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Introducing Dentistry to the Child
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F o r each d egree o f saturation, there w ould be a h ig h brillian ce (A ) and a lo w b rillian ce (B ). T h e coordinate color scale w ou ld therefore be as indicated in F igu re 7. T h is system contains tw elve colors. F ro m a p ractical standpoint, how ever, they are not all necessary. T h e
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bulk of the teeth w ou ld be o f low er b ril liance. T h erefore,
could be d e le te d ;
w ou ld be a rare color, and that could be d eleted also. T h e practical scale w ou ld be as indicated in F igu re 8. T hese ten colors w ou ld cover the entire range in n atural teeth.
INTRODUCING DENTISTRY TO THE CHILD By R
alph
L . I r e l a n d , * B .S., D .D .S ., L in coln, N ebr.
H E im pression created in a young ch ild ’s m ind on his first visit to the dentist is lasting, and, in most cases, determ ines his fu tu re attitu d e tow ard dentistry and his fu tu re behavior in a d en tal chair. Because the first visit is so im portant, the dentist’s “ ap p roach ,” or “ routine,” is o f v ital concern. W h ile th e first appointm ent routine is significant, it is also im perative th at the dentist “ follow throu gh” at fu tu re visits so th a t the dentist-child relationship w ill be strengthened. T h e confidence and trust w h ich a ch ild has in the dentist should never be je o p a rd iz e d : once lost, they m ay n ever be regained. C on se quently, n ot on ly the first, but also every association th at a ch ild has w ith dentistry should be, as fa r as possible, a pleasant experience. U n fo rtu n a tely , the dentist is n ot al w ays given the op portu n ity to properly introduce him self and dentistry to the child. Som e children, because o f re marks m ade b y their parents, áre p a r tially or com pletely ruined as dental patients before they ever enter a dental office. S u ch rem arks at the dinner
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•Professor of pedodontics, University of Nebraska, College o f Dentistry. Prepared for the American Dental Associa tion, Section on Dentistry for Children and O ral Hygiene, 19 4 a.
Jour. A.D.A., Vol. 30, February 1, 1943
table in the child’s presence as “ I w ent to the dentist today an d he n early killed m e,” or “ I h ave to go to the dentist to m orrow and I know i,t is go in g to hurt terribly,” are certainly im portan t factors in the ch ild ’s b eh avior w hen he later visits the dentist. E specially is this true if the child has never b een to the dentist, because the im pression is im m ediately created in his m ind th a t the dentist is n othin g short o f a d e v il; otherwise, w hy w ou ld h e w a n t to h u rt “ M om m y” and “D addy” ? T h e m ajority o f children, how ever, do not, before their first den tal appoint m ent, h a ve this kin d of background. E ith er n othin g has been said in their presence abou t dentists or they h a ve been wisely educated by their parents to look upon the dentist as a friend, some one w ho w ill help them . T h ere is no one “ tech n ic” or “ routine” th at can be used to m an age a ll children. E very child is different. T h ere are, h ow ever, certain procedures th a t w e can use in ou r approach w h ich w ill apply to all children. In order to form u late a suit able techn ic based on sound principles fo r our approach, it is necessary th at w e h a ve some know ledge o f : ( 1 ) childhqod psych ology; (2) childhood fea rs; (3) how children react to certain procedures and situations, and (4) certain of
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the new er concepts o f child training. Sadler, w h o thinks th a t -childhood psychology is not easy to m aster, says, “ T h e child is born w ith b u t tw o or three innate fe a r s : fea r o f sudden loud and shrill noises, fe a r o f fallin g, and fear upon sudden arousal from sleep.” H e says, “ T h e child in the nursery is subject to innum erable fears, b u t in the m ajority o f cases they fa ll into the follow in g com prehensive classifications o f ad u lt f e a r s : i. F ear o f extinction. 2. F ea r o f the u n know n. 3. F ea r of being trapped. 4. F ear of the herd. 5. R eligious fears.” 1 Jersild,2 in observing a group o f ch il dren betw een 5 and 12 years o f age, observed th at th ey h a d m any unnecessary fears. H e group ed them as fo llo w s: (1 ) fear o f the supernatural, death, co rp ses; (2) fear o f a n im a ls; (3) fea r o f the dark, new surroundings, new environ m ent, and (4) fea r o f bodily hurt. W ith the help o f a group o f children betw een 5 and 12 years, W illard C . O lson, professor o f ed u cation at the U n i versity of M ich iga n , listed a grou p of statements abou t den tal office p ro cedures. E ach ch ild was asked to check w hether he liked, disliked o r was in different to each procedure. T h e exp eri m ent revealed th a t these children liked the fo llo w in g : 1. Calling me by my first name when I come in. 2. Showing me all around the office and laboratory. 3. Having magazines, books, paper, pencil and things to play with in the waiting room. 4. Having interesting pictures on the wall. 5. Talking about the things I like to do. 6. Explaining what he is going to do and how he is going to do it. 7. Giving me a mirror so that I can watch the work. 8. Telling me about his instruments and what they are used for. 9. Giving me a signal I can use when it begins to hurt. 10. Stopping when I tell him to. 11. Taking radiographs of my teeth. 12. Using flavor in the mouth wash and cleaning powder.
