A Parent's Guide to Consent-Based Dental Care

We went for a regular check-up, which my 9-year-old was not nervous about. He’s always had positive experiences with the dental hygienist we used to go see. But then we moved, and we had to find a new dentist & hygienist. 

The one we found was great. They specialized in working with kids, though it wasn’t a dedicated pediatric dental office. We had been there a few times, and each time was a green light of dental health, with some slight concerns that they gave us a heads up about, so we could keep an eye on it (spoiler, I wasn’t as on top of it as I thought). 

At our most recent visit, we found out my 9-year-old needed four cavities filled. It brought back memories for me of when I was a kid and needed to get cavities filled. It was scary, very unpleasant, and quite invasive. It triggered a bit of anxiety for me, but I was confident that this would be different for my child and that I wouldn’t let my own experiences become my child’s.

If you experienced negative dental experiences growing up, or if you're worried about your anxious child having difficult experiences at the dentist, or if challenging visits have already happened in your family, read on to learn how you can turn this around and create positive change moving forward. 

Here's what I learned along the way, and why the approach we take matters so much more than we might realize.

The Foundation: Choosing the Right Dental Environment

I never take my children to a dentist who doesn't see many kids regularly. There's a huge difference between dentists who know how to talk to children, help them relax, and create an environment where kids feel welcome. The hygienist who saw my 9-year-old was wonderful. She explained everything she was doing and consistently checked in to get approval before proceeding with each step.

This matters because dental procedures are invasive. Someone is going into your child's mouth with tools that often look scary and make strange sounds. Unfortunately, the media often portrays dentists as frightening places, so children already arrive with apprehension.

When you bring your child to a dentist without explaining what will happen, you set the stage for surprise, shock, fear, and ultimately, a lack of consent on your child's part. The more we prepare ahead of time, the better outcomes we create.

If you don't have access to a pediatric dentist (especially in rural areas), you need to be explicit in your questions and requests about how they handle children. Make your expectations clear and advocate for your child's needs.

Age-Appropriate Preparation Strategies

Ages 2-4: Start with simple explanations about your own positive dental experiences (if you don’t have them, ask if your partner or other family member can share theirs). Share that the hygienist will check their teeth carefully using special tools like a tiny mirror and a gentle poker that checks for any problems. Use role-playing with stuffed animals or dolls to demonstrate what happens during a visit.

Ages 4-6: Explain the process in more detail. Show them pediatric dentistry videos made for children (many dental offices create these). Establish hand signals they can use if they feel uncomfortable, or create a safety word they can say if something doesn't feel right. Reinforce that dentists are there to help keep teeth healthy, and that you’ll be there to support your child so they are safe and supported.

Ages 6+: Have detailed conversations about what to expect, including X-rays if needed. Explain that the hygienist might find areas that need extra attention, and what that could mean follow-up care.

When Cavities Need Treatment

Here's where things get real. If your child needs a filling, you have choices in how you approach it.

You’ll need to return for a second appointment. If your child resists treatment, you can explain natural consequences: "We understand you don't want to do this procedure. We can wait and see what happens, but that means all sweet treats are off the table completely. No desserts, no birthday cake, no ice cream at parties, because sugar feeds cavities and makes them worse." This shouldn’t be a false promise either. It is true, and it should be a natural consequence of a child who won’t allow you to help them brush, or doesn’t brush well enough on their own if they’re older. And they’ll likely realize that this trade-off isn’t worth it and choose to go with the necessary treatment.

For situations where treatment cannot be delayed, this becomes a health and safety issue. You can explain: "This is one of those times when it's my job to make decisions about your health because you don't yet know all the consequences. As you get older, you'll make more of these decisions yourself, but right now, I need to protect your health."

This is one of those times where you have to remind your child (and yourself) that their autonomy is ‘my body my rules’ but also, autonomy levels get unlocked at different stages and ages. And at the ages between 0-12, this is one of the health and safety choices that you are still in charge of making.

Always explain the consequences of untreated cavities in age-appropriate ways, while reassuring them that today's dental techniques are much gentler than they used to be.

Preparing for the Unknown

Before any procedure, contact your dentist's office and ask for details:

• What will the process look like step by step?
• What type of anesthesia will be used?
• Does it contain adrenaline that might make your child shaky?
• How long will numbness last?
• Are there videos or materials to help explain the procedure?

This preparation helps your child feel safer because they know what to expect and understand that you're there as their advocate.

These were my initial thoughts about navigating dental visits, but I wanted to bring in expert insight from someone who lives and breathes this work every day.

