Does Your Child Love Visiting The Dentist?

Does Your Child Love Visiting The Dentist?

First published in Taking Children Seriously 29

by Sarah Fitz-Claridge

A good dentist can make the difference between whether Little Alex loves his dentist and looks forward to visiting her, or comes to share the almost ubiquitous view that dentists are little more than legalised torturers. We used to travel sixty miles to visit our excellent dentist – until we moved closer. Someone suggested that if being close to my dentist was a factor in choosing where to live, perhaps I need to ‘get a life’, but I think that it is her values that are skewed, not mine! Access to a good dentist is an important resource in anyone's life, but absolutely essential in a child's. It is worth the effort, and worth paying for – though to my surprise, the cost of my own private dental work has been lower than the grim National Health Service dentists I had been subjecting myself to before.

One way to find a new dentist is to find out whether children you know enjoy visiting the dentist or fear it. Otherwise, look for a dentist who specialises in children's dentistry and whose waiting room contains toys, books or other things that will interest children. If the waiting room does not look child-friendly, can you expect the dentist to be? Find a dentist with a sunny disposition and a non-patronising manner, who does not turn into a schoolteacher when a child walks through the door.

Try to find a dentist who keeps abreast of current research – attends dentistry conferences; reads the journals … is she interested in her field? Does she take the ancient medical maxim ‘First, do no harm’ seriously? Does she understand that it is vital to avoid putting children off dentistry for life by pressurising them when they are not completely happy to allow an examination? Is she easy-going with customers who decide at the last minute that they do not want to open their mouth at all? Is she happy to examine Alex while he is sitting on your lap? Does she seek consent from the child, or does she say ‘Now you will be good for me, won't you? Because if you aren't, it will take longer and cost Mommy more, and she won't like that.’ If she uses such tactics, you should either explain more clearly what you require, or seek another dentist. You really must protect your child from that sort of coercion.

Does the dentist take the view that current research supports a much less interventionist approach than is common in the US? In America, finding a minimal-interventionist dentist might be more difficult than in the UK, because the dentistry culture there seems to be geared to performing as many procedures as possible. I think that American dentists may also be more prone to scientism than their British counterparts – more likely to think that the treatment needed can be determined scientifically, and therefore that your opinion is irrelevant. However, US readers may well have an advantage in one respect: if you state a condition for consenting to treatment, a US dentist should bend over backwards to respect it, for fear of lawsuits. In Britain, one can't necessarily assume that one will be obeyed by a medical professional, so it is even more important to find one who respects human rights of her own accord.

Even if the dentist will obey you, she must also have the skill required to work in that way. For instance, does she have the knowledge and experience needed to make her treatment pain-free?

Visit the dentist in advance, and say something like: ‘I want you to consider Alex to be your customer, which means that the treatment he has is for him to decide. Although this may sound odd to you, we have found it to work well for medical treatment that he has had before. Therefore, for instance, there is no point planning treatment that is going to involve anything Alex will not consent to. On the other hand, Alex is reasonable and responds well to explanations. But ultimately I'd rather end the treatment than have it done against his will. Are you willing to go along with that?’ The dentist will probably say, ‘That's fine. We’ll do it that way.’

However, that is not enough. You should also say that you expect the treatment to be painless. Of course they will all say that they make it as painless as possible. That is not enough. You need to determine whether this dentist's working practice is actually geared to providing pain-free treatment. How much effort does she apply to that problem?

A good dentist should say something like: ‘I do not expect this to hurt. I go to great lengths to ensure that it won't, and I normally succeed. But I can’t guarantee that there will be no pain at all, because to make the more complicated procedures pain-free requires a lot of effort, some of which can go wrong, so there might be a twinge or two sometimes.’

If she just says, ‘Don’t worry, we’ll just give him a local anæsthetic and he won’t feel a thing’, then you should point out that you have had local anæsthetics that have not worked, and ask how she proposes to ensure that it will work – and that the procedure of giving the anæsthetic is itself not painful. Does she use a surface anæsthetic first, and invite the child to choose his favourite flavour? Does she start working after the briefest possible wait or does she first carefully test to see whether the anæsthetic has taken effect? Does she take great care to inject anæsthetic in several places around the area to be worked on? All this takes time, but it makes the difference.

Would she prescribe a tranquilliser for a child (who wants one) an hour or two before a major procedure? Is she willing to provide a good painkiller for use afterwards if necessary?

Does she say to the child, ‘If at any time you want me to stop or pause, just raise your hand like this, and I'll stop right away’? If not, say to the child ‘If you want the dentist to stop, raise your hand and she will stop right away – won't you?’

A common diagnostic procedure is to blow the tooth with cold air. That sometimes causes twinges of pain, so you should discuss that with the child in advance. Tell the dentist that she must inform the child before embarking on any procedure, and explain what she is doing at every stage. It is important that the child remains in control of what happens to him, and is not left wondering what the dentist is doing, or may do next.

Remember, the child is in charge. If it does not seem like that to him, then he isn't. If he does not have control over the inside of his own mouth, what does he control? Your duty as a parent is to enforce that control come what may.

