Dentaltown May 2018 - 101

forms of parental support include providing
positive reinforcement at appropriate times
and comforting the child during difficult
moments.
Parental behaviors that can negatively
inf luence dentist/child communication
are the use of negative terms (e.g., "shot,"
"hurt"), negative behavioral reinforcement,
and repetitive or contradictory information.
Given a choice, the child is more likely to
listen to a parent than the dentist.

Finding the perfect balance
The successful treatment can be guided
by several suggestions to enlist the parent
as an engaged partner in the child's oral
health care:
Fully explain the possible options. As
part of a valid informed consent process, the
dentist should discuss all realistic options
available for treatment. In addition to the
treatment needed, it's necessary to discuss
parent desires and expectations regarding
behavior management and possible treatment
settings. Risks and benefits of each behavior
management technique should also be
covered.
The conversation is very straightforward for a well-behaved older child; for
precooperative or uncooperative infants or
toddlers, it will likely be more complicated.
In the case of a young infant with extensive
treatment needs, it may make sense to use an
advanced behavior management technique,
such as treatment with sedation or general
anesthesia.
A parent may prefer to treat the infant
in the office rather than administer general
anesthesia in a hospital or ambulatory
surgery center, because of the potential risks
versus benefits. The goal is to reach a best
solution utilizing the provider's experience
and respecting the parents' wishes.
Establish ground rules and expectations
of the child, parent and provider. Before
providing any restorative treatment, it's
important to discuss and explore the expectations of all involved and establish ground
rules for the method that the treatment is
provided. The initial or recare examination

can provide a perfect setting to assess the
child's behavior and parental interaction in
a noninvasive setting.
In the case of a parent who is likely to
interfere with doctor-child communication,
it will be helpful to discuss that the parent
may need to be a silent partner in his child's
care. For a child who may behave better in
the presence of one parent than another, it
may be helpful to have the "cooperative"
parent or family member be present with
the child. The potentially "uncooperative"
parent or family member can attend the
appointment but should remain out of the
child's sight.
In the case of a child potentially requiring
advanced behavior management techniques,
establishing a system of go/no-go during
treatment would be helpful. For example,
with a marginally cooperative child and
a parent who desires in-office treatment,
establishing that the dentist will stop and
check in with parents at strategic points (e.g.,
after local anesthesia) will help the dentist
avoid exceeding parent comfort level. If
the check-in reveals that the parent is not
comfortable with the progress of treatment,
alternatives can be discussed for continuation
of care in an alternative setting.
Realize that you may not be able to
help everyone. Unfortunately, there will be
families that do not have realistic expectations
for their child or desire treatment that may
not meet the standard of care. If after a
thorough discussion of options a consensus
is not possible, referring for a second opinion
may be the best option for you and your
patient. In the best case, it may be helpful
for the family to hear the same reinforcing
message from a neutral party. Alternatively,
they may find someone who better meets
their needs and expectations. Either way,
the child's needs and best interests are
being advanced.
Working with children can be a fun
and rewarding experience. You have an
opportunity to make an impact in the
overall growth and development of a young
individual and shape their dental experiences
for a lifetime. ■
dentaltown.com \\ MAY 2018

101
http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown May 2018
