Easing Anxieties Before the First Visit to the Dentist

By the time they’re 1 year old (or have their first tooth), children should see a dentist, according to the American Academy of Pediatric Dentistry. Unfortunately, entering the dentist’s office—full of unfamiliar tools, people, and procedures—can be a harrowing experience for a young child.

A University of Minnesota startup company aims to take the fear and anxiety out of that first trip to the dentist through a custom-made smartphone app. Yonder, which started serving its first dental clinic earlier this month, introduces children to a talking cartoon hippo named Mimi who shows them around the exact clinic they will soon visit—helping to set expectations and build familiarity. The platform is designed to not only make appointments easier for children and clinic staff alike, but set the stage for longer-term comfort going to the dentist and better health outcomes as a result.

Adam Choe, managing director of gener8tor Minnesota, and Courtney Hill, MD, a practicing pediatric head and neck surgeon, developed Yonder during their time as members of the Innovation Fellows program at the U’s Earl E. Bakken Medical Devices Center.

A notification to download the app comes along with the appointment reminder that parents receive before their child’s appointment. Upon opening the app, a short video plays, filmed at a child’s height, that walks the viewer through the experience of entering the dental clinic, being greeted by the smiling staff, seeing the waiting room with the toys in it, proceeding through the hallways, and eventually reaching the dentist’s chair. Once there, Mimi shows the child where they will sit and introduces the different tools the dentist uses. The whole time, the child chooses when to progress to the next part of the video—a feature that helps promote learning, Hill said.

Lower-tech alternatives for preparing children to visit the dentist have existed in the past, mostly in the form of children’s picture books. More recently, online videos have cropped up as well, though they do not follow Yonder’s approach of featuring the specific dentist’s office that the children will actually attend—an important part of lowering the fear response.

Only 63 percent of 2- to 4-year-olds had a dental visit in 2016. Early visits, when successful, help instill good habits in children and their parents, not only in terms of dental hygiene, but with lifestyle choices like sugar consumption. Dental caries (cavities) are the most common chronic disease among children ages 6 to 11, according to the Centers for Disease Control and Prevention.

“We hope, in the long term, Yonder increases positive patient experience and improves preventive dental care at a young age in a way that decreases the number of fillings or other interventions,” said Choe, who himself grappled with fear and anxiety in clinical settings growing up.

Getting to the Root of the Problem

The idea behind Yonder came in response to a call from the U of M’s Pediatric Device Innovation Consortium (PDIC), which aims to accelerate the creation of medical technologies for children. PDIC was looking for ideas to help serve children’s unmet medical device needs, and one of the ideas submitted was to lower the anxiety children feel in clinical settings. It was then that Choe and Hill took on the challenge as a research project at the Medical Devices Center.

To figure out why children feel apprehensive at dental clinics, they started digging into the neurobiology behind fear and anxiety. Deep-seated, instinctual fears that have long helped humans avoid danger, such as a fear of the unknown and of physical threats, can manifest in dental clinics. Children (and adults, for that matter) may experience these fears when leaning back with their head exposed and mouth open under a bright light, surrounded by a stranger and their unfamiliar (and sharp-looking) tools.

“It’s totally natural to have some fear going into a new situation,” said Hill, adding that a negative first experience could set children up for more fear and anxiety in the future and reduce the chances they will return for regular appointments. “But when your expectation matches reality, you are not on high alert anymore. That fear pathway is not triggered.”

Choe and Hill tested the app with help from Teresa Fong, DDS, a pediatric dentist at Metro Pediatric Dental Associates and an adjunct faculty member in the U’s School of Dentistry. They found it effective; Fong reported that the app appeared to calm many children’s anxieties in her office and that children were more willing to open their mouths for her during their appointments.

“Yonder offers preparation that in our beta testing is shown to work,” Choe said. “Every child who used our program had a complete dental exam and cleaning and these children and parents left the office smiling.”

In addition to researching the pathways to fear and anxiety, Choe and Hill worked to ensure they had the right cartoon host for their app. Research into speech development, for example, revealed that certain consonants are easier for young children to pronounce, as was a repeated syllable, leading to the name “Mimi.” A hippo was a good fit because of the animal’s prominent teeth and the lack of hippos used in other child-oriented brands. They tested Mimi in interviews with over 200 children to ensure their audience would respond well to the character.

Throughout the process, support from several University groups made the work possible. Funding from the PDIC, the MDC, the MnDRIVE initiative, and Clinical and Translational Science Institute all played an important role in keeping the project moving forward. In 2017, the U’s Technology Commercialization office helped launch Yonder as a startup with Choe and Hill serving as cofounders, allowing the project to move beyond the Innovation Fellows program.

Bringing Mimi to More Clinics

Right now, Choe and Hill are Yonder’s full staff. They do it all, from observing the dental clinics they partner with to get a feel for them, filming the walkthrough experience, integrating the video footage with Mimi the Hippo, and working the finished product into the app.

Over the next few months, they hope to build off of their progress by finding 10 to 15 more pediatric dental clinics to partner with in Minnesota. They intend to focus their growth within the state first, with their longer-term aspirations to offer the app in dental clinics across the nation.

“We want to create better experiences for these kids,” Choe said. “When all’s said and done, if we can say we helped a handful of kids, we think we’ve made a difference.”

See Yonder in action: