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#18 – Preventive Care Instructions for Children

The PC (Preventive Care) Experience

We offer a unique experience in preventive dentistry to the children. You will be asked to follow the general guidelines outlined in this section. If any of these ideas don’t agree with your experience, or what you were taught, get with the Dr. and discuss them. Any procedure we do can be changed. If you have a better way, share it with us. We’ll all be better off.

First, let’s look at the goals. Everyone parent, child, doctor, and hygienist have a different view of PC. Your responsibility is to recognize and respond to these various needs by the different individuals.

Parent Goals

1. be affordable

2. provide good care for kid

3. do what they should do

4. learn

5. have child accepted by office staff

6. have their child accepted as the best better than average

7. give child positive attitude feel good about themselves

8. be good model for kids!

Dr.’s Goals

1. healthy kids growing

2. economical profit

3. vehicle for individual staff growth

4. fun center of the practice

5. establish and maintain relationship (long term)

6. keep things running on schedule

Child’s Goals

1. please the parent (younger children)

2. please self and parent no decay

3. teens attractiveness

4. have a good time at the dentist office

5. reward

6. please us

7. curiosity of dental offices

8. pretty smile

9. chew food relate to here and now

10. learn

RDH Goals

1. fill the schedule avoid losing 1/2 days

2. enjoy affection and feeling of being needed

3. being part of guiding child adult to a better dental health

4. variety in the day

5. have fun enjoy the kids

6. be on schedule

The goal of a preventive care appointment is to build the self esteem of the child and parent. The tools we use to accomplish this are brush and floss skill development. Be sure to read the book Your Child’s Self Esteem. It is summarized in the following pages. If you focus on manual skills and not the child you missed the point. You became part of the problem, not the solution.

Remember the goal is not for you to teach brush and floss techniques. If the child has high self esteem he will want to learn how to be healthy and you won’t be able to stop him!

Your Child’s Self-Esteem

The child’s self esteem is the major factor in their success in life.
Our job is to build this self esteem.
How do we do this?
1. Establish a quality relationship with the child
a. Give them your total attention
b. Help them feel important
2. Help him feel competent to maintain his own health
3. Our attitudes toward child’s efforts are more important than the actual ability itself.

expect to fail expect success
fail fail success success
expect to fail expect success

Many parents set up the failure wheel for their kids. One positive appointment with you can have a major impact on breaking the chain!
How will you recognize a child with low self esteem?
1. Covers up feelings of inadequacy
a. Tattling
b. Bullying d. Attention devices
c. Constant chatter e. Very quiet, withdrawn

2. Child always good
a. Never does anything that could be criticized
b. Quiet, hard to give you eye contact

Traits of a Genuine Encounter

1. Builds trust be honest, share your feelings
2. Use “I” words (tells how you feel) rather than “you” words than accuse, put down
3. Find the uniqueness of the child and appreciate it verbally to the child
4. Remember how we see the world or a particular situation isn’t the only way or even the best way!
5. Use empathy (listening with your heart, not your head) to help understand someone.
Sympathy- you feel for that patient.
Empathy- from personal experiences you feel for that person.
6. Watch the child’s body language

How do we Decide if our Expectations are Valid?

1. Why do we have this expectation?
2. Where did it come from?
3. What is in it for me?
4. Is it based on my needs or the child’s?
5. What purpose does it serve?
6. Does it realistically fit this child at this age with this temperament and background?

How do we handle a child’s negative feelings?

1. The fastest way to get rid of them is to acknowledge them and work them out. This takes precedence over all other agendas.
2. If you ignore them they will bottle up and be turned inward on the child (headaches, hyperactivity) or toward others (hostility)
3. Hear empathetically, accept feelings, provide acceptable outlets through negotiation
4. Proof of understanding comes only through “active” listening (reflecting child’s thoughts)
5. Remember negative feelings come before negative acts. Don’t focus on the action, focus on the feelings. Embarrassment, frustration, jealous, fear, come before anger. Use active listening to get past the anger.
6. Understanding never makes feelings worse, it only gives them permission to be revealed.

