Trygge Barn i Tannbehandling (TBiT) is a treatment service for children and adolescents aged 8-18 who have dental anxiety and/or needle phobia to such an extent that they cannot cope with regular dental treatment. TBiT is part of the Public Dental Health Service in Norway, and the treatment is free of charge.

TBiT started as a project in Trøndelag county at the Competence Centre for Dental Health Mid-Norway (TkMidt) and is now being established in several counties in Norway. At TBiT, dental health personnel and psychologists work together to help children and adolescents cope with dental treatment. TBiT is a supplement to existing dental care, and collaboration with others in the dental health service is important.

Treatment at TBiT is primarily aimed at the child's anxiety regarding dental treatment. There can be several causes for dental anxiety, and at TBiT, we work to facilitate the child's success and sense of mastery. This is done in close cooperation with the child and their guardian. The treatment is based on cognitive behavioral therapy, with an emphasis on exposure, where we work in a safe and systematic way with the things the child finds anxiety-inducing.

In this way, we facilitate an environment where the child can experience a sense of mastery, increased control, and learn that dental treatment is not dangerous. A standard course of treatment always begins with an intake interview. During this conversation, the therapist and the child get to know each other, and information about relevant circumstances is gathered. It is desirable for a caregiver to participate in the intake interview.

From the start, we work on establishing a secure relationship with the therapist. The duration of the treatment is typically between 5-10 sessions with weekly appointments. Upon completion of treatment at TBiT, the child/adolescent is referred back to their local dental clinic, and we communicate any recommendations for further treatment and accommodations to the local clinic.

Referrals to TBiT are made by your local dental clinic or a dentist at the Children's Advocacy Centre (Barnehuset). If TBiT is considered a relevant option, this can be discussed with your local dental clinic.

TBiT aims to develop methods and tools to help children with dental anxiety. TBiT will actively contribute to increasing competence regarding dental anxiety within the Public Dental Health Service through, for example, courses and training.

The goal of TBiT is to actively contribute to research on children with dental anxiety and children who, for various reasons, struggle to cope with dental treatment.

Prevention and knowledge sharing are key priority areas, and we therefore offer courses and guidance to both private and public dental health services, as well as other partners who work with children and adolescents.

Skills development includes both general and specialized measures. TBiT contributes to general skills development through courses and lectures within the dental health service and at other relevant venues. The TBiT team at TkMidt is also available to discuss patient cases if needed.

More specialized skills development takes place through systematic training and supervision of the decentralized TBiT teams within the Public Dental Service. The teams receive training in anxiety treatment and regular supervision from a psychologist, enabling them to carry out complete treatment programs locally.

TBiT is a treatment service for children and adolescents aged 8-18 who struggle to receive dental treatment. TBiT is based on principles from cognitive behavioral therapy and exposure therapy.

The goal is for the child to be able to undergo dental treatment at a local clinic after completing treatment. TBiT is a treatment service for children with dental anxiety. If the child has acute dental treatment needs at the start of TBiT treatment, this should primarily be handled by the local clinic, but if dental treatment can be carried out as part of anxiety treatment, this can be done at TBiT. The child's and adolescent's motivation to try anxiety treatment should be present.

The child or adolescent is referred to TBiT by their local dental clinic or dental practitioners associated with the children's advocacy center (barnehuset). If the child is referred from the children's advocacy center, the local dental clinic must be informed of the referral. This is to ensure that the dental clinic is aware of the child's difficulties with dental treatment and to establish cooperation where necessary. See the attached referral template.  

All referrals are sent to the central TBiT team. Geography, capacity at decentralized teams, and psychological complexity are factors that determine which team is assigned the referral. In cases of suspected complex psychological difficulties, the referral is handled by the central TBiT team.  

The referral must contain concise information about the following:

• Reason for anxiety
• What measures have been attempted
• The child's motivation for receiving treatment at TBiT
• Other treatment/follow-up and any diagnoses

• Children and adolescents aged 8–18 who suffer from dental anxiety, e.g., needle phobia and/or anxiety regarding other procedures or aspects of dental treatment 
• The treatment method of cognitive behavioral therapy/exposure therapy requires a certain level of cognitive maturity. Children under the age of 8 or those with difficulties incompatible with cognitive behavioral therapy should not be referred for TBiT treatment. These children may benefit from adapted dental care at a local dental clinic, and TBiT can assist the local clinic with guidance in this work.  

It is important to conduct a comprehensive assessment of the child's/adolescent's challenges and situation before referring. In the event of the following challenges, please wait to submit a referral:

• Active substance abuse issues 
• Severe mental illness/developmental disorder (e.g., severe depression, severe eating disorder, active psychosis, severe autism spectrum disorder).
• Children placed in emergency foster homes

The central team holds a monthly intake meeting where received referrals are assessed. If it is determined that the child should receive treatment, the referrer receives a letter informing them that the patient has been placed on a waiting list and providing an estimated waiting time.