I reached out to Dr. Ashley Lerman, Board Certified Pediatric Dentist and Founder and CEO of Firstgrin, to get her professional perspective on creating positive dental experiences while honoring both consent and necessary care.

A Pediatric Dentist's Approach to Consent-Centered Care

What should parents look for in a truly child-centered practice?

Dr. Ashley emphasizes looking beyond kid-themed decorations to find practices with teams trained in pediatric behavior guidance and philosophies that respect children's autonomy. "Board-certified pediatric dentists complete two to three additional years of specialized training focused on children's development, behavior, and medical needs," she explains. "That training really matters."

How do you balance necessary medical care with respecting a child's autonomy?

"With preparation, transparency, and choice," Dr. Ashley shares. "I explain what's necessary and why, then offer options within that frame. For example, 'We do need to clean these teeth, but you can choose the toothpaste flavor and if you want to sit on your own or on mom's lap.'" Research shows that children who feel a sense of control during medical experiences are less likely to develop phobias or trauma (Kain et al., Pediatrics, 2007).

What are red flags parents should watch for?

Dr. Ashley warns against practices that use dismissive language about children's fears, forced restraint without discussion, or a "get it done at all costs" mindset. "If you're told things like 'We don't let them say no' or 'They'll get over it,' that's a sign the practice may not prioritize consent or trauma-informed care."

How should parents communicate their family's approach to body safety and consent?

"Start by saying, 'Our family practices body autonomy and talks openly about consent. We'd like to prepare our child in advance, explain each step, and make sure they're given choices where possible,'" Dr. Ashley recommends. "That sets a clear framework and normalizes these expectations for the care team."

What if parents feel their child's boundaries aren't being respected?

"Interrupt. It's okay to say, 'Let's pause,'" Dr. Ashley states firmly. "You can always regroup. If something doesn't feel right, it probably isn't. Children should not be coerced into silence or stillness. Your presence is your child's safety net, not a silent observer role."

How can parents advocate effectively without seeming difficult?

Dr. Ashley suggests approaching it as a partnership: "Let them know you're on the same team: your child's. Clarify that you're not questioning their expertise, you're adding insight into what your child responds best to. You know your child, they know teeth. When that's respected on both sides, care goes better."

Here are more specific questions I asked Dr. Ashley and her detailed responses.

Specific Scenarios and Procedures

What should parents expect during a routine cleaning and examination? "We count teeth, check for cavities, clean if the child allows, and apply fluoride. But the first visit is also about trust-building, not just getting everything done. Some kids just take a ride in the chair and look at the tools, that's okay too."

How can parents prepare children for the sounds and sensations of dental tools? "Play pretend at home. Use a toothbrush to 'count' their teeth, play the sound of a suction straw, or read books that explain what to expect. I also love the phrase, 'We're going to a tooth doctor who's really good at helping kids feel safe.'"

What's your approach when a child needs X-rays for the first time? "We go slow. I show them the sensor first and let them feel it in their hand. I explain what the machine does and offer choices, like which side to do first. Often, we take one image and see how it goes. Gentle persistence, not force."

Cavity Treatment Details

What are the different approaches to treating cavities in children of different ages? "For baby teeth, options depend on age, behavior, and severity. Sometimes we use silver diamine fluoride (SDF) to arrest decay without drilling. Other times we use white fillings or stainless steel crowns. Treatment should always match the child, not just the tooth."

What anesthesia options are available for pediatric patients? "We use topical numbing gel first, then local anesthesia. For very anxious children or extensive treatment, options include nitrous oxide (laughing gas), oral sedation, or general anesthesia, always case-specific and parent-informed."

How should parents prepare children for anesthesia? "Use simple, neutral language. I say, 'We're going to make your tooth fall asleep.' Avoid words like 'needle' or 'shot.' Also let them know their lip might feel big or tingly afterward, that's normal and will go away in a few hours."

What side effects should parents know about? "Some local anesthetics include epinephrine, which can cause jitters or a racing heart. I always let parents know that ahead of time so they don't panic. If a child is particularly sensitive, we can use anesthetics without epinephrine."

Emergency Situations

What constitutes a dental emergency in children? "Tooth trauma (like a knocked-out or broken tooth), swelling or infection, uncontrolled bleeding, or severe tooth pain. These need same-day care."

How should parents prepare for emergency dental visits? "Have your pediatric dentist's emergency number saved. If your child loses a permanent tooth, place it in milk or saliva and get to the dentist immediately. For swelling or fever, seek care quickly, it can escalate fast. Stay calm!"

