Little tips & tricks in pedodontics not taught in dental school

[Smilemaker100]

I think one of the greatest tips I can give in regards to treating the pediatric population is that the dental assistant (if she's any good) can take on a greater role at reducing anxiety with these patients.


As much as I try sometimes, I don't think I am as gifted at behavioral intervention with pedo patients as some assistants, also mothers, who have had 10 or more years of experience working with kids. I find that it is usually helpful to have the assistant bring the child into the room and explain the treatment to them before the child even meets the dentist. The assistant will then proceed to let the child see and feel the handpieces, the suctions, etc. By the time I enter the room, the child knows what to expect so that during the procedures, when I re-explain (show,tell,do) nothing will be as mysterious or novel.


Last weekend, I had to perform a pulpotomy on a 6 year old girl who refused to stay still and keep her mouth open. She nearly bit one of my fingers off. I thought that using a mouth prop would help (it usually does to a certain extent) but the girl kept displacing it with her tongue. My assistant then took me by surprise when she told the patient, "Listen to me. We are going to sing a song together." I was thinking to myself, "What in the world?!" She then proceeded to singing scales and the child imitated her and ...this kept her mouth open long enough for me to work! It was also an efficient method at distracting the child's attention.


I work with another assistant this weekend who jokingly said to me this evening, "Are we going to sing together this weekend?" Well, we were both disappointed we wouldn't be singing !

Some little phrases that have helped me:

When you have an uncooperative child, tell them:

"Your mama and I talked a bit before I saw you. She said that you are such a great helper at home. Can you help me too? "

When a child behaves - my positive reinforcing words:

" You were the best patient of the day today " (even if they exactly aren't ) Since you were so good, you get to pick more than one prize!"

" Your mama is going to be so proud when I tell her how you behaved like a big boy/girl."

I occasionally give high fives when the kid behaves.

And of course there are all types of kiddie terms we use for dental equipment- one of my favorites is "Mr Thirsty" for the saliva ejector. Anyone else want to share the terms they coin for dental terminology when they work with kids? I can always increase my pedo "vocabulary" .

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[aphistis]

High-speed: "Mr. Whistle"
Slow-speed: "Mr. Bumpy" (I know, I know, gender discrimination...)
Rubber dam: "Raincoat for your tooth"
Rubber dam retainer: "Special ring for your tooth"

Man, I hate pedo. Pedodontists deserve gold medals as far as I'm concerned.

 

[Smilemaker100]

High-speed: "Mr. Whistle"
Slow-speed: "Mr. Bumpy" (I know, I know, gender discrimination...)
Rubber dam: "Raincoat for your tooth"
Rubber dam retainer: "Special ring for your tooth"

Man, I hate pedo. Pedodontists deserve gold medals as far as I'm concerned.

I think if you refer to the slow speed as a "tickle brush", you`ll have an easier time. Some of the kids even giggle when I use it. LOL!

Yeah, I really admire pedodontists - I think my fingers are precious. Shouldn`t pedodontists get a better disability insurance? They are in a high risk profession ;-)

 

[1992Corolla]

don't ever ask a kid if he/she wants to do something...they will say no.

Tell them you need them to do something (along with extra prizes, mr whistle, and a STRAIGHT JACKET this works great)

 

[scalpel2008]

ketamine

 

[psiyung]

High-speed: "Mr. Whistle"
Slow-speed: "Mr. Bumpy" (I know, I know, gender discrimination...)
Rubber dam: "Raincoat for your tooth"
Rubber dam retainer: "Special ring for your tooth"

Man, I hate pedo. Pedodontists deserve gold medals as far as I'm concerned.

I share your pain. I am just going to refer all my pedo out. Its just not worth the stress in my opinion

 

[Smilemaker100]

I share your pain. I am just going to refer all my pedo out. Its just not worth the stress in my opinion

That might not be a good idea if you are trying to build a practice. More often than not, when the parents are satisfied with the treatment you provide for their children, they will want to become your patients as well.

I don`t always like to deal with difficult patients but it`s a part of the profession. If you don`t attempt to try, you will never improve. However, it doesn`t mean that I will not refer when I come across a patient who is beyond my expertise or technical ability.

 

[Smilemaker100]

ketamine

Nitrous oxide *thumbs up* (if your office is equipped).

 

[Chrono1984]

Nitrous oxide *thumbs up* (if your office is equipped).

My pedo always called that the "magic nose"

It was truly magical.

 

[ktcook83]

My pedo always called that the "magic nose"

It was truly magical.

Magical indeed. We just had an activity in our pedo class this past semester where we administered nitrous to each other.
It's been the best day of dental school thus far...

 

[crazy_sherm]

High-speed: "Mr. Whistle"
Slow-speed: "Mr. Bumpy" (I know, I know, gender discrimination...)
Rubber dam: "Raincoat for your tooth"
Rubber dam retainer: "Special ring for your tooth"

Man, I hate pedo. Pedodontists deserve gold medals as far as I'm concerned.

