Saturday, December 16, 2017

For those who don’t know me, I graduated in 2002 and yes - I am actually a MALE! You can probably tell from the picture above, eh? :-) I have what I think is good experience dealing with children and see about 50% children in my practice. I know most people would think that being a male would scare a lot of the kids but for some reason they all warm up to me very fast! I have a lot of little tricks and ways to make them feel welcome and motivated and wanting to come back for more! Let me also mention that in no way do I claim to be an expert. I just really enjoy and love children and they seem to enjoy me and I am going to share my experiences and how I handle them.


 

This will mainly be about a new patient child, but a lot of descriptions can be about any young child. Some of what works for me may not for you. I started this page because a recent graduate started work at a pediatric practice and wanted some pointers. You may have your own ideas and if so, I’d love to hear them and add them to this page.

 


 

Children can sometimes be fearful, but mainly it is of the "unknown".   When you first go to the waiting room to get the child that is where first impressions count the most.  Be cheerful and smile and say "Hi Madison! I'm so happy to see you!  Let's go to my room so we can get a new toothbrush!".  Leave it as simple as that and let them follow you.


Once they are in your room have them "sit on the big chair" and as soon as they do - this is VERY important - squat down beside them so that you are at a LOWER eye level than they are.  This makes you appear less like an authority figure and that you are on their level.  It psychologically makes them feel like a big girl/boy because you are looking up to them.  Then say "Hi, I'm __ and I am going to count your teeth today and get you a new toothbrush!  Did you bring all your teeth with you or did you hide some in your pockets?"  This helps loosen the mood and will get a smile out of them the majority of the time.


The next step is critical also.  Start with something they already know!  Don't introduce something new immediately.   This is the time to let them pick out a toothbrush and ask them to show you how they brush their teeth.   You can take "Mr. Squirt" and squirt a little water on the brush to soften the bristles.  This introduces the air/water syringe and they will now know what that is for.  Next, get the hand mirror and hold it for the child to see what they are doing.  Children are visual learners and seeing themselves for a moment in the mirror relaxes them.    You can then say "Great Job!  I really like how you did that!  Now let me show you how I hold the brush.  Take the brush and show a real quick demo. This is a great time to educate the parent as well as the child briefly on brushing technique, but don't get long winded as any long delay in keeping the child's attention could turn things around quickly.

As you're putting on your gloves say "You are such a big girl/boy! When we get finished I might take a picture of your teeth to show you how pretty they are!".  This is referring to the X-rays.  Yes, we do need to take radiographs but doing so in the beginning often proves it can be detrimental to the completing the appointment.  If the child does great, then take the films at the end.  Sometimes the "camera" (tubehead) can look scary because it is so large, and if the radiographs gag the child, then you've just earned some tears and lost them for the rest of the appointment.

 


 

 I then lay the chair down “so I can see you better with my sunshine light/ flashlight”. I also think it's important to offer them sunglasses if they want them, because most children have a small distance from their Maxillary teeth to their eyes and while it may not actually be directly on their eyes, it is close and they can wiggle their way under it. I'll then put my gloves on in front of them first telling them that I need them to keep my germs off them and so they don’t have to taste my fingers. I'll then put on my mask and tell them it is so they can't see my teeth while I'm working and so that I don’t breathe germs on them. After that I put on my glasses (I wear loupes) and tell them that they are my special bug eyes and as soon as I put them on I look straight into their eyes and ask if they can see me and if my eyes are big or small. I think its VERY important to do this IN FRONT of the child as when you put on the PPE gear behind them it might scare or startle them seeing a masked man in big glasses coming at them.


Then I'll pick up my mirror and let them see themselves and let them hold it and tell them that the other mirror is too big and I need a tiny one for their mouth.  I'll then pick up my "tooth counter" (explorer) and tell them that I am going to count how many teeth they have.

IMPORTANT! - I make certain that when I pick up the explorer I put my finger in the rounded part so that the pointed end is pointing away from them so that they can not see the sharp point...they only see the rounded edge...when I put it in their mouth I then rotate it away and tell them that the tooth counter touches the teeth and tickles them to make sure its a nice hard tooth because we want healthy teeth to be able to eat things that are hard or crunchy. If the child is apprehensive about opening their mouth you can have them say "weeeeee" and it will allow you to see the teeth - at least the buccal surfaces!

 


Then I'll show them Ms. Sparkle (or Mr. Sparkle if my patient is a little boy) and tell them that it’s "just like a spin toothbrush but only mine has a tail" and then I let them touch the tip so they can see it's soft and then I put some "toothpaste" (prophy paste) on it and will polish E and F first so that they don't get scared having it all the way in the posterior first. Plus, if they don't let you finish at least you were able to polish the front teeth first.

 

Then I’ll get "Mr. Thirsty" and tell him that he is like a "bendy straw" and he likes to drink up the water when you get too much in your mouth. I’ll usually tell them that "he likes to whistle when you turn him on" (so that the noise does not scare them). I usually squirt a little water on my tray or will take out my prohpy paste from the blue holder and squirt some water inside and show how he drinks it up.  I'll then show them my water syringe and put a little on their tooth and use the straw to "suck it up”. This is a perfect time to ask them “DO YOU LIKE WATER!?” It will introduce you to their drinking habits at home and hopefully they do like water and they DO drink it!

