by David W. Epstein, DDS, MSD
Kids on your schedule should bring a smile to your face, not a churn to your stomach. A recall visit with a child is a wonderful break from the tedious scaling and high dental anxiety associated with adults. Children warm up to an individual who sincerely cares and give a great sense of purpose. Like most dental procedures, there is a method with children that will yield a very high success rate if practiced and perfected. We follow the scenario below for children under age six.
We allow 30 minutes for a preventive care appointment at this age. We don’t want to feel the pressure of the clock ticking, which creates an immediate sense of anxiety for the child. Many of us in dentistry are so schedule-oriented that we forget to be child-oriented. At our office, we go out into the reception area to greet the child and parent. Making the beginning of each appointment personal and warm by presenting ourselves to the patient, rather than just calling his or her name, sets a calming tone for the visit.
Greeting the child first is important since he or she is the one receiving treatment, and we try to give that child a sense of importance. Children are more receptive to adults who stoop or bend to their eye level because it is less intimidating. We simply say, “Hi, Jennifer, my name is Carol, and today we’re going to be friends. I have lots of fun things to give you, and I know we’ll have a great time. We’re going to shine up your smile and check your teeth. Don’t worry - nothing will hurt.”
Despite what you were taught about even mentioning the word hurt in front of the child, almost every child is concerned with any type of medical or dental care, so addressing this concern up front is very comforting. As Mr. Rogers used to say, “Please tell me what to expect.” Surprises, especially unpleasant ones, make kids worry. Many children will act like they are ignoring or rejecting you at this initial contact, but be assured they have heard you and are processing the information.
We do not want to begin a discussion with the child yet, so we turn to the parent and ask our usual questions such as: Are there any significant changes in your child’s medical history since your last visit? Do you have any special dental concerns or questions for us? How are you doing with home care?
There is great value in speaking to the parent at this point because it allows the child to listen to your voice, watch your mannerisms, and observe that the parent recognizes you as the professional who will provide care. Now, break the ice of formality by saying something child-oriented that will flatter and befriend the child, such as, “You sure are cute! I bet everyone tells you that.” Or, “I like Tigger, too. That is the coolest shirt.” Then extend your hand to the child and say, “Is it OK if your mom comes with us?” If he or she refuses to take your hand, simply say to the parent, “Why don’t you and Jennifer come in with me?” Turn away and allow the parent to take charge of bringing the child into the room.
Some children are shy and some are just negative, but the parent will find a way to get the child to enter. Enlisting the help of the parent creates an alliance in caring for the child. We have found that many parents today have a sense of overprotecting their children, and they are compelled to take charge of helping them adapt to situations. Getting off to a good start with the parent is as important as getting along with the child.
Everyone likes presents and choices, so we start by saying, “I have a present for you - a new toothbrush. What color would you like?” Give the child a choice of just two brushes to make things simple. Open the brush, give it to the child, and say, “Do you know how to brush your teeth? Can you climb up on my chair? I would like you to show me how you brush your teeth.” Allow the child a few seconds to brush his or her own teeth. Then explain that you have observed that children under six generally do not do a very good job of cleaning their teeth, and that it is important for parents to help their kids get their teeth clean every night.
Ask the child if you can borrow the toothbrush and then show the parent an easy way to clean the teeth. A method that most parents find easy and comfortable is having the child sit or stand in front of them. If the child resists, have the parent demonstrate brushing with your hands-on help. When the parent begins, tell him or her you would like to demonstrate a trick to make brushing easy, and get your turn with the child. This is the first step to getting into the child’s mouth.
This initial contact will be a simple transition to the exam.
Since we advocate that the parent brush without toothpaste (it makes it hard to see debris), we ask the child to look up at the light so we can see better. Have the parent hold the brush like a pencil so that they can brush gently and not harm the gingiva. Many kids fight with the parent about brushing because the parent hurts them by brushing too hard. The parent who stands in front of the child and pokes at him or her with the brush will not do a very effective job of cleaning and will probably injure the gingiva.
After spending a few minutes on oral hygiene and diet counseling, it’s time to see if we did a good job of brushing. Our office uses the show, tell, and do approach for the exam and cleaning. When we show the child the dental light, we offer a pair of sunglasses because the light is so bright. Children love sunglasses. We explain that we sit in the dental chair because it is comfortable and makes it easy for us to do a super job of polishing their teeth.
We have found that everyone likes to choose the prophy paste and fluoride vitamin flavors we use. Be sure you have tasted all of the products you use, because children are much less tolerant of bad-tasting materials than adults. If you don’t like the prophy paste, you can bet the child will hate it. Explain to the child not to eat the paste and that it may feel a little sandy, and that he or she will get to wash it off as soon as the teeth are shiny. The visit goes downhill quickly if the paste tastes awful, so we are very selective with these products.
The child has a very short attention span for the actual procedure, so we try to minimize the duress by keeping the time short. We give lots of praise for being a wonderful helper and having a great smile, then we present the child with a prize and a sticker. You will have a much better time if you realistically understand the primary purposes of these procedures. RDH
The Value of Child Recall Visits
• To educate the parent and child about prevention. Our story is repeated at every recall visit because we know information is absorbed through repetition. Parents will act as if this is the first time they have ever been told to help their child brush, even though they were told six months ago.
• To create a happy dental experience for the child. Each recall visit will be easier if the child remembers this as a positive experience.
• To make the child comfortable with someone working in his or her mouth. Some children do get decay and will need restorative care. Introducing rotary dental tools to the child during recall visits makes the transition to a high-speed handpiece simpler.
• To recognize and explain any dental problems.
• To polish the teeth to remove stain and provide added resistance to decay. The parent may perceive this as the most important part of the visit, but you know your value to the patient has far more to do with how much he or she enjoys the visit.
David W. Epstein, DDS, MSD, a graduate of Indiana University School of Dentistry, is the developer of Glitz Premium Prophy Paste. For 35 years, he has practiced pediatric dentistry in West Hartford, Conn., and has been affiliated with the University of Connecticut School of Dental Medicine.