We can design and theme our office till high-noon and do all the pop-in tours and tell-show-do and have a happy and kind staff, but there are some kids for whom this does not have the effect of acceptance. Our armamentarium of toys and stickers (or any additional rewards), does not always work with significant progress. It is these children I am speaking of and it is OK!
I present this subject because I am a realist on behalf of the parents for whom upon mentioning an upcoming dental visit to their children, are in turn facing endless questions or conversations of self-assurance by their kids. I often hear from parents that their child would not stop pep-talking themselves about how well they were going to do this time and how excited they were to get it all done this time. Sometimes, these kids come to the office and halt in the doorway, no longer so sure of their ability to comply. Again, that is OK!
In my years of experience, I can absolutely assure you that it is NOT only your child! In fact, even one of my children does not like anything in her mouth very well, hence making going to the dentist more challenging for her. I have my distractions and rewards, but there are some children who will take a long time to get comfortable with their dental visits.
Let me share my own story of my daughter. I started her baby exams with my dental hygiene colleague (Thanks, Tesa!), where I would sit in knee to knee to get her used to the baby exam process. My husband and I brushed and flossed for her at home in the same position I recommend for my families to practice. What I am suggesting, is that theoretically, I was doing “all the right steps of preparation”, but it took her (and still does at nearly 5 years age), a long time to do complete her exam and cleaning and we take numerous breaks. She asks many questions about what am I going to use and how many teeth do I really have to tickle, and that she does not like my paste and vitamins (any flavor, even pumice mixed with her toothpaste), and that I’m not going to use anything pokey (of course she only sees “Dora, the explorer” and my “ice cream scooper” and “back-scratcher”), and that she can do the exam herself (insert picking up the mirror and putting into her mouth). Oh, and she always declares when it is done—on her terms, of course. She rolls in and out of the chair when she feels she can no longer do it and yes, getting her first x-rays was challenging for her. I share all of this because I literally understand how you feel with your child and that you are NOT ALONE!
So why is this happening? I often hear words of declaration that their former dentist “traumatized them”, and to this I admit, I do not know of a colleague who causes difficult experiences for kids—neither pediatric nor general, nor any other dentist I know. I do, however, think that we all have different approaches or that perhaps what worked with our other kids that were struggling just did not have the same result with yours. Kids and parents can feel more comfortable with various people and it just may not be with us. Sometimes kids are familiar with a place and suddenly experience a change and they do not like it. It may take them a while to adjust, but I usually say to try to stick something out a few times and then decide because frequent change can be hard on them to adjust.
I often share with families that I think dentistry can feel invasive for little people and because of this we are all on high alert to make accommodations for their personal space and intentionally modify our pace and approach. Upon entering most dental offices, there may be a lot of noise—TVs, various families in the waiting room and kids chattering in the play nook, the whirring noise of the special tooth-tickling toothbrush and the conversations and humming of each child and family with their provider in the exam areas. This can be a lot, especially for someone not so keen on it all. Then there is the reality that our profession differs from their pediatric medical experiences. We come far closer in, we wear gloves and masks all the time, we ask to use various toys to look directly in their mouth, our toothpaste has more grit than they are used to, we scratch debris off their—all this in close-proximity to them for a good duration of time. Because of all these sensory and personal space concerns, I do agree it can be overwhelming for some of our little patients.
I try to keep their experience FUN & LIGHT! I offer various sunglass options to give them as much control as possible. Your kids select from various animals to clean their teeth, as well as numerous toothpaste and vitamin options. It really helps to add in some jokes from my favorite book. Oh, and check out my shark tooth collection and my crocodile dentist game—it helped train even my experienced fingers to avoid incidental chomps from my littles! Best of all…TOYS, TOYS, TOYS! We reward their hard work each and every time!
So how do we in pediatric dentistry navigate all these concerns for our more apprehensive kids? We share various tactics noted below. I know of kids for whom this has worked and others for whom nothing has worked for years and then, BOOM—they do it!
Here are the most common approaches:
We welcome you and your little to come and tour the office, no exam, no cleaning—just take a look around and meet our staff and team. Perhaps you see some exams in process. We have you play in the nook and I will come out and say hello. I position myself ALWAYS at eye-level and maintain a personal space distance for them.
We position ourselves for an exam and cleaning, be it knee-to-knee or on a parent’s lap in the reclined dental chair. I again provide tell-show-do for all my dental toys and we negotiate tickling one tooth at a time until all of them match the bright white results. For some children, drawing this process out does not do well for them, but for others, incremental steps work better.
Increasing their frequency of exams might be a great idea as well. I generally offer this for kids who struggle with their home care as well. Parents may feel nervous that despite their best efforts, they just can’t get in there with confidence that all the teeth are getting brushed and flossed regularly. For these families, an exam-only every 3 months is beneficial to reduce their cavity risks and get them more familiar with the process overall.
Time of day matters! We don’t advise this to cause parents conflict with their scheduling, but a child’s first experience really should be earlier in the day, especially for the younger or more cautious ones. Later day visits are better for experienced kids whom the tiredness of a long school day or day in general, is less likely to affect them. For that reason, many of us pediatric dentists will insist that kids under 5 or 6 should have earlier appointments. Kids get tired and that can add some additional difficulty for them with all the stimuli.
I admit that my goal when I see very apprehensive children is to certainly get a good look at their teeth to evaluate for signs of early cavities. The last thing we all want is that someone who is very scared for their exams, not be properly evaluated and then results in numerous cavities. This blog subject mostly touches on exams and cleanings. As pediatric dentists, we can often meet families referred for cavities with kids who are still adjusting to the process and presents with nervousness surrounding all things dental. The combination of fearful patient with cavities ties in more so to a previous blog of dental cavity management options and it varies significantly per child and family.
I hope this has helped some of you in this position to understand our direction and guidance. I wrote this to reassure you that progress will develop, but not always in a short period of time. Be patient with yourself and your child and make sure you have an open communication relation with your dentist!