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13. Treating me just as he does a “grown-up.” * 14. Keeping my father and mother in the room when he is working.* 15. Giving me tooth paste or some little thing after work is finished. 16. Giving me the teeth that are taken out. 17. Telling me “ You are a good patient” or something like that. T h e y disliked these p ro ced u res: 1. Keeping me waiting. 2. Asking questions about my age, grade, school, teacher and birthday to “make” conversation.* 3. Putting all of his tools out in front of me at once. 4. Telling me “ It won’t hurt” even if it will. 5. Staring at me while he is working. 6. Scolding me for not sitting still or fol lowing directions. 7. Making fun of me, calling me a “ baby” or anything like that. 8. Comparing me with other children. 9. Trying to be funny or acting silly.* 10. Telling my parents that I was hard to work on. T h e N atio n al C om m ittee fo r M en tal H ygiene has set forth in contrast the older and n ew er view s concern in g child training. Som e o f the new view s that ■apply to our problem a re as follow s3 : 1. Understanding the complex life of a .child is a difficult art worth acquiring. 2. Besides the physical care, the child needs a sense of security, understanding and affection. 3. The child inherits traits and tenden cies, yet his behavior is largely the result of training and imitation. 4. Even the very young child is pro foundly influenced by the moods of those about him. 5. A ll children should be treated with equal consideration, but each with special regard for his peculiar make-up and needs. 6. Love is a much better basis than fear. Too great fear may cripple. Love does not mean indulgence and pampering. 7. Unwise “ don’ts” m ay provoke mis behavior. Activity should be directed to wholesome pursuits. •Show ed an age difference in reaction.
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8. Obedience is not an end. The child should be taught to make wise choices for himself. 9. “ W ill” is an abstraction, and the child faces concrete choices, desires, obstacles and control of emotions. •10. Repression is dangerous and proper recognition is helpful. 11. A child’s questions deserve straight forward answers to establish the right rela tions. 12. The child reasons from such knowl edge as he has and grows in reason by wise encouragement.
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3. Proper introduction of instruments. 4. C a refu l w ord usage. 5. C om fort of the child in the op erat in g room. 6. Gifts. t h e
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S ig h t.— N o t on ly children, b u t also m ost adults, are a fra id o f the unknow n. T h e first visit to th e dentist is a n ew ex perience to the child. H e im m ed iately explores his surroundings by looking around the reception room to see w hat kind o f p lace his m other has brought him to. If, in the first appraisal o f his environm ent, h e sees som ething w ith w h ich he is fam iliar, the plu n ge from
Fig. 2.— Appearance of child in adult den tal chair. In this position, it is difficult for the child to relax.
his w orld into the dental w orld w ill not be too sudden. A satisfactory w ay to set the stage for conditioning the child to his new en vironm ent is to reserve a p a rt o f the 13. True information protects from false reception room fo r him . It need not be and unwholesome attitudes. large, just one corner, in w h ich can be F rom the foregoing, it can be seen p laced a sm all table and a fe w chairs, th at if the ch ild ’s association w ith den some ch ildren ’s books and some toys. tistry is to be a pleasant experience, w e (F ig. 1.) Seeing objects o f this type w ith m ust take into consideration and incor w hich he is fam iliar has the effect of porate into our techn ic o f approach relieving most, if n ot all, o f the ch ild ’s these fe a tu r e s : an xiety, and he decides th at the p lace is 1. A p p e a l to the ch ild ’s special senses. n ot very differen t from hom e. 2. R eco gn ition o f the child as an in d i T h e reception room should also be vidual. light, cheerful and clean and the color Fig. 1.— Reception room of dentist in gen eral practice, showing corner reserved for child patients, whose drawings decorate the wall.
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com binations appealin g. T h e sam e a p plies to the laboratory and the operatin g room . W h en the child comes into the op eratin g room , all instrum ents should be out o f sight. A bracket table “ loaded dow n w ith terrible looking instrum ents” is n ot con d ucive to good ch ild m an age m ent an d does not afford the m ost pleasant introduction to dentistry. T h e situation is n ot unlike b eing m et at the door b y a huge, fierce looking d og on visitin g a strange house. H earing .— N o t only w h a t w e say, b u t also h o w w e say it is im portant in talkin g w ith children. A sm all child can sense displeasure b y the tone o f voice. W e can, b y the tone o f the voice, help to instill confidence in the child. O n the oth er hand , the tone o f voice has m uch to d o w ith negative reactions in children. T h a t an in d ivid ual’ s m ood is easily b e trayed b y the vo ice is evidenced d aily on rad io program s. E ven though you m ay be an gry o r em otionally “ upset,” never let your vo ice b etray you r felings. Y o u r vo ice should reflect kindness, sincerity and courtesy. S m e ll.— T h e reception room and the op eratin g room should be free from offensive odors. A n od or o f iodoform or o f form ald eh yd e or some oth er o b noxious odor has a tendency to cause the child to b e apprehensive. Since m ost children are v e ry critical, the ch ild m ay inform us in n o un certain terms th a t “ it smells b a d aroun d h ere.” R e g a rd in g odors, P elton says, People have always believed and na turally cling to the notion that anything that has a bad odor must be detrimental to health. T he odors of medicaments per meating hospitals and doctor’s offices excite an uneasy and apprehensive attitude through association with the horror of the place, real or imagined. While the disagreeable odors are not harmful, they should be eliminated from the dental office for esthetic and psychologic reasons. T aste.— T a ste, b ein g closely associ ated w ith smell, likew ise plays an im por tan t p a rt in introducing dentistry to the
