PSYCHOLOGICAL APPROACH TO THE CHILD
- Introduction :
The dental experience is a more or less difficult ordeal for the child to overcome.
To cope with this, he adopts variable behaviors depending on his psychological development, his personality, his environment and his history. Sometimes, his attitudes make dental care impossible, or limit its quality, and therefore its sustainability.
- Definitions:
➢ Fear : is a feeling of strong worry, alarm, in the presence or at the thought of a danger, a threat.
➢ Anxiety : is a strong worry born from the uncertainty of a situation,
the apprehension of an event. It is an emotional state of nervous tension, of
fear, strong and often chronic; a mental state characterized by the expectation of a
imminent danger accompanied by discomfort, fear and feelings of helplessness.
➢ Anxiety: is a psychological and physical discomfort, born from the feeling of imminent danger, characterized by a diffuse fear that can range from worry to panic and by painful sensations of epigastric or laryngeal constrictions.
➢ Phobia: is an unreasonable fear triggered by an object, a person, a situation, and whose unsuitable character the subject generally recognizes, but feels powerless in the face of this state.
- behavior : is the set of reactions, objectively observable, of an organism which acts in response to stimuli coming from its internal or external environment.
- personality: the Petit Larousse defines it as the set of
behaviors, skills and motivations, the unity and permanence of which constitute the individuality and singularity of each person.
2) People present: 2-1 The practitioner:
- A relaxed practitioner: he approaches the child with serenity and gains his trust easily.
- An anxious practitioner: he lets his emotion appear which the child feels immediately.
- An authoritarian practitioner: who does not encourage dialogue with the child much
- A mothering and even sentimental practitioner.
2-2 The child:
It can be divided into 03 successive stages:
- The neonatal period (from birth to the 28th day ).
- First childhood (from the 29th day to 2 years): it characterizes the infant.
- The 2nd childhood (from 2 to 12 years) itself divided into
- preschool age (2 to 6 years)
- and school age (6 to 12 years).
- classifications of behaviors:
There is a classification based on the child’s personality:
➢ The child with a strong temperament and a valued nature: generally does not pose any difficulty for the caregiver.
➢ The agitated child: wants to direct all care despite his level of anxiety.
➢ The aggressive child: of a disturbed nature, more or less strongly opposes care,
by a behavior and language that are willingly aggressive, not hesitating to make
avoidance gestures, fidgeting and even biting the practitioner .
➢ The fearful child : stays close to his parent, hides his head, looks at his feet.
➢ The shy child: is very similar to the fearful child, he hides and communicates very little, but once his trust is gained he will be very cooperative
- Psychological considerations of the child in dentistry:
b-1 The child and his body: The child identifies and knows the entirety and parts of his body, since he is very small, around two years old.
b-2 The Child and his mouth:
His mouth is one of the very first organs that the child notices: explores it with his fingers or with objects; he plays with it, opens it and contemplates it in the mirror. He also discovers it indirectly by looking at and inspecting the mouths of his friends, or by playing with them by sticking out his tongue or making funny noises.
2-3 Parents:
- There are no single children! Carriers of the demand for care.
- Parents, especially the mother, are the first credible informant for everything that surrounds her child, for him she represents the world and life.
EVALUATION METHODS:
- Self-assessment
This technique is most appropriate for children aged 6 years and older.
It can be done by different means
➢ Drawing is a projection technique, where the child must produce a
representation in a stressful situation. The interpretation will be carried out using the colors or nuances used. But according to some authors this technique would be unreliable.
➢ The visual analogue scale (VAS) is a simple technique, easy to use and
to understand.
➢ The questionnaire is a method that takes into account only feelings
felt, the child must be able to read and understand the questions asked.
2) Hetero-evaluation
Rating scales were created to allow for more objective measurement
3) Psychological behaviors established between Practitioner-Child-Parents:
- Fear and anxiety in children:
- “Objective fear”, in direct relation to a physical stimulus, an operative act for example, easily gives way to a “successful” explanation or demonstration.
- “Subjective fear” results from association of ideas, imagination, insecurity related to an unusual situation. It must be disciplined and dominated by the child and the practitioner.
Before each treatment a careful assessment of the patient’s anxiety must be carried out,
Communication must occupy a prominent place during meetings, the “Tell, show, do” method is very useful, in fact, when we take the time to explain it is much easier to progress afterwards.
This strategy allows the child to be prepared through his 5 senses :
➢ Visual : The instrument that is going to be used is shown to the child, a mirror is left in front of
proximity so that he can see the act unfold.
➢ Auditory : It is important to have the child listen to the sound of the instrument
a potential source of inconvenience during treatment.
➢ Kinesthetic : The practitioner uses the cutter on the child’s nail so that he
feel the vibration sensation. “I’ll show you on your nail because it’s hard, a bit like your tooth.”
➢ Olfactory : The practitioner can make the child smell the odor of the contact anesthetic
(pineapple for Topex®), or the smell of polishing paste.
