There can be few adults of a certain age who didn't endure a bad experience at the dentist as a child.
From noisy drills and nerve irritation to multiple orthodontic extractions, children growing up in the 1970s and early 80s were generally expected to grin and bear dental treatment.
One bad experience could translate into a life-long phobia.
Now, dentists are helping ease the trauma of the reclining chair for children - and their parents - in an area that has historically led to Scotland having the worst dental record in Europe.
Youngsters who suffer from severe anxiety or those facing the hurdle of major treatment in Glasgow are being offered a range of innovative approaches to remove decayed or abscessed teeth.
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Pre-pandemic a general anaesthetic was normally the standard option for children requiring multiple extractions.
Now, sedation is increasingly being used which does not require a hospital visit while children as young as three are able to tolerate local anaesthetics with a new approach that has led to pain-free injections.
“Anxiety among children is an ongoing issue for us, and even pre-Covid it was really quite problematic," says Tara Dunseith, Clinical Director of NHS Greater Glasgow and Clyde's Public Dental Service, which prioritises the most vulnerable patients.
"We had to prioritise those children with the most urgent problems first as we had restricted access to General Anaesthetic due to the pandemic
"We had started to see increasing numbers of children needing extractions and suffering pain.
“We desperately tried to address this, and the approaches we took had some success, but not as much as we’d have liked. So we decided to get creative."
A new, slower method of delivering local anaesthetic known as The Wand has led to less traumatic injections.
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“People think the pain of an injection comes from the needle piercing the gum, but it’s actually the balloon of anaesthetic that causes the discomfort," said Ms Dunseith. "By delivering anaesthetic really slowly, this method is completely painless.
"In the case of one three-year-old child, we would normally go for GA and there’s no way back from that. But with The Wand we were able to treat the child without that.
“They came in bouncing around the waiting room, and left the same way.
"That’s a serious breakthrough for us – and the child."
The technique is often used with sedation, where the child breathes a mixture of nitrous oxide and oxygen via a nosepiece. It has a relaxing effect and the patient is able to talk throughout.
Cognitive Behavioural Therapy (CBT) is now, also an option which gives children coping strategies such as visualisation techniques and graded exposure.
Dentists are also increasingly using Silver Diamine Fluoride (SDF), which helps harden the tooth structure softened by decay and keeps the affected teeth stable until a dentist determines if further action is necessary.
Susan Frew, Operational Service Manager for the Oral Health Directorate, says staff have also been known to collect nervous mums to ensure they make it through the door of the surgery.
"We do a lot of work with parents too in terms of mental health support," she says. "We've evolved so much and the Childsmile programme (a national scheme to reduce dental inequalities) has led to major progress but there are still some children for whom caries are a significant problem.
"When a child attends their dental practice and things haven't gone as intended, an option that is available is a referral into the public dental service.
"They might have a complex medical condition, or a physical or mental disability or have high levels of dental anxiety. The other category is if the child has extensive decay."
Pre-pandemic figures from 2019 show that in Scotland, 80% of Primary 7 children had no obvious dental decay experience.
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However this varied between the health boards: the lowest proportion of children with no obvious decay experience was in NHS Greater Glasgow & Clyde (76%) and the highest proportion was in NHS Orkney (94%).
"In 1988, we had only just 42% of children in primary one who had no obvious signs of decay.
"By 2020 74% had no obvious decay. We have gone from having the highest levels of dental decay in Europe to significant improvements.
"However, we are going to go back out into schools to ask them to come in to measure dental decay because we know that everything that happened pre-pandemic has to be re-visited."
While Covid caused major and ongoing disruption to dental services, in the private and NHS sectors, she said the service actually scaled up efforts to try to reach as many vulnerable children as possible. An emergency service was available every day.
"We provided more care against the backdrop of really difficult circumstances.
"It really is a good news story."
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