Prerequisites Of Paediatric Dental Care Introduction
It was discussed that refining the attitude of the dentist and redefining the workplace is essential to delivering effective and efficient treatment. The behaviour of children has to be understood to rightly manage them in the operatory. The following modes of attitude refinement help in managing the children in the dental operatory:
Table of Contents
- Exercising routine interaction with children
- Developing certain qualities to handle children more efficiently
- Culminating a capable dentist attitude
Redefinition of the workplace helps in changing the way children see the dentist.
Read And Learn More: Paediatric Dentistry Notes
Routine Interaction
Certain modes of interaction should become a routine practice in the paediatric dental clinic. Routine interaction with children helps in their behaviour management during the treatment. A dentist can interact with the child in the ways described as follows.
Data Gathering And Observation
Data gathering in a paediatric dental operatory implies gathering information about a child. This can be done in four ways, which are as follows:
- Observation of the child
- Interaction with the child depends on his level of cooperation
- Obtaining a written interview from the parents
- Formal/informal questionnaire filed by the parents
Observation implies the perception of explicit as well as subtle behavioural characteristics of a child.
It can provide clues to how the child should be encountered by the dentist and the staff Observationcanhelpindiffrentiating a relaxed, cooperative child from an anxious, potentially uncooperative child. An anxious child requires a slow and elaborate strategy of behaviour management.
Observation is a continuous activity as behaviour is dynamic and not static. The dentist should continuously observe the behaviour of the child and make appropriate changes in the behaviour management strategy as the behaviour of the child changes.
Structuring
Structuring refers to the communication of behaviour expected from the child. The establishment of guidelines of behaviour is communicated to the child by the dentist and the staff The child is made aware of what to expect and the amount of time required for the treatment
Structuring also comprises appointment scheduling techniques. The attention span of a child is the amount of time a child can be oriented with undivided attention to a particular object/situation.
It is usually around 25–30 minutes for a 4- to 6-year-old (early childhood years). Therefore, the appointments are structured in small units, each lasting for 25–30 minutes for this age group.
The attention span is shorter for younger children and longer for older children. Appointments are scheduled accordingly for the other age groups.
Externalisation
Externalisation is a process in which the child’s attention is focused away from the stressful emotions/distressed stimuli associated with the dental treatment. This de-emphasis method can be done in two ways, namely, distraction and involvement. Distraction and involvement are equally preferred modes of externalisation to help the child overcome anxiety.
- Distraction: The child is distracted from the stimuli presented during the dental procedure by presenting a more exciting stimulus. It can be a wall-mounted television showing a cartoon movie. The child may be allowed to hug a favourite fur toy during the procedure. The orientation of the child would be more on the television/toy and not on the dental instrument in the mouth. The child is asked to look at the computer screen and to count the number of flowers/leaves while treatment is going on. The visual may be some rhymes, cartoons or other puzzles, depending on the interest of the child and his/her age.
- Involvement: The objective of involvement is to create interest and involve the child (but without overstimulating him) in mental, verbal and motor activities so that the distress/strain of treatment is not felt. Asking children to count to 20 in their minds while a local anaesthetic injection is being administered is a mode of involvement by mental activity. Allowing children to observe the procedures being done in a hand-held mirror is a motor activity type of involvement. A brisk and brief, authentic conversation is a verbal mode of involvement. These modes help children overcome their anxiety. The child is asked to observe the treatment going on closely in a hand-held mirror. She may conceive herself to be a part of the treatment team.
Empathy And Support
Empathy is the capacity to understand and experience the feelings of another person without losing track of one’s objective. Empathy in paediatric dentistry means addressing the emotional immaturity of children without allowing their emotional distress to dominate at the dental operatory.
The following methods would exemplify empathy and support:
- The dentist should not be totally immersed in the technical aspects of the procedure and should possess the sensitivity and capacity to understand the child’s feelings.
- The children should be permitted to express their fear, anger, distress and desires. But violent expressions such as kicking and fighting should not be entertained.
- Appropriate choice of words and tone, a reassuring touch and a pat or a hug should be used to comfort the children.
- Acceptable behaviour should be appreciated.
- Listening to children’s comments when they wish to talk is essential. However, children should not be allowed to use verbal communication as a tool to delay treatment.
- Explaining to the child that his reactions are being understood will convince the child.
- Providing a structured environment where the child feels secure is very important to deliver effective treatment. The dentist and the assistant concentrate on multisensory communication to establish trust and communicate to the child that her feelings/distress are being understood.
Flexible Authority
The dentist has to clearly communicate to the child that he (the dentist) is the authority to make decisions in the dental operation. But the personality should be carried in such a way that the authority is not overtly displayed. The dentist should show some flexibility owing to the emotional immaturity of children. He should look approachable to the child.
Education And training
The dentist should implement a programme to educate both the child and the parent about good oral health. This should make the children aware and the parents motivated on the importance of oral health and hygiene. The educational programme should focus on diet counselling, caries control and oral hygiene measures.
The onus is on the dentist and the team to motivate the child and to make the parents aware of dental disease and its prevention.
1. Qualities Of A Dentist
The dentist should develop certain qualities to handle children more efficiently. The dentist should have a positive attitude, team approach, authenticity, tolerance and empathy towards treating the children.
- Positive attitude: The dentist should have a positive attitude while receiving children in the clinic. He should be confident that human behaviour is a pattern that is modifiable when appropriately dealt with.
- Team approach: The dentist should encourage a team approach while handling children. The receptionist and the dental assistant team should carry the same positive attitude. They must work in a complementary fashion so that the appointment is short.
- Authenticity: The dentist should never lie to a child. The child sees an object as black or white. He does not discern shades of grey. The child sees a dentist as honest/dishonest. One lie told to a child by a dentist may inculcate the thought that all dentists are liars. This thought will remain for a long time in the mind of the child.
- Tolerance: The dentist must train his temper to encounter children displaying uncooperative behaviour. The dentist should expect children to cry and learn to tolerate this.
- Empathy: The dentist should have the capacity to understand the child’s feelings, reactions and distress towards dental treatment and must address them appropriately.
2. Attitude Of A Dentist
The baseline attitudes of dentists may vary. The dentist should be able to display a capable attitude towards children. The attitude of dentists may fall into any of the types depending on the way they see children.
- Fearful attitude: The moment the assistant informs the dentist about a child waiting for treatment in the waiting room, the dentist becomes petrified. He starts thinking about how to handle the situation.
- Procrastinating attitude: The dentist postpones the treatment of a child to a later date due to disinterest or doubt in his own capability.
- Maternal attitude: The dentist takes a stand and thinks only about the discomfort the child is going to face rather than the treatment benefits.
- Arbitrary attitude: The dentist has a rational character and blindly stresses the treatment procedure with no consideration of the child’s emotional distress.
- Sentimental attitude: The dentist is moved by the emotions of the child. He is enthusiastic about treating a happy child but feels incompetent when an emotional outburst occurs in the child.
- Entertainer attitude: The dentist becomes an entertainer to the child. He maintains his clinical setting like circus gadgets and behaves like a clown, mimicking to keep the children entertained.
- Capable attitude: The dentist is balanced, competent, confident and considerate, keeping an eye on both the procedural techniques and the status of anxiety or level of emotional maturity of the child simultaneously.
The right dentist has to fall into the last category or be a capable person to handle children effectively and efficiently.
To conclude, the dentist can change the way he sees children in the modes suggested in this chapter. Knowledge about different kinds of children’s behaviour and refinement of attitude is essential to deliver proper treatment to children.
SUMMARY
The dentist’s strategy/attitude can be refined by the following methods:
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