April 1, 2003
How can I treat their itty-bitty mouths in a one-size-fits-all treatment room? Can I go home without an aching back or neck? Our pint-sized patients certainly present some perplexing challenges.

By Anne Nugent Guignon

In today's competitive business world, the word "downsizing" strikes a note of trepidation. It may mean the loss of a position, funding cutbacks, or an increased workload for those who survive the reduction in the workforce. Downsizing also comes into play for many of us now in the midst of the empty nest syndrome. We have raised our families and are looking for smaller homes and a simpler lifestyle. Another way to consider the term downsizing is the way we treat our younger, smaller patients.

If I were a magician instead of a hygienist, I would figure out how to wave a magic wand every time a little kid climbs up into my chair. How can I treat their itty-bitty mouths in a one-size-fits-all treatment room? Can I go home without an aching back or neck? Our pint-size patients certainly present some perplexing challenges. Downsizing is the answer!

First, think about how you position a child in the chair. The typical patient chair is built to accommodate patients who range from 30 pounds to 300 pounds or more. Each time a kid sits in the middle of the chair, where the typical adult is positioned, we are forced to lean forward in an unnatural position just to reach his or her mouth. Your back, neck, shoulders, and arms will remind you of this "posture breaker" long after your workday ends.

Simply ask your younger patients to move closer to where you are sitting so you don't have to reach halfway across the chair just to reach their mouths. Also, if possible, once the patient chair is reclined, have your patient scoot up to the top of the chair so his or her head is positioned right at the end of the headrest area. Several dental supply company catalogues market booster chairs that children can sit on, which repositions your miniature patients higher in the patient chair. Their head is now located in an area that is much easier for clinicians to reach. By the way, these secrets work well for petite patients.

Now look at the height of the patient chair. Elevate the chair slightly when treating smaller patients, but avoid getting it too high. It is important to position the chair at a level that still allows you to keep your shoulders relaxed and arms at your side.

Remember loupes are very beneficial for all patient care. Don't shortchange your pediatric patient or yourself by thinking you are just working with children. It is a real treat to place a sealant wearing loupes. Magnification allows us to work more precisely and use our time more effectively. If you are worried that loupes will scare your younger patients just tell them that you are going to look at their teeth with your "bug eyes." That line has worked well for me through the years.

Now comes the challenge of working inside a tiny mouth. Smaller intraoral mirrors make the job of visualization easier and small mouth props can help children who find it difficult to keep their mouths open for long periods of time. A few brands of saliva ejectors are extremely compact and some are fabricated with spongy pillow-like heads. Some saliva ejector apparatus have built-in tongue retractors guaranteed to tame even the wildest tongue.

Prophy angles and cups can be downsized as well. Small teeth in small mouths are easier to polish with junior sized cups or reduced size prophy angles. Soft prophy cups also conform to little teeth better. In addition, contra-angled prophy angles also make it easier for us to access posterior teeth in our smaller patients or those that have a limited opening.

You may have never considered using an ultrasonic scaler for pediatric patients, but today's sophisticated ultrasonic scalers make this an excellent instrumentation choice. It can be quite safe and comfortable providing your scaler is set for deplaquing or light calculus removal and you are using the ultra-slim tips that are available. In addition, the extraoral soft tissue rest used with ultrasonic instrumentation is more comfortable for both you and your patient. Amazingly, children respond favorably, especially when you explain that you are "blowing up the germs." If you let them watch while you scale they are fascinated to see all of the biofilm coming off their teeth, especially if you have used a disclosing solution.

Today's sealant materials are designed with ultra-slim tips that allow easy application even in the confined quarters of a child's mouth. Some have brush or sponge-type applicators at the tip end of the syringe, which can ease application. There is even one glass ionomer that can be applied in a moist environment without a curing light and releases fluoride over the life of the sealant. Since the glass ionomer tends to wear away faster than traditional sealant materials, it is ideal to use it in a partially erupted tooth and then apply a traditional sealant at a later date.

A gagging child can be one of the most challenging situations we all encounter. A light sprinkle of table salt on the tip of their tongue is quick and easy way to control this reflex. Suddenly, they are calmer and more cooperative for procedures such as radiographs and fluoride treatments.

Downsizing dental hygiene for our pint-sized patients is easy. Forget the magic wand and just use your imagination. Search the booths at conventions and scour the catalogues for ideas. Talk to your fellow hygienists and see if they have any great trick they use successfully. Soon you will be able to treat kids in a comfort zone that is downsized just for them!

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics ( She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].