Whose treatment is it anyway?
Treatment room or operatory, patients or clients, whichever nomenclature you prefer, the question is the same when discussing family members in the operatory. Some offices have a strict policy of banning family members beyond the front desk. Others have varying degrees of leniency, allowing, for example, one parent or a family member/interpreter into the inner sanctum. Others will allow a child to watch the process to become acclimated to dental procedures.
Problems arise no matter what we do. We can compare ourselves to medicine in this respect. They wouldn't expect to see a five- year-old alone. Parents are always on hand when the doctor examines the child. On the other hand, a five-year-old wouldn't be welcome into an exam room with a parent as the patient. If we could establish a third rule, it would be that children are never left unattended in the reception area — a problem our medical colleagues seldom have, but one that frequently happens indental offices.
As dental-care providers, our focus is on the patient lying in the chair — the one with his or her head in our lap. Some might argue that our focus is really the mouth in the face of the patient in the chair. I most forcefully disagree with this attitude. So, if our focus is on the person in our chair — and we are of the mindset where we treat the whole person — doesn't that include immediate family?
Parents or children can be an equal encumbrance when they are upright in a spare chair or in the treatment chair. The reasons parents may want to be in the treatment room during their child's appointment vary from quiet support of the child, anxiety toward their own care, to a deep guilt for leaving their children in day care. As providers, we must keep this in mind. Finding the cause of parents' reluctance to leave their children alone in the operatory is a challenge that is very much part of our profession.
The guilty — A parent that is guilt-ridden may come across as demanding and give a number of excuses for everything. The guilt may have nothing to do with the appointment, other than being late and the appointment itself being six months overdue. The guilt stems from a long list of things we may never know about — daycare, a cheating spouse, a drug or alcohol habit, molestation, or worse. Obviously, if the issue is molestation or a drug habit, we're required to dig deeper. That's an entire topic on its own. Basically, though, we just need to know guilt exists. As a result of the patient's state of mind, we may need to tread a little lighter and watch the tone in our voice. We may want to deliver our speech on the appropriate age of a child to brush his or her own teeth a little differently. A regular, run-of-the-mill explanation of why a five-year-old needs adult guidance can sound like a flogging to a parent who harbors feelings of parenting guilt.
The parrots — "Parrot parents" are by far the most annoying. While you are giving directions to the child, this parent is in the corner repeating every word. Everything from "open/close" to reiterating the color options for toothbrushes is repeated. The parent is on auto-pilot. Every waking moment, these parents are teaching their child. They are explaining things to them, showing them the how and the why. As a result, it carries over into our territory. We hardly have a chance to ask the child to bite their teeth together and the parent starts parroting. We have to wonder how this child makes it through the day at school. Most parents don't know they're doing it. Pointing it out can inspire a steely stare or profuse apologies.
The trial balloon — The parent who plans to bring junior to their appointment for acclimation is also problematic. They spend 20 minutes in the car explaining to their little one how it doesn't hurt. Any kid worth their Pull Ups® knows that if a grownup says it doesn't hurt, it's going to hurt! Then, we start putting pointy objects into the parent's mouth that frequently exits tainted with blood! Our only options are to continue as if the child isn't ready to fall into the parent's mouth or do a Class I prophy on a Class II condition.
Intense interest by the child in the parent's treatment is troublesome1. The child who shows no interest in the parent, yet tons of interest in the rest of the room, is laborious. It's like trying to work in a room full of mosquitoes.
These situations warrant re-appointing. Proper care of the patient cannot be administered under those conditions. Separation anxiety or a wild child in the room, a patient nursing a child, or other such incredibly distracting goings-on should mandate a new appointment.
All in all, our patients are paying for quality treatment. If it's impossible to render treatment at a level of professional quality and professionalism, then treatment can be rescheduled when the circumstances are remedied. A child sitting quietly playing with a toy in the corner of the treatment room is not a bad way to render treatment to the parent. However, when the parent is doing abdominal crunches at a rate of one per minute, checking on the peacefully-playing child, there is no way to provide care and education.
Other family dynamics also come into play. Translators of a foreign language are necessary. Sometimes, the child is the translator and legal issues may come into play. It may be time to include a language into the prerequisites for entrance into a dental hygiene program. Husbands watching their wives in the treatment room are a little strange. However, making an issue of this might be the origin of spousal abuse later that day or week.
Each situation is unique. Have standards of care ... and stick to them! If your standard cannot be attained under existing circumstances, those circumstances must be altered. Discuss them with both the front and back staff. Maybe an extra charge for baby-sitting (large or small "baby") will drive home the point.
Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at firstname.lastname@example.org.