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child. Strong, bad -tastin g m edicam ents should be avoid ed w h en ever possible. A ll m outh-w ashes, disclosing solutions and pastes used fo r prophylaxis and po l ishing silver or gold in the m ou th should b e flavored. S everal drops o f oil of w intergreen in a glass o f w a ter m akes a pleasant m ou th rinse. A drop o f w intergreen or oil o f cinnam on should also be added to the m ixtu re o f pum ice and w a ter used fo r polishing silver am algam in the m outh . E aslick has suggested a form u la fo r a pleasant tastin g prophy laxis paste and a disclosing solution : Prophylaxis Paste Flour of pumice Borax Glycerin Carmine O il of spearmint
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70 gm. 30 gm. 75 gm25 gm. i drop
Disclosing Solution Bismarck brown 3 gm. Alcohol 10 cc. Glycerin 120 cc. O il of anise i drop r e c o g n it io n o f t h e c h il d a s a n in d iv id u a l
O n e o f the procedures th a t children liked in D r. O lson’s experim ent w as to be treated like a “ grow n up.w A ll ch il dren w a n t to be accep ted on the ad u lt level. T h e y m a y .,n o t alw ays w a n t to respond as adults, b u t th ey w a n t to be recognized as individuals. T h e dentist w h o talks b ab y talk and calls a b u r a “ bee” an d the h and p iece a “ buzzer” is on ly m akin g him self rid icu lous in the eyes o f the child. T h is prac tice w ill not b u ild confidence or respect. T h e child should b e greeted w ith a smile, called by his first nam e an d treated as tho u gh he w ere an im portant person. in t r o d u c t io n o f in s t r u m e n t s
W h en the ch ild first enters the operat in g room , all instrum ents should b e con cealed. A s th ey are needed, they can be taken from the cabinet an d the child told the nam e of each instrum ent. T h e child should also be allow ed to see and
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feel and, w hen ever possible, b e given a dem onstration o f h o w th e instrum ents are used. T h e use of the bur or rubber cup can first be dem onstrated on the dentist’s fingernail, then on the child’s. T h e exp lo rer can be introduced in a sim ilar m anner. T h e ch ild ’s finger can be held in fron t of the m ou th m irror to show th at the m irror reflects objects and the saliva ejecto r can be held in a glass of w a ter to dem onstrate h ow it “ drinks” w ater. T h e dentist can dem onstrate how the air syringe works b y first blow in g air on the ch ild ’s hand or arm . B efore tak-
in securing the ch ild ’s cooperation. In dealin g w ith children up to 4 or 5 years o f age, the few er words used in givin g com m ands, the better. In m any cases, only one, or not m ore than tw o o r three w ill suffice. I f too m any words are used the child becom es confused. W e should say “ Sit b ack ,” instead o f “ I can ’t do anythin g fo r you if you keep leanin g forw ard a ll the tim e” ; say “ O p e n ,” in stead o f “ W h y don’ t you keep your m ou th op en ?” O u r rem arks and instructions to ch il dren should b e positive. T h e y suggest the correct w a y o f doing things. Sadler says, T h e constant repetition of “ don’t”— “ don’t do this” and “ don’t do that”— is in
Fig. 4.— Under side of seat shown in Figure 3. The small boards, which are curved to fit the arms of the chair, are padded to prevent scratching. Fig. 3.— Seating arrangement suggested for office having no child’s chair.
in g roentgenogram s, he should explain to the ch ild w h at he is go in g to do and th at the m achin e w ill m ake a “ buzzing sound,” stating w hat h e expects o f the child. T h is is a wise precaution in all op erative procedures. I f children h ave ad van ce instructions, they cooperate better. T H E U SE OF W O R D S
T h e righ t words, sincerely spoken, can do m uch to allay a ch ild ’s fears and aid
itself a great producer of fears.1 We can do much to avoid arousing undesirable negativism in youths by the way in which we approach them. We can give commands with a smile. We can employ indirect in timations in the vein of “ Will you do me this favor?” 5 W e should talk to the child on the ad u lt level, avoid in g b ab y talk. W e answ er all questions tru th fu lly and sensi b ly and should praise the child, not criticize him . T h e child should be w arn ed if any p a rt o f the operation is to be painfu l. Com m ands to sm all children
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need tim e to “ sink in.” W e can n o t ex p e ct them to respond im m ediately, and w e should avoid such words as “ p a in ,” “ h u rt,” “ cu t,” “ slice,” “ chop” a n d “ blow u p ” w h en referrin g to pulpotom ies or pulpectom ies. the
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I f the child is to retain a pleasant m em ory o f his visit to the dentist, p ro vision should be m ade for his com fort w hile in the d ental chair. I t is im pos sible to low er the b ack and headrest of the a verage d ental ch air sufficiently to accom m od ate children. W ith the back and headrest in the low est position, the ch ild ’ s head is throw n forw ard , so th at the chin is alm ost resting on his chest. (F ig. 2.) I t is impossible fo r the child to relax in this position. A c h a ir th at is too b ig gives the ch ild the im pression of b ein g “ trap ped ” or surrounded. In a seat placed over the arm s of the chair, the child is elevated so that his b ack and shoulders fit the b ack rest and his h ea d can be properly positioned in the headrest. (F ig. 3.) T h is m akes the w hole d ental procedure m ore com fort able and less tiring fo r the ch ild as w ell as fo r the dentist. GIFTS