Processing Difficult Experiences

How can parents help children process difficult dental experiences afterward? "Debrief at home with validating language: 'You were scared and you did it. I'm proud of how brave you were.' Let them play dentist at home to regain a sense of control. If it was traumatic, it's okay to acknowledge that too and seek care with a provider who understands."

Professional Collaboration Details

What information is most helpful for parents to provide before appointments? "Sensory sensitivities, developmental concerns, previous experiences, specific fears, or even favorite characters we can reference. I'd much rather be over-prepared than caught off guard."

What misconceptions do parents often have about pediatric dental care? "That baby teeth don't matter, or that cavities always cause pain. Many early cavities are silent, but they can affect speech, nutrition, and even permanent teeth. Another misconception is that fear is normal, yes, it's common, but it doesn't have to be inevitable."

Special Needs and Accommodations

How do you handle children with special needs or developmental differences? "We individualize everything. That might mean visual schedules, social stories, extended appointments, or desensitization visits. Every child deserves care that meets them where they are."

What accommodations can be made for children with sensory sensitivities? "We can dim the lights, minimize noise, offer weighted blankets or noise-canceling headphones, and go at the child's pace. Parents know what works best, and we build from there."

Managing Fear and Building Trust

Dr. Ashley addresses common fears children have about dental visits: fear of the unknown, fear of pain, or fear of separation from caregivers. She also recognizes sensory fears around bright lights, loud noises, and strange tastes.

Her approach includes:

• Tell-show-do techniques
• Comfort positioning (sitting on a parent's lap if needed)
• Calming language and breaks as needed
• For children with previous trauma: "We talk about it openly and go at their pace. Trust takes time to rebuild."

For parents supporting anxious children: "Be calm, encouraging, and non-apologetic. Sit close. Let your child know you're there, but allow the dentist to lead the conversation so we can build trust directly."

The Prevention Connection

"Prevention is peace of mind," Dr. Ashley emphasizes. "Kids with fewer cavities need fewer invasive procedures. That means fewer needles, drills, and tears." She notes that according to the CDC, cavities are the most common chronic disease in childhood, yet they're nearly 100% preventable.

Her recommendations for supporting good oral health at home include:

• Brushing twice daily with fluoride toothpaste
• Flossing daily once teeth touch
• Avoiding frequent snacks
• Visiting the dentist by age one
• Making oral hygiene playful through songs, apps, and choices

When children resist brushing and flossing: "Stay calm, stay consistent. Let them know it's non-negotiable, like car seats or seatbelts. But give choices: 'Do you want to brush with the pink brush or the blue one?' Over time, resistance fades."

A Note for Parents with Dental Trauma

If you experienced traumatic dental visits as a child, you might feel significant hesitation about taking your own child to the dentist. Your nervous energy can transfer to your child, so being mindful of this is important.

Consider finding grounding practices that both you and your child can use together if anxiety arises. Deep breathing, counting exercises, or bringing a comfort item can help both of you stay centered during visits.

Remember that healing your own relationship with dental care is part of creating a positive experience for your child.

The Bigger Picture: Teaching Self-Advocacy

These dental experiences are teaching your child important lessons they'll carry into adolescence and adulthood. Learning how to self-advocate in any medical setting is crucial for their wellbeing and health throughout life.

Your child is watching how you communicate with the dentist more than they're listening to your words. When you ask questions, express concerns respectfully, and advocate for your child's needs, you're modeling self-advocacy skills they'll need forever.

Even when situations require you to override your child's immediate preferences for health and safety reasons, you can still approach these moments with respect, explanation, and repair conversations afterward if needed.

Creating Positive Habits Early

When we make dental hygiene fun and creative from the start, children are less likely to resist and create power struggles. Health and safety practices like dental care, buckling up in cars, or holding hands to cross streets are non-negotiable, but how we approach them makes all the difference.

Power struggles might still happen, and sometimes you might need to proceed with necessary care despite your child's resistance. These moments can feel difficult, but remember you can always have repair conversations afterward to process the experience together.

Looking Ahead

I want to encourage you to check out Dr. Ashley's Instagram account and the Firstgrin website for a wealth of information on proactive dental health practices. When we focus on prevention, we reduce the number of visits needed for problems like cavities or other dental issues.

I'll be doing a video interview with Dr. Ashley soon to dive into the specific details of proactive and preventative dental health practices. We'll talk about how to make teeth brushing and dental hygiene more fun and create fewer power struggle battles in your home. Stay tuned for that conversation, where we'll get into the practical, day-to-day strategies that make all the difference.

Remember, you're not just taking care of your child's teeth. You're teaching them how to navigate medical care, advocate for themselves, and understand that their voice matters in decisions about their body. These lessons will serve them well beyond childhood.