Dentistry for Kids. Ulrike Uhlmann

      Fig 3-4 Illustration of plaque- disclosing solution that turns plaque pink for easy visualization. (Reprinted from Terry DA. What’s in Your Mouth? Chicago: Quintessence, 2013.)

      Parents also need to be made aware of the eruption of the first and second permanent molars because no primary tooth will fall out prior to their eruption. It is very important to brush these permanent teeth crosswise during their long eruption phase because the bristles of the toothbrush will not reach their surface if the tooth has not yet reached the occlusal level.

      Teenagers

      In this sometimes very tricky phase when teenagers are resistant to advice, it can occasionally be very difficult to motivate patients. Good oral hygiene is crucial, especially for children with braces. If the oral hygiene is poor and the child is wearing braces, then the orthodontist should consider taking them off. Besides that, parents often have to be reminded to come back to the family dentist after orthodontic therapy. Many parents think that the orthodontist also takes care of the prophylaxis, but that is not the case.

      Many parents come into the practice with the words ”Please have a serious word with my child. He or she won’t brush.” The author refuses to do so in her role as a dental practitioner. It is not our job to raise our patients but to motivate them through positive reinforcement. What is the point of giving patients a good talking-to every 6 months if oral hygiene at home goes down the drain in between? This is why it is important to get the parents on board as allies during this phase. Regular individual prophylaxis measures and, if necessary, professional teeth cleaning can prevent dental and periodontal diseases in this phase of life. The highest priority, however, is to remotivate parents and adolescents so that oral hygiene at home is ensured between recall appointments.

      PROPHYLAXIS

      It is essential when treating pediatric patients to address the cause of caries and, ideally, eliminate it completely. Pediatric dentistry is not just a symptomatic “drill and fill” procedure but far more than that. Because each child is different, caries is multifactorial, and there is no panacea that works for every patient, we need to actively seek out discussion with our pediatric patients and their parents, reconsider our strategies, remotivate both child and parent, reassess our approaches, and, to the best of our knowledge and belief, choose and adopt an individual prophylaxis strategy for each particular patient. After all, what works wonderfully for one patient may fail completely with the next.

      A huge range of prophylactic measures and products are available to us (dietary and drinking advice, professional tooth cleaning, at-home hygiene instructions, sealants, fluorides, etc), and it is our job to make use of these options in an individualized way according to the patient’s needs. While many of the elements of dental prophylaxis are performed by dental hygienists or dental assistants, we as dentists have the responsibility to ensure that parents and children are continually remotivated and informed. We have to decide on and arrange regular recall intervals. It is proven that practices with a functioning recall and prophylaxis system have decreased incidence of caries and improved satisfaction among patients, not to mention that a well-implemented recall system is economically viable. Especially for families with difficult social or personal circumstances, it is extremely important to secure a recall schedule. Often times these children must be given extra instruction and motivation for carrying out their own oral hygiene because these steps are not being implemented rigorously by their parents. Unfortunately, caries is still a social condition.

      Special equipment or materials are not necessarily required for prophylaxis in childhood. It is more important to get the parents on board and simplify and shorten the existing prophylactic steps so that they succeed in a child-appropriate way. This requires a colleague with a knack for dealing with children as well as some specific further training in this field. Prophylaxis for our young patients should be fun, pain-free, and not take too long.

      TIP FOR PROPHYLAXIS WITH CHILDREN

      It is important, especially in pediatric dentistry, to make compromises without losing sight of the final goal. If a child does not want to have his or her teeth cleaned, it often works if the assistant uses their electric toothbrush instead of the prophy angle. Even the child’s own toothpaste can be used to clean the teeth. The main goal is that the plaque is removed so that the fluoride varnish can be applied and work. There are also inexpensive, child-friendly materials that improve compliance (eg, prophy angles that look like animals, flavored fluoride varnish, colored gloves, masks with painted faces). Sometimes it’s the little things that make all the difference.

      Talking to parents

      Sometimes the discussion with parents is a greater challenge than treating their children. This is partly due to a generation of parents who are confused, for instance, because of the widely varying sources of information or who increasingly question our scientifically based measures. Another factor is that the timing of the visit to the dentist may be unfavorable—for instance, if a strong and acute need for treatment already exists.

      It is not always easy to convey sometimes very extensive information to parents in a focused, concise, and understandable manner so that they are able to follow the advice when they get home. A lot of parents only remember the last three sentences of a far-ranging discussion with the dentist. Why is that?

      On the one hand, a visit to the dentist is stressful for many parents. Not only because they have to get one or more children there on time and they have to cope with the waiting time and any boredom that may be building up, but because visiting the dentist is associated with stress and anxiety for many parents themselves, and now they are managing the anxiety of their children as well. All these factors can diminish parents’ attention during an extensive explanatory discussion. This is why it is so important to keep the discussion brief and individualized, for example, based on the completed medical history form. A good method is to check the completed medical form for risk factors (eg, frequent juice drinking or oral hygiene that is performed only by the child) and mark them before we retrieve the child from the waiting room. Then we can concentrate on the risk factors and age-appropriate facts to discuss with the parents rather than telling them information they do not need at this point. The main goal should be to gain the loyalty of future parents, young parents with their babies, and the children themselves right from the very beginning in order to accompany them into a healthy life. Children are not able to take responsibility for their own oral hygiene—we have to get the parents on board from the very beginning. This is the only way we can monitor and influence children’s oral health, which is an integral part of any healthy physical development.

      Now and then parents are profoundly confused because they get contradictory advice from midwives, pediatricians, dentists, and, last but not least, from the Internet. This is why it is all the more important for the dental team to give consistent advice as the authority responsible for dental health.

      Fluorides

      Fluorides are the most important pillar of caries prevention. They are safe in the concentrations