C h ild ren like to receive gifts. T h is w as clearly shown by D r. O lson ’s exp eri m ent. Jersild’s6 w ork also b rou gh t this out. T h e p ractice o f givin g children som e g ift a t the end o f the dental a p pointm ent is one that has recently gain ed in popularity. In discussing this p ractice, Pelton says, “ I f a child w h o fears th e dentist is given a toy or souvenir a t each ap p o in t m ent, h e soon learns th at th e dentist is n ot a person to be feared, and the u n pleasant aspects o f the appointm ent are forgo tten .” 4 T h e dentist should not, how ever, give gifts to children fo r good con d u ct alone. C h ild ren should not b e “ bribed” into
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being good. I f the dentist desires to giv e souvenirs, every child should be given one regardless of w hether he w as a good or a bad patient. Souvenirs should be given , as P elton says, “ to m ake the d en tal office attractive to children, to inter est the shy and apprehensive patient, to im prove the behavior o f children, to in crease the num ber o f children in his practice and to transform the visit into an excitin g even t.” 7 SUMMARY
T o prop erly introd u ce dentistry to children, a definite “ approach” should be plann ed so th at every association th at the ch ild has w ith dentistry w ill b e a pleasant experience. The follow in g points are suggested for the first as w ell as subsequent appointm ents. I . T h e D e n ta l O ffice E nvironm ent. A . T h e reception room . 1. A special corner should b e reserved fo r the child. A sm all table and chairs, picture books and a few toys should be provided. 2. T h e reception room should be light, clean an d cheerful. B. T h e op eratin g room . 1. T h e op eratin g room should be clean and free fro m offensive odors and should be d ecorated in pleasing colors. 2. A m p le tim e should b e allow ed for the ch ild to inspect his surroundings. II. T h e Special Senses. A . Sight. 1. T h ere should be a ch ild ’s corner in the reception room . 2. T h e reception room and operatin g room should be decorated in pleasing colors. 3. A ll instrum ents should be Out o f sight w h en the child first enters the operatin g room . B. H earing. 1. L ou d noises should b e avoided. 2. T h e vo ice should b e low and gentle. 3. T h e vo ice should reflect kindness, courtesy an d sincerity.
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C . Sm ell. i . T h e reception room , laboratory an d operatin g room should b e free from offensive odors. D . T aste. 1. B ad tasting m edicam ents should be avoided. 2. T h e prophylaxis paste, disclosing solution, m outh rinse and polish in g paste should b e flavored. I I I . R ecogn ition o f the C h ild as an In d ivid u al. 1. T h e child should be approach ed on the a d u lt level. 2. T h e dentist should not talk baby talk. 3. E ach child should be treated as an ind ivid ual— a “ som ebody.” 4. T h e dentist should not com pare the child w ith other children. I V . T h e In troduction o f Instrum ents. 1. E very instrum ent should be p rop erly introduced. 2. T h e child should be told the nam e o f the instrum ent and the dentist should dem onstrate h ow it is used. 3. T h e child should be perm itted to feel and handle each instrum ent. V . T h e U se o f W ords. 1. A ll questions should be answ ered truthfully. T h e child should never be deceived. 2. T h e bur should n ot b e called a “ bee” or the handpiece a “ buzzer.” 3. T h e child should be called by his or her first nam e. 4. Such words as “ h u rt,” “ pain,” “ cu t,” “ blow -up,” “ ch op” and “ slice” should be avoided. 5. R em arks should be positive. 6. Com m ands should be simple. V I . C h a ir S eating A rran gem ent. 1. T h e average d ental ch air cannot b e adjusted to m ake the child com fort able. 2. I f a jun ior ch air is n ot available, som e other provision should be m ade. 3. A board m ade so th a t it w ill fit over the handles o f the ch air w ill elevate th e child so th at it w ill b e possible to
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properly position his h ead in the headrest. 4. P la cin g a tow el o r paper n apkin over the seat o f the ch air w ill prevent scratching. V I I . G ifts. 1. I f gifts are m ade to one child, they should be given to every child, rega rd less o f behavior. 2. G ifts are m ade to render the dental appointm ent attractive. V I I I . A d d ition al Suggestions. 1. D o not keep the ch ild w aiting. 2. G reet the ch ild w ith a sm ile. W ith a sm all child, kneel so as n ot to “ tow er” above him . 3. D o not rush the ch ild into the o p erating room . 4. B e slow and deliberate in your m ovem ents. R a p id m ovem ents tend to confuse th e child. 5. D o not fu m ble or hesitate. A child w ill soon sense indecision. 6. A v o id pain a t the first appointm ent. A prophylaxis is a good introduction to dentistry. 7. M a k e appointm ents short. Sm all children can not cooperate fo r long periods. 8. D o not exp ect the child to respond im m ediately. Requests need tim e to “ sink in.” BIBLIOGRAPHY 1. S a d l e r , W . S .: Theory and Practice of Psychiatry. S t. Louis: C. V . Mosby Co., 19 3 6 , P- 336. 2 . J e r s il d , A. T .: Child Psychology. New York: Prentice-Hall Inc., 1933 . 3 . National Committee for Mental H ygiene: O ld and New V ersions-of Child Training. New York, 1929 . 4 . P e l t o n , W. J.: Fear Control in Chil dren’s Dentistry. J.A .D .A ., 2 6 : 138 1 , August 19395 . Reference 1 , p. 364 . 6 . J e r s il d , A. T . : Children’s Fears, Dreams, Wishes, D ay Dreams, Likes, Dislikes, Pleasant and Unpleasant Memories. New York T each ers College, Colum bia University, 1933 , pp. X I, 17 2 . 7 . P e l t o n , W . J.: Three to Six Appeal. J.A .D .A ., 2 7 : 1502 , September 1940 .