How do you strengthen the child’s self esteem?

1. Show the child you enjoy being with him that he is fun, intelligent, etc. Laugh, joke, tell stories, etc.
2. Don’t expect more than the child can do notice small successes and praise them
3. Don’t pressure the child
4. Negotiate your way through problems
5. Recognize and praise each sign for initiative
6. What you say matters less than what you do

Discipline the goal is self discipline your goal is to show the parent how to use discipline wisely
1. Limit the number of rules
a. Increase friendliness
b. Increase safety of child

2. Three approaches to limit setting
a. Power kept authoritarian nag, punish, reward, praise only works while you are there encourages dependence
b. Power given away
c. Power shared
1. Kid’s needs as important as ours
2. High level of trust
3. Can use other two occasionally

3. Constructive discipline
a. Increases self esteem, reliance, intellectual growth, creativity, and responsibility
b. We don’t own the kid they own themselves and their feelings
c. “I” reactions not “you” judgments
d. Realistic expectations, shared honest feelings
e. Decide what the problem is and who owns it
f. Stick to the facts, don’t make someone feel guilty
g. Empathetic listening
h. Try to create options, choices
i. Never demand conformity if not necessary
j. Avoid evaluation, fear
k. Give kid opportunity to make suggestions
l. Show process of problem solving and willingness to share power
m. Obedience not based on fear, based on admiration, inner conviction

Age Related Ideas

To be successful in counseling in preventive care you must match your attitude, words, etc. to match the level or maturity of your client. This level of maturity relates somewhat to age, but watch out for the person who falls outside the norms. Whatever the age, structure the appointment to foster involvement, reasoning, creativity, and responsibility.

A. Up to age 2
1. Child will cooperate because he doesn’t know anything else
2. Focus on Mom, she will be responsible for:
a. Frequency
b. Nutrition
c. How clean mouth is
d. Attitude of child

3. Develop a climate of safety for Mom and child
a. Tolerate imperfection, even failure
b. Look for good qualities self confidence, calm, independent, self trusting
c. Reasonable standards

4. Cradle child’s head from behind when brushing don’t face them

5. Listen to what parent says if they can’t (won’t) invest time in helping, don’t judge just accept and focus on the child

B. Age 2 to 4
1. Beware of the Terrible Two’s Now the child is learning independence. Avoid head on collisions of will. When I examine the child may not even open that’s ok as long as you got a look and Mom understands. Remember their rebellion isn’t disrespect. It is their first step in developing as an independent person!

2. Keep his environment as frustration free as possible
a. Give lots of time when shifting activities
b. Use lots of games: toothbrush race track, string game, etc. (choo choo train)
c. Don’t give orders, make positive suggestions
1. Not Brush your teeth
2. Better Show me how you get the sugar bugs off your teeth
3. Give the child some degree of control through choices  (ex. Which color toothbrush do you want to use today?)

3. It’s hard to force 2’s to do anything. If you need major changes have Mom work on his diet and fluoride and you wait to work on skills till he’s 3.

4. This is a walking question box.

5. When the child has achieved a separate identity (usually by age 3 4) work on achievement and
recognition as he learns to master himself and his environment
a. Give lots of praise, encouragement, recognition
b. Easily frustrated by lack of muscle control support them

6. Use terms that they can understand:
a. Race track pattern
b. Sugarbugs
c. Brush the big teeth model (Sam and George)
d. Back and forth brushing like choo choo train

7. Look for all signs of personal initiative recognize and praise even the screw ups! This
leads to success in later years.

