A handy guide for general dentists on
easier treatment of pediatric patients
A few years ago, a colleague pulled me aside before his patient arrived and handed me his patient’s chart. “Please trade with me,” he begged. “I’m afraid of treating little kids.” It didn’t really make sense to me. The situation seemed a little backward—usually it’s the child who is afraid of the dentist—but I agreed to trade with him.
In hindsight, we were both just kids ourselves, only months out of school and afraid of doing just about anything on a real patient. I figured that, over the years, we’d all become comfortable treating patients of all ages. However, many general dentists still dislike treating children—they’re all too familiar with the wiggly children who scream in the dentist’s ear before treatment has even begun, the curious kids who grab instruments, and the terrified ones who cry or scream so loudly that it makes other patients afraid, too.
These fears aren’t unwarranted. Some pediatric patients will behave this way—some adult patients behave this way. However, this doesn’t mean that all young patients need to be treated by a specialist; with a few techniques, many general dentists can learn to treat children comfortably and safely.
I am a general dentist. I don’t use nitrous oxide and I don’t use a papoose board. I have, however, treated thousands of children, using several techniques I’ve found helpful.
Often, getting the patient to relax makes a huge difference in how an appointment will proceed. There are certain phrases that always seem to engage children and may even get a smile or a laugh. Simple things like a child’s sparkly or light-up shoes are a great way to start a conversation with a 5-year-old. It’s not enough to say, “I like your shoes!”—I’ll typically get a small smile in response to that, but I can do better. I’ll point to my clunky black clogs and say, “Wanna trade?” They’ll usually smile and say, “No! They won’t fit you!” When they say that I pretend to be offended and say, “Are you saying I have big feet?” it always gets a smile and a laugh. And now that they’re a little calmer, I can begin dental treatment.
I always start with “magic jelly,” the topical anesthetic. The anesthetic burns a little, so be sure to warn children long before it starts to burn. I usually say, “You can tell the magic jelly is working because it will tingle a little bit—it may even feel hot like spicy food.” Never use the word burn.
The S-H-O-T is often the make-it or break-it moment of treating pediatric patients. For wiggly patients, I typically recruit the help of the parent/guardian. As long as the guardian consents, I use the following technique:
• My assistant holds the children’s hands (so they can’t reach and grab the syringe).
• A parent covers the children’s ears (so they can’t move their head during the injection).
I’ll tell the patient, “My friend is going to hold your hands, Mommy is going to cover your ears so you don’t hear the loud noise, and I want you to close your eyes so that my bright light doesn’t hurt your eyes.”
Be sure to warn the child that an uncomfortable sensation is coming. I’ll typically say, “You might feel a little pinch from the medicine,” or the slightly less honest, “You might feel a little poke from my fingernail.”
Try to get all the “ouchies” done without having the reload the syringe. Typically, if I’m treating a lower quadrant, I’ll give 90% of the carpule for the IAN block. Then, without ever leaving the mouth, I’ll give the rest of the carpule for the buccal infiltration. That way, when I go to give more anesthetic for the buccal infiltration, it won’t hurt. I typically tell the patient while reloading the syringe, “No more ouchies, I just have to drop a little bit of the medicine next to your tooth.” The children already have some lidocaine in the area, so they don’t feel the second injection.
Oftentimes, I try to distract the children with questions during the injection. Try to be very specific. I used to just ask, “Do you want a sticker when you’re done?” but I didn’t always get a response. So then I started giving specific options. I’ll ask, “Which color sticker do you want—blue or red?” This always gets a response.
While they are numbing, make sure to use that time to show the patient exactly what you’re going to do. Always show them the handpiece (without a bur). Let them hold it. Make sure to demonstrate the loud noise it makes and how it sprays water. You can even spray the water on their little hands and say, “See? Just water and a loud noise. I’m just going to use it to clean your tooth.” If they’re getting a crown, let them hold a stainless steel crown. Tell them they come in different sizes, like shoes, and we will have to find the one that fits. If they’re getting a composite, put a little composite on their nail and harden it. They think it’s an amazing magic trick!
Extractions are often pretty quick on small children, but they can be very upsetting. If a patient is getting an extraction, make sure the guardian knows ahead of time that even though the patient is numb, they will respond to the procedure. Tell the guardian that the patient can still feel pressure and that even though they might get upset, they are in fact entirely numb. After a procedure, stress to the guardian that the child will be numb for a couple of hours and that they should be very careful not to bite their lips, tongue or cheek.
For simple exams, I try to make the experience fun for the kids. My loupes have a light, which I control with a switch attached to a small battery pack in my pocket. One time I said to a tiny patient, “I can’t get my light to turn on. Could you help me? Say, ‘Light on!’ ” When the child said, “Light on,” I flipped the switch in my pocket; his face lit up and he got all excited. It worked so well that I continue to use that little “magic trick” on tiny patients. The 5-and-under crowd love it!
Many of your patients have kids. The parents already know you and trust you as their general dentist, so there’s often no need to refer their kids to a specialist. With a few technique alterations, children can be treated by a general dentist. Many general dentists dislike seeing kids, but with a little practice, I think many will master—and maybe even enjoy—treating them.