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F o r each d egree o f saturation, there w ould be a h ig h brillian ce (A ) and a lo w b rillian ce (B ). T h e coordinate color scale w ou ld therefore be as indicated in F igu re 7. T h is system contains tw elve colors. F ro m a p ractical standpoint, how ever, they are not all necessary. T h e
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bulk of the teeth w ou ld be o f low er b ril liance. T h erefore,
could be d e le te d ;
w ou ld be a rare color, and that could be d eleted also. T h e practical scale w ou ld be as indicated in F igu re 8. T hese ten colors w ou ld cover the entire range in n atural teeth.
INTRODUCING DENTISTRY TO THE CHILD By R
alph
L . I r e l a n d , * B .S., D .D .S ., L in coln, N ebr.
H E im pression created in a young ch ild ’s m ind on his first visit to the dentist is lasting, and, in most cases, determ ines his fu tu re attitu d e tow ard dentistry and his fu tu re behavior in a d en tal chair. Because the first visit is so im portant, the dentist’s “ ap p roach ,” or “ routine,” is o f v ital concern. W h ile th e first appointm ent routine is significant, it is also im perative th at the dentist “ follow throu gh” at fu tu re visits so th a t the dentist-child relationship w ill be strengthened. T h e confidence and trust w h ich a ch ild has in the dentist should never be je o p a rd iz e d : once lost, they m ay n ever be regained. C on se quently, n ot on ly the first, but also every association th at a ch ild has w ith dentistry should be, as fa r as possible, a pleasant experience. U n fo rtu n a tely , the dentist is n ot al w ays given the op portu n ity to properly introduce him self and dentistry to the child. Som e children, because o f re marks m ade b y their parents, áre p a r tially or com pletely ruined as dental patients before they ever enter a dental office. S u ch rem arks at the dinner
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•Professor of pedodontics, University of Nebraska, College o f Dentistry. Prepared for the American Dental Associa tion, Section on Dentistry for Children and O ral Hygiene, 19 4 a.
Jour. A.D.A., Vol. 30, February 1, 1943
table in the child’s presence as “ I w ent to the dentist today an d he n early killed m e,” or “ I h ave to go to the dentist to m orrow and I know i,t is go in g to hurt terribly,” are certainly im portan t factors in the ch ild ’s b eh avior w hen he later visits the dentist. E specially is this true if the child has never b een to the dentist, because the im pression is im m ediately created in his m ind th a t the dentist is n othin g short o f a d e v il; otherwise, w hy w ou ld h e w a n t to h u rt “ M om m y” and “D addy” ? T h e m ajority o f children, how ever, do not, before their first den tal appoint m ent, h a ve this kin d of background. E ith er n othin g has been said in their presence abou t dentists or they h a ve been wisely educated by their parents to look upon the dentist as a friend, some one w ho w ill help them . T h ere is no one “ tech n ic” or “ routine” th at can be used to m an age a ll children. E very child is different. T h ere are, h ow ever, certain procedures th a t w e can use in ou r approach w h ich w ill apply to all children. In order to form u late a suit able techn ic based on sound principles fo r our approach, it is necessary th at w e h a ve some know ledge o f : ( 1 ) childhqod psych ology; (2) childhood fea rs; (3) how children react to certain procedures and situations, and (4) certain of
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the new er concepts o f child training. Sadler, w h o thinks th a t -childhood psychology is not easy to m aster, says, “ T h e child is born w ith b u t tw o or three innate fe a r s : fea r o f sudden loud and shrill noises, fe a r o f fallin g, and fear upon sudden arousal from sleep.” H e says, “ T h e child in the nursery is subject to innum erable fears, b u t in the m ajority o f cases they fa ll into the follow in g com prehensive classifications o f ad u lt f e a r s : i. F ear o f extinction. 2. F ea r o f the u n know n. 3. F ea r of being trapped. 4. F ear of the herd. 5. R eligious fears.” 1 Jersild,2 in observing a group o f ch il dren betw een 5 and 12 years o f age, observed th at th ey h a d m any unnecessary fears. H e group ed them as fo llo w s: (1 ) fear o f the supernatural, death, co rp ses; (2) fear o f a n im a ls; (3) fea r o f the dark, new surroundings, new environ m ent, and (4) fea r o f bodily hurt. W ith the help o f a group o f children betw een 5 and 12 years, W illard C . O lson, professor o f ed u cation at the U n i versity of M ich iga n , listed a grou p of statements abou t den tal office p ro cedures. E ach ch ild was asked to check w hether he liked, disliked o r was in different to each procedure. T h e exp eri m ent revealed th a t these children liked the fo llo w in g : 1. Calling me by my first name when I come in. 2. Showing me all around the office and laboratory. 3. Having magazines, books, paper, pencil and things to play with in the waiting room. 4. Having interesting pictures on the wall. 5. Talking about the things I like to do. 6. Explaining what he is going to do and how he is going to do it. 7. Giving me a mirror so that I can watch the work. 8. Telling me about his instruments and what they are used for. 9. Giving me a signal I can use when it begins to hurt. 10. Stopping when I tell him to. 11. Taking radiographs of my teeth. 12. Using flavor in the mouth wash and cleaning powder.