8. Expect child to be self centered. Don’t make him feel guilty about it.

9. Skill expectations
a. Understand why they are here
b. Sugarbugs
c. Racetrack
d. Hold brush like baseball bat and brush with teeth together

10. Most important develop a good attitude in parent and child

11. Mom will do the flossing up to 3 4 then child will take over with floss holder or a piece of
floss tied through the hose in the end of the brush.

12. Technique ideas
a. 2 3 year olds you will probably need to teach them how to spit
b. They need to learn to brush with their teeth apart
c. Listen for the brush on the teeth. It sounds different than when it’s riding on the gums.
d. On age 3 5 you may want them to brush with 1/2 the brush on their gums and the other
half on their teeth. It may help guide them.

C. Age 4 7
1. Conscience begins to develop around age of 6 first ideas of right and wrong (before this obedience comes only to avoid punishment or to please: other directed)
2. What you say matters less than what you do.
3. During the first 6 years the child learns autonomy, mastery, initiative, attachment to others, self centeredness, and preference for the same sex while they are learning language, muscle skills, modern contraptions, and society’s rules. Be kind to them!
4. Slow, non pressure learning
5. Time to wean kid from Mom work on independence
6. Only teach flossing to break contact.

D. Age 7 13 “The Gang”
1. The middle years that follow the rapid physical changes of the first 6 years and don’t have to deal with the sex pressure of puberty.
2. Child’s primary task is to define himself outside of the family.
3. Child needs group support to stand eventually on his own
4. Sense of competence comes from peer acceptance and mastery of physical and social skills
5. “No Decay Club” has added significance if it includes his friends. Ask him if his friends are in.
6. Wants to be like his friends decay and fillings stand out as different and bad
7. Skills start to take hold –  Work on brush and floss angles, etc. now is the time to work on complete technique.
8. Good age to work on thumb sucking
9. Words –  Garbage rather than sugarbugs
10. Allow child to be assertive give choices
11. Easy to feel guilty, inferior be careful!
12. Mom is now only an observer and by 11 12 may not even be with you
13. Develop positive self image: give up shame and doubt
14. Try to interfere as little as possible “Its your show, Rose, take it away and show me your stuff!”
15. Great age to collect things stickers may have great value. Find out what the kids are collecting this yr. We may get some to hand out.
16. Secrets are important keep a secret from Mom
17. Apparent dislike of opposite sex, but perhaps a secret boy/girl friend
18. Avoid pressure, comparisons to others, humiliation, withdrawal of approval
19. Don’t force activities she genuinely dislikes
20. Cherish the child, not the performance
21. Conscience develops, but still needs support
22. Remember the child sized tensions they are dealing with now are every bit as important and big as ours are to us!

E. Age 11 – 18
1. This group will be shifting over to regular adult cleanings very quickly.
2. They will be uncomfortable involved in an activity they associate with little kids.
3. Even if their skills aren’t fully developed, when they ask to terminate PC their request should be honored.
4. They are rapidly becoming adults. Bodies change shape, parents are less heroic, more human.
5. Everything they have learned must now be reevaluated. Prevention must be made relevant to them as an adult = not a child.
a. Avoid fillings (no drilling, no numbing)
b. More attractive to opposite sex
c. Good appearance means a better job

6. Accept them as they are don’t try to change them only clarify and facilitate what they want to be that meets your goals also!
7. From day to day or hour to hour you don’t know whether you’ll be dealing with an adult or a child.
8. Everything is black and white, right or wrong, heavy judgments, much idealism
9. Maintain a sense of humor but no humor at their expense
10. Often a teen will be asked to return for a PC appointment to control a specific decay or gum problem. Be careful to establish your contract carefully and don’t overstep it.
11. Listen actively to their feelings and point of view
12. Use the ultraviolet dye rather than the red tablets and explain that this is to avoid their embarrassment
13. They may risk some intimacy/sharing with you. This is great. It is a step in giving up isolation and shows growth.
14. Limit your praise. Accept their behavior. Give your ideas and feelings. This will serve as a model for them to do the same sharing.
15. When finish PC great time to let them know they have now mastered their skills and its time to move onto an adult type appointment.

