Behavior Guidance in Dentistry for Children

Children often have anxiety when they experience something new. It is natural to have a fear of the unknown and this fear can show itself as misbehavior in the dental office. Pediatric dentists have special training to help manage the fears of children and guide their behavior in the dental office. Pediatric dentists have several goals regarding children’s behavior. One is to have the child be comfortable during dental treatment. Another is to provide the optimum in dental treatment safely and easily for the patient. Still another is to encourage the child to continue regular dental visits in the future. Pediatric dentists have a variety of methods for achieving these goals.

Behavior guidance in the dental office begins at home. Parents should never talk about pain from their dental visits or tell other dental “horror stories” in front of their children. A visit to the dentist should never be threatened as punishment for bad behavior. Parents should have and should give their children reasonable expectations for what will happen in the dental office.  Young children are usually best seen in the morning; even the best behaved child’s attention span is shortened after a day of activity.

Tell – Show – Do
The pediatric dental team explains the treatment in terms just right for the child’s age and level of understanding, demonstrates the treatment in a simplified manner and then does the treatment.

Voice Control
The pediatric dental team changes voice tone or volume to calm a child or get their attention. Typically we speak in a soft controlled tone and repeat messages as necessary. We may occasionally use a louder tone to discourage disruptive behavior or movements that can pose a risk to the child, such as reaching for a sharp instrument or grabbing the dentist’s hand.

Parental Presence
Some children behave better with parents in the room, while others do better without their favorite audience. Sometimes a parent may be asked to leave the room for a short while in order to gain control of the child’s behavior and enhance effective communication between the dentist and child.

Local Anesthetics
With modern equipment and techniques, many pediatric dental procedures can be performed comfortably without anesthetics, but some procedures still require local anesthesia to avoid discomfort. New techniques often allow us to make single teeth numb without the face and tongue being involved.

Nitrous Oxide/Oxygen Analgesia
If a child is worried by the sight, sounds, or sensations of dental treatment, they may respond more positively with the use of nitrous oxide/oxygen, which can reduce anxiety and gagging and make appointments easier. The child remains fully conscious during treatment with this extremely safe analgesic. Recovery after treatment is rapid and complete within a few minutes.

Oral Conscous Sedation
There are children whose age, behavior and the extent of necessary treatment make the use of deeper sedating medications necessary. Both New York and New Jersey require that dentists who use these medications be specially trained and licensed to perform treatment under conscious sedation. The child is given a measured amount of medication before treatment and must wait until the medications take effect before treatment. The child is conscious during treatment but less aware of what is happening. Often these medications allow the dentist to complete treatment of an entire mouth in just one visit. The child is monitored with the same sophisticated equipment found in hospital operating rooms.

General Anesthesia 
Many pediatric dentists have full surgical privileges at a hospital to provide necessary dental care under general anesthesia for those children for whom conscious sedation is impossible or inadequate. The child is asleep during treatment and there is a longer recovery period than with conscious sedation.

A conversation with your child’s dentist can help determine the best way to provide optimum dental care for your child.
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Dr. Richard Gindi is a pediatric dentist in Brooklyn, NY and Oakhurst, NJ with a license to perform oral conscious sedation in New York and New Jersey and is a senior attending at Monmouth Medical Center.