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13. Treating me just as he does a “grown-up.” * 14. Keeping my father and mother in the room when he is working.* 15. Giving me tooth paste or some little thing after work is finished. 16. Giving me the teeth that are taken out. 17. Telling me “ You are a good patient” or something like that. T h e y disliked these p ro ced u res: 1. Keeping me waiting. 2. Asking questions about my age, grade, school, teacher and birthday to “make” conversation.* 3. Putting all of his tools out in front of me at once. 4. Telling me “ It won’t hurt” even if it will. 5. Staring at me while he is working. 6. Scolding me for not sitting still or fol lowing directions. 7. Making fun of me, calling me a “ baby” or anything like that. 8. Comparing me with other children. 9. Trying to be funny or acting silly.* 10. Telling my parents that I was hard to work on. T h e N atio n al C om m ittee fo r M en tal H ygiene has set forth in contrast the older and n ew er view s concern in g child training. Som e o f the new view s that ■apply to our problem a re as follow s3 : 1. Understanding the complex life of a .child is a difficult art worth acquiring. 2. Besides the physical care, the child needs a sense of security, understanding and affection. 3. The child inherits traits and tenden cies, yet his behavior is largely the result of training and imitation. 4. Even the very young child is pro foundly influenced by the moods of those about him. 5. A ll children should be treated with equal consideration, but each with special regard for his peculiar make-up and needs. 6. Love is a much better basis than fear. Too great fear may cripple. Love does not mean indulgence and pampering. 7. Unwise “ don’ts” m ay provoke mis behavior. Activity should be directed to wholesome pursuits. •Show ed an age difference in reaction.
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8. Obedience is not an end. The child should be taught to make wise choices for himself. 9. “ W ill” is an abstraction, and the child faces concrete choices, desires, obstacles and control of emotions. •10. Repression is dangerous and proper recognition is helpful. 11. A child’s questions deserve straight forward answers to establish the right rela tions. 12. The child reasons from such knowl edge as he has and grows in reason by wise encouragement.
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3. Proper introduction of instruments. 4. C a refu l w ord usage. 5. C om fort of the child in the op erat in g room. 6. Gifts. t h e
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S ig h t.— N o t on ly children, b u t also m ost adults, are a fra id o f the unknow n. T h e first visit to th e dentist is a n ew ex perience to the child. H e im m ed iately explores his surroundings by looking around the reception room to see w hat kind o f p lace his m other has brought him to. If, in the first appraisal o f his environm ent, h e sees som ething w ith w h ich he is fam iliar, the plu n ge from
Fig. 2.— Appearance of child in adult den tal chair. In this position, it is difficult for the child to relax.
his w orld into the dental w orld w ill not be too sudden. A satisfactory w ay to set the stage for conditioning the child to his new en vironm ent is to reserve a p a rt o f the 13. True information protects from false reception room fo r him . It need not be and unwholesome attitudes. large, just one corner, in w h ich can be F rom the foregoing, it can be seen p laced a sm all table and a fe w chairs, th at if the ch ild ’s association w ith den some ch ildren ’s books and some toys. tistry is to be a pleasant experience, w e (F ig. 1.) Seeing objects o f this type w ith m ust take into consideration and incor w hich he is fam iliar has the effect of porate into our techn ic o f approach relieving most, if n ot all, o f the ch ild ’s these fe a tu r e s : an xiety, and he decides th at the p lace is 1. A p p e a l to the ch ild ’s special senses. n ot very differen t from hom e. 2. R eco gn ition o f the child as an in d i T h e reception room should also be vidual. light, cheerful and clean and the color Fig. 1.— Reception room of dentist in gen eral practice, showing corner reserved for child patients, whose drawings decorate the wall.
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com binations appealin g. T h e sam e a p plies to the laboratory and the operatin g room . W h en the child comes into the op eratin g room , all instrum ents should be out o f sight. A bracket table “ loaded dow n w ith terrible looking instrum ents” is n ot con d ucive to good ch ild m an age m ent an d does not afford the m ost pleasant introduction to dentistry. T h e situation is n ot unlike b eing m et at the door b y a huge, fierce looking d og on visitin g a strange house. H earing .— N o t only w h a t w e say, b u t also h o w w e say it is im portant in talkin g w ith children. A sm all child can sense displeasure b y the tone o f voice. W e can, b y the tone o f the voice, help to instill confidence in the child. O n the oth er hand , the tone o f voice has m uch to d o w ith negative reactions in children. T h a t an in d ivid ual’ s m ood is easily b e trayed b y the vo ice is evidenced d aily on rad io program s. E ven though you m ay be an gry o r em otionally “ upset,” never let your vo ice b etray you r felings. Y o u r vo ice should reflect kindness, sincerity and courtesy. S m e ll.— T h e reception room and the op eratin g room should be free from offensive odors. A n od or o f iodoform or o f form ald eh yd e or some oth er o b noxious odor has a tendency to cause the child to b e apprehensive. Since m ost children are v e ry critical, the ch ild m ay inform us in n o un certain terms th a t “ it smells b a d aroun d h ere.” R e g a rd in g odors, P elton says, People have always believed and na turally cling to the notion that anything that has a bad odor must be detrimental to health. T he odors of medicaments per meating hospitals and doctor’s offices excite an uneasy and apprehensive attitude through association with the horror of the place, real or imagined. While the disagreeable odors are not harmful, they should be eliminated from the dental office for esthetic and psychologic reasons. T aste.— T a ste, b ein g closely associ ated w ith smell, likew ise plays an im por tan t p a rt in introducing dentistry to the
