Patient management

Our primary goal in paediatric dentistry is to deliver quality dental care to children, but also to help teach children how to cope with their dental treatment. Some behaviours that interfere with our ability to provide quality care include: refusal to open the mouth, aggressive physical resistance to treatment such as kicking, screaming, biting, hitting and grabbing at hands or sharp instruments. Children are very open with their emotions and will cry as a part of their natural release of stress and some will use it as avoidance behaviour. A number of management techniques are available to help manage patient behaviour.

Tell-Show-Do

A method of "show-and-tell" about a procedure or instrument, using simple words and/or demonstration(s). The procedure is done as was told, followed by praise when completed. With this method, the child shows less anxiety because they know what to expect. For this reason, we ask that you leave all of the explaining to us – do not try to 'prepare' your child beforehand.

Positive
Reinforcement

A form of reward, given when a child displays positive behaviour. This may be a sticker, verbal praise, a hug or a prize.

Voice Control/
Voice Modulation

A method of gaining the attention of a child exhibiting disruptive behaviour by which the dentist's voice changes in tone or volume. What is said is not as important as the abruptness or sudden nature of the voice change. Teachers often use this method to gain a student's attention in the classroom.

Mouth Props

Are devices that support the child's mouth – we often refer to them as a chair for the teeth - in the open position, to prevent accidental closing on sharp instruments. They also permit relaxation and support for the jaw muscles during longer procedures.

Physical Support

Physical support by dentist/assistant/parent or guardian to prevent undesirable movement by holding the child's hands or upper body; stabilizing the head and/or controlling leg movements – all with the intention to prevent possible injury. Thus this is referred to as an active form of restraint.

Protective support
(pediwrap/papoose)

This is a specialized Velcro blanket used to support and limit disruptive movement and prevent injury, enabling safe and efficient treatment. It is often referred to as passive restraint since a person is not involved in holding the child.

Sedation

For some children, sedating agents will be suggested to help the younger child cope with their anxiety during treatment. This may take the form of an inhalation drug such as nitrous oxide that is breathed through a nasal hood or an oral drug that is swallowed. The use of sedation reduces anxiety and can also have an amnesic effect during the procedure.

Separation

Sometimes, treating the child without the parent in the room is the best for all concerned. This limits the distraction for both the dentist and the child and permits better communication between them. Most parents find it upsetting to witness their child's treatment and the child becomes more upset when they see their parent upset.

General Anesthesia

Sometimes a general anesthetic is considered when a child is very young, has a large number of teeth with carious lesions or has special medical needs. The anesthesiologist or sleep doctor puts your child to sleep and the dentist fixes all the teeth in one appointment as a day-care procedure.