Treatment of your first patient is, without doubt, one of the biggest hurdles in the dental career pathway. Kalpesh Prajapat a fourth year Dental Student, shares his experience on the invasive treatment of his first paediatric patient; highlighting the fundamentals to success.
It was quite some time since I visited the dentist as a child. Now, the moment had finally arrived to treat my first paediatric patient. With memories of my first childhood dental visits in my mind, I was conscious of the importance of these encounters on the child's long-term attitude towards dentistry.
Shortly after commencing the fourth year of the BDS programme at Liverpool School of Dentistry undergraduates, such as myself, are fortunate to be allocated a paediatric patient. Despite experiencing adult dentistry and having managed child patients in the hospitals prevention clinic, the thought of undertaking more invasive dental treatment on a child patient was a somewhat daunting prospect. Needless to say a different challenge from a multi-rooted endodontic treatment or a flap design in minor oral surgery experienced on the adult clinics.
Preparation is key to success
From the moment I arrived on clinic, an anxiety driven 40 minutes early, I felt a mixture of excitement and nerves as I prepared the unit for my first restoration. Setting up the dental dam for the LL6 composite resin restoration seemed somewhat more unnerving than what I had previously imagined.
Planning was a vital component in the architecture of successful treatment. Ensuring the appointment was booked in a timely manner, allowing appointment details to be sent via post, and following this up with a phone call to the patients parents undoubtedly reduced the chance of patient non-attendance. Furthermore, by familiarising myself with patient notes, educational materials and discussing the case with tutors prepared me mentally for the visit. Finally, a pragmatic dental setup with all equipment, materials and relevant radiographs at hand, exemplified a professional and structured clinical approach to treatment.
However no matter how much you prepare, it is only natural to feel apprehensive about treating your first patient!
Building relationships, keeping organised and infusing confidence.
Building a rapport with my patient was fundamental to easing the patient's apprehension and acted as a method of increasing patient compliance, as trust forms an inherent part of dental treatment.
At the first consultation, I arranged a structured but very informal preventive appointment. The patient's diet diary was explored, correct brushing technique was demonstrated with toy models, followed by application of six resin based fissure sealants and fluoride varnish.
A beneficial principle to stay organised and efficient is ensuring a systematic approach with treatment, whether it is delivering oral hygiene advice or restoring a carious cavity. The paediatric patient can be relentlessly energetic thus working in a timely manner can favour the clinician and the child.
Non-pharmacological behaviour management techniques; integral to successful treatment
Clinical skills in relation to paediatric and adult dentistry actually vary insignificantly. However, the fundamental difference is the clinicians approach to behaviour control, and it is this that plays an imperative role in determining the success of treatment in the child patient.
The thought, to a child, of a high-speed drill cutting away at their tooth would not be a far cry from a nightmare. Thus, appropriate verbal communication; voice control and body language can reassure even the most anxious of patients. The use of systematic desensitisation can also be adopted. This technique involves introducing the child to increasing 'fear-producing' stimuli as they mature with further treatment experience. For instance, providing a fluoride varnish then at a subsequent appointment fissure sealants. The patient is effectively progressing up the hierarchy of invasive treatment but only when they feel ready.
A fundamental stage, for new procedures, is to ensure the patient knows what to expect. I implemented a tell-show-do technique; using a life-size model mouth I was able to convey information in a fun, relaxed and informative style. Both parent and patient were aware of what was to be done and why, thus reinforcing patient education.
Throughout treatment, the patient was always felt to have control. The use of 'stop signals', such as a raised hand, allowed trust to be established. Positive reinforcement during and after treatment helped to boost patient moral and, no doubt, their confidence. Finishing the visit with a well-deserved sticker can also reap benefits!
Ultimately, the experience was inevitably one to remember. This is a brief summary of what I gained from the treatment of my first paediatric patient. I am now embarking the journey of further restorations followed by extractions on this patient. The experience gained through treating a paediatric patient was, for me, both rewarding at a personal and professional level.
Kalpesh Prajapat