Comments

"Turning into a schoolteacher"

I am a speech/language therapist for a public school, a schoolteacher. I came upon your website while researching how to help a student who is terrified of going to the dentist. I am not sure what is meant by your line, "Find a dentist with a sunny disposition and a non-patronising manner, who does not turn into a schoolteacher when a child walks through the door." Could you please explain what is meant by that?

Schoolteachers

Schoolteachers are often rather rude and patronising people. They attempt to teach children things that they do not necessarily want to learn at the time when the teacher wants to teach them and they won't take 'no' for an answer. If a child refuses to do the work the teacher sets, the teacher punishes him. If a child is late for class the teacher punishes him. If the child talks in class the teacher often punishes him. Teachers also dictate timetables for many children. So teachers collude in a school system which deprives children of freedom of speech and association and they say they do this for the child's own good.

Some dentists are almost as patronising as schoolteachers. They give children boring lectures. They try to motivate children through rewards and punishments rather than explaining what he thinks he should do and why.

dental-children

Are you able to talk to your parents about it? Do you need information about why you would want to see a dentist? Do you know if dental care is available to you?

Dentists like to do regular

Dentists like to do regular check ups. I'm not sure why, actually. Does anyone know? Is it to do with catching decay early?

Assuming the poster above doesn't have any pain or bleeding or other dental problem, I'd want to know whether there's any point to regular check ups before offering advice

dentist policy

i was recently told by a dentist office that i would have to wait in the lobby while my 3yo daughter had her check up...i think she is still to young and would like to go back with her...am i being over-protective? are most dentist offices like this?

3 year old check up

I have never heard of a dentist not permitting a parent to be in the surgery while their child has a check up. Find another one, pronto!

The best dental practices for little ones have lots of toys in the waiting room, and the children wander in to have a look at their parents having their teeth checked, and then if they feel like it, they get on the chair and have a ride up and down, and they maybe open their mouth and the dentist has a quick peep inside. That would be an ideal dentist visit for a 3 year old, in my opinion.

Dentists as schoolteachers

I agree that some dentists can sound like schoolteachers. They are rather imposing and don't really know how to talk to children. Dentists should act more like friends to kids, someone they can relate to, someone whose words they will actually obey. I believe this should apply to older patients as well.

Dentists as Friends

This is a good article. Every parent has a responsibility in taking good care of their children and their children's teeth shouldn't be set aside. Initially, they could teach their little kids the values of having a good and healthy set of teeth. Stories about dentists and proper brushing are helpful too. This would lessen, if not remove their fear when they're about to visit their dentists.

Consider Your Objectives

When I am dealing with a patient that has anxiety about their dental visites, I always ask myself what are we trying to acconplish here.This applies to both children and adults.Childrens teeth only need to last until the permanent teeth are ready to come.There is no need for anything but mininal treatment to accomplish that goal.While every dentist likes to practice optimum dentistry ,this is the time to use careful judgement. I believe that to traumitize any patient in the long run will be worse for the patients lifelong dental health. When I meet resistance, I back off very quickly. Give the patient some time, establish a relationship,do what is absolutely necessary and in my opinion the long term results will be more in the best interest of the patient.

Early experiences at the Dentist

I was lucky.

I had a great dentist when I was young and the whole thing was, well, whilst not the most enjoyable thing to do, I felt safe and in good hands.

If only others were so lucky. Bad early experiences shape our view of going to the Dentist. Even if in later life we have a rough time, it's less likely to cause a problem if our attitude toward going to the dentist is positive.

Those who didn't get good care use avoidance strategies storing up dental health problems, leading to even more trauma when they finally have to seek help.

Mike

13 and i have NEVER been to the dentist

I have never been to the dentist. I have a bad cavity and it hurts to eat with it. Ive told my parents many times that i need to go but they never take me. I know that i need Braces bad but i just dont have anyone to take care of the problem. I have been using Whitestrips just so they wont look so bad. I hate it when my friends talk about going to the dentist and i cant say anything about it. PLEASE i would appreciate the Help!!!!

advice to Leah

Leah, if you live in the US (this probably applies to a lot of other countries) it is ILLEGAL for your parents not to provide you with the care you need for your health. If they cannot afford it there are public programs to pay for it. Tell them this, and if they still do not take you, talk to a trusted teacher, counselor or nurse at school. You have a right to this care. Make sure you receive it.

Anæsthetics

Any anæsthetic should be explained especially carefully to a child - there are (admittedly rare) cases where a child will prefer enduring a certain amount of pain to having an anæsthetic, potentially because it stops them from using feelings from that area to determine if something is wrong. In any case, anæsthetics also tend to cut off sensation in general, rather than just pain, and a child should know what to expect.

Also, unless your child wants to go by themselves and you and your child are absolutely sure that the dentist will respect consent (and refusing consent) from your child, go into the treatment room with them. I've seen cases (from the child's viewpoint!!) where the dentist proceeded despite clear, explicit, and repeated refusal of consent, gave no explanation to the child, refused to perform the procedure without the component to which the child did not consent (the intended procedure is perfectly feasible without it), and did not even give a full explanation to the parents. Fortunately, I realised that such experiences shouldn't be generalised to dentists as a whole.