When you feel you have mastered the PC appointment. Set up the small recorder (Dr. Smith will give it to you). Record your entire appointment and review it. When you are satisfied you have everything correct give Dr. Smith the tape and set up an appointment to review it with him. Also, read Your Child’s Self Esteem and plan to discuss it with Dr. Smith.

The Preventive Experience

I have titled this section the “PC experience” rather than an appointment. It is much more than a dental appointment. It is an opportunity to shape another human beings life.

I hope you have the opportunity to visit Disney World. As you saw in the video tape “In Search of Excellence”, they know how to put on entertainment that involves and pleases everyone of all ages. They don’t have employees, they have actors.

I want you to think of the PC experience as an exhibit in Disney World. In this case, I want you to memorize this entire script. You will be expected to act your part in providing a wonderful experience for each of these children.

I hear and I forget, I see and I remember, I do and I understand.

Aim for service, not success, and success will follow.

Our primary purpose in life is to learn so we can grow, our secondary purpose is to help others grow.

I. Establish Atmosphere
A. Before patient arrives
1. Send a note to new child patient welcoming them (see computer generated sample)

2. Read chart and learn about child
a. Favorite activities
b. History of problems
c. Level of success

3. Set up PC room brush, floss, red tablets, baggy, brochures
4. Be on time!
5. Set your personality: friendly, concerned, fun, knowledgeable, confident,, gentle, honest, feelings, can do attitude!
6. Remember always give choices, options that’s how people grow!

B. Greet the child and parent using your first name
1. Sit down with Mom for a minute and introduce yourself and ask her if there is anything she wants you to look for specifically. Has there been any change in child’s medical health.
2. Smile, touch, ask, listen, don’t judge, feedback
3. If the child is playing, show interest in what she/he is playing, after 1 2 minutes guide the child back to the PC room holding child’s hand or placing hand on child’s shoulder. “Come with me ________. I’ve got lots of things to show you!”
4. Don’t allow interruptions
5. Show child which sink is “theirs” today

C. Spend 3 5 minutes getting to know the child and parent so you can confirm your “contract” THIS “CONTRACT” IS YOUR PRIMARY JOB IN THIS APPOINTMENT. Most parents just bring their kids in because they believe they “should”. Your job is to clarify Why Mom believes she and her child are better off. Remember the types of motivations (refer to page #8, F). Talk with her. Find out what is valuable to her. Clarify it. Speak it. “Mrs. Jones, then from our talk, the main reason you bring Tom to us is _______.”

Occasionally the parent will ask that the child’s teeth be cleaned no PC. Honor the request. When finished, show the parent any decay or gum disease that might be able to be controlled by a PC appointment.

Next, bring the child to the preventive room, go through the same thing with the child. Again, you must help him clarify what he gains from working with you to develop his skills at becoming independently healthy: “Tom, what I’m hearing you say is that you want to develop good skills with the brush and floss so you won’t have to get shots and be drilled.” Who has shaped your child’s opinions? Ask if a teacher has talked about going to the dentist, a TV show like Sesame Street, have they been to a previous dentist, finally the experience they have in mind. Alter or reinforce their ideas as appropriate. You just developed your contract.

1. Child and parent “contract” will probably match some of the goals discussed.
2. Make some statements to show that you know something about them as people
a. “John, you had a filling 6 months ago. I bet your goal is to never have another one. Am I right?”
b. “Mrs. G., you work during the day. I bet it’s hard for you to find the time to supervise John’s flossing. Am I right?”
c. Ask some questions to get them on track: “John, tell me, when is the best time for you to clean your teeth? Show me how you go about it.” Build trust frankly tell him what you expect be honest share your feelings, good eye contact good body language

