by Rachel Iverson, RDH
Stuck in the operatory with an uncooperative kid? Give him a task.
Placing the perfect sealant is less about getting into the child's mouth and more about getting into his or her head. The mind of a child is an amazing thing. One minute it can invent an unlimited number of horrible things to associate with a trip to the dentist, and, in the next minute, it can comprehend an impending dental procedure better than most adults.
I have seen all types of children, from the screaming, kicking, crying kind to the angelic, calm, collected kind. At times, these kids seem to be from different planets, but there are common threads running through even the most difficult children. Uncovering these is the key to building a positive relationship with your pediatric patients. To do this, we must become students of the child's mind and unlock the best ways to approach these very special patients.
First things first
The most basic principle when working with children seems so simple, yet overlooking it will have disastrous results. At the core of any visit, the child must trust you. Now, how do we go about doing this? I simply begin by visiting with her for a while. It gives us a chance to get to know each other so a bond of trust can begin to form. From there, I move into the explanation stage - letting the child know what I'm going to do and providing models and pictures so she understands. For instance, if I'm going to be placing a sealant, I explain how a sealant works and why we place them. I use a typodont to show what a sealed tooth looks like compared to a non-sealed tooth, and I introduce her to the instruments I'll be using. Once this is completed, the bond of trust has increased to a stable level and the patient is ready to move forward with the procedure.
At our office, when the dentist places the sealant, he has an assistant who provides an extra set of hands. As a hygienist, I'm on my own when placing sealants. The extra pair of hands that I need now belong to my newest employee: the child in the chair. Another wonderful thing about children is their willingness to help out any way they can. Have you ever been raking the yard and your child comes out and picks up a rake of her own? The child begins trying to drag the tool across the lawn in a sweet attempt to assist you in any way she can. Whether they are seeking attention or praise, this is just a natural thing for kids to do. We can use it to our advantage when in the office.
I give my little patients a task to perform while I'm doing my work. They take to it like a fish to water! I hand over the suction device, show my young patients how it works and what it does, and place it in the appropriate spot. They sit like statues, completely concentrating on the task at hand. They feel important and have an element of control. I continually praise them for the wonderful job they're doing as I begin the procedure. We go through the first sealant rather slowly, as I repeat my explanation of the procedure step-by-step, often referring back to my earlier demonstrations. Once the first one is completed, the rest of the sealants go rather quickly as the child understands the procedure and relaxes, trusting that I know what I'm doing. Success! We've earned their trust and built a solid foundation for repeat visits.
Is it always so easy?
This method isn't foolproof, unfortunately. Some children simply will not respond and will need a little extra coaxing and attention to settle down. After working with children for so long, I have identified certain strategies for reaching the minds of particularly difficult children and activating their imaginations in a positive manner, especially when dealing with technology.
Technological advances in dentistry can be your greatest ally in dealing with an unhappy, uncooperative child. One tool I have talked with other hygienists about using is an intraoral camera. Children are fascinated with themselves (as are some adults, too) and love watching their own mouth on "TV." If they can see what you're doing, they have a much easier time accepting it. Plus, have you ever watched a child in front of a television program they like? She gets this glazed look and it takes a great deal to take her attention away. Taking advantage of this mentality helps us both out a great deal.
Since sealant placement is a large part of dealing with children, advancements in these materials add another tool to my belt. The syringe delivery is a great system for placing sealants because it helps eliminate bubbles and fits in small mouths easily. However, it looks like a shot, and kids do not like shots. That's where the "world's smallest brush" comes into play. I take a sealant brush and touch it to my glove so my patients can see how small and unintimidating it is. They really get a good laugh out of this "world's smallest brush" routine, and in these situations, laughter truly is the best medicine.
Another sealant-related advancement is color-change technology. 3M ESPE's Clinpro™ Sealant has a pink color that kids think is really cool. It also helps me explain to a child how the sealant works, and the color-change really makes it easy for the child to literally see how and where the sealant is placed. Then, of course, when I show her how it changes from pink to tooth colored, she thinks that's just amazing!
Lastly, a key for fidgety little ones is to show off your curing light (not turned on, of course) to get them talking and relaxing. Some of the newer generation of curing lights are cordless and have a straighter shape. When you can go into the operatory toting what looks to the child like a "light-saber" straight out of "Star Wars," you should have no trouble getting an unhappy child to become responsive to what you say. You're using this as a way of getting her mind off of the dentist's office and onto something she enjoys - like imagining what she would do if she had a "light-saber" like the one in your hand. May the force be with you!
Working with children can be frustrating at times, but if you know how to enter the mind of child it can be a very rewarding experience, too. Remember the little things, like smiling; earn their trust; help the child feel important; and, if necessary, dig into your bag of tools and let the fun begin!
Rachel Iverson, RDH, BA, has worked with Associated Dentists of River Falls in Wisc. for the past 14 years. She is a member of the American Dental Hygienists' Association, with ties in the Minnesota and Wisconsin components. Iverson has a son, 16, and daughter, 14, and is an avid volunteer with the Girl Scouts of America.
That was then … This is now
Treatment with sealants has changed over time as we've become smarter in the dental industry. At least, I think we are smarter! In the past, sealing teeth was performed on a random basis. If we saw a tooth that looked like it "might" be a problem later on, we sealed it. Now, we give each tooth more of a chance to prove itself by paying more attention to the surface.
If there is any coloration in the occlusal groove, a sealant will not be used. If we think a carious lesion is present on a tooth surface, we'll eliminate the caries with fissure burs before deciding to take the plunge with a sealant. Caries detection units aid us in determining if caries are present and whether or not we can seal a tooth. We use one of these units (DIAGnodent) mostly for borderline cases when we are just not sure what is there.
These advanced systems seem to be quite accurate, but, as with all new technologies, they are not always able to give us absolute results. Therefore, we might still end up with unanswered questions.
Another device available for aiding sealant placement is micro-etching. Some dentists like this to prepare the teeth before sealing. Our office found them to be too immobile and messy, so we don't use them. However, even with the occasional setback or personal preference decision, dentistry is better off for having such devices.
Technology also has improved the end process of curing sealants. It has become easier because curing lights are more effective at curing sealant materials. As far as I'm concerned, the easier it is to cure a sealant in a wiggly child's mouth, the better!
Of course, even though we're being more selective about sealing teeth, we are still using sealants as a wonderful way to protect the teeth of our youngsters. When those 6- and 12-year molars come in, we're glad for the advances in the sealant materials, too. The sealant kits come with everything you need to take care of business. Some sealants have a more flowable consistency than in the past, making it easier to flow into pits and fissures. And newer syringe delivery systems allow a sense of control in tight spaces.
One of the latest advances is color-change technology recently introduced to the market. Clinpro™ Sealant (3M ESPE), for example, is pink when it comes out of the syringe, so it's easy for me to track where I've placed the sealant. Then it cures to a natural-white color.
I'm amazed at what technology can do to make our jobs more enjoyable for us and our patients! I wonder what they'll come up with next?
I can't wait to find out.