Paediatric dentistry has always been a challenge, especially in the area of patient management. Typically in the past, it was recommended that a child be seen by a dentist between the ages of two and half and three years. Unfortunately, by that time many children presented with advanced dental decay and parents with a host of negative preconceived notions of what to expect. Clearly this was a challenge to the dentist.
There have been many changes over the years such as early engagement with infants and toddlers, micro-managing parents and keen scrutiny from various sources. We now recommend that children see a dentist for their first visit when the child’s first tooth erupts or by their first birthday. While this is a positive step in the interest of good dental health for children, it presents new challenges for the dentist in terms of patient management. Learning specific techniques in order to examine and provide information about the very young child becomes imperative. Certain skills are also required to positively engage the parent during this exam process. Parents are often anxious about the appointment and misinformed. Furthermore, older children have a keen eye that can make them wary and uncomfortable. Forming a trust can be the difference between a positive or negative experience. On occasion, a parent with a subtle remark or negative inference can unknowingly sabotage that trust.
The role of the dentist is to encourage a positive interaction with the child and the parent(s). The ideal situation is one where parents can be present for procedures offering silent support. Once an optimal level of cooperation is achieved then the focus is on the child and completing the procedure at hand. Gaining the child’s trust is imperative. This can only be successful when the dentist maintains an atmosphere of encouragement, positive reinforcement and truthfulness. It is important to be honest with children and choose one’s words wisely as children can sense insincerity. Not all children can be successfully treated. The use of sedation or a referral to a paediatric dentist may be inevitable for some children. However, by taking the time and effort, great satisfaction can come from meeting the challenge of treating a difficult child. OH
Dr. Julian Geller is a paediatric dentist in private practice in Toronto, Ontario. He is also a clinical instructor in paediatric dentistry in the Faculty of Dentistry at the University of Toronto.