3. When you feel that you have the correct atmosphere let them show you how they take care of their teeth. First, let them pick the color toothbrush they want.
a. If they are a new patient or under the age of 7 start by explaining what a red tablet is and how it works. For the young child, make it a game hide and seek. For the older child, offer them the ultraviolet approach so the red won’t show. The young child may be apprehensive that her parent is watching and judging how well she performs. Really work to keep the appointment light and fun. Hide and seek with the sugar bugs, etc.
b. For patients older than 7 who have been through a PC appointment at least twice, have them go through their brush and floss routine as they normally would at home, only more slowly, so you can see what’s going on. Remember, the goal is not to have the child perform to your standards. The goal is to maintain the child’s self esteem and have them develop skills that they can use easily at home. By waiting on the red tablet, you focus on them and give then a couple ideas on technique. When the red is in there it’s almost impossible not to focus on the red with comments such as “Let’s see if you got all the red off that time!” or “There’s still some red on the inside of your lower back teeth. Why don’t you brush there again.” The red tablet is an easy way to set up a judging pattern in the appointment. The later and less it’s used the better. Use the lighted magnifying mirror to help your child see in their month. When you have finished the skill development part of the appointment, go to the chair and examine them. Look for decay, gum infection areas, etc. Base your brush and floss suggestions on this rather than the red tablet. Ask them first if they know what the red tablet does.
4. Don’t ask someone to make a change unless there is some reason they have to change.

D. As child is brushing
1. Keep it loose and fun Ask if they brushed before they came in. If not don’t worry!
2. No paste on toothbrush explain that brush provides the cleaning and that toothpaste is just a
flavored soap. We use toothpaste to:
a. Add flavor
b. Add fluoride
c. Add an abrasive to help the brush clean

3. If there’s no paste on the brush he can talk while they clean.
4. Now’s a good time to ask about hobbies, pets, friends, family, interests, etc.

5. As you watch, make sure they have the basics down
a. How to hold the brush
b. Start on outside of upper right back molar
c. Race track pattern (outside of uppers, inside of uppers, drop down to outside of lowers –
start on back right molar and then insides, finally the tops of the teeth
d. Angle of bristles working edge at gum line

6. Don’t constantly correct them if you have to work hard on establishing the race track pattern then only mention brush angles and floss corrections briefly. If you need to correct the child, try putting your hand over his so he can get a feel for what you want him to do.

7. Now is the time to see what the child knows about the decay process. Don’t quiz him. Just ask if he knows how people get holes in their teeth (under 6). If over 6, assume they know the process unless you see an active decay problem. If the child is having a problem handling the toothbrush, introduce him/her to the ProClean 2000 and let them try it.

8. Next, have them floss. Again check the basics:
a. How they wrap the floss on their fingers
b. Same race track pattern
c. Saw through contact, bend and work up and down on both proximal surfaces

9. While they are doing this, ask how they are doing with sugar. If sugar or decay is a problem, find the worst offender (example sugar pop, lunch dessert) and offer a substitute the child likes (sugar free pop, juices, apples, bananas)

10. Next, check on fluorides both tablets and brush on. Ask child how often he uses the fluoride (check pink sheet 1st) and in which forms tablets and/or gel. If it’s not being used, this is the time to try to reinforce it. Make sure they live at same address if still on fluoride tablets.

11. If the child is not flossing, reassure him that you know he can do it, that it’s only a matter of finding the right time. When he finds a habit that he has that occurs daily, he’s relatively by himself, and doesn’t need his hands (ex. reading, tv), then tie flossing to it. Explain how hard it is to try to make flossing its own habit. Its easier to tie it to a habit you already have. The worst place is in the bathroom before going to school or at night just before bed. Its too easy to skip!

12. Be sure to find lots of positive things to mention. At least 3 positives for each negative correction and start out with at least 2 positives before the first negative.

13. Finish asking all pink sheet questions. If child answers no or less than best answer (example brushes 3 times per week). Remember whose problem it is! Ask why. Explain you are concerned that this may let them get decay, etc. How do they feel about that?