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child. Strong, bad -tastin g m edicam ents should be avoid ed w h en ever possible. A ll m outh-w ashes, disclosing solutions and pastes used fo r prophylaxis and po l ishing silver or gold in the m ou th should b e flavored. S everal drops o f oil of w intergreen in a glass o f w a ter m akes a pleasant m ou th rinse. A drop o f w intergreen or oil o f cinnam on should also be added to the m ixtu re o f pum ice and w a ter used fo r polishing silver am algam in the m outh . E aslick has suggested a form u la fo r a pleasant tastin g prophy laxis paste and a disclosing solution : Prophylaxis Paste Flour of pumice Borax Glycerin Carmine O il of spearmint
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Disclosing Solution Bismarck brown 3 gm. Alcohol 10 cc. Glycerin 120 cc. O il of anise i drop r e c o g n it io n o f t h e c h il d a s a n in d iv id u a l
O n e o f the procedures th a t children liked in D r. O lson’s experim ent w as to be treated like a “ grow n up.w A ll ch il dren w a n t to be accep ted on the ad u lt level. T h e y m a y .,n o t alw ays w a n t to respond as adults, b u t th ey w a n t to be recognized as individuals. T h e dentist w h o talks b ab y talk and calls a b u r a “ bee” an d the h and p iece a “ buzzer” is on ly m akin g him self rid icu lous in the eyes o f the child. T h is prac tice w ill not b u ild confidence or respect. T h e child should b e greeted w ith a smile, called by his first nam e an d treated as tho u gh he w ere an im portant person. in t r o d u c t io n o f in s t r u m e n t s
W h en the ch ild first enters the operat in g room , all instrum ents should b e con cealed. A s th ey are needed, they can be taken from the cabinet an d the child told the nam e of each instrum ent. T h e child should also be allow ed to see and
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feel and, w hen ever possible, b e given a dem onstration o f h o w th e instrum ents are used. T h e use of the bur or rubber cup can first be dem onstrated on the dentist’s fingernail, then on the child’s. T h e exp lo rer can be introduced in a sim ilar m anner. T h e ch ild ’s finger can be held in fron t of the m ou th m irror to show th at the m irror reflects objects and the saliva ejecto r can be held in a glass of w a ter to dem onstrate h ow it “ drinks” w ater. T h e dentist can dem onstrate how the air syringe works b y first blow in g air on the ch ild ’s hand or arm . B efore tak-
in securing the ch ild ’s cooperation. In dealin g w ith children up to 4 or 5 years o f age, the few er words used in givin g com m ands, the better. In m any cases, only one, or not m ore than tw o o r three w ill suffice. I f too m any words are used the child becom es confused. W e should say “ Sit b ack ,” instead o f “ I can ’t do anythin g fo r you if you keep leanin g forw ard a ll the tim e” ; say “ O p e n ,” in stead o f “ W h y don’ t you keep your m ou th op en ?” O u r rem arks and instructions to ch il dren should b e positive. T h e y suggest the correct w a y o f doing things. Sadler says, T h e constant repetition of “ don’t”— “ don’t do this” and “ don’t do that”— is in
Fig. 4.— Under side of seat shown in Figure 3. The small boards, which are curved to fit the arms of the chair, are padded to prevent scratching. Fig. 3.— Seating arrangement suggested for office having no child’s chair.
in g roentgenogram s, he should explain to the ch ild w h at he is go in g to do and th at the m achin e w ill m ake a “ buzzing sound,” stating w hat h e expects o f the child. T h is is a wise precaution in all op erative procedures. I f children h ave ad van ce instructions, they cooperate better. T H E U SE OF W O R D S
T h e righ t words, sincerely spoken, can do m uch to allay a ch ild ’s fears and aid
itself a great producer of fears.1 We can do much to avoid arousing undesirable negativism in youths by the way in which we approach them. We can give commands with a smile. We can employ indirect in timations in the vein of “ Will you do me this favor?” 5 W e should talk to the child on the ad u lt level, avoid in g b ab y talk. W e answ er all questions tru th fu lly and sensi b ly and should praise the child, not criticize him . T h e child should be w arn ed if any p a rt o f the operation is to be painfu l. Com m ands to sm all children
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need tim e to “ sink in.” W e can n o t ex p e ct them to respond im m ediately, and w e should avoid such words as “ p a in ,” “ h u rt,” “ cu t,” “ slice,” “ chop” a n d “ blow u p ” w h en referrin g to pulpotom ies or pulpectom ies. the
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I f the child is to retain a pleasant m em ory o f his visit to the dentist, p ro vision should be m ade for his com fort w hile in the d ental chair. I t is im pos sible to low er the b ack and headrest of the a verage d ental ch air sufficiently to accom m od ate children. W ith the back and headrest in the low est position, the ch ild ’ s head is throw n forw ard , so th at the chin is alm ost resting on his chest. (F ig. 2.) I t is impossible fo r the child to relax in this position. A c h a ir th at is too b ig gives the ch ild the im pression of b ein g “ trap ped ” or surrounded. In a seat placed over the arm s of the chair, the child is elevated so that his b ack and shoulders fit the b ack rest and his h ea d can be properly positioned in the headrest. (F ig. 3.) T h is m akes the w hole d ental procedure m ore com fort able and less tiring fo r the ch ild as w ell as fo r the dentist. GIFTS
