Essay letter to Pediatric Dentistry.
Dear colleagues, our child patient comes/will come to us, accompanied by parents who are more, less or not at all prepared for a dental consultation. We, as doctors of pediatric and/or multidisciplinary approach and specialization, have the obligation of being qualified. Therefore, we are prepared to have all the needed patience in the initiation and familiarization sessions. In turn, our patient needs training not only at the beginning, but also during the treatment plan, whenever a new treatment category is required, such as a first injection, first extraction, first print, first orthodontic appliance, etc. The question –how much does a filling cost- which many parents address to us,  is incorrect and incomplete, considering that it’s ignoring the costs of time and energy dedicated in preparing and ensuring the comfort of the pediatric patient and can only receive an answer once we know who the patient is, how familiar they are, which kind of dental experience they have.

So, in parallel, we deal with two types of procedures : the preparation and optimization of the patient’s cooperation and also the dental treatment itself, as  it is the first visit or even desensitization after a failed experience.

First visit and familiarization

Although modern dental treatments are minimally invasive, a quality treatment –even a professional brushing- can only be performed after obtaining the patient’s cooperation. Sometimes the results are visible and the child can immediately accept the consultation, some other times the positive attitude towards effective treatments is evident only after a few sessions. Once obtained, the child’s cooperation must be maintained throughout their childhood, in order for them to become an educated adult patient without any dental trauma.

A dental treatment that belongs to a different class of treatments than that of non-invasive treatments -directly approached in the first session -without any pharmacological support (e.g.sedative) is justified only in the exceptional case of maximum urgency and only if we already obtained the child’s cooperation.

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Desensitization = Re-acceptance of treatments after a failed/unsuccessful treatment performed by another colleague in another office (applies to adults or children) is a procedure that requires a lot of time, the results being uncertain and not guaranteed.  The treatment of a child’s anxiety/fear/frustration is not the same as the treatment of dental caries. These are separately or in parallel approached, but the dental treatment can never precede the psychological one. Therefore, in a situation as the one above, three methods of approach are proposed :

First method: Psychological patience. This means that we aim to do the following during a few short sessions (10-15 min) at a distance of 2 or 3 weeks:

– to gain the child’s trust and the child to build self-trust.

– to prove that our methods are non-invasive and to let the child check/test if they can cope with them (which means that they have coping resources).

Second method= Psychological patience + ATI assisted conscious inhalation  This means that after at least one/several desensitization sessions we can propose conscious inhalation with MEOPA as pharmacological help (an equimolar mixture of nitrous oxide and oxygen). Inhalation reduces the child’s anxiety and helps the patient see ..le cabinet et la vie en rose…it doesn’t put them to sleep and this is why the child must be prepared to accept the treatments to be performed under inhalation while being aware.

Third method= Pharmacological methods of deep sedation and General anesthesia–with lack of consciousness. Requires ATI monitoring and qualified personnel in the operating room.

 

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