Many of you are now well aware that as part of my VT scheme I divide my time between general dental practice and the HSE, where I mainly treat patients under the age of 16.
Within the HSE, one of the many challenges I have repeatedly faced over the last few months is dealing with the anxious, over-protective and often rude parent of the child I am treating. Where was my undergraduate training in this area?
Now, don’t get me wrong. I have great empathy with children who are anxious with regard to attending the dentist. I myself was one of those children, when that little white postcard was shoved through our letter box addressed to the parent of Mairead Cotter, stating that it had been six months since my last visit. As for what followed, I can only describe is as a feeling of impending doom. I often felt that a person going to the gallows in bygone days must have experienced the very same thing! This was followed by bouts of nausea, panic attacks, restless nights and horrid dreams – until D-day (dentist day) arrived. Despite my dramatic pleas, my mother never entered the surgery with me, always remaining in the waiting room. I have no doubt my dentist greatly appreciated this.
Children are like sponges; they are not born with an abundance of knowledge but rather they acquire it, a huge amount of that knoweldge acquired in the early years from their parents or primary caregivers. Dental anxiety is a phenomenon that is learned by a child from a parent. It is often the case, at the beginning, that it is in fact the parent who is more anxious about the child attending the dentist than the child themselves.
It is a very difficult task, I may add, to perform an examination on a child while a parent insists on coming into the room, insists on being near the child, insists on putting their arms around the child, insists on stroking the child’s hair while all four siblings run riot in the surgery.
Since this episode, which did actually occur, no parent, except in extreme cases, is allowed in the surgery. The door to the surgery is kept open and both parent and child are able to see each other. I speak directly to each child in appropriate language and explain everything before I do it. As I go through each step I allow them to listen to the sounds of each handpiece and give them a mirror if they would like see their teeth while I’m explaining.
In the majority of cases I find this very effective, but there are times when exceptions are made and a parent is allowed into the surgery. This is usually when administering LA; mum or dad will place a hand on the child’s leg for reassurance. It is not necessary to cradle a patient while administering LA; in fact it is inappropriate from both health and safety and cross-infection control perspectives.
Not every technique will work for every parent-child situation and some parents will insist on staying in the surgery, creating a tense atmosphere to begin with and exacerbating the feelings of an already anxious child. It undermines my ability as a dentist, contaminating the work area and placing undue pressure on me as I work.
I have learned that the best way to handle this is to discuss it with the parent in a non-confrontational manner at the end of the session, explaining my reasons and that I have only the best interests of their child at heart. Usually we start with a clean slate at the next visit.
But you can’t win them all. And in those cases where parents feel the need to indulge in a litany, you can only hope you don’t have to see them again before your contract is finished!