Dr Imneet Madan talks about recognising the individuality of young patients and addressing their fears and anxieties to foster a lifetime of positive dental experiences
Healthcare encompasses a wide-reaching realm that extends beyond the mainstream of focus. In the narrative of Paediatric Dental care, the conventional focal point revolves around the dental health of children. When we think of a child, our mindset naturally gravitates towards guidance, caregiving, advising, instructions, and love, followed by subtle to intense expectations that our guidance is being heeded.
There are several instances where children are considered as ‘miniature adults’, although Child Psychology contradicts this notion, as elucidated by Swiss Psychologist Jean Piaget in 2001. The conceptualisation of children as miniature adults places a series of responsibilities on them, impacting the way they think and act from a very young age. Regarding the dental environment, expecting all children to cope in the same manner as adults or to exhibit the same levels of fear or confidence is almost unfeasible.
Clinical psychology has established that children are indeed individual beings with their own soul, heart, and mind, each possessing unique thought processes deserving of respect and understanding. Once we acknowledge the individuality of the human brain, we can forge deeper connections and establish mutual understanding.
From a broader perspective, the word ‘dentist’ has often been synonymous with ‘needle’ and ‘drill’, leading to the dental office being invariably correlated with a place of fear. Since this inherent fear is known on a generic level, it becomes the responsibility of healthcare providers to acknowledge these fears, educate children with essential information, and ultimately shift their perception to a more comfortable state.
The Stanford School of Medicine’s Clinical Psychology department has documented numerous articles regarding the mental health and significant roles of all tiers of care providers in various environments. These tiers include parents and caretakers at tier one, followed by the community, school, teachers, friends, and family at tier two, and finally, tier three, which involves caregivers, therapists, and other externally engaged health professionals.
One key point to remember is that ‘avoidance prolongs anxiety’. It is of vital importance to teach children to confront their fears gradually and with care, reassuring them that no fear is as daunting as it may appear on the surface. As documented by Cuellar in 2015, this reassurance significantly reduces associated anxiety.
During paediatric dental appointments, one of the crucial aspects of consultation is understanding the child’s behavioural patterns. This understanding often stems from parents or caregivers. Collaborating with caregivers goes a long way, as it enables the paediatric dentist to comprehend the child’s actual coping mechanisms and plan an appropriate mode of behaviour management for dental treatment that ensures the child’s cooperation.
Anxiety levels in children can be assessed and managed step by step, starting from lower levels. The Stanford School of Medicine introduced the concept of the ‘Worry Thermometer’, which indicates the level of anxiety a child is experiencing. In a dental setting, this tool helps children articulate their anxiety levels using a colour-coded system, which can then be addressed accordingly.
Another technique introduced by Thomas & Zimmer-Gembeck in 2011 is called Parent–child interaction therapy or PCIT, a family-centered treatment approach for younger children with challenging behavioural issues. PCIT operates under the acronym PRIDE:
Praise: Acknowledging correct behavior encourages the child to repeat it.
Reflection: When children express their feelings about a particular tool or procedure, it is the moral responsibility of the paediatric dentist to listen, reflect on the shared information, and respond accordingly.
Imitation: Imitating children’s actions, such as showing them that it’s natural to be anxious about the sounds produced by suction, air, or water in the mouth, helps children connect with the dentist and become more receptive to further instructions.
Description: Describing how well children are coping with each step.
Encourage: Offering rewards to reinforce good behaviour.
The magnitude of this field surpasses the scope of brief reviews. Consistently practicing, continuously educating oneself in the field of mental health has been at the core of my dental practice for almost two decades. Yet, with the vast amount of knowledge that remains undiscovered, each child patient I see as a dentist presents new opportunities for learning and implementation. It is essential to remember that as a community of paediatric dentists, we bear the responsibility of fostering a positive dental attitude in children for a lifetime.
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