Wednesday, March 01, 2006

Pediatric Language

Which sounds better to you:

“I am going to squirt some sleepy juice on your lip to make it go to sleep. Then we are going to wash out the cavity bugs with this water. After I wiggle on this other tooth to see if it is loose, we can go get a toy”. Or-

"After I give you a shot of Novocaine with this needle, we are going to drill on this tooth to remove the carious lesion. Then we will put in the restorative material. Then I am going to pull out this other tooth”. --Now just wait a minute!

The words you use make all the difference. I often have parents look right a the child and say, “Are you going to have to give him a shot?" or “It’s ok Johnny, the shot won’t hurt a bit.” and “Do you want him to pull out your tooth today?” Wrong , wrong, wrong. These parents in a misguided attempt to help their child or to be “honest” with their child, have set up anxiety that will make treatment much more difficult. I cringe along with the assistants when a parent uses these no-no words in front of the child. Yes, with some kids words alone will not suffice. Sometimes we need other measures like sedative medications, Nitrous Oxide (Laughing Gas), or any of a hundred other techniques. It's all hopefully adapted for the individual child, what works best for him.

Whatever words we use with children we do try and be “honest”, but we use words that communicate what we are doing in a way they can understand and produce the least amount of anxiety. “I am going to squirt sleepy juice, I am going to wiggle on the tooth and wash out the cavity bugs”. Using the proper words can increase the chance of a good outcome. Now with older kids I might use different terminology than with a preschooler, but the same method still applies. I can’t really explain every behavior management technique here as it sometimes is quite the art rather than a science, but I do know all pediatric dentists learn early on how to use language to make the children have a more pleasant experience. Unfortunately we are so used to using language a child can understand we find ourselves talking that way in front of friends or family..Ha! I even have to be careful the parents understand what treatment I am recommending. "Why are you just going to wiggle on the tooth? I want you to pull it." Good grief.

Very often I have a child in the chair whose parents or siblings have prepared him properly. They have used proper terms or even told him nothing about the visit or at least done nothing to hinder the process. Once I am through, the child says something like “When are you going to take out my tooth?” Well, it’s already out. I have it over here so you can take it home to put under your pillow.” “Really? Wow!”

11 comments:

Anonymous said...

I know this is an old post, but I would LOVE to get some suggestions on specific language I can use to prepare my 5 1/2 yr old for getting her baby teeth pulled. She is very anxious about all the changes happening in her body right now, and she is very worried EVERYTHING is going to hurt. Do I just not tell her the dentist is going to pull teeth? Do I just tell her he's going to wiggle them (she associates this with pain)? I'd LOVE any suggestions!
(-:
Thanks!!

Dr. Dean Brandon said...

Well, I do not have any majic words to use. The dentist will usually find what works for him most of the time. I usually say something that is in general truthful just not as threatenting. Some kids are really excited about loosing a tooth, others not. If there is lots of anxiety, sometimes it's best not to say much of anything and just behave as if it is a normal kind of thing. Worst case, they might punt and try some kind of medicationbeforehand--no biggie if that is needed-most do not need that.

Mama26kids said...

I think you can tell a child the truth and prepare them for pain and procedures with out lying and using fake 'kiddie' words that confuse them. This is just setting kids up to not believe in the dental and medical system as a whole, and I guess that's good because the current medical and dental system stinks!

wiggle that!

Donna said...

Hello.
Nov 26 I fell down the stairs holding my 15 month old. His two front teeth were reinserted into the gums almost completely. We were rushed to children's hospital dental and after xray found that luckily the teeth were forced up and forward so no harm was done to the adult buds. The front two were up and the left upper tooth wad lose. I chose the "wait and see" route. Check up on dec 23 showed that front two were halfway down and the 3 are still slightly lose. Will be returning end of jan again. As of today his front two have almost came back into place. They have not turned any color as of yet. My question is do you think he still has a chance of graying or abcess? Specialist says if one tooth abcess e's she will most likely pull all affected in injury and my heart stopped beating....I really don't want that to happen.

Dr. Dean Brandon said...

Often it's best to leave things alone with these kinds of trauma. If a baby tooth is going to turn dark as the result of a trauma, it usually does it with in 2 to 3 weeks. See my post on getting a dark tooth.

Donna said...

Weird I was posting on that page haha it must have changed. I did read that article and the one about absorption. Was more curious on your thoughts on chances of.it accessing. I'm feel like I'm paranoid about it. Checking multiple times a day for a blister or any signs of abcess

Dr. Dean Brandon said...

Will it abscess? Who knows? Most traumatic injuries I see, well, it does not abscess too often. -The younger the child, the better the outcome. Well, don't obsess. Even if it does happen, it's not the end of the world. Be optimistic. I'd just have a pediatric dentist check at least every 6 months, or if you see anything... Good luck.

Donna said...

Thank you so much for your response. I was shocked at how quick your did! Xoxo

Kayla Lafleur said...

My 4 year old daughter hit her front tooth on our bathroom counter 6 months ago...she went to the dentist to see how it was because it actually pushed the tooth up a little and was bleeding...the dentist said keep an eye on it because it was a little loose and to check for abscess she also got put on medicine to fight infection...2 weeks later she went in for her check up and it had tightened and no sign of abscess. Now fast forward 6 months to her current cleaning and she now has an abscess which we had never noticed nor did she complain of any pain above that front tooth. The dentist now days because she formed that abscess her front baby tooth must be pulled! I am freaking out over this because she already has anxiety over going to the dentist just for a cleaning nevermind getting numbed and having her front baby tooth pulled. Please ease my mind with some knowledge and advice.

Anonymous said...

My daughter hit her tooth on counter 6 months ago it pushed one of her front teeth a little up into gum dentist check it next day and she gave us medicine to prevent infection and said it was a little mobile and for us to just keep an eye on it to look for an abscess and that she would see us back in a few weeks for her routine cleaning and check mobility of tooth. She went back and all was good no abscess and tooth tightened and only turned a little yellow in color...now fast forword 6 months and at her current appt for a cleaning the dentist noticed an abscess above that tooth which we had never even seen before as you have to pull the lip all the way back to even see it..and she also never complained of any pain so we thought we were free and clear...anyways the dentist is now saying because of the abscess the tooth must be pulled and im freaking out now cause my almost 5 year old daughter already has anxiety over the dentist and thats just for a cleaning nevermind having to be numbed and have her front tooth pulled! Please ease my mind...any knowledge and info would be greatly appreciated. I dont want this to traumatize her even more.

Dr. Dean Brandon said...

The scenario you mentioned, (a trauma followed by retightening, but 6 months later,an abscess) is quite common. If I see an abscessed baby tooth, I almost always recommend removal. Seems you main concern is the procedure itself. There is a lot here on the blog about behavior management, sedation, general anesthesia, referral to an oral surgeon, etc. Talk with your pediatric dentist as tot he best what to handle this. Pediatric specialists, (while we aren't perfect) do have some experience in handling these situations the best way possible.