My personal favorite:

Papoose board = "death blanket"

 

[aphistis]

Nitrous oxide *thumbs up* (if your office is equipped).

Oh yeah. N2O = clown nose. How'd I forget that one?

 

[dinesh]

eg:
"how old are you"
Patient " 6"
" a big six or a small six?You see we have realized only big six kids can do these kind of things....only they are brave enough"

eg2:
"shudup, mommie willl take you to disney land if you be quiet"

 

[ItsGavinC]

don't ever ask a kid if he/she wants to do something...they will say no.

True that. Give them choices to choose from, but always be able to live with the outcome. In other words, don't ask them if they want to get up into the dental chair. If they answer no, then you're up a creek. Tell them they need to get into the chair and ask them if they can do it on their own or if they need help. Now they have a choice and either way they are ending up in the chair.

 

[Smilemaker100]

don't ever ask a kid if he/she wants to do something...they will say no.

Tell them you need them to do something (along with extra prizes, mr whistle, and a STRAIGHT JACKET this works great)

Very good point.

 

[ivorinedust]

Whatever you do, don't bribe the kids. Rewards should come after they have shown good behavior, not before. I also do not agree with making false promises(disneyland, etc). It puts the parents in a compromising situation with the child and makes you a liar if they can't fulfill the promise.

It helps if you would gain the child's confidence by initially talking in a higher pitched voice, just like his playmates. Then as the procedure commences, you can talk in your normal voice to establish authority.

BTW, you can always make a crying child feel better by giving a ballon. Blow up a clean rubber glove with the air syringe, tie up the cuff and draw the eyes between the thumb and forefinger. Tell him it's a chicken. Works every time. Be sure to give this balloon only if he has shown some cooperation.

Ivorinedust

"Apolonia, relieve my toothache!"

 

[Lesley]

I think pedo is very hard to perform in an adult office on very young children. I don't know if it's just me, but it feels ergonomically and strategically uncomfortable to perform dentistry on a small child in a large chair. Many of the comments are correct, if you give the child an opportunity to say no, they more than likely will take it. As I work on primarily adults, young and older, I find working on young children comfortably requires a different mindset and set of skills. You and your assistant have to be prepared to work quickly and smoothly. Children have very short attention spans. My assistant is 61 years old, so the quick part is not happening for me. Knowledge and proficiency in pediatric dentistry, i.e. stainless steel crowns, different equipment all scaled down in size, a staff knowledgeable in how to deal with young children, and an office that utilizes nitrous, which we do not. I prefer to refer pedo out especially if the child requires a lot of dental work. For children who just require prophies and an occasional filling, and if the parent prefers, I'll happy to try it, but for children with extensive work or who are very anxious, it is absolutely a referral. I always let the parents know when the child is older and ready, we look forward to seeing him/her again. For those that we refer, we find that our patients look forward to returning to our office with their children and do so around mid-elementary school age or slightly later. Good luck and remember, referral is a very pleasant option for both you and the patient!

 

[capisce?]

This was something that took some experience for me to learn, so basically I learned it the hard way.

Even the most well-behaved children have a set time for which they will cooperate; if you don't get your work done in that time span, even a good child will become disruptive from frustration/impatience.

Speed (while doing clinically acceptable work) is the key. Even if you have a 5 year old who's behavior is perfect, if you push the working time past 30 mins or so there's a good chance they will become uncooperative. It's nothing they are doing wrong, but really just due to the fact that kids that young aren't supposed to have long attention spans. It may sound crazy, but learn to isolate an entire side of the mouth with a rubber dam. You can effectively clamp the Es or 6 years on the UR, LR and isolate both arches with a RD and get a lot of work done fast.

Also, parents in the operatory can be a blessing or a headache. We allow parents back with the patients at my program and I'm glad because I'm comfortable seeing patients in that situation. They can be used as leverage if needed, and in some cases the child will behave much better if the parent is gone. Sometimes, the opposite is true. The more you see children, the more experience you will gain in knowing which way to go. Sometimes you just have to call a kids 'bluff', and once you do they will cooperate.

Empathy is key. Try to imagine what it's like as a child with a wild imagination in a dental setting. If a child is scared, ask them what scares them. Always communicate with them. Tell them it's okay to be scared, and then go through TSD with the child.

If a child is crying or throwing a tantrum, instead of trying to use voice control, bend down and get in their ear and whisper to them. You'd be surprised, but they want to know what you are saying and will tone down their tantrum to hear what you are whispering. That's a good way to calm a child down.

If a child complains of something hurting them and you choose to reanesthetize, try this little trick. Next time you go back to whatever was hurting them (say, the slow speed handpiece), run it in their mouth without touching their tooth and ask if it hurts. When the answer is no, they will gain some confidence again. Next, run it only touching enamel and ask again. That way, you can discern if it's the vibrating of the handpiece that's scaring them.

I'll post more as they pop up.