14. Establish when they will brush and floss. Remember, the worst times are in the morning just before going to school and at night just before going to bed. It’s too easy to skip. The worst place is in the bathroom for flossing. It ties them down too much. Have them find a place where they are relatively by themselves doing an activity that they repeat daily and don’t need their hands to do. Examples watching TV, reading the newspaper. Don’t try to make them establish a new habit, it’s too hard. It’s much easier to add flossing to a habit that already exists.

15. Your last step in the PC room is to have the child brush one more time with a toothpaste to clear any residual red off so you can evaluate the gingiva at the chair and help them look better.

E. Wrap up the session.
1. Bag up the supplies, pick out a sticker if appropriate
2. Have child wash down sink and clean up the area
3. Switch to an operatory. Take necessary “decay” x rays (Please don’t call them bite wings) Usually, we take our first decay x rays when the 6 year molars are in occlusion and then every 2 years after that. If a decay problem develops, we may go to annual x rays. Try to take adult films if at all possible. This helps me see the position of the erupting permanent bicuspids. After you have placed the x rays in the processor, let me know that you are ready.
4. If this is the child’s first visit, show him the chair, light , etc., explain who doctor is and that doctor’s job is to help kids have big smiles and bright teeth!
5. Use your mirror and exploring point probe for pocket depths and decay, check for bite problems.

Here are the six possible distinct periodontal infections you may diagnose. Statistically, you can expect to see some bone loss and loss of periodontal attachment on 5 9% of 5 11 year olds and 5 46% of 12 15 year olds. The wide percentage ranges are due to different results from different studies. The important point is that you can’t assume that the destructive forms of periodontal disease are confined to adults.
a. Chronic gingivitis stage I of soft tissue management program
b. Chronic periodontitis stage II of soft tissue management program
c. Localized juvenile periodontitis rapid bone loss (often localized to molars and incisors
in a client who is medically healthy Treatment same as stage II plus tetracycline if no
primary teeth remain)
d. Generalized juvenile periodontitis begins around puberty, generalized bone loss, inflamed
gums stage III treatment with antibiotic
e. Acute necrotizing ulcerative gingivitis/periodontitis interproximal ulceration, pain,
sloughing tissue caused by stress and poor hygiene stage I treatment
f. Prepubertal periodontitis Begins from time primary teeth erupt until age 5 rapid bone
loss, inflamed gums, can be localized or generalized

6. Ask Mom if she has any questions
7. Polish off all stain and calculus
8. Review the changes (if any) that you and the child have decided on
9. Reinforce positive, can do attitude and confidence
10. Does Mom need any written info.? Sealants, PC/Kids, etc. If yes, be sure to write on it to
personalize it for her.

F. When Dr. comes in
1. Be sure to use the child’s and Mom’s 1st names so I can know them!
2. As I’m examining, tell me how the appointment has gone. You can read down the pink sheet if you want.
3. Write down all my comments
4. If child has gum problems, set up a time in 2 4 weeks to reevaluate (if Mom wants) plan on IU

