Keeping kids calm



Photo: photodeti/123RF

Dentistry is rarely straightforward but when dealing with children, there’s no telling what may happen. So how do you prepare for kids as patients? Kerryn Ramsey investigates

A vital part of paediatric dentistry is the ability to interact positively with children. Fortunately, formal tuition in child development, child psychology and behaviour management all form a large part of specialist training. “We have that extra training to back up our specialist knowledge and skills,” says Dr Juliette Scott of The Specialist Paediatric Dental Practice in Sydney’s Crows Nest.

Paediatric dentists are well aware that a fearful child is one of the most problematic types of patients. If the stress of the situation is not minimised, or even eliminated, then the fear can snowball and have a detrimental effect on the patient for life. Fortunately, there are a few strategies that prove very successful in allaying that fear in the child.

According to Dr Caroline Chung of About Smiles Kids in the Sydney suburb of Chatswood, a paediatric dentist has to know how to deal with kids of all ages and temperaments.

“The three-to-four-year-olds aren’t uncooperative because they are just too little to understand what’s happening,” she says. “For any kind of invasive treatment, they need a general anaesthetic to get the job done properly.

“I don’t do anything to a child’s mouth or teeth the first time I meet them, apart from an examination and perhaps X-rays. We just have a conversation with the child and parents about the problem and ways to fix it.”—Dr Juliette Scott, The Specialist Paediatric Dental Practice, Sydney

“Then there’s the group who are a little older. They can be worried and are mentally mature enough to understand what’s going on. We have good success in using nitrous oxide to help relax them. We also have a television in the ceiling and that works excellently as a distraction.”

One of the more difficult patients for a paediatric dentist is the anxious or fearful child. It can be challenging to get them to sit in the chair, let alone win their trust.

“They’re usually six or seven years’ old and are petrified. They won’t listen to anything we say as they have the ‘real’ information from their friends. Their anxiety levels are very high and the whole dental environment is quite intimidating to them,” says Dr Chung.

In the 2014 book, Behavior Management in Dentistry for Children (2nd Edition, John Wiley & Sons), authors Gerald Z. Wright and Ari Kupietzky write that dental anxiety is not inherent: “It is acquired, and it is commonly accepted that genesis occurs in childhood.
A reasonable speculation is that these early dental fears shape a patient’s attitude in adulthood.” The research shows that many adults who hold negative dental attitudes convey their feelings to their children.

Consultation time

By the time a child comes to see a paediatric dentist, they have usually seen their Dentist and possibly one or two other dentists. By this stage, it is easy for a child—and their parents—to be stressed as soon as they walk in the door.

“It’s important that the first appointment is a consultation,” says Dr Scott of The Specialist Paediatric Dental Practice.

“I don’t do anything to a child’s mouth or teeth the first time I meet them, apart from an examination and perhaps X-rays. We just have a conversation with the child and parents about the problem and ways to fix it. During the conversation, we will discuss whether to use a local with nitrous oxide or general anaesthesia with an anaesthetist.”

There are various techniques to keep everyone calm. The first step is to provide information by describing the procedure and explaining the sensations (noise, vibrations, taste) the child will experience. Dr Scott has a kit with fact sheets for parents covering all aspects of anaesthesia for children.

It is also important to have well-trained staff. “Sometimes parents talk more to the practice manager than to me,” says Dr Scott. “Our staff have done quite a bit of training on how to talk about procedures—particularly what to say and what not to say.”

Many paediatric practices, including About Smiles Kids, have a designated kids’ room with colourful artworks and cartoons playing on TV. “Getting the environment right is essential,” says
Dr Chung.

Surgery time

There’s one important decision that every dentist has to make—should the parent be in the surgery for the procedure? For Dr Chung, it depends on the personality of the child. “Even though mum or dad is just sitting in the corner, it helps the child be a bit less anxious,” she says. “On the other hand, there are kids who play up and put on a show. Once mum or dad is out of the room, they usually behave a lot better. I just use my best judgement.”

As a paediatric dentist of almost 20 years’ experience, Dr Scott believes that a general anaesthetic is often the best option for young children. “Nitrous gas can be helpful but it’s not a magic bullet. It doesn’t change an uncooperative child into an amazing patient, though it’s very useful for kids who are potentially cooperative. Many patients wind up having a general anaesthetic because they’re very young. There’s lots of work to be done and they’re extremely anxious in the dental environment.”

The biggest advantage of general anaesthetic is that it is a safe and effective way for the specialist to complete high-quality work. “There’s no point having an appointment where everybody’s upset and it’s not going well,” says Dr Scott. “General dentists often have a lot of pressure from parents to get the job done quickly. It can be worthwhile saying, ‘You know what—we really need to look at doing this properly’.”

It is important to explain the procedure to the child as they are more cooperative when they understand there will be minimal pain. Talking about instruments and how they are used gives them more confidence. Dr Chung points out that the child needs to know that they can trust the dentist. “I explain that there won’t be any sudden surprises, and we will talk through every stage,” she says. “They feel a bit more in control of the situation when they know the next step. Constantly talking to them and explaining what’s happening definitely helps, especially with older children.”

Relax and distract

To minimise anxiety, teach the child simple deep-breathing techniques. This lets them gather their thoughts and helps prevent nervousness.

Distraction also works—for instance, tell your patient to bring a favourite toy to hold, or get them to visualise an unforgettable experience, such as a favourite movie or birthday party. Some children enjoy kids learning songs to keep them distracted.

It is hard to continue these conversations once the procedure begins, so turn to the audiovisual devices—a ceiling-mounted TV screen or an iPad, with headphones or earphones on hand.

According to the parenting website, “eight to 22 per cent of children experience anxiety more intensely and more often than other children”. So, from the first consultation with a child, be aware of the child’s behavioural signals, then instigate various strategies to keep the child—and the parent—calm and stress-free throughout the dental experience.

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