Dentistry for Kids. Ulrike Uhlmann
an open smile, a calm manner, and nonjerky movements. Equally important is a respect for the individual child’s personal space—the personal space that they need to feel safe and secure. If people invade our personal space against our will, it can result in rejection, aggression, and anxiety, so we should not expect children to react any differently. While we generally think of any violation of this space in terms of physical proximity, personal space can also be breached nonverbally with a look or a gesture.3 Note that anxious children generally require a larger personal space than outgoing children do.
Therefore, it is important for dentists and dental assistants to read, interpret, and respect a child’s signals when interacting with them. At the same time, however, this personal space needs to be shrunk enough to make dental treatment possible. This is often where the real challenge lies. It calls for patience, a slow approach, acceptance, positive nonverbal signals, rituals (eg, similar sequence when greeting patients or going about the treatment), and sometimes even the patient’s stuffed animals or toys to act as neutral mediators. Once comfortable, children will allow the dentist to encroach on their personal space, and a neutral approach can often be adopted. Stuffed animals can also be a great advantage during treatment: They can be used to demonstrate to the child what the dentist is going to do, thereby allaying the child’s fears, or they can reflect the child’s behavior and thus be used to alter that behavior.3 For example, the dentist can use a hand puppet to mimic a child’s resistance (eg, refusing to open their mouth) and then convince the puppet to let itself be examined, rewarding it with praise and maybe even a small prize. This can influence the child’s behavior and often positively change their attitude. It is not uncommon to see young patients reflect the behavior of the stuffed animal (eg, by opening their mouth).
As mentioned initially, these aspects do not only have a bearing when the child sits down in the dentist’s chair but as soon as the child enters the practice. A friendly smile from the dental assistant at reception and greeting the young patient by name while respecting the patient’s personal space will pave the way for a successful start. When greeting or calling a child from the waiting room, it is important to get down to the child’s eye level. Anything else has an intimidating and threatening effect. On first contact in the waiting room, the ideal distance to maintain from the patient is about 1 m (3 ft). The child should be greeted before his or her parents. Personal information that can be obtained from the case history (eg, the name of the stuffed animal or the child’s favorite color) makes it easier to establish contact and create trust. In doing so, it is important to be authentic and empathetic. If it becomes clear that the child is very anxious or agitated, do not tell them that what they are feeling is not necessary. Telling a child that “there’s no reason to be nervous” is well intentioned but will not reassure a child. On the contrary, it creates additional insecurity because children learn that the feelings they are experiencing are wrong. It is better to show empathy by saying, “I can see you’re pretty nervous. I can understand that. I’ll explain everything to you exactly. That’ll help you feel comfortable.”
To maintain this first connection, once established, it is important for the young patient to be accompanied into the treatment room. This can be used as an opportunity to explain what things you might notice along the way (sounds, smells, or images), or the dentist can give an idea of what is going to happen in the treatment room.5 If the dental assistant brings the child into the treatment room, he or she should introduce the dentist and explain to the child what will happen next.
During the treatment, it is an important part of nonverbal communication for dentists or dental assistants to reassure the child with appropriate touch as soon as they have a hand free. An assistant’s hand on the shoulder, tummy, or head (especially the temples), for instance, conveys a feeling of care and protection and may set the child more at ease.6 At the same time, various acupressure points can be massaged during the treatment (see chapter 7). By contrast, stroking is often counterproductive because it may increase a child’s awareness of being touched. Be aware of this nonverbal communication, and if it is clear that the child is uncomfortable with any of this touching, stop it at once.
VERBAL COMMUNICATION: THE RIGHT CHOICE OF WORDS
Even though children are often preconditioned by their family (“If you don’t clean your teeth properly, you’ll have to go to the dentist and he’ll drill them”), we as dentists are responsible for shaping children’s positive experiences with our profession. Generally speaking, voice control is needed when dealing with young patients: different phases of treatment can be accompanied by different tones of voice and/or levels of loudness. For example, while the treatment is going on, the dentist should talk in a monotone voice that is not too loud. If a child tries to touch the syringe, for instance, he or she can be stopped in a friendly way but with a louder voice. If the child is constantly crying or whimpering, a quiet whispering voice can be used, and the child’s curiosity about what is being said may silence the crying.7
Child-appropriate language is another foundation of successful pediatric treatment. This means using simple, short sentences without any complicated or foreign words. Before the age of 5 years, children cannot grasp abstract expressions of time (afterward, then, later, etc), which can easily be a cause of frustration. In addition, it can be very helpful for the dentist to be reasonably familiar with the latest children’s movies or TV series. This can be a way of gaining the young patient’s trust. The dental practitioner must be sensitive and reflect on his or her choice of words, especially when explaining equipment or treatment steps. If a toddler has only ever heard of a drill from daddy’s tool box, it is understandably frightening if the word is used in connection with their own mouth. (Table 2-1 offers suggestions for child-appropriate terms for dental instruments.) Children have a fertile imagination, which the dentist can readily tap into. In the beginning it may involve some effort to open yourself up to this world of imagination and create a story to explain the treatment and put the child’s mind at ease. Stories can help to distract young patients and make them far more relaxed during a dental treatment.
TABLE 2-1 Suggestions for correct choice of words
| Instrument | Child-appropriate term(s) |
| Lamp | Sun |
| Probe | Tooth feeler; tooth counter |
| Suction | Magic wand that carries away spit; snorkel; drinking straw; vacuum |
| Red contra-angle or turbine (water) | Shower; water sprayer |
| Blue contra-angle | Tickle bee |
| Excavator | Little spoon |
| Syringe | Sleeping water; sleeping medicine |
| Etching gel | Smurf cream; tooth shampoo |
| Curing lamp | Magic lantern; light saber |
| Composite or other filling materials | Magic cream |
| Cotton wool rolls | Pillows for your tooth |
| Rubber dam | Raincoat for your tooth |
| Matrix | Gold or silver medals for your tooth (depending on the color of the matrix) |
| Wooden wedge |
Garden fence
|