G. When I leave

1. Discuss fluoride with Mom 2 types:
a. Fluoride tablets optimum level .7 1.2 ppm If child uses a municipal water supply, look up the content in the 3×5 file. If the child uses well water, give Mom a fluoride sample bottle so the state can analyze the fluoride content. (We get the results from the state and notify the parents.) Make sure the paper insert is filled out with name, address, etc.
2. Now is a good time to give Mom our booklets on PC and prevention. Be sure to underline several important points in each booklet to personalize them for Mom.
3. Focus now on the goals the Mom and her child discussed with you in the beginning of the appointment.   “Mrs. Jones, you were most concerned about Tom avoiding decay. Today we really worked hard on his racetrack pattern. If you will work with him on this skill until our next check up I’m sure he’ll have a better chance of avoiding decay. “Tom, you were really concerned about not getting decay. Your most at risk areas are between your teeth. Finding the right time to floss while you watch TV should be a big help in avoiding those shots and drilling!”
4. See if Mom has any other suggestions. Make sure they have their bag of brush, floss, fluoride, etc.
5. Have child go to the NO DECAY bulletin board and find his star and put a star on it
6. While he is doing that you can drop the chart off at the desk, so Mom can complete the transaction with the secretary. Decide how long until the next recall and whether it should be a PC or a cleaning. Pick the computer recall code. Make sure the chart and pink sheet are filled out completely. Is there a referral sheet filled out for Dr. Farley? Fill in the remarks section of the yellow sheet with important info. about the child: favorite games, pets, names, etc.
7. Pick out the computer codes for the next recall and how much time will be needed.
8. Thank Mom for bringing her child and tell him how well you think he’s doing and thank him for working so hard with you. Remind him to look in the next newsletter for his name (if had no decay).
9. Write the child’s name on our newsletter no decay list (if decay free). Their name will appear in the next newsletter.

Special Situations

A. Mom doesn’t want to come back with you and child
1. We prefer Mom to be present for first visit
2. Child older than 10 – you judge – mom may embarrass child
3. Child less than 10 acknowledge Mom’s feelings, let her know you’ll give her a report
4. Work with child
5. Report results to Mom
a. All ok
b. Problems = report and encourage Mom to be with child next time

B. Child 4+ and Mom still cleans teeth
1. Let Mom show what she can do
2. Have child go through appt. praise child show Mom how much he can do and encourage child to do their thing with Mom helping only once per day

C. Child has been in PC for several years and skills are good and no decay
1. Go through PC
2. Congratulations and time to go to cleanings

D. Child who won’t cooperate and Mom no help
1. Focus on child, tell him (eye to eye) that you would like to help him to be healthy, but you can’t do it for him. Does he want to work with you? If yes go through appt. If no turn to Mom, acknowledge that skills can’t be learned by force and recommend discontinuing the appointment and only having me examine. Also recommend yearly x rays, real care with sugar, and emphasize use of fluorides.

E. Mom monopolizes you and won’t let you concentrate on the child
1. Listen to the Mom, then as quickly as possible, tell her what she says is interesting and you enjoy talking with her, but now you need to work with her child
2. If she interrupts you later, try to answer with yes or no and don’t look at her.

F. Mom says this isn’t important wants teeth cleaned
1. Find out why Mom doesn’t want PC
a. Money
b. Education
c. Remember 40 70% is nonverbal

2. Try to “clarify” why doesn’t want 4 types of people
a. Money save future dental bills
b. Self preservation be healthy, avoid body breakdown
c. Recognition Looks, self improvement
d. Romance social, business, dating, get parent to focus on the future of the child

3. If you can’t convince Mom of the value of the appt., then clean their teeth instead

G. Handicapped children
1. Switch gears to match their behavior related age
2. Find out what they like to do to clean their teeth and work with these steps parents don’t usually do a lot to help and don’t challenge the kids.
3. Make appointment fun.
4. Work hard with parent on sugar limits (not a treat for good behavior)

H. Child 3 or younger
1. The first appointment should be by age 1. 8% of 2 year olds have decay.
2. Fluoride is almost entirely screened out at the placental barrier, so the developing teeth lack fluoride before birth.
3. Schedule the appointment in the morning and not at nap time.
4. Parent can bring the child’s favorite toy or blanket.
5. Begin with a lap brushing by the parent. You and the parent sit knee to knee on chairs with the child in our lap facing you. Lean the child back into the parent’s lap. You control the child’s hands/legs. The parent brushes.
a. Develop a “race track pattern”
b. keep the lower lip retracted.
c. No toothpaste
d. play a favorite song
e. start flossing when the teeth touch.

