The sound of fear: Reduce noise to reduce dental fear

Dental fear and anxiety (DFA) are not innate. They are learned. They are learned through personal experience, what’s observed, or what’s heard.¹ What is innate is the fear of loud noises. We are born with two innate fears: the fear of falling and the fear of loud noises.

And what can dentistry be? Loud.

We are taught early on to protect our hearing and to invest in ear protection. What about a young child hearing these sounds for the first time? Think about the sound of a corded hygiene handpiece … the sound of the saliva ejector … or even more so the sound of the HVE … and the sound of the ultrasonic buzzing away in sterilization. These sounds may be unfamiliar and overwhelming,² so we must consider the sensory environment of our practice and how to adapt it to be child-friendly.

Now, let’s assume a young child is coming to the dentist for the first time. They have only been told positive things. The parents share how they get to watch TV, have their teeth brushed, and maybe even get pictures of their teeth.

Then they arrive.

They walk into a brand-new space, and anxiety starts to creep in. They were told about what they would see at the dentist, but they were not prepared for what they are going to hear.

They hear the buzzing from the ultrasonic cleaner. They hear the beeping of a blood pressure monitor. They hear the loud noise of the HVE. And fear kicks in.

That fear is not truly fear of the dentist.³ It is fear of the loud noises that come from inside the dental office.

Over time, repeated visits can help a pediatric patient become desensitized to these loud sounds. The real challenge is how we can set the stage from their first visit to create a positive experience. How can we show them that these sounds aren’t threatening and help prevent DFA from forming in the first place?

Minimize the sound

One thing I cannot go back on is switching from a corded to a cordless hygiene handpiece. Have you tried one? If you haven’t, I highly recommend it. And if you have and didn’t find it your cup of tea, try a different brand.

Cordless hygiene handpieces have a range of ergonomic benefits for the clinician, but they are also more child-friendly. They look familiar, like an electric toothbrush a child may have at home or have seen in commercials or at the grocery store. More importantly, they are quiet.

A cordless hygiene handpiece has no resemblance to what the child has imagined or heard as a dental “drill” (something loud and that looks cold, being made of stainless steel).

Now, what about an ultrasonic cleaner? We need sterilization to run. To minimize the sound exposure, create distance. If possible, seat pediatric patients in rooms that are furthest away from the sterilization area.² Small changes to the environment can have a big impact on how safe a child feels.

Describe the sound

Tell-show-do is a powerful behavior guidance technique⁴ that is often underutilized or not used correctly. It should instead be called tell-pause-show-pause-do. If you’re not finding success with this technique, it may be because you are not allowing enough time between each step for the patient to process what is being said. The amount of time for the pause can vary depending on the child’s developmental age.

Let’s take the saliva ejector as an example. When you tell the child what a saliva ejector does, it’s also beneficial for you tell them what it sounds like. For some children, I describe it as a whisper or the sound of the ocean. After that, pause for a few seconds. Then slowly turn the saliva ejector on at low volume and allow the child to hear it before it goes near their mouth. Increase the volume gradually as the child becomes more comfortable.

Check your voice

There is a common misconception that working with pediatric patients means you have to be overly animated to capture their attention. In reality, children often need the opposite.⁴

When DFA is present, their senses are heightened and can be easily overstimulated. What children need in those moments is regulation and calmness. You can still be warm and positive without being loud or exaggerated. A calm and steady tone can help settle their nervous system.⁴

Conclusion

DFA does not necessarily begin with dentistry itself. It begins with how a child experiences the environment. Sound matters. Tone matters. Preparation matters.

When we take the time to intentionally minimize noise, describe what children will hear, and regulate our own presence, we create the space for trust to grow.

References

1. Shindova MP, Belcheva AB. Dental fear and anxiety in children: a review of the environmental factors. Folia Med (Plovdiv). 2021;63(2):177-182. doi:10.3897/folmed.63.e54763
2. Liu Y, Chen X. A study on the influence of dominant sound sources on users’ emotional perception in a pediatric dentistry clinic. Front Psychol. 2024;15:1379450. doi:10.3389/fpsyg.2024.1379450
3. Cristea RA, Ganea M, Potra Cicalău GI, Ciavoi G. Dentophobia and the interaction between child patients and dentists: anxiety triggers in the dental office. Healthcare (Basel). 2025;13(9):1021. doi:10.3390/healthcare13091021
4. Dhar V, Gosnell E, Jayaraman J, et al. Nonpharmacological behavior guidance for the pediatric dental patient. Pediatr Dent 2023;45(5):385-410.