 

[DrJeff]

My nice basket of 10 cent plastic toys over in the corner of my operatories as a reward combined with a calm voice and some explaining does the trick for me most of the time. That and a cold 6-pack for me back in my office for afterwards

Had a great pedo one come into my office last Thursday, and fortunately I wa sable to pick up on the roughly 20 red flags going off on this one before I got in too deep. The case, a 6 year old who has been seen on/off over the last 2 years by our local pedo medicaid dental van, for basically just screenings. Mom just started workjing for one of the local casino by my office and now has dental insurance. Her child had a 36 hour new onset complaint of almost constant, increasing throbbing pain and swelling of her right mandible. Mom took her child to another local dentist the day before, who Rx'd 250mg Amoxicillin liquid(1000mg/day) and Tylenol with Codeine Elixer and gave referrals to both a local pedodontist and oral surgeon for extraction of tooth S. Mom couldn't get into either referral, her child's pain/swelling increased overnight and momstarted calling around to other dentists to see if someone could help her child. Both my partner and I saw the child, who had a 3cm x 2cm x 1cm erythematous, warm firm extraoral swelling of the right mandibular body. Intraorally, the child had a cavitated lesion on the DO of tooth S, which also had its occlussal table approximately 4mm lower than the adjacent teeth. To top it off, the child was VERY apprehensive, and Mom and the other 2 siblings weren't exactly the best of behaved/ dentally educated folks either. A PA of Tooth S, showed the distal lesion to the pulp space, no current sign of an apical radiolusceny, and NO PDL space. Diagnosis, a blown out anklyosed lower right pedo 1st molar on a swollen child in pain whose never had any dental treatment other than a couple of cursoryscreening exams and a very dentally uneducated mom/family This case had 99.9% disaster written all over it if either myself or my partner had attempted it. This is also one of the few times when I make a referral to one of my local oral surgeons where I personally pick up the phone and speak directly with the surgeon and basically say "look, I've got a kid in pain, I know it's almost 5 o'clock already, this tooth is ugly, the exo is going to be ugly, but it has to be done because it the right thing for the child" A little guilt, combined with the 12 pack of fine Maine micro brews( the oral surgeon is originally from Maine and I always notice that he has cold Maine micros when I goto to his house for the yearly pool party he throws for his referring Docs), and many forth coming bread and butter college age wizzy extraction/sedation cases in the coming months, and it all got done.

If there's 1 pedo scenario you always want to treat witht he utmost respect, its the pedo tooth that hasn't fully errupted to the occlusal plane, when there's no reason why it shouldn't have

 

[aphistis]

If a child is crying or throwing a tantrum, instead of trying to use voice control, bend down and get in their ear and whisper to them. You'd be surprised, but they want to know what you are saying and will tone down their tantrum to hear what you are whispering. That's a good way to calm a child down.

I like this one. I'd never thought of that approach.

It's remarkable just how many pediatric patient management techniques basically reduce to harnessing the kid's own personality traits and then using them as a steering wheel.

 

[toofache32]

ketamine

You beat me to it.

 

[angeeeeee]

some that i heard while shadowing a few years ago...

varnish/polish/fluoride foam/etc = tooth shampoo

bacteria = sugar bugs *caution if kid is afraid of "bugs"

 

[DrJeff]

some that i heard while shadowing a few years ago...

varnish/polish/fluoride foam/etc = tooth shampoo

bacteria = sugar bugs *caution if kid is afraid of "bugs"

The entire "bugs" vs. "germs" terminology debate when dealing with kids is an interesting one. Personally, I've found the phrase "cavity germs" to be one that most younger kids can relate to/comprehend without bringing up any fear. This is because, most kids past the age of 3 have learned that "germs" are something that you don't want to have, and also by that point via either "your expert dental descriptions" and/or what they've heard from their parents/friends/siblings that cavities are something they don't want either.

 

[Sprgrover]

...If a child is crying or throwing a tantrum, instead of trying to use voice control, bend down and get in their ear and whisper to them. You'd be surprised, but they want to know what you are saying and will tone down their tantrum to hear what you are whispering. That's a good way to calm a child down...

I'll try this with my nephew sometime, but that's assuming I'll be brave enough to approach him, or a pedo patient, during a fit.

 

[dinesh]

Saw this on COSBY show the other night
"this is the tooth shuttle, we need a tooth astronut"
"see the tooth shuttle can take off and land, but you need to get on now! we need an astronut!"

(shuttle= chair btw)

 

[Smilemaker100]

Saw this on COSBY show the other night
"this is the tooth shuttle, we need a tooth astronut"
"see the tooth shuttle can take off and land, but you need to get on now! we need an astronut!"

(shuttle= chair btw)

LOL! Good one! Darn, I miss the Cosby show!

This reminds me of how I get little wee ones to sit in the chair (only works for toddlers -after 4 years of age they get too smart LOL!). I tell the kid that it's a "magic" chair and that the only way to make it work is if they sit in it and push the button (their nose). Each time they touch their nose, the chair either goes up or down. It always makes them giggle.