towards a child-friendly dental practice i

8/14/2019 Towards a Child-friendly Dental Practice I

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PRACTICE INFORMATION RESOURCE

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In this rst article on communicationbetween dental practitioners, childrenand their parents, we discuss why a dentalvisit may be an unpleasant experienceor some children and oer some toptips that could be adopted to help ease,and maximise the eectiveness o, thecommunication process.

Much has been written to help dentalproessionals deal with their youngpatients. Two o the most notable

publications are: . Guideline on behaviorguidance for the pediatric dental patient

by the American Academy o PediatricDentistry (AAPD); and 2. Guidelineson behaviour management in paediatric

dentistryby the European Academy oPaediatric Dentistry (EAPD). Both othese guidelines have paved the wayor best practice in paediatric dentistryand consider verbal and non-verbalcommunication key to successul dental

practitioner-child patient relationships.

Goo pa

paa syThis includes the absence o dentalear and anxiety as well as healthy oralstructures with the aim to orm thebasis or good oral health throughoutlie (Klingberg, 2006). Nevertheless,dental ear and anxiety is not uncommonamongst children and has long been

recognised by dental proessionals.

Some children are dentally earul andthis may stem rom previous dentalexperiences and their perception thatthese were traumatic, dicult and/orpainul, or example an extraction.Alternatively, they may pick up the earrom their dentally anxious parents.Irregular visits to the dentist and dentalhygienist can also be responsible or childpatients being nervous. I parents onlyseek dental care or their child when theyhave a dental problem, this may reinorcethe childs impression that all dentalvisits are traumatic and involve bad news,serious treatment and pain.

It is only when rapport and trust isestablished between a dental practitioner,a child and a parent that a positive dentalexperience, in which dental ear andanxiety is allayed and prevented, canoccur. Good communication skills are,

unarguably, the most important toolsneeded to achieve such good relationships.

COMMUNICATINg

As all dental proessionals

will know, one o the toughest

aspects o dental practice

is working with difcult,

challenging or uncooperative

patients. Children, more

oten than we would like,

are represented in this group

and it is during these times

that the dental practitioners

communication skills are put

to the test.

with children

Towards a child-friendly pracTice I

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cag a posv

s mpssoThe manner in which a child is welcomedinto the dental practice by the dental teammay infuence his/her uture behaviour

during treatment. Communication startsbeore a word is said and the rst ewminutes o an encounter are vital as it isdicult to alter a rst impression.

Is there a smile?

Is there eye contact?

Does the child feel that you look

friendly or angry and scary?

Then you begin to send verbal messages.

Is your greeting friendly and relaxed

and does the child perceive it

that way?

Do you speak and act as rushed as

you may often feel?

Usag

as pasAlthough children can see a dental visit asa distressing experience, the extent o theirdiscomort during a dental appointmentcan vary greatly rom one child to thenext. While some children are robust andcan cope well with stressul situations,others are shy and vulnerable and mayneed more time and attention in orderto eel at ease. The childs level o socio-emotional development and cognitive

unctioning is one o the key actors whichinfuences the childs reaction to dentaltreatment.

A stressed, tired, rightened or rustrated child

oten has a more immature state o mind.

Som ssa os

Dental fear a normal emotionalreaction to threatening stimuli in thedental situation.

Dental anxiety a state where thechild is evoked and eels apprehensive

about dental treatment; this isassociated with more abnormalconditions.

Socio-emotional development a growth in the eelings that we haveabout ourselves and others as well asour capabilities to adapt and respondto people.

Cognitive functioning a thoughtprocess that involves the acquisition,processing and use o inormation.

Children o the same age vary widelyin their level o maturity and cognitiveunctioning. When a child visits thesurgery, their level o development andunctioning needs to be noted and thecommunication approach adapted

accordingly. To add to this complexity,when they are under stress, tired,rightened or rustrated the child mayregress to a more immature state o mind.

I this situation arises they may not be

able to understand the necessity o dentaltreatment or may conuse the pain causedby toothache with the eared pain o theproposed dental treatment.

