Three Tips to Ease Dental Care for Anxious Patients

For many, a visit to the dentist brings fear, anxiety, or memories of uncomfortable experiences. But dentistry is changing - and it's becoming much kinder.

Today, needle-free and drill-free approaches are helping manage tooth decay in ways that are more comfortable, especially for children, anxious patients and those with special healthcare needs. Three of the most promising techniques are silver diamine fluoride (SDF), atraumatic restorative treatment (ART) and the Hall technique.

During the COVID-19 pandemic, many dental clinics sought out non-aerosol-generating procedures (those that don't spray water or create mist), to reduce viral transmission. SDF and ART became essential treatment approaches during that period - and their popularity has continued to grow. These techniques don't just make dentistry more acceptable - they challenge the traditional belief that every cavity needs to be drilled and filled.

Tooth decay is caused by bacteria in dental plaque that feed on sugars and produce acids, gradually wearing away the tooth's surface when tooth brushing isn't good.

Traditional treatment ordinarily involves numbing a tooth by injection of local anaesthetic followed by removal of the decayed part of the tooth with a drill. The hole (or cavity) left is then then restored or "filled" with a filling material, for example dental composite. While effective, this method can be painful or frightening, especially for younger or vulnerable patients.

But we now understand that not all cavities need to be restored immediately, and that stabilising disease and preventing progression can be just as important.

Parents are often surprised - and relieved - to learn that their child's cavity might not need an injection or a filling at all. Sometimes, especially for small cavities in baby teeth close to falling out naturally, just monitoring or applying SDF may be enough.

Equally, there's a growing recognition that patient comfort and trust are essential parts of long-term oral health and quality of life. A traumatic dental experience early in life can deter someone from seeking care for years, making problems worse down the line.

Radically different approach

Silver diamine fluoride offers a radically different approach. It is a clear liquid applied directly into a cavity using a small brush. It takes only seconds and requires no drilling, no needles or costly, complicated equipment.

SDF works in two ways. The silver has antibacterial properties that kill the bacteria causing the decay, while the fluoride helps harden the remaining tooth structure. It's particularly effective for shallow cavities and can stop decay in its tracks. Several studies have found that SDF stopped decay in about 80% of treated cases.

It's not a perfect solution. One side effect is that the treated area turns black, which can be an aesthetic concern, especially for front teeth. But for back teeth, or for children who cannot tolerate other options, this may be an acceptable alternative for avoiding needles and drilling or costly treatment under general anaesthetic.

Filling teeth with hand tools, not drills

Atraumatic restorative treatment is another gentle approach. Originally developed for use in areas with limited access to dental equipment, it's now widely used as a patient-friendly option.

ART involves removing soft, decayed tooth tissue using hand instruments - no noisy drills or anaesthetic injections needed. Once the decay tissue is removed, the cavity is filled with a material called glass ionomer cement. This special material sticks to the tooth, releases fluoride over time, and helps prevent further decay.

The process is quiet, minimally invasive and usually takes less time than conventional treatments. It can often be done with the patient sitting upright, which is particularly helpful for very young children or those with special needs. This treatment doesn't require a dental chair or power source so it can be done anywhere - from schools to nursing homes.

Crowns without drilling

Another gentle and increasingly popular option for managing decay in children's teeth is the Hall technique .

Unlike traditional treatments that involve drilling or removing decay, the Hall technique works by sealing the decayed tissue in, rather than taking it out. It uses a preformed metal crown - often called a "stainless steel crown" - that is simply placed over the decayed baby tooth without any drilling, injections, or removal of tooth tissue.

Here's how it works: after checking that the tooth is suitable (usually with an x-ray), the dentist uses small orthodontic separators between the child's teeth for a few days to create space. Then, in a quick and painless appointment, the crown is gently pushed onto the tooth and held in place with special dental cement. That's it - no needles, no drill and no discomfort.

By sealing the cavity in this way, the bacteria inside are cut off from the sugars they need to keep causing damage. Over time, the decay becomes inactive, and the crown protects the baby tooth until it naturally falls out.

Parents are often amazed by how well children cope with this approach. In fact, studies show that children who have had the Hall technique often experience less discomfort, fewer dental visits, and better long-term outcomes than those who undergo traditional drilling and filling.

The future of kinder dentistry

Of course, the best (and kindest) way to avoid needles, drilling and filling is to prevent tooth decay in the first place. But when treatment is needed, the options above are changing the game - and they're here to stay.

Silver diamine fluoride, atraumatic restorative treatment and the Hall technique aren't right for every situation, but they're safe, backed by evidence and a powerful reminder that dental care doesn't have to be painful to be effective.

For anxious patients, nervous kids, or anyone who's put off going to the dentist because of fear, these gentler approaches can be the difference between avoiding care and finally getting it.

Dentistry is changing - and it's time our expectations caught up.

Paul Leavy is currently undertaking his PhD at the Trinity College Dublin (TCD) Centre for Health Policy and Management. Paul Leavy receives funding from the Health Research Board (HRB) as a PhD Scholar under the SPHeRE Programme (2018-1).

Isabel Olegário does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.