It’s already well known that dental treatments can cause anxiety to a great part of the adult population, but how do dentists have to act when preparing to treat pediatric patients?
Pediatric patients in dentistry are usually considered those between 2 and 16 years old. Due to this wide difference of age, we decided to divide patients into three additional groups:
2 – 6 years old: primary dentition
6 – 12 years old: mixed dentition
12 – 16 (teenagers): mixed/permanent dentition
These three categories include pediatric patients who have different dental needs, physiological growth and psychological evolution.
It is absolutely important for the dental practitioner to consider those differences when preparing to treat a patient. Dentists must asses first of all the psychological and behavior conditions of the patient in order to plan the correct sequence of treatment. It is also extremely important for the Pediatric dentist to be able to provide not only the best quality of dental treatment but a great behavior management too. It is of primary importance to implement a good behavior strategy that will allow the dentist to manage the pediatric patients, especially those we included in the first two groups, and to promote a long term effect able to positively reinforce the patient’s attitude about the dentist and its oral health. A particular attention must be put on these patients, focusing on enhancing healthy oral habits and discouraging those bad habits that could provoke dental anomalies.
We insist on the fact that pediatric dentists have a great responsibility in being able to transmit a positive memory and reinforcement about their professional figure to the young patient, in order to establish a durable relationship that will benefit both the dental professional and the patient. In other word, dentists not only have to try not to scare the patients but they must be able to promote a great consideration about their role in the patient’s mind. The reason why most adult’s patients are not so keen to visit their dentists routinely can have a link with the negative experiences they lived when visiting their dentists in young age. Bad memories are strongly resistant and they affect importantly the psychological development of children and the habits they mature in adult age; that’s why dentist must be able to make their pediatric patients “falling in love” with them.
Here we report some accepted techniques for managing the pediatric patient’s behavior, in order to promote a more positive experience about the dental treatment.
Prior to any treatment, dentist must assess the social context to which the patient’s belongs. This is not aimed to change the quality of treatment procedures but it has the objective to understand how to implement an effective behavior management and an optimal communication between the dentist, the pediatric patient and the family.
1. COMMUNICATION TECHNIQUES
The first and most important objective, before starting a dental treatment, is to establish an effective communication between the dentist and the pediatric patient in order to make the patient conformable and make him trust the dentist’s figure. The right communication strategy must include both verbal and non verbal communication. Verbal communication has to be carried on with a calm but decisive voice; patient’s must be reassured and find themselves into a comfortable environment but at the same time they have to understand and respect the dentist’s role. It’s highly recommended to start the conversation searching for a topic that could awake the patient’s interest (sports, school, classmates, family and siblings, animals, hobbies, etc) in order to begin a more natural conversation. After gaining the child’s attention the dentist must explain the treatment s(he) is going to perform and to provide simple and clear instructions, that the patient’s can easily understand and follow. The dentist can adopt a “pediatric language” when describing the treatment procedure and the instruments is going to use. Other recommend techniques are: distraction and voice control. Non verbal communication must be complementary and it’s aimed to strength the verbal communication. It includes facial mimics, visual contact and spacial position of the dental practitioner with respect to the patient. The main communication technique, which includes the previously described instructions, is the “Tell-Show-Do” technique, which consist in describing the dental procedure to the patients, to show an example of what is going to be performed on the oral cavity and after that, procede with the intervention.
- BEHAVIOR MODIFICATION TECHNIQUE
The behavior modification can result in being one of the hardest tasks to accomplish for a pediatric dentist. Once a certain negative behavior or habit is established, it happens to be particularly hard to change it towards a positive one. To success in this objective it’s absolutely important to establish an effective communication between the dentist and the patient, as well as between the dentist and the patient’s family. It’s of primary importance to include the parents in this process, making them understanding which positive behaviors and habits must be reinforced at home and which must be discouraged. In the dental clinic dentists are suggested to start with an introductory visit to assess the patient’s characteristics and to make it familiar with the environment and the specialist. After that some techniques can come in help when approaching to the dental treatment:
Desensibilization: gradual approach of the stimulus that provokes anxiety (anesthetic syringe, turbine or any other instrument) to the patient, avoiding a fast and more stressful procedure. Patients must have enough time to prepare psychologically to the dental procedure in order to maintain the necessary calm needed to follow the dentist’s instructions.
Imitation: when possible, it result successful to show to the patient examples of good behaviors from other pediatric patients present in the dental clinic.
Positive reinforcement: it’s used to generate a reinforcement in any good behavior or habit with the objective to make it permanent.
When implementing these techniques the dental practitioner must give a great importance to the time element. To success in these techniques dentists must act carefully and be patient, especially giving attention to both the patient and its family. On the other hand, according to its professional experience, the dentist has to be quickest as possible in performing the dental treatments taking into account a more limited resistance in pediatric patients, who are easily getting tired.
- LIMITATION TECHNIQUES
These techniques are based on a physical limitation of the patient mobility and they must be used only on exceptional with the objective of protecting the patient during the dental treatment. Its mainly recommended on patients with neurological disease affecting their movement’s control or extreme cases of patients with uncorrectable behavior, especially after the previous techniques have totally failed. It’s absolutely necessary to involve the parents in the decision process and to make them sign a informed consent reporting the details about the movement restriction technique. The psychological approach of the patient remain of primary importance and the dentist must make it understand that the physical limitation is aimed to its safety and that it isn’t a punishment.
Written by Dr Jacopo Felisi for European Dental Society on 22nd March 2020
European Dental Society 