Why having parents in the operatory is a great idea!
The times they are a-changin'
Hello people of the world! It has been a long time since I wrote to you all. I am currently in Year 1 of my 3 year pediatric dental residency. It has been a wild ride so far. I am happy to report that it has been going well. I was nervous about the utility of a residency program as I was a practicing dentist for a while before I took the plunge and decided to pursue a post graduate degree. Thankfully, there is a lot to learn and some bad habits/patterns to unlearn.
My newsletters going forward will be geared towards general dentists or hygienists who treat kids in their practice. I want to share what I am learning as I make progress in my educational journey.
Doing so concurrently helps me make sense of what is being taught to me and to share with you fine folks the wonderful things I wish I knew when I was seeing kids as a general dentist.
Today’s topic is about a very personal preference I have and many dentists I know have. Back in the day, pediatric dental offices would have a strict policy - “No parents in the operatory.” While this has its advantages, this is no longer an acceptable practice if you ask young parents today.
Behaviour guidance in pediatrics has to evolve as parenting styles evolve. See how I used the term “guidance” instead of “management”? This is one of the first few things I learned at the start of the program! We don’t manage the child’s behaviour, rather, we guide it.
Anyway, back to the topic at hand - Having parents present in the operatory is a great idea for the following reasons -
They need to see how their child is responding to non pharmacological methods of Behavior Guidance like Tell-Show-Do, positive reinforcement, distraction, etc. When they watch you try your best to gain cooperation from their child and if sadly you fail, they will be more accepting of pharmacological methods of behaviour guidance. You can then hope for an easier discussion on using minimal sedation with Nitrous oxide or referral to a pediatric dentist for oral conscious sedation or GA.
For children with separation anxiety, due to age or otherwise, having a parent in the room is a good way to avoid meltdowns. This is especially important for children 3 or under. It is natural for these young ones to fear being separated from their parent. As they get comfortable seeing a dentist, they will feel less anxious not having a parent around. Moreover, sometimes the only way you can complete an exam is using the knee to knee approach or while the parent is lying down on the dental chair and the kid is laying on top of them.
For gentle hand holding and/or active restraint during procedures - Of course, the parent has to be comfortable doing this! In my program, we only actively restrain with the help of certified dental assistants and the parents and only during administration of local anesthetic, if needed. The parent becomes part of the behaviour guidance and they appreciate your patience in helping their child more after they have seen the brute force these young kids can exert :D
For approval of any unprecedented changes in treatment plan - Having the parent in the operatory where they can be shown why a certain treatment is being suggested instead of the one that was previously discussed, is a time saver and is less anxiety-provoking for the parent. We show parents the tooth of concern in the patient’s mouth or on a radiograph. After all, a picture is worth a thousand words!
For demonstrating oral hygiene techniques - I love using the disclosing agent to show where and just how much plaque is being missed! That magenta pink really makes them pay attention ;) A parent who is in the room during a simple hygiene visit is more likely to assist their child at home and supervise their brushing/flossing.
Now let’s talk about the Helicopter parents or the Authoritarian parents or the permissive parents who can make your job a lot harder to do!
My only advice is to be firm with the parent (not rude, just firm - something I constantly struggle with!) and to remind them that they are required to be silent observers in the room.
We always tell the parents that we may have to use “Separation” as a behaviour guidance technique where they can stand outside the operatory but out of sight of their child so we can ensure that the child is paying attention to us and not them.
Obviously, you can’t always win. But you sure have to try!