Psychological approach to the child
1- Introduction
The child’s conception of the outside world is generally relative and suggestible by adults, so dental care for a child can be part of strange or even unknown experiences because the child-practitioner confrontation is far from being devoid of any ulterior motive.
Physical, psychological and intellectual development is unique for each child. In fact, when faced with dental care, a child may adopt hostile behavior and a feeling of fear in the face of dreaded pain, or a poor perception of the environment.
2- Child development
2-1 Early childhood period: from 0 to 2 years
Responding to the “oral” phase, the child develops his baby teeth from 6 months to 2 and a half years, and through the mouth the child discovers his environment.
The child needs to touch objects and hear sounds. It is difficult to separate him from his parents.
2-2 Preschool period: 2 to 6 years
*3-4 years: this is the “questioning” age, of why. He must be reassured and calmed.
Anxiety dominates at this age: The presence of a parent is mandatory at the first consultation. Afterwards he can stay alone. But he should never be separated to punish him.
*4-5 years : He needs to be reassured. He fears pain, bleeding. He is very proud of new experiences in new relationships. He needs to touch, feel and explore. He needs to be allowed to use certain objects
2-3 The school period: from 6 to 11 years old
He learns a lot about the world around him, it is a period of real and imaginary fears.
*6-7 years : he only understands what he sees. The sight of a syringe can cause a great feeling of danger.
*7-11 years : the child’s fears and apprehensions can be comforted through dialogue.
Fears and anxiety are related to experiences in previous therapeutic relationships (medical, hospitalization, and dental).
2-4 Adolescence period
It is a complex period centered on the constitution of a “self-image”.
The adolescent is characterized by a desire for independence. Therefore, as often as possible, we will set appointment dates directly with the patient.
3 the different classifications of the psychological approach
3.1 the Fränkel scale (1962): This is a classification which allows the preschool child’s behavior to be assessed and the evolution of behavior to be monitored over the course of the sessions.
Level 0: Definitely negative behavior
Refuses treatment, shouts loudly, resists care
Level 1: Negative behavior
Some signs of opposition exist but are not necessarily declared.
Level 2: Positive Behavior
Accepts treatment with reservations, is cautious but follows the practitioner’s instructions
Level 3: Definitely positive behavior
Good rapport with the practitioner, interested in the treatment, he laughs often and seems to enjoy the visit
3.2 Wright’s clinical classification (1975)
Cooperative: A child is considered cooperative when he or she is generally relaxed and shows minimal apprehension during dental treatment.
Lack of cooperative ability : those with a disabling condition or young children.
Potentially cooperative: have the ability to adapt to become cooperative children.
4- The caregiver-patient relationship
The parents, the dentist, and the child form a three-way relationship called a triad in which the role of one protagonist directly influences the other members of the triad.
4-1 Child-centered relationship
The child is a *small being* in his own right with his level of understanding, we cannot take care of him without obtaining his collaboration and participation.
Despite everything, we expect the child to make efforts on his own, to take responsibility and work towards his own good care.
4-2 Parents
The mother’s attitude and her way of education influence the child’s behavior and allow us to predict the child’s behavior.
The practitioner is therefore also led to manage maternal behavior (super protective, permissive, authoritarian, benevolent)
The parent has a role during the treatment but also outside of the treatment (before and after the consultation).
4-3 Practitioner
We expect his authenticity, whatever his personality, he will have to listen to his young patient and detect beyond his suffering.
We must be careful not to become too emotionally involved, otherwise we will not be able to carry out certain treatments successfully, and we must also avoid falling into the trap of therapeutic obstinacy.
Psychological approach to the child
5- Behavior management in the dental office
Support involves managing the child’s behavior, and can use two methods of control and communication.
5-1 Communication techniques
5-1-1 the non-verbal method
Speech is not the only way to communicate. Facial expressions, postures, gestures, clothing are involved and can reinforce or replace, in certain situations, speech:
-not wearing a mask or glasses
-touch: take the child’s hand and caress it
-the listening attitude
-communication distance
-the look, the smile, the tone of voice.
5-1-2 the verbal method “Tell-Show – Do”
-Verbal explanations with vocabulary and images adapted to the child’s age.
– Show the visual, auditory instrument, hand demonstration
-Do: perform the gesture
5-2 Communication control techniques
5-2-1 Stop signal
When the act begins, it is possible to interrupt the treatment by raising your hand.
5-2-2 Modeling
Learn how to behave in the chair by observing another child receiving treatment.
If he is particularly young, taking care of his comfort blanket or doll can also help to gain his trust.
5-2-3 Voice Control
When the child begins to become uncooperative, raising your voice abruptly can create a surprise effect.
Once calm has been achieved, the practitioner resumes a normal tone .
5-2-4 Hand Over Mouth Technique
Only used when the patient is difficult, the cries are held back by the practitioner’s hand but without brutality and with the parents’ agreement
6- Organization of the consultation
6-1 The first visit
This is an exceptional moment , essential to determine the future of the future relationship between the child and the practitioner, so this visit must be an “area of good impression”.
6-1-1 Home
The practitioner always greets the child by his first name and does not hesitate to lean towards him in order to be at his height to start a conversation.
He can take him by the hand and speak to him in language appropriate to his age.
The practitioner must answer all of his questions
6-1-2 First consultation
Clinical observation will be able to follow, the stages of the consultation are stated to the parents and the child.
For a child aged 2-4: a gentle approach
Before 6 years old: you must encourage him to open his mouth by counting the number of teeth for example, a summary of the examination will be given to the parents with a treatment plan and the practitioner must ensure that they have understood correctly
Give dietary advice
Motivate him to be hygienic by teaching him the right method
Check if the messages have been sent.
6.2 organization of appointments
It is best to schedule appointments in the morning for young children because that is when they are calmest and medical staff are most available.
Work through the hemi-arch if the patient has multiple caries under local anesthesia or MEOPA
Avoid giving long appointments and during school sessions to avoid absenteeism.
Never start with extractions unless there is an acute infection or trauma.
6-3 Relationship with the parent
If parents are involved and an integral part, the practitioner expects them to positively reinforce his action by encouraging the young person and not to complain, must be authoritarian and punctual.
Psychological approach to the child
7- 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 trusting practitioner-patient relationship
Psychological approach to the child
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.