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How to make visiting the dentist child’s play

How to make visiting the dentist child’s play

Johnson & Johnson Ltd. is delighted to bring you this article, with the aim of supporting the ongoing Enhanced CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD.

To provide feedback on this article, please contact [email protected]

Learning Outcomes: A | D

Aims & Objectives

The aim of this article is to explore how dental professionals can work to best effect with child patients in order to try, firstly, to avoid developing any fears and secondly, if that time has passed, to help them overcome their fears for a lifetime of happy and healthy visits to the dental practice.

On completing this Enhanced CPD session, the reader will:

  1. Understand the significance treating children in a knowledgeable and compassionate manner
  2. Understand the prevalence of dental anxiety in the UK for both children and adults
  3. Understand the oral health problems associated with childhood dental anxiety
  4. Understand that the communication triangle (made up of child, parent and dental professional) is a particularly important aspect of a child’s long-term dental care
  5. Understand how to support and reinforce a child’s coping behaviours during an appointment.

This article explores how dental professionals can work to best effect with child patients to prevent the development of any fears associated with attending the practice.

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Young (2016) wrote that, ‘….every GDP and every DCP should know how to treat children in a knowledgeable and compassionate manner so that their very young patients end up with a disease-free mouth and a very positive attitude towards dental health and dentists in general.’1

However, figures from the Oral Health Foundation indicate that almost half of UK adults have a fear of the dentist, with 12% suffering from an extreme dental anxiety or phobia.2

This data suggests that there may be an opportunity to reduce these worries for future generations, especially if fear of the dentist stems from a perceived traumatic event in childhood.3

Building on this picture, a UK-wide study identified high levels of dental-related anxiety in youngsters aged 12 and 15 years old, assessed at 14% and 10%, respectively.4

In addition, as suggested by Morgan and colleagues (2017), ‘Childhood dental anxiety is associated with an increased prevalence of decayed and extracted teeth, more episodes of toothache and symptomatic attendance, and lower oral health-related quality of life. As dental anxiety in adolescence is likely to continue into adulthood, it can consequently have long-term negative implications for oral health outcomes.’5

A triangle of co-operation

Young (2016) stated that dental professionals should never underestimate the influence a parent has over their child, and that such influence may be positive or negative.1

For example, as indicated by Yuan and colleagues (2019), ‘…if the parent is overly anxious for the child’s welfare or experience dental anxiety themselves, this may increase the complexity of communication strategies required to care for both child and parent. Hence, to enable a treatment alliance to occur and for treatment to begin, DHPs will require special communication styles when engaging with young children and their parents.’6

Offering further insight into this issue, Young (2016) wrote: ‘Difficult children come with a parent in tow and this three-way relationship needs to be worked on if the goals of the child’s dental care are to be achieved. Co-operation between the parent, the GDP and DCP, and the child is very important because there must be a relationship of mutual trust and understanding between all parties.’1

He continued: ‘An initially difficult child will gain confidence and develop the trust needed to become calm, unafraid and co-operative when the parent and dentist work together. By working together, the GDP, DCP and parent can help develop a positive attitude in a child, which leads to a lifetime of good dental experiences. This communication triangle (child, parent and dentist) is a very important part of a child’s long-term dental care.’1

Overcoming communication challenges

In their exploratory study of interactions between dental health professionals, children and parents, Yuan and colleagues (2019) were of the opinion that, ‘Dentists tended to use more direct communication strategies such as ‘instruction’ when interacting with parents to enhance the children’s attention and compliance. It may be suggested, however, that the focus upon parental engagement at the expense of the child resulted in poorer child participation. This proposition is supported by the findings reported here as the children were less responsive to the dentist’s communication strategies.’6

On the other hand, ‘EDDNs’ [Extended Duty Dental Nurses] observed communication strategies were different. They engaged first with the child and used ‘child speech’ to involve and provide an opportunity for the child to participate in the preventive care appointment. They exhibited this by ‘permission seeking’, ‘telling jokes’ and providing rewards to encourage involvement, the child’s participation using OHA prior to FVA. This, we believe, supported and reinforced the child’s coping behaviours during the preventive care appointment.’6

Whilst his study did have its limitations, it may offer dental professionals interesting insight into various communications styles and their potential efficacy.6

Practical guidance

Bellis (2013) offered advice on how to establish effective communication and trust with younger patients, suggesting that children tend to react to how something is said, rather than what is said to them.7

Offering practical guidance, she wrote: ‘Any language used should naturally always be age appropriate (childrenese) as should the non-verbal communication component which should act such as to reinforce rather than contradict what is being said.’7

She added, ‘Such communication includes having a child-friendly environment in the waiting area and a happy, smiling team who are positive and genuinely ‘up-beat’.’7

Continuing this train of thought, it was stated: ‘This may come as a surprise to some of you but the available research suggests that using reassurance to manage a child’s behaviour doesn’t actually work very well!’7

Put succinctly, ‘In other words, reassurance doesn’t really reassure. The act of verbally reassuring without doubt makes the dental staff feel better; however, it doesn’t actually reduce anxiety in children.’7

For example, as stated by Bellis (2013): ‘Simple phrases such as ‘Is that okay?’ or ‘Does that feel a bit funny?’ ... are remarkably effective in reducing distress in children. This is an important part of the rapport building which is so essential to the successful management of the child patient.’7

She added: ‘Combining an empathic approach with gentle pats and squeezes has been found to minimise distress for young children undergoing operative treatment. These non-verbal cues and signs are used to give positive encouragement and enhance other management techniques.’7

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Creating positivity

The effect of the interaction between dental professionals and child patients should not be underestimated.

As Schnell (2019) wrote: ‘Practitioners should strive to be aware of the messages they are sending and ensure these messages do not contradict each other. In situations where the patient is unaware of dental procedures, as is frequently the case with children, dental team members can make the difference between a positive or negative experience.’8

Questions: 

References

  1. Young MR. Welcoming children into your practice . BDJ Team 2016; 3(16119): https://doi.org/10.1038/bdjteam.2016.119

  2. Dental Anxiety and Phobia. A brief guide. Centre for Dentistry and Anxiety UK 2017

  3. https://www.dentalhealth.org/my-fear-of-the-dentist. Accessed 22 June 2020

  4. Health and Social Care Information Centre. Children's Dental Health Survey 2013 Report 1: Attitudes, Behaviours and Children's Dental Health: Health and Social Care Information Centre; 2015

  5. Morgan AG et al. Children's experiences of dental anxiety. International Journal of Paediatric Dentistry 2016; 27(2): 87-97

  6. Yuan S et al. Recording communication in primary dental practice: an exploratory study of interactions between dental health professionals, children and parents. BDJ 2019; 227(10): 887-892

  7. Bellis W. Managing the young child patient. Vital 2013; 10: 26-27

  8. Schnell J. Communication strategies for reducing patient anxiety in pedodontics dentistry. Online Journal of Dentistry & Oral Health 2019; DOI: 10.33552/OJDOH.2019.01.000521