time, the Journal of Oral Health and Craniofacial Science (2017) approaches the role of dental clowns as a complex psychological role, which transcends that of a simple means of entertainment, and involves dimensions related to intuition, sensitivity and therapeutic vision regarding to the needs of small patients. Moreover, Pedodontics (2019) states that “clown doctors” themselves can have an increased therapeutic effect, contributing to the return and future cooperation of children who have undergone minor dental interventions. Studies in this regard are limited, but they recommend considering the inclusion of this role in the structure of dental offices. On the other hand, it is necessary to consider the possibility that patients do not react positively to the presence of clowns or suffer from coulrophobia (intense fear of clowns). Studies are also limited in this case, with a study published in Nursing Standard Magazine (2008) in British hospitals conducted by the University of Sheffield which found that all 250 children interviewed (4-16 years) showed fear or reservation in relation to clowns. Nevertheless,  another scientific study published in the European Journal of Pediatrics (2017) and conducted on 1160 children in a medical setting contradicts these data and states that only 1.2% of children express these feelings.

The tools available to dentists, parents and young patients in overcoming anxiety or fear of the dentist are numerous and diverse. A review of them can be useful, but it is obvious that they must be considered and applied depending on several variables, related to the patient, or the resources of the dental office. However, any efforts in this regard are essential, as they could bring significant benefits to the mental and physical health of young patients. And oral health is undoubtedly crucial to children’s well-being.