Piedalue R J, Milnes A
Baie Verte Peninsula Health Centre, Newfoundland, Canada.
J Mass Dent Soc. 1994 Winter;43(1):231-5, 247-51.
Occasionally, a child will have neither previous experience with a dentist nor exposure to the attitudes of others. In this case, the dentist has to worry about the child's fear of the unknown. Managing this is relatively easy in comparison to managing children who have had bad experiences or have been influenced by the fears of their parents, siblings, or peers. For the non-problematic child, management techniques are based largely on communicative skills, starting at the first contact with the parents or guardian. Even problematic children should be handled in a similar manner during non-episodic times. As an initial assessment of a possible problematic child, dentists should determine to what extent the child is fearful, incorrigible, and overindulged. When episodes occur, the management procedure should address the culprit. If it is fear only, the child can be taught to cope with the situation through any of the behavior modification techniques, ideally in a preventive manner. The specific technique used is the operator's preference, since all depend on a high degree of suggestibility. The operator must be confident in his choice, but must keep in mind that a certain amount of maturity is required of the child for successful use of these techniques. Dentists should never display emotions that can be construed as malice. An overworked, tired, time-pressured dentist would be better to end the session and start on another occasion. However, the child must not be aware that the dentist is "quitting" the struggle. When the child returns to a productive, positive behavior it should be positively reinforced by praise and other social reinforcers. The time and effort required to treat children and the desire to teach them coping strategies will be rewarded in the long run. They will remain your patients.
