Defining and consistently enforcing clear protocols can
help reduce strife that occurs during pediatric patient visit
As a pediatric dentist, the most consistent challenge of my clinical practice is often somehow related to the parents. My colleagues, pediatric dentists and general dentists alike, share this sentiment. How we choose to address the challenge that parents bring is an integral part of the patient/dentist relationship. Managing children in the dental practice is one thing, but addressing the parental dynamic is its own distinct topic.
Although parenting styles have evolved, and they will continue, parents will consistently affect how dentists provide care to pediatric patients. In this article, I highlight key strategies to help you stay in control of this dynamic.
Get to know them
Picture this: 6-year-old Jessica, in tears and crying loudly as she clings to her mother, Samantha. Samantha doesn’t look too good, either; her face is flushed and she’s saying everything you dread hearing in a pediatric dental office. “I told you it won’t hurt, sweetheart. They don’t have any needles here! You know what, we’ll get ice cream after this.”
At first glance, this situation might lead you to make quick assumptions and unfair judgments about Samantha and Jessica. And that reaction may lead to an unproductive appointment filled with frustration for you and your dental team.
I’ve seen this situation in my practice, and when I could have fallen for that distorted sequence of events, I decided to take a step back instead and do something different. I took extra time to introduce myself and my practice philosophy.
I then set a goal for today’s visit—something simple and achievable: an exam. From there, we would have other goals to reach, whether it was today or another appointment: dental radiographs and a dental prophylaxis. During the exam, I engaged in dialogue and shared experiences: a favorite toothpaste flavor, a popular movie, or that my children are similar in age.
Over time, and several future visits, Samantha began to trust me and she shared her personal journey with me. Jessica was born prematurely and spent several weeks in the neonatal intensive care unit. Her first year was filled with frequent pediatrician appointments and evaluations by pediatric specialists. Although Jessica is a completely healthy child now, Samantha’s experience has permanently changed how she relates to her daughter. She can’t leave her unattended and can’t bear to hear her cry.
Understanding this dynamic helped me approach behavioral management in a way that is distinct to Samantha and Jessica’s relationship. Some of these behavioral challenges were not just Jessica’s actions but also a reaction to her mother’s experience. My interaction with Samantha was received better when I showed empathy for her journey and genuine concern for her daughter’s dental experience. A unique approach to treatment evolved and as the trust was built, Samantha became my ally in her daughter’s dental care.
I’m not suggesting that I—or you—take this particular approach to treatment for all children who are uncooperative. I’m suggesting that taking the time to get to know the parents will allow for more open and honest communication. As time continues and trust develops, you can create a unique approach to treatment for each child, considering their individual parental dynamic.
Parental guidance suggested: Who’s allowed in the operatory?
One concrete method of managing the parental dynamic in a dental setting is to decide when or whether you will allow parents to be present in the clinical space. Among pediatric dentists, there are varying opinions on this topic; ultimately, the key is to know your preferences in your particular clinic, under your specific circumstances. Understanding your practice style and communicating it effectively to your dental team and patients is the key to a successful dentist/parent/child relationship.
The parental presence in the clinical space can be a wonderful way to introduce yourself and to get to know the parents and children on a more personal level. This is also a great opportunity for you to ask questions, do some teaching and show your skills. You can gain parents’ trust and confidence simply by having them see you perform your magic.
The right parents can assist you in behavior management. For young children and children with special needs, parents can be supportive and effective. It is also important to recognize that parents accompany their children to their medical appointments and are expected to assist with care, and for many parents, the dentist should be no different.
While there are certainly several advantages in having a parent be present in the clinical space, you cannot deny how well you can manage a child’s behavior and how much more quickly treatment can proceed when a parent stays in the waiting room. Children cannot divide their attention between the parent and the dentist. And if there is a choice, the parent’s voice, commands and emotional response will always take priority over the dentist.
What a parent isn’t able to do, however, is give children guidance on how they should sit, when they should open or close their mouths, or what they should expect during a dental appointment. This is where the benefit of eliminating the parent’s voice or presence from the clinical space can really help. It allows you to engage the child without interruption and maintain control of the circumstances.