C h ild ren like to receive gifts. T h is w as clearly shown by D r. O lson ’s exp eri m ent. Jersild’s6 w ork also b rou gh t this out. T h e p ractice o f givin g children som e g ift a t the end o f the dental a p pointm ent is one that has recently gain ed in popularity. In discussing this p ractice, Pelton says, “ I f a child w h o fears th e dentist is given a toy or souvenir a t each ap p o in t m ent, h e soon learns th at th e dentist is n ot a person to be feared, and the u n pleasant aspects o f the appointm ent are forgo tten .” 4 T h e dentist should not, how ever, give gifts to children fo r good con d u ct alone. C h ild ren should not b e “ bribed” into
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being good. I f the dentist desires to giv e souvenirs, every child should be given one regardless of w hether he w as a good or a bad patient. Souvenirs should be given , as P elton says, “ to m ake the d en tal office attractive to children, to inter est the shy and apprehensive patient, to im prove the behavior o f children, to in crease the num ber o f children in his practice and to transform the visit into an excitin g even t.” 7 SUMMARY
T o prop erly introd u ce dentistry to children, a definite “ approach” should be plann ed so th at every association th at the ch ild has w ith dentistry w ill b e a pleasant experience. The follow in g points are suggested for the first as w ell as subsequent appointm ents. I . T h e D e n ta l O ffice E nvironm ent. A . T h e reception room . 1. A special corner should b e reserved fo r the child. A sm all table and chairs, picture books and a few toys should be provided. 2. T h e reception room should be light, clean an d cheerful. B. T h e op eratin g room . 1. T h e op eratin g room should be clean and free fro m offensive odors and should be d ecorated in pleasing colors. 2. A m p le tim e should b e allow ed for the ch ild to inspect his surroundings. II. T h e Special Senses. A . Sight. 1. T h ere should be a ch ild ’s corner in the reception room . 2. T h e reception room and operatin g room should be decorated in pleasing colors. 3. A ll instrum ents should be Out o f sight w h en the child first enters the operatin g room . B. H earing. 1. L ou d noises should b e avoided. 2. T h e vo ice should b e low and gentle. 3. T h e vo ice should reflect kindness, courtesy an d sincerity.
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C . Sm ell. i . T h e reception room , laboratory an d operatin g room should b e free from offensive odors. D . T aste. 1. B ad tasting m edicam ents should be avoided. 2. T h e prophylaxis paste, disclosing solution, m outh rinse and polish in g paste should b e flavored. I I I . R ecogn ition o f the C h ild as an In d ivid u al. 1. T h e child should be approach ed on the a d u lt level. 2. T h e dentist should not talk baby talk. 3. E ach child should be treated as an ind ivid ual— a “ som ebody.” 4. T h e dentist should not com pare the child w ith other children. I V . T h e In troduction o f Instrum ents. 1. E very instrum ent should be p rop erly introduced. 2. T h e child should be told the nam e o f the instrum ent and the dentist should dem onstrate h ow it is used. 3. T h e child should be perm itted to feel and handle each instrum ent. V . T h e U se o f W ords. 1. A ll questions should be answ ered truthfully. T h e child should never be deceived. 2. T h e bur should n ot b e called a “ bee” or the handpiece a “ buzzer.” 3. T h e child should be called by his or her first nam e. 4. Such words as “ h u rt,” “ pain,” “ cu t,” “ blow -up,” “ ch op” and “ slice” should be avoided. 5. R em arks should be positive. 6. Com m ands should be simple. V I . C h a ir S eating A rran gem ent. 1. T h e average d ental ch air cannot b e adjusted to m ake the child com fort able. 2. I f a jun ior ch air is n ot available, som e other provision should be m ade. 3. A board m ade so th a t it w ill fit over the handles o f the ch air w ill elevate th e child so th at it w ill b e possible to
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properly position his h ead in the headrest. 4. P la cin g a tow el o r paper n apkin over the seat o f the ch air w ill prevent scratching. V I I . G ifts. 1. I f gifts are m ade to one child, they should be given to every child, rega rd less o f behavior. 2. G ifts are m ade to render the dental appointm ent attractive. V I I I . A d d ition al Suggestions. 1. D o not keep the ch ild w aiting. 2. G reet the ch ild w ith a sm ile. W ith a sm all child, kneel so as n ot to “ tow er” above him . 3. D o not rush the ch ild into the o p erating room . 4. B e slow and deliberate in your m ovem ents. R a p id m ovem ents tend to confuse th e child. 5. D o not fu m ble or hesitate. A child w ill soon sense indecision. 6. A v o id pain a t the first appointm ent. A prophylaxis is a good introduction to dentistry. 7. M a k e appointm ents short. Sm all children can not cooperate fo r long periods. 8. D o not exp ect the child to respond im m ediately. Requests need tim e to “ sink in.” BIBLIOGRAPHY 1. S a d l e r , W . S .: Theory and Practice of Psychiatry. S t. Louis: C. V . Mosby Co., 19 3 6 , P- 336. 2 . J e r s il d , A. T .: Child Psychology. New York: Prentice-Hall Inc., 1933 . 3 . National Committee for Mental H ygiene: O ld and New V ersions-of Child Training. New York, 1929 . 4 . P e l t o n , W. J.: Fear Control in Chil dren’s Dentistry. J.A .D .A ., 2 6 : 138 1 , August 19395 . Reference 1 , p. 364 . 6 . J e r s il d , A. T . : Children’s Fears, Dreams, Wishes, D ay Dreams, Likes, Dislikes, Pleasant and Unpleasant Memories. New York T each ers College, Colum bia University, 1933 , pp. X I, 17 2 . 7 . P e l t o n , W . J.: Three to Six Appeal. J.A .D .A ., 2 7 : 1502 , September 1940 .