Wednesday, March 27, 2013

Open Wide


This is a picture of me and a patient taken during my senior year of dental school by the Des Moines register.

My job as far as it comes to kids is a LOT easier than it was in dental school. While I had to learn maneuvers like vocal control (trying to show firmness with your voice) and a new vocabulary ("Here comes Mister Whistle!"), I am lucky enough to be able to "drug 'em" into cooperation for most of my procedures now. This makes my life a lot easier. After four years I don't remember as much about how to place silver caps or sealants like I did before. But there is one thing I will never forget--how much parents can help (or hurt) the process of routine dental care for their children.

As a rule, people are afraid of dentists. I am told on a somewhat regular basis that people “hate (me) the dentist.” I get it, I do. This phenomenon can range from annoying to very frustrating. I have been told on multiple times by patients that I “can’t come at” them with “sharp tools” that ironically are necessary for my job. I have been walked out on. I have listened to crying and screaming, cussing, and have been blamed for dental problems because of a “bad experience as a kid.” I’ve even been grabbed or pinched. It can be annoying to be told multiple times how much people are unhappy to see you and it is frustrating when you can’t get the job done because of anxiety (I’m lucky to have drugs to help with this), but it is very sad when people, especially children, are debilitated by their dental fear. I have worked on children and sometimes adults who are so afraid of the dentist they cannot tolerate ANY dental work. Think about the negative effects over a lifetime of a young child who is unable to undergo dental exams, cleanings, simple fillings, etc! 

It is unfortunate that so many of us pass on these fears to our children.

I see a lot of examples of this both in my personal social life and as a dentist over the years. In dental school we learn all sorts of techniques to explain, show, and reduce the anxiety associated with the dental appointment. We talk about "Mr Thirsty" (the suction "straw"), "silver stars" (silver fillings), and "my rocket ship" (the dental chair). We don't give shots, we "squirt sleep juice" on teeth and we try to be brave and not cry or scream because there are "sleeping babies" that we don't want to wake. Often times this special vocabulary and a little extra time with a caring/competent/patient/skilled dentist is all that is needed to make a smooth dental appointment with a happy child, proud of their shiny teeth and the sticker they received at the end. And sometimes they had no idea they even got "a shot."

Unfortunately, the fear and anxiety the parent feels often gets passed on subconsciously. Simple things like explaining in every detail what is going to happen during the procedure to “prepare” the child can be counterproductive. Mom remembers and describes in detail the horrible SHOT that they STAB in your mouth before they POUND in the filling, not the SLEEPY JUICE which is SQUIRTED on the tooth and the TAPPING in of the SILVER STAR. Not to mention when parents or siblings goad the patients with comments like, "You're gonna get a shaw-ot, you're gonna get a shaw-ot!" And please don’t use me or the appointment as a punishment or threat. I remember seeing a four year old on a dental school rotation who was screaming and thrashing around. I needed to look in her mouth to check quickly for large cavities. Her mother was scolding her and threatening her with, "If you don't stop she's going to give you a shot!" I was less than pleased with this. First, I wasn't going to give her a shot as punishment, so I couldn't follow through and two, if I needed to give her a shot later she would think she was being punished.

So here are some tips:

1. Start young! If your child is used to going to the dentist often from an early age they are likely to be less fearful. The pediatric dentistry association recommends the first dental appointment being by age 1.

2. Let them see you or other children having a positive experience. Emphasize your shiny clean teeth and your new toothbrush.

3. Some dentists will let you do a tour of the office prior to the upcoming appointment so the child can see what it is like beforehand.

4. Don't try to prepare your child too much for the appointment. Remember, most dentists (or at least ones good with children) have been trained to interact with your child in an age appropriate way. Trying to describe exactly what will happen often makes things worse and is an easy way to pass on your own fears.

5. Try to avoid comments like, "Don't worry, it wont hurt!" This often makes the child worry about what is coming next. My mom tells a funny story of a dental appointment she had when she was a kid. Her sister and brother were screaming and crying during their appointments. When it was her turn they told her she better watch out for the shot. She gripped the chair in fear until the end of the appointment when they said she was all done. She asked, "When am I going to get the shot?!" They told her she already had and was completely done. She had no idea.

6. Helping your child brush and floss until they are able to write in cursive will prevent decay and more extensive (and unpleasant) procedures at the dentist. Think about it, most adults probably can't brush their teeth well enough to avoid cavities at times and yet we expect young children who can't perform fine motor skills to perform this somewhat dexterous task. I have people tell me proudly all the time, "My two year old loves brushing his teeth!" That's great, but you really should do it again for him after he finishes.

7. Avoid sugary drinks, even juice and milk. Only water should be placed in a sippy cup and they should never go to bed with a bottle or sippy cup filled with anything but water.

8. Try not to worry so much! Trust your child’s resiliency and expect them to handle it well. Fueling their fears and not expecting them to manage their anxiety only makes things worse in the long run.

9. Trust your dentist. If you aren't sure about how they are with kids, ask them – there are many dentists who do not feel comfortable seeing children and they will probably let you know. Or find a well respected pediatric dentist in your community if you have any question or concerns.


And finally, a real life example of a great dentist at work, taken from my great dental colleague and friend Dr. Jada Kurth:

8yr old: was that the shot?
Dr K: yeah not so bad huh?
8yo: yeah easy stuff. Now I'll just wait for you to clean the tooth, and then the star dust goes in, and then some tapping and them I'll be done!
LOVE COOPERATIVE KID PATIENTS!!! Especially during spring break week when I'm seeing SO many!


I'm no pediatric dentist but I hope these can help! I don't think any parent wants to pass on a dental phobia which may prevent their child from receiving the care they need in the future. I have seen too many people who lose their teeth because they were too afraid of the dentist for routine care. Hopefully the idea of dentures is scarier for our children than the minor discomfort and anxiety a dental visit can bring!


brenna said...

I talked about this with my dentist on Monday. He recommended We bring B with us to our appointments, so he is familiar with the place, and sees it isn't scary for us. He also let's kids "help" with their parents' appointments and has little dentist toys for them to play with. I thought that is a great idea.

HSBahr said...

Thanks for sharing Erin. I appreciate all of your suggestions and totally agree with everything you said. I seriously LOVE going to the dentist and hope that I can pass that on to Kate :)

Donna said...

Thanks for this post; it's helpful. I just read an article in Parents magazine today about children's dental care so I was already thinking about some of these issues today. I take my boys to a pediatric dentist and they don't even let parents come back there anymore with the older kids. I guess we're too much of a pain! :)

Denturist said...

I loved your dental experience :) Actually, I feel a bit scary to go to the dentist. But now I feel energized and confident to go to the dentist. Thanks for helping me getting out my fear.