It is essential that a dental proessionalsupports the child and attempts toalleviate his/her ear and anxiety. Givingout messages that are suited to the childslevel o maturity rather than their agemeans that the dental proessional will beable to oer reassurance to the child and

their parent, which in turn promotes amore pleasant dental experience or all.
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Gvg ou g mssagsAs part o normal paediatric dentistrypractice, a dental practitioner will otenhave to guide and give advice to the child.The level and amount o inormationinterchange between the two partiesdepends on the childs socio-emotionaldevelopment, which has to be accuratelyassessed by the dental proessional. Inaddition to this development, otherconditions that may act as communicationbarriers should also be recognised. Thesebarriers may range rom previous negativedental experiences, parental anxiety,physical or mental disability and acuteor chronic conditions. In these cases,the dental practitioner may need to

communicate with the child using a morestructured and time-allowing approach.

Guiding the child involves teaching him/her why a regular dental visit is vital or

good health as well as amiliarising him/her with the dental procedure and setting.It is important that when dispensingadvice to the child, the message is notonly heard but it is heard in the way that itis intended. Here we discuss a wide rangeo communication techniques that canbe learned and eectively applied to anychild patient in order to allow a dentalpractitioner to achieve these goals.

Tell-show-do

One approach that is ecient andthereore should be considered is thetraditional tell-show-do method o

teaching. Have a look at the box on the letto see how this technique can be achieved.

Voice control

In order to gain the childs attentionand establish authority, a tactic o voicecontrol can be put into practice. Thisinvolves a controlled alteration o voicevolume, tone, pitch and pace to infuenceor direct the child. However, parentswho are unamiliar with this techniquemay nd it aversive, or example whena loud voice is used to get the childinterested, and they should be given anexplanation prior to its use to prevent amisunderstanding (AAPD, 2008).

It is important that when dispensing advice to

the child, the message is not only heard but

it is heard in the way that it is intended.

t-so-o

The technique involves: (AAPD, 2008)

tell verbal explanation o dentaltreatment in a language that isappropriate to the childs levelo maturity

show demonstration or the child othe visual, auditory, olactory and tactileaspects o the treatment in a careullydefned, non-threatening setting

do completion o the procedurewithout deviating rom theexplanation and demonstration.


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Positive reinforcement

Any improvement in a childs oral healthand oral care routine should be recognisedand rewarded by a dental proessional.This strategy o positive reinorcement isvery eective as it builds condence in the

child and encourages him/her to continuegood behaviour. Social reinorcersinclude positive voice modulation, acialexpression, verbal praise and appropriatephysical demonstrations o aection,while non-social reinorcers can be tokenseg stickers and toys (AAPD, 2008).

Non-verbal communication

Although relevant to any child patient,this technique should be emphasised inchildren who are hearing impaired. It is thereinorcement o other communicationstrategies through appropriate contact,

posture, acial expression and bodylanguage, which is commonly used togain and maintain the childs attention(AAPD, 2008).

Every child should be empowered

with a positive attitude towards

dental care as this forms the basis for

good oral health for life. This scenario

can only be achieved when effective

communication skills, many of which

have been discussed here, are put intopractice. It is in the dental practitioners

power to change what may once have

been perceived as a traumatic dental

visit into a more pleasant experience,

in which dental fear and anxiety is

eliminated and guidance and advice is

truly understood.

rfs

AAPD (2008). Guideline on behavior guidance for the pediatric dental patient. Chicago.

Klingberg G, Freeman R, ten Berge M, Veerkamp J (2006). EAPD Guidelines on behaviour management in paediatric dentistry:revised draft.

Fu fomao

AquareshScienceAcademy.com houses a wealth o materials and resources designed tohelp you and your team unction as an eective dental care unit. For more inormationon tactics that can be successully used to make the dental experience pleasant orchildren, reer to the article: Towards a child-friendly practice II Strategies for success.Visit our Patient Focus section or urther articles and slide presentations on patientmotivation and communication.

Positive reinorcement is very

eective as it builds confdence

and encourages good behaviour.

towards a child-friendly dental practice i

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