You should weigh the pros and cons of each approach and decide what works best in your practice. You may even want to try both techniques and see what works best for you. What may be ideal for one dentist may not work for another. Your office culture, your dental specialty and your personality are some of many factors that will play a role in this decision. So, unfortunately, there’s no single “right” or “wrong” way to do it. And that’s OK!
Consistency is key
How you choose to practice in relation to the parents of your pediatric patients is ultimately your decision. The key is to
be consistent. Once you define your preferences, stick to your decision. It will not only be easier on your dental team but also, more importantly, will be better for your communication with the patient and their family.
It’s important to recognize that you won’t be everybody’s dentist. The trade-off is having a dental clinic that produces consistent quality results with recognizable systems in a methodical environment.
Set expectations well before the treatment appointment: Parents need to know these expectations before scheduling with your office. Be clear and authoritative, while also maintaining kindness and honesty. There is nothing worse than informing anxious parents upon arrival at the office that they can’t hold their child’s hand and comfort them. Besides creating conflict, the child may struggle with the separation more when they see their parent’s negative reaction.
Parents during a pandemic
COVID-19 has changed the landscape of clinical dentistry, including how we think about who’s in our operatories when we’re trying to minimize the number of people in the building at one time. In my practice, parents can’t remain in the operatory during an aerosol-producing procedure; they are asked to wait in the waiting room or in their vehicles, depending on the type of appointment and the age of the child.
Most parents have been understanding, considering the pandemic. This has created an opportunity for practitioners who normally practice with parents in the clinic to try a different environment. Likewise, it has allowed parents to navigate an alternative approach to treatment, where they are separated from their child or where fewer adults are allowed in the clinic.
Although we aren’t sure how temporary these new guidelines are, I’m sure they will leave some permanent changes in the practice of pediatric dentistry. If you aren’t happy with your clinic flow or you want to try something new, take this time as an opportunity for change.
My preferences and protocols
After years of practice, I have identified my preferences and defined a system in my practice. I will share those preferences, recognizing that there are many different ways to practice pediatric dentistry.
Dental disease is often recognized at the new patient exam, recall appointment or during an emergency visit. I welcome parents to accompany their children for these types of appointments. I also found this to be advantageous in perceiving the parents’ emotional and psychological role in our dynamic and determining their placement for the upcoming visit. At this time, I formulate a treatment plan and discuss the role of the parents during the next visit. We plan ahead if a different parent will bring the child to the appointment. Each parent is given plenty of time to ask any questions or address concerns. A well-informed parent is more confident and trusting.
For parents who are hesitant about separating from their child, having an open door or a window into the operatory can be a creative compromise. They can check in periodically without interrupting the procedure. Parents who insist on being present in the operatory, however, can be welcomed within clear boundaries. Specifically, no more than one parent can be present and, in an effort to minimize disruption, parents cannot tag-team or exchange places once the appointment begins. No other children can be present in the room besides the scheduled child. There is a seat in the corner of the operatory, well away from the dental chair, where the parent can sit.
I make it clear that parents cannot reposition or move the child during the procedure, because this can be unsafe. I encourage parents to be silent observers. The dental team has to direct the child during the procedure and the parents’ guidance can be a significant disruption to the child’s attention. Clearly, parents aren’t trained to explain the procedure or the steps in the same way that a dental professional can, so I worry about them using distressing terms such as needle, drill or hurt.
I absolutely will not allow cellular phones or electronics in the operatory. If parents have work to do or want to browse the internet, they are welcome to use the lounge chairs in the waiting room and have a cup of coffee.
When it comes to the parental dynamic, there’s no single “right” or “wrong” way of doing things. I encourage you to try different approaches. But if you already know your preferences, trust your gut and stick with it.
Remember that working in a positive environment where you feel confident and in control will create a happier and healthier workplace for you and your team. Show your patients and their parents that you have their best interests at heart.
If you need education on certain topics, sign up for continuing education—better yet, reach out to pediatric dental colleagues in your community, or on Dentaltown’s message boards! I’m a firm believer that knowledge is power, and that sharing knowledge with one another empowers us all. Collaboration makes for a better community.