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A Structured Approach to the New Patient Exam in Pediatric Dentistry


January 3, 2019
by Darsi Perusini, BSc, DDS, MSc, FRCD(C)

When a child is scheduled to be seen by a dentist, it is important to remember that this visit will likely involve at least two individuals: the child and his or her parents. Today, parents want to play an active role in their child’s healthcare, and will report to the dental office with certain expectations of the dentist and his team. The dentist must spend time with parents to inform them about their child’s oral health, as well as educate parents about their child’s treatment needs. For many practitioners, interacting with parents can be as daunting as working with a young patient who may be uncooperative. A structured approach to the new patient exam will help minimize this stress, and allow the dentist to work more effectively with children and their parents.

Before the Appointment
Clear communication starts even before the family attends the practice. Either on the phone or in person, front desk staff should outline clinic policies regarding children when the appointment is being made. For example, if the dentist does not book treatment on the same day as the exam, the reception team should ensure that parents understand this policy to avoid conflict. Such information can also be listed directly on the practice website for parents to read prior to their child’s appointment. When the day arrives, front desk staff should be prepared to discuss clinic policies with the family (Fig. 1).

Fig. 1

Receptionist greets child and parent at the front desk.

Inviting Parents into the Dental Operatory
Most parents will expect to be present with their child in the exam room, and it is important to address this expectation before the appointment. In general, inviting parents into the dental operatory promotes greater communication between the dental team and the family (Fig. 2); at the same time, the team must realize that this invitation could lead to disorder and distress. 1

Dental anxiety is insidious, and can be transferred from parent to child either through words or body language. Crafting an intake form to identify the parents’ fears will provide them with an opportunity to describe their concerns, and promote an honest conversation with the dentist. Short of answering questions or clarifying their child’s medical history, parents ought to be silent observers during the exam so that the child may be focused on the dental team. Also, as the dentist moves through his exam, he should show the parents significant findings directly in their child’s mouth (Fig. 3). This will improve the parents’ understanding of any problems, and prepare them for the treatment discussion.

Fig. 2

Dental assistant demonstrates oral hygiene with child and parent.

Fig. 3

Dentist shows parent important clinical findings during exam.

Radiographs
When indicated, intraoral radiographs form an important component of the new patient exam. In cases where the child is unable to cooperate for intraoral films, consider how this might impact the dentist’s ability to administer local anesthesia or complete a restoration. Likewise, a comprehensive treatment plan is best supported by diagnostic radiographs. If the dental team cannot obtain these, the dentist should be prepared to discuss alternatives with the parents including referral to a pediatric dentist. 2

The Consultation
When it comes time for the dentist to review his findings, counsel the family on oral disease and discuss treatment options, inviting the parents into a private office separate from their child can help improve the parents’ concentration. Furthermore, parents may be more comfortable sharing sensitive information with the dentist in private, particularly if they feel that the information might upset their child if discussed openly during the exam. Words like needle, filling or extraction can frighten younger children and create anxiety heading into treatment. As children age and develop confidence, the dentist should consider inviting them to participate in the consultation. 3

In addition to discussing his clinical findings, the dentist should also present any radiographs that were taken during the exam (Fig. 4). More often than not, parents are interested in this information, and it the dentist’s responsibility to review all the data that was collected during the exam. 3 In his presentation, the dentist should use words that the average person would understand, and avoid jargon that may confuse or overwhelm parents.

Fig. 4

Dentist reviews radiographs with parent.

When the dentist describes restorative materials, he should consider using models or photographs to show parents exactly how each material will look. Verbal descriptions can sometimes be overwhelming, and parents will appreciate seeing real life examples. This is particularly beneficial if the family has no prior experience with restorative dentistry. A dentoform is an excellent way to present options as the parents will be able to see the difference between direct and indirect restorations, and how they are placed (Fig. 5).

Fig. 5

Dentist shows parent restorative options on model.

Similarly, if the dentist is planning a surgical procedure, such as an extraction or frenectomy, photographs or illustrations of the procedure may help the parents better understand the steps involved. Keep in mind, some parents may be sensitive to these pictures, and it is good practice to ask parents about their interest prior to showing them graphic images.

Predicting and Managing Behaviour
Imagine what the first treatment session might look like. If the dentist is planning multiple appointments, think about how the child’s behaviour could change from one visit to the next. Predictions will be influenced by a number of factors including: the child’s age, the child’s temperament, the type of treatment, the volume of treatment, and the parents’ expectations. 2 The dentist should be honest with the family, especially if he feels that the child lacks capacity to cooperate for the prescribed treatment.

If the dentist provides sedation, he should take time to review the risks and benefits of each modality that he offers.2 Also, he should be prepared to answer difficult questions about sedation. Parents may bring up tragic stories that they see on television or read online about children and sedation, and the dentist will need to address the parents’ concerns in an educated and informed manner. If the family is seeking care beyond the dentist’s scope of practice or level of comfort, it is best for the dentist to refer the child to a pediatric dentist where appropriate treatment can be provided.

Conclusion
A successful new patient exam is rooted in effective communication. Connecting with parents is as important as working with their child. While the thought of interacting with parents might intimidate some dentists, a structured approach to the new patient exam will make the task less daunting, and leave a positive impression on the family. OH

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References

  1. American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. Pediatric Dentistry 2017; 39(6): 246-59.
  2. American Academy of Pediatric Dentistry. Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. Pediatric Dentistry 2017; 39(6): 205-07.
  3. American Academy of Pediatric Dentistry. Record-keeping. Pediatric Dentistry 2017; 39(6): 389-96.

About the Author
Darsi Perusini is a certified specialist in pediatric dentistry and a fellow of the Royal College of Dentists of Canada. He maintains a private practice in Edmonton, Alberta, and is a part-time clinical instructor and lecturer in the Department of Pediatric Dentistry at the University of Alberta. Darsi would like to thank his coworkers and RSS Designs (https://www.rssdesigns.ca) for their assistance with the preparation of this article.