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Tailor dental hygiene appointments: How to adjust to the various temperaments of the child patient

Oct. 1, 2017
Katie Melko, RDH, discusses adjusting dental hygiene appointments for the pediatric patient.

By Katie Melko, RDH, MSDH

What will happen when a child sits in the chair is always a toss-up. Will the child be cooperative, happy, sad, crying, shy, or something else? The more important thing is how you’re going to handle it.

No matter what you do, some kids will cry and that’s OK. As soon as you’re done, they are done too, and most of the time, they will bounce right back to being happy, especially if toys and stickers are at the ready.

In my opinion, there are no definite best practices for this type of appointment. This is because no two children are the same and also because children can be temperamental. As dental hygienists, we like to have a plan to execute, and if it doesn’t go as we intend, it can stress us out and cause us to feel flustered or annoyed. The more you’re willing to go with the flow, the better your chances are for having a successful visit. Try to keep different options in mind to help make the appointment successful.

My main plan

I use a puppet with teeth to help with oral health instruction, a fun-flavored paste, an animal-shaped paste holder, and an animal-themed polisher head. I also use a soft voice, nicknames for everything, and positive reinforcement.

Many companies make flavored prophy pastes, but my favorites are Next (Preventech) and Zooby (Young Dental). Zooby also offers prophy angles with animal designs, prophy paste holders, bibs, and flavored gloves. You can get your puppets from most dental suppliers. For nicknames I use the following: Mr. Sunshine for the light, Mr. Thirsty for the suction, tooth tickler for my prophy angle, and superhero or princess vitamins for the fluoride treatment.

Here are several different approaches you can try:

  • Sit knee-to-knee with the parent, depending on the child’s behavior, from the first visit until the child is about two years old.
  • Have the child sit on the parent’s lap. This works from ages two to four, depending on the child’s behavior.
  • Have the parent kneel next to the child and hold his or her hand for support. Do this for ages five and up until the child and parent are comfortable with more space.
  • Play a movie on a phone or tablet held by mom or dad, or if the office has one, turn on the TV.
  • Let the child hold a puppet during the appointment. I have a unicorn and a dragon.
  • If behavior or parent comfort is an issue, a toothbrush prophy may be necessary for some children.
  • If a patient is very uncooperative and the parents are OK with it, you can ask the parents to hold the child’s hands down.
  • Show the child everything on his or her nail or finger before you use the tools in the mouth.
  • If a first visit is unsuccessful or the parent is concerned about the child being very scared, suggest bringing the child to a parent’s appointment. Seeing parents have a prophy done can show children that it isn’t scary or painful. You can also have an older sibling go first.
  • Do oral health instruction first and have the child show you how he or she brushes and how to brush the puppet’s teeth. This will help the child be more comfortable with you and the office environment.

Educate the family

When taking the time to educate, I like to make sure I’m speaking and looking at the whole family. I want to make sure everyone is included and realizes the importance of good oral health care and the longevity of teeth.

Educating the parents about taking care of baby teeth, nutrition, and the importance of teeth exfoliating naturally is something that needs to start from the beginning. If you can, start educating the parents when the mother is pregnant. Parents don’t always know or think about it; many think, “They’re just baby teeth and will fall out, so it’s no biggie.” As professionals, we know that isn’t the case. It can cause the child to require procedures that seem stressful and scary and to grow up fearing the dental office. Parents are often shocked when I tell them that the first permanent tooth comes in at five or six years old. Many parents don’t realize that children get permanent molars that early.

Here are the top five tips I give parents to help stubborn brushers or nonbrushers:

  1. Brush together as a family. Making it a family activity helps increase interest in brushing and shows that it is important to parents too.
  2. Use Listerine Agent Cool Blue when the child brushes. It tints the teeth blue to encourage them to brush thoroughly by making it more like a game. Adding a timer helps give the child a better concept of what two minutes of brushing should be.
  3. Have the child use ACT fluoride rinse.
  4. Make healthier snack choices and eat together as a family.
  5. Don’t use a negative approach when discussing oral health.

Too often, I hear parents say things like, “I told you what would happen if you didn’t brush!” When I’d ask what would happen, the child or parent would say something about how “the dentist is going to rip your teeth out” or “it’s going to hurt to get your teeth cleaned because your teeth are so dirty.” Sometimes the children will say that their teeth are rotting and will fall out or that they’re going to be bleeding and miserable. I spend the first five to 10 minutes promising I’m not going to rip their teeth out before I can even start.

When discussing negativity with parents, I try to explain that negativity can cause children to fear coming to the office and that positive reinforcement is a better approach than this. Most of the time, I learn the parents are scared of the dentist. I recommend that they try to embrace the fear together.

The approaches you choose for your office will depend on what you have to offer and what you’re comfortable with. I strongly recommend trying these out and seeing what you do and don’t like and what works for you. I love working with children, and I always find myself learning something new while treating them. Enjoy taking care of them, and as always, continue to help brighten their smiles and their days.

The main issues about kids

The most common issues I face when treating children are parents who don’t want fluoride to be applied, patients who have a high caries risk, and the need for sealants.

  • Fluoride - When parents come in with their children and say they don’t want fluoride, what do you do? I have a printout of facts about topical fluoride and provide it to the parents. Some parents change their minds once they hear it’s topical and not ingested, and some still refuse the fluoride treatment. When this happens, I recommend taking detailed documentation and making sure to note that you provided a handout and explained the importance of fluoride.

A patient I had about a week ago had a lesion so large that it was very close to the nerve. The doctor recommended a liner that had fluoride in it and a temporary filling to see if they could put off a root canal because of the child’s young age, but the mother refused because the liner contained fluoride. When patients’ parents decline fluoride, I like to recommend Arm & Hammer toothpaste because it isn’t as abrasive, and it helps neutralize the pH of the saliva, which will hopefully help minimize decay. I also recommend regular exams and prophies and sugar-free foods and balanced nutrition.

  • High caries risk - For high-caries-risk patients, I recommend three-month recall visits for fluoride treatments and regular dental cleanings and exams. I also provide nutrition and oral health education with demonstrations for parents and children, and I ask what the child eats and drinks at home. We provide a caries risk assessment yearly at my office, and it helps to see how things have changed over the year. Products I recommend for use at home are ACT fluoride rinse, flossers, and Colgate PreviDent prescription toothpaste.
  • Sealants - Sealants on children can be tricky and sometimes downright impossible without help. When I do sealants, I find it best to show the child everything and try it on a finger first. This allows them time to process what they are about to have done. Usually this works well. The only other issue is getting the child to keep his or her mouth open so the tooth can stay dry. With some children, bite blocks are great, but with others, it’s too much in the mouth and causes them to gag. I also use cotton rolls and dry angles, and I love to use cotton-roll holders when I’m working alone.

As for products, at my office I use Embrace (Pulpdent) or Clinpro (3M Oral Care). My preference is Embrace because the tooth doesn’t have to be 100% dry, unlike Clinpro. Clinpro is great for those patients who are very cooperative. After the sealant is applied, I review oral health instructions. I discuss foods that can cause sealants to dislodge, such as really sticky candies and ice, and I review some home-care tips for better brushing for parents and children. RDH

Katie Melko, RDH, MSDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She is president of the Connecticut Dental Hygienists’ Association, and has practiced dental hygiene since 2009.