Dentaltown May 2019 - 99

These fears aren't unwarranted. Some pediatric patients will behave this
way-some adult patients behave this way. However, this doesn't mean that
all young patients need to be treated by a specialist; with a few techniques,
many general dentists can learn to treat children comfortably and safely.
I am a general dentist. I don't use nitrous oxide and I don't use a
papoose board. I have, however, treated thousands of children, using several
techniques I've found helpful.
Often, getting the patient to relax makes a huge difference in how an
appointment will proceed. There are certain phrases that always seem to
engage children and may even get a smile or a laugh. Simple things like a
child's sparkly or light-up shoes are a great way to start a conversation with
a 5-year-old. It's not enough to say, "I like your shoes!"-I'll typically get a
small smile in response to that, but I can do better. I'll point to my clunky
black clogs and say, "Wanna trade?" They'll usually smile and say, "No!
They won't fit you!" When they say that I pretend to be offended and say,
"Are you saying I have big feet?" it always gets a smile and a laugh. And
now that they're a little calmer, I can begin dental treatment.
I always start with "magic jelly," the topical anesthetic. The anesthetic
burns a little, so be sure to warn children long before it starts to burn. I
usually say, "You can tell the magic jelly is working because it will tingle a
little bit-it may even feel hot like spicy food." Never use the word burn.
The S-H-O-T is often the make-it or break-it moment of treating pediatric
patients. For wiggly patients, I typically recruit the help of the parent/
guardian. As long as the guardian consents, I use the following technique:
* My assistant holds the children's hands (so they can't reach and grab
the syringe).
* A parent covers the children's ears (so they can't move their head
during the injection).
I'll tell the patient, "My friend is going to hold your hands, Mommy is
going to cover your ears so you don't hear the loud noise, and I want you
to close your eyes so that my bright light doesn't hurt your eyes."
Be sure to warn the child that an uncomfortable sensation is coming.
I'll typically say, "You might feel a little pinch from the medicine," or the
slightly less honest, "You might feel a little poke from my fingernail."
Try to get all the "ouchies" done without having the reload the syringe.
Typically, if I'm treating a lower quadrant, I'll give 90% of the carpule for
the IAN block. Then, without ever leaving the mouth, I'll give the rest of
the carpule for the buccal infiltration. That way, when I go to give more
anesthetic for the buccal infiltration, it won't hurt. I typically tell the patient
while reloading the syringe, "No more ouchies, I just have to drop a little
bit of the medicine next to your tooth." The children already have some
lidocaine in the area, so they don't feel the second injection.
Oftentimes, I try to distract the children with questions during the
injection. Try to be very specific. I used to just ask, "Do you want a sticker
when you're done?" but I didn't always get a response. So then I started
giving specific options. I'll ask, "Which color sticker do you want-blue
or red?" This always gets a response.
While they are numbing, make sure to use that time to show the patient
exactly what you're going to do. Always show them the handpiece (without
a bur). Let them hold it. Make sure to demonstrate the loud noise it makes

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