First published in Taking Children Seriously 29
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.