Working at the Specialist Paediatric Dental Department has opened my eyes to how amazing specialist paediatric dentists are at providing an environment for children that is comfortable and safe for both the child, parent and practitioner.
Adult dentistry, opposed to paediatric dentistry, is a bit like playing baseball after cricket, or rugby league after rugby union. Sure, they’re very similar, but the rules, priorities and treatment planning goals can be quite different. While adjusting for occlusion may not be as pin-point accurate as it needs to be with children, having to consider tooth eruption and the drifting of adult teeth into the wrong spaces is something we don’t often think about (but still should)!
We are now much more understanding of the long-term effects of mental trauma a child can experience at the dentist, leading to dental-phobia and poorer longer-term dental health outcomes. While we often prioritize the ‘acute’ phase of treatment, such as pulpitis, the experience of a first-ever tooth extraction in an anxious child may have greater adverse effects.
Here are some tips I have developed through my rotation at the Specialist Paediatric Dental Department at Sydney Dental Hospital that I hope help you in your journey in treating children.
Getting good bitewings:
When a child has an extensive active carious lesion in a single primary tooth, there’s a very high likelihood that there will be more caries. Getting good bitewings can tell us so much about what treatment options are available when discussing overall treatment plans with parents. Here are a few tips that get me over the line.
- Allow the child to hold the film themselves. Give them time to feel the film. You can then ask the child, ‘Do you know what this is?’"
You can then say ‘It’s a film, we’re going to take an old-fashioned photograph that’s in black and white, and there’s our camera!’ which you can then point to the Xray unit
‘The way old cameras work, is that you need to be reaaaally still like a statue! Do you know how to play statues!?’
‘We want to take a photo of your teeth, do you want to see what your teeth look like?’ Children normally love surprises!
When the parent walks out of the room, this may upset the child, if this happens you can make a joke ‘We don’t want mum/dad to photobomb your teeth’!
Have the child tilt their head up, and when they open their mouth, use your finger on your opposite hand to push the cheek out of the way
Place the film so it is sitting in the buccal sulcus first rather than the lingual sulcus and get them to slowly close
You can then say, ‘See how easy that was?’ This may sound trivial, but it familiarizes the child with the film in their mouth, making placement on the lingual side much easier.
Do the same again but now place the film on the correct sulcus side and aim the cone to centre at the corner of the lips.
Once you exit the room and take the X-ray, you can give the child a high five before proceeding to the next bitewing.
Have patience, often-times kids just need that extra try to bite down on the film. Parents can normally tell if you are trying your best. Even if the bitewing didn’t come out so well, you’ll have a much easier time on the next visit now that the child understands what is going on and can see the photo of their teeth.
2. Learn to sing
While adults may internally brace themselves at the dentist, children are not shy about expressing their discomfort. It can be quite awkward as a new dentist treating a child once we hear a scream, often the parents can be understandably concerned. A great way to create a ‘state-break’ in this situation is to say to the child ‘You have an amazing singing voice!’ Which can usually be followed with yourself holding an ‘aaaaaah’ in a comedic way. Parents may even laugh which allows the child to pick up body language from yourself and their parent that everything is okay and expected.
3. How to know when things are going south
We all have things we are afraid of. My fear is waterslides and if you got me up the top of a giant waterslide there wouldn’t be much you could do or say to make me go down a long winding watery tube of darkness! Sky diving is another example where you can’t really rationalise someone if they don’t want to jump out of a plane.
So, it’s understandable when children can be too scared to proceed with treatment, even having a tooth extracted as an adult takes lots of courage!
Parents want their children out of pain and to be treated. Often, quotes for general anaesthesia are very expensive. As a recent graduate, it can be extremely difficult to see a child in pain with a scared parent begging you to perform treatment while the child is awake. Giving local anaesthetic to children in a way that is ‘pain-free’ and not detectable by the child takes lots of practice and mental energy. A big red flag for me is when a child cries during local anaesthetic delivery. Through my time in the paediatric department, I've learned that this is normally the time to stop before treatment has even begun.
When there are tears during local anaesthetic, even with support from the parent, it becomes difficult to know if you’ve properly anaesthetised the child. While anaesthetic may be the hardest part for adults, the sounds of buzzing from drills, the pinging noises of rubber dam clamps and pressure on extractions can also upset a child that is already having difficulty with a simple buccal infiltration that has had topical anaesthetic. Nobody wants to have to stop treatment halfway through a filling or extraction. Congratulate and reward the child on being brave and while it may seem too early to stop, the child will be able to go home knowing that the experience wasn’t so bad.
Specialist Paediatric dentists are incredible at both the technical aspects of paediatric dentistry, but also the behaviour management that allows for the child to have the best experience possible at the dentist when you need to refer. If not feeling confident to go ahead with a child that is anxious about treatment, the specialists will be able to provide greater opportunity to treat the child without general anaesthetic if the child hasn’t had too heavy an experience.
While there are still so many tips and tricks out there, I hope these have helped you to better treat your paediatric patients!
