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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
practice management | Another commonly used behaviour rating method Phobia of needles is by following clinical gradation: – Cooperative – Uncooperative – Apprehensive – Fearful – Obstinate Children generally associate dental ap- pointments with vaccination appointments with doctors. They are highly phobic about needles. Any treatment can be a nightmare with the underlying fear of needles. The contemporary form of dentistry is laser dentistry, which is needle free and child friendly. How does laser replace needles? In case of fillings, the need for numbing is completely ruled m o k . c c u tt e r s t o h o r n / S a is © k The American Academy outlines several ethical be- haviour management techniques. Apart from using these methods of be- haviour management, one of the basic principles that can be kept in mind is effective and positive result oriented communication. The first step to gain the child’s cooperation is to develop a proper rapport in the first appointment. We generally use a special child friendly language in order to gain the attention and interest of the child in concern. This special language of paediatrics is referred to as “euphemisms”. Commonly used euphemisms are: – Laser: magic popping light – Needle: sleepy juice – Numbness: magic balloon – Cotton roll: cotton pillow – Handpiece: tickle brush – Suction: vacuum cleaner/sucker/Mr. Thirsty – X-ray: marshmallow picture – Mouth prop: tooth clip Dental fear Fear is one of the most constant limitations in the paediatric practice. Children’s fear can sometimes have a rational explanation and sometimes occur for incomprehensible reasons. The solid foundation of a rapport between child and paediatric dentist depends on the actual acknowledgement of the child’s fear. When we know that fear exists, the best way to over- come is to face it and resolve the cause. Children’s fear of dentistry is generally related to the words, tools, idea and concept of treatment. By keep- ing the first appointments only for check-up, X-rays and cleaning, we are able to understand the treatment needs, and the coping ability of the child. The child is made aware of what the next steps can be in the language of euphemisms. This way they go with the eye opener of awareness of what to expect in the next appointment. In case of long treatment appoint- ments, generally the mornings are preferred as chil- dren are more fresh and receptive to instructions then. out as the Erbium laser is a non-contact procedure. Since there is no actual contact of tooth and laser, there is no vibration or pressure on the tooth as in case of drilling. This exempts the need for anaesthesia. In a pre-procedural appointment, when the kids are informed about playing Star Wars with sugar bugs and not using any “injections”, their fear factor gets significantly reduced. This helps them to overcome the picture of dentistry as presumed before. During the procedure, no numbing can help chil- dren to remain relatively relaxed, get the procedure done and leave the practice after a short appoint- ment with no sensation of numbness afterwards. They can eat fifteen to twenty minutes afterwards and parents do not have to worry about traumatic lip or cheek bites. What procedures can be done without anaesthesia? Regular restorative dentistry including all types of cavities can be done easily without any need for injec- tions. Pulp therapy such as pulpotomy, direct or indi- rect pulp-capping procedures and pulpectomy can be performed with intrapulpal anaesthesia after pulp exposure. In cases, where the child does exhibit ap- prehensive behaviour, minor infiltrations can be used. Laser sealants have become quite popular in the practice with a success rate much higher than the normal sealants. The Erbium laser is used at Bond prep: 3.35 Hz. This causes a slight enamel abrasion in order to allow for a better mechanical bond between seal and tooth surface. The normal cover period that I consider in the practice for seals done this way is about two years. The Erbium laser also helps to anaes- thetise teeth externally. This itself can help to take away the initial fear and get the procedure started. laser 3 2017 29