 

I’ll usually find the parent will start talking about what they give the child to drink and it allows you to discuss it while your polishing. I also like to mention to the child that “You need to drink a lot of water so you can grow up and get bigger. I have a potted plant in my room and I will have the child look at it and say It’s just like if you gave a plant or flower outside some juice or soda to drink… it would never grow would it? Your teeth are the same way and need to water them too.  You also need to drink water so you grow to be a big healthy boy/girl”. It at least gives the child something to think about. I find most kids DO want to grow up, while it may not be getting older that they desire – it’s getting bigger that they want!

 


 

Then I’ll finish polishing and then introduce them to floss (if they don't already know). Then I ask if they know what it is and say "Is this someone’s hair? (and hold it next to my head as if it was next to my hair), then ask "Is it a jump rope?" (and start moving it up over my head as if it were a jump rope) ..and then they laugh! I'll say that it is my special string to hug their teeth because their toothbrush is too big to fit in between. It's similar to when you was the germs off your hands, you have to clean in between your fingers - you have to clean in between your teeth, too!

After this I'll do the Fluoride and call it my "tooth bubble bath" and then ask if they need a new tooth brush now... then I get my BIG toothbrush and say "here...how do you like this one?" They sometimes like it and sometimes want to keep it! I'll tell them that since I cleaned their teeth, I am going to let them clean mine and I'll get the big tooth model out and put it on their lap and put the dental light on the teeth making them "feel like the dental hygienist now". Never do I say "dentist" because we are not dentists and we don't want to be ashamed of our profession nor think that it will confuse them, besides - when does a dentist ever polish teeth?


The next thing is something that I came up with that gets allot of excitement out of the children that I see. I will take some of the foam hand soap and explain to child about plaque, and how that it's sometimes invisible, but you can also see and feel it at times when you get too much of it. Then I'll go on to explain that when you brush you are trying to remove the plaque because that is what can make your teeth soft and cause problems/holes/cavities.

So, I then show the child that I am putting plaque on the teeth and that I want them to brush it off for me so that I can see they can do a good job. After putting some "plaque" in one area that the kid watches, I then turn around so the child can't see and then put some more in the special hidden places that this particular child was missing, or is a common missed spot by children.

This is a huge hit with the kids I see, and their parents even enjoy it! This is the perfect time for the child to be entertained while you are getting X-ray's, writing in chart, making appointments, or anything else and it will keep the child from touching everything in sight!

I also often put the dental light on the teeth for the kids because it makes them feel like a dentist or dental hygienist! :-)

Below are some photos of what I am referring to.


 


After this I'll usually do more OHI but where I think I am unique is that I do magic tricks for them! I'll usually do about 2-3 while waiting for the dentist to come check and its usually ones they can hold like the invisible magic coloring book, or floating cups, disappearing items, etc and they love it! I'll then tell them that they can do their own magic in their mouth by using their own “magic wand” at home which is their toothbrush and they can brush away the little plaque bugs on their teeth. I’ll tell them that if they come back in 6 months and have NO cavities - I'll teach them how to do ANY trick that I showed them! There are several other OHI aids that I use such as disclosing, the mirror, intraoral camera, etc but I don’t normally do ALL of them at once and lose their attention span.

 


 

So far, this is the best motivation tool that I have ever came up with! I started magic tricks a few years ago. Now that I've been seeing my children recalls, I have really seen a HUGE improvement in them loving to come to the dentist and WANTING to do a great job brushing at home. I feel like I am accomplishing more than just a prophylaxis because the parents tell me when they are home they always brush their teeth and say they want to do magic and kill the bugs and want to learn a real magic trick when they come back. I’ve found myself teaching a lot of magic tricks in the last six months and while some have a history of no decay, it’s the ones that have to come in repeatedly after each prophylaxis for restorative care that I am finding with no cavities. It could be the magic, it could be the extra motivation and fun, it could be that they have all their teeth already restored, or it may just be luck – but all I am worried about is that they don’t have any decay and that is what matters most to me!  I find this motivates the parents too because they usually want to learn my tricks too!  This helps them stay on top of their children's habits and brushing, as well.


User submitted info:

Gina Foxx - I was able to hold a childs wiggly tongue out of the way with placing my thumb on the floor of the mouth.

Alison - A girl in my dental hygiene class made a tooth out of paper and laminated it. Then she bought a dry erase marker and put laminated paper candy on the end. She then cut the bristles off of a tooth brush and put a peice of eraser in place of the braces. Most of us have used this and it is great. We have the kids color on bacteria and plaque and then we have them brush it off with the eraser. The kids love it and it keeps them interested.

Anonymous Have a kid you can't take bitewings on? Have them lick one of those flat, sugar-free lollipops and stick the film to it, then expose the x-ray (i.e. use the lollipop as the film holder)

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