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Here is how I manage children in my practice!

Gillian's PhotoBy Dr. Gillian Smith

I am a dentist based in Ireland and I am a general dentist with post-graduate qualifications in conscious sedation, so having a scared child in the chair is a  scenario I deal with everyday.

In my view, the first visit is the most important one. I do not do any treatment that day. The parent is advised about this on the phone and asked to tell their child that they are going to meet the dentist and show her their teeth. We have lots of positive story books and teddies with teeth in the waiting room. Parents are informed about these books and resources on the phone, to prepare their child at home, if they notice that the child is nervous. There are also some excellent apps you can get to prepare a child for the visit, and we offer a ‘social story’ to parents with pictures of children at various points in a dental visit specific to our practice.

On arriving in the operatory, I greet the child and parent and usually let the child have a wander around and look at everything first, while I take a history from the parent. There are lots of interesting things for them to look at (keeping dental instruments out of view). We have a tiny “tooth fairy door” and lots of funny sunglasses for them to try on. The dental nurse plays “dress up” with the sunglasses with the child while I talk to Mum. It takes the focus away from the dental chair. If the child is clinging to the parent I will ignore them for a while until they realise there is no threat, and then look them in the eye and using age-appropriate language, tell them that I would like to look at their teeth. I ask them if that is ok so that they give permission and I reassure them that it will not hurt. I tell them that they are the boss and that they can raise their hand to say stop. I show them the light (and explain why sunglasses might be fun), the mirror and the moving chair. Knee-to-knee works well for small kids or moving the chair into the correct position and then seating the child can also be a winner.

Once I am finished my exam, I bring the parent over and show them their child’s mouth – adult teeth, baby teeth and any cavities or plaque.

After the exam, I make sure to tell the child how well they did and how proud I am of their achievement (high fives etc). I then sit down with Mum while the dental nurse again plays with the child (makes balloons and the prize etc).

At this stage, I discuss the diagnosis, causes of any disease etc. I show them the radiographs, pictures of a skull with adult teeth under baby teeth.

We discuss prevention first: give them a diet diary, disclosing tablets, tooth timers (again you tube has some great brushing songs). If the child is old enough, I involve them in this conversation – tell them they can be the “sugar police/detective” in their house and to go home and find all the things that are heavy on sugar.

I then talk about the treatment needed, the different options and options for sedation/GA. If the child is listening intently, I signal to the parent that I will phone them later to discuss it as I can see we have “listening ears”. I stress to the parent that the success of treatment will depend on how the patient is prepared and that our language is very important. If the parent and I have a chance to discuss the plan then and there and a decision is made, I will explain to the patient then and there while the parent listens. I will tell the child that we are going to fix the tooth/give it to the tooth fairy as a team (the dental nurse, the child and me!). I tell them again in age-appropriate language about the sleepy jelly, Mr. buzz and Mr. bump and focus on the positive. If I have a nervous parent like the one in the scenario (featured on Oasis Discussions) and I feel they are contributing to the anxiety, I will stress to them that this must not be conveyed to the child. I suggest letting another adult accompany the child at the treatment appointment.

I feel that this first visit is the key and helps me to avoid situations like the fearful child scenario. I have won the child’s trust and prepared the parent and child before we even start.

If I was faced with the scenario above I would do the following:

1. I would tell the child we don’t have to do the treatment that day, if they do not want to or are too upset. But I would explain why it was necessary at some stage. I would ask them what they are afraid of and try and encourage them to do something that day – no matter how small; then there is a sense of achievement

2. I would have a word with Mum as quietly as possible and advise her that she needs to try and avoid passing on her fear to the child. I would reassure her that the child will not be in pain and the advantages of successful routine dental care. I would talk to her again about the options for sedation and if that might help her child. I usually avoid the mention of needles altogether, if I can help it and talk a lot about sleepy jelly and washing it away! This doesn’t work all the time, but almost always, and as the parent squirms in the corner the kid barely flinches!! And if they do raise their hand after the first administration, I stop straight away (after admin of a little LA) and say in a big loud voice “I see your hand, that means stop”. Then, when they have calmed down I can reinject at the now numb site.

3.Bribery!! It doesn’t have to be expensive – I usually suggest we postpone the visit, but that when they do come in for treatment and if it is successful that there will be a reward. That can be a new DVD for after, mum or dad taking the day off work and the child getting some quality time together or a special prize under their pillow from the tooth fairy. Laying out three prizes and letting the child pick their favourite BEFORE treatment so that they only get it if they go ahead is my secret weapon when all else fails!!

Anyway – that’s my modus operandus at the moment! Hope it’s helpful!

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