6. Parent sit on floor with child between legs; is a safe, controlled approach to “squirmers”.
a. If child uncooperative, parent swings leg over child’s legs and hand hold child’s hands.
b. Brush for one minute or less.

7. Focus your attention and conversation on the child.

8. Now reverse the child so the head is in your lap for the exam.
a. Bite
i. Overbite may be 100% until second baby molars erupt
ii. Overjet 3 mm or less
iii. Open bites: pacifier-stop by 2, fingers/thumb-stop before permanent anteriors erupt.
iv. 4 year olds+ should have crossbites evaluated.
b. Decay
c. Gums
d. Behavior

9. Review Independence brochure while counseling parent. Is there any need to have the dentist polish the teeth?
a. Give a copy of our PC booklet
b. Maternal antibodies deplete by 6 months and child is more susceptible to infections. Cranky, lack of sleep, poor eating may be an infection, not teething.
c. Drooling at 3-4 months may be due to normal salivary gland development, not teething.
d. Stop using the bottle by 1 year of age.
e. Plain water at nap/bedtime bottles
f. Breast feeding past 18 months increases caries risk
g. Probably no vitamin supplement after 1 year – read labels – avoid chewable vitamins where sugar is the first ingredient, but chewable vitamins at meals are absorbed best.
h. Tetracycline antibiotics before 8 can stain permanent teeth.
i. No fluoride toothpastes until child spits effectively.

Your Checklist for the PC experience

The PC Experience

1. instructor (facilitator) friendly, concerned, knowledgeable, confident, gentle, honest feelings, sense of humor

2. everyone is different

3. have enough time not rushed or preoccupied

4. kid should feel important, unique

5. be honest, empathetic, straight forward

6. use words pt. can understand (and parent)

7. first names to be more personal

8. remember whose problem it is

9. be a good listener

10. be a good role model

11. non verbals / tone of voice in portraying #1 above

12. touch take hand to guide to room

13. no interruptions

14. praise

Get Information

1. Who is this person?

2. What are patient and parents beliefs?

3. How to avoid “20 Questions”

4. Time to develop trust accept their attitudes

5. We develop beliefs from our experience and this becomes our philosophy and makes it easier for us to be consistent and make decisions easier

6. Only ask and listen don’t judge

7. Know as much about the person before you meet them as possible

8. develop focus, clarify

9. Feedback in their terms – Independence brochure

10. Call parent ahead of appt.

11. Behavior matches self image

Specific Instructions Develop Commitment/ Contract

Commitment: Why should pt. and family change?

a. options always options shows respect

b. rewards positive

c. purpose in life
1. primary learn in order to grow kid
2. secondary help others to grow parent

d. what motivates pt?

e. recognize pt. / parent emotions

f. dental IQ

g. Interests of patient/ parent
adults associated improved oral hygiene with:
economics
appearance pretty smile
better chewing
bad breath teens
independently healthy

h. Instructions in their terms – Independence brochure

i. Lovable, worthwhile

j. active involvement models, red tablets

Develop Attitude/ Confidence

“Can Do” believe they can be healthy

a. how solve problems preventing good health

b. how do people learn? remember? –  personalize!

c. hear not as good see not as good as do

d. what specific plan will meet this person’s needs
Material open up PC book and relate to person

e. give constructive criticism

f. be aware of maturity level and self esteem (image)

g. be aware of emotions

h. lots of praise

i. if neg? asked ask to repeat (give you a chance to think)

j. Guidelines
1. relate disease process to pt. involve pt.
2. real process

k. praise small accomplishments don’t push for your standards

l. stickers/ no decay club

m. facilitate enthusiasm

Action Repetition/ Follow up

1. call one week after appt.

2. send card

3. people will forget 80 90% of what you tell them

4. establish given time for home care. Establish daily reminder.

5. Newsletter punch

6. no decay club

7. Decide on recall code for computer

8. Give one of your business cards