➢ Gustatory : Once the act has been explained and shown it will be carried out and the child
will perceive the taste of the products used.
b- The practitioner’s anxiety :
- The practitioner must adapt to each child and each moment… To the child’s fear, the practitioner must oppose calm, understanding, certainty of diagnosis and action, and success.
c- Parents’ concerns :
It is essential to establish valid relationships before considering therapies. These will only be effective if they are accepted and understood by the child and the parents.
The practitioner must ensure, while giving them the place they deserve, that the parents do not come between the child and him, nor prevent him from establishing the individual dialogue.
1. The practitioner must take into account this important bond and not hesitate to examine and treat the young child on his mother’s lap using the privileged parent-child relationship.
2. A situation to avoid: the child feels excluded from the decisions made. Dialogue has been established between the parents and the practitioner.
3. On the contrary, from a certain age, the child feels the need to establish a personal relationship with the practitioner.
He wants to assert his personality. Care is much easier when it is carried out outside the “guardianship” of the parents and a real connection can exist between the practitioner and the child.
4. The ideal relationship allows the three people to “find their place” and to dialogue without interfering. Vigilance is required from the practitioner, because the child’s own character is to be changeable!
4) Approaching the child to the dental office:
The relationships between practitioner, child and parents are established during three distinct phases:
before care
during care
after care.
4-1 Before treatment:
- Meeting with the child and his parents:
First, the child will observe the premises and the practitioner.
The premises, without necessarily being decorated like a pediatric dentistry specialist’s office.
Many smells in a dental office are reminiscent of those in a hospital, with all the bad memories that come with it for some children.
The light should not be too aggressive and a light musical atmosphere will be welcome.
The practitioner’s movements should not be abrupt, nor should his voice be loud and rapid.
Wearing a mask during this first consultation is not useful.
A colorful blouse is recommended.
- Child-practitioner report:
The use of instruments during the first clinical examination of the arches should be avoided.
The easiest thing is to use the child’s imagination by telling him a story in which he can relate.
This methodology of approaching the child in the dental office may seem long to the practitioner, but it is better to lose a few minutes, or even a consultation at the start, to have easier subsequent sessions.
Caring for a child in good conditions is above all a question of time.
4-2 During care:
1-The presence of parents during care:
Each situation must therefore be adapted to both the maturity of the child and that of the parents.
- The very young child (under 4 years old) finds real comfort in being able to stay on his mother’s lap. She then provides the child with the reassuring bodily contact that he may still need.
- From the age of 5-6, the child very often feels valued by a personal relationship. We can then judiciously offer care in the absence of the parents.
2- Means of communication between practitioner and child:
Several forms of contact can be used:
2- 1 the voice : the practitioner explains his interventions calmly and serenely. He reassures the child.
2-2 the look : the practitioner must remain particularly attentive to the child’s slightest expressions.
2-3 hands : the child who feels firm and precise gestures is secure.
2- 4 Communication modes: The transmitter transmits a message which must be received by the receiver.
- Nonverbal communication:
It is immediately more effective than verbal communication. A smile, a disapproving look can completely change the meaning of a sentence.
- Non-verbal messages picked up by the child: On arrival at the premises: the environment, the decor, the reception, the waiting room, the comfort, the cleanliness… but also the behavior of the care team, namely, the welcome, the competence, the kindness, the human qualities and the physical appearance of the assistant and the practitioner.
- Non-verbal messages from the child : Their behavior, their appearance, their way of moving, their clothes, whether or not they smile, their facial expression, their way of sitting, etc. are indicative of their state and the message they are conveying.
- verbal communication:
- Speech is the fastest instrument we have for exchanging feelings and knowledge.
Of course, age plays a role in these approaches.
PSYCHOLOGICAL APPROACH TO THE CHILD
3. Duration of care:
It is recommended to group treatments by half arch to save time and limit the number of restrictive sessions for the child, parents and practitioner.
4. The role of the chair assistant:
- through its effectiveness ensures the sequence of planned care .
5- The atmosphere of the premises:
- If the child feels pleasantly impressed by a cheerful and welcoming room, he wants above all to establish contact with people and to feel secure in this. The material organization contributes to improving human relations
4-3 After care:
This is when the practitioner will ensure that he devotes his time to:
- show the results: parents can thus follow the progress of the care.
- explain the postoperative consequences and possible complications.
- inform and educate the child and parents for better oral health.
Plan the frequency of check-ups and screening visits.
PSYCHOLOGICAL APPROACH TO THE CHILD
5) CONCLUSION:
- The care of children in the dental office presents complex psychological characteristics; caring for children requires time, patience and knowledge of the psycho-affective development of the young patient.
- Human and relational qualities are fundamental to being able to establish a relationship of trust between practitioner and patient.
PSYCHOLOGICAL APPROACH TO THE CHILD
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.