© J Can Dent Assoc 1999; 65:618-9
Imagine a dental practice where parents rave about the care their children receive. Envision regular doses of gratitude and appreciation for you and your staff. Picture the beaming faces of small children who leave your office feeling better about themselves because of their experience with you. You are looking at the power of trust.
Three years ago I relocated to a rural area to manage a new dental office. I believed I was prepared for this new challenge: I had organized and managed offices in the private, not-for-profit and political sectors, at times supervising more than 20 employees.
Unfortunately, my confidence was soon to be shaken
Some of our patients travelled upwards of an hour for modern dentistry, half of them in search of emergency dental services. Fear was etched on the faces of many patients who entered the office and they spoke openly of how they dreaded their visit.
My greatest challenge was the sense of powerlessness I felt when children came into the office. As a mother of five and grandmother of four, I found it difficult to watch them struggling with the very idea of seeing a dentist. Because dentistry was new for many of them, the only experience they could identify with was their parents horror stories or unspoken fears. The parents themselves were concerned about exposing their children to something they believed might be traumatic - a natural response considering their own childhood experiences.
One day, a terrified ten-year-old and his parents came into our office. Two of the boys teeth had abscessed and required immediate extraction. Unfortunately, this was not Marks first toothache and his past experience only served to aggravate his panic.
I was drawn into the operatory by his desperate, whimpering sounds. I sat beside him, massaging his hands. It seemed to me that if he could become a participant in the decisions being made, he wouldnt feel so helpless. I began by showing him a picture of his teeth. He was thus better able to understand why he was in so much pain. I let him know that I was very sorry he had suffered so much over the last two days and that I wanted the pain to stop. I told him that these were his teeth and his pain he could choose to leave and come back another time, or he could decide to take care of the problem today. I explained that he had to decide whether he wanted to be really scared only once, or go home and have to be really scared twice. He looked at me and said he only wanted to be scared once.
I praised him for making such a difficult choice and told him I wouldve made the same decision, which seemed to give him some comfort. He visibly relaxed. Bolstered by his response, I explained that I knew a special trick which could make this experience very manageable for him. If he wanted me to, I could stay and show him exactly what to do. I certainly had his attention!
Gently, I explained that when we take a deep breath, we breathe in a warm, safe light through the top of our head. As we slowly release the breath, we allow that light to flow through our body, relaxing all the muscles. Every time he did this, his body filled with courage and pushed out fear. We practised for a few minutes. As he began to experience the relaxing effect of this technique, I explained that breathing this way helped many people control how much pain they felt.
Although the dentist was unaccustomed to having additional people in the operatory, he welcomed any suggestions that might help Mark through this difficult procedure. Mark and I continued our relaxation breathing. My voice was soft and reassuring. Occasionally, he looked at me and I would wink at him as I continued to stroke his hand. I noticed that his eyes began to flicker shut as he entered into a deeply relaxed state. There was no movement during the injections and the extractions were completed without incident. When it was over, he was beaming. The first thing he said to me was, That was the best extraction I ever had. His mother was overjoyed. Mark and his entire family are now regular dental patients in our clinic.
I am deeply grateful to be able to work with a dentist who is open to creative ideas and who has encouraged me to experiment with new techniques. Since anxiety appears to be significantly reduced when children become directly involved, I start by making contact as soon as they come into the office and by chatting with them in the waiting room. I ask them and their parents if theyre nervous about seeing a new dentist. If I know that this is their first dental visit, I acknowledge that it probably feels strange for them. Both parents and children are receptive to any reassurances that are provided.
One mother once explained to me that her son Jeffrey would only speak through her. He was very shy and uncomfortable when strangers spoke to him. He sat on her lap, face buried in her blouse. While Jeffrey listened, I told his mother that we thought children were very special and that we always respected their wishes. The staff was informed of his request and directed all their praise of Jeffrey to his mother. By the third visit, he no longer required his mothers presence in the operatory. She was amazed, especially since Jeffrey was still refusing to acknowledge some of his aunts and uncles! Respecting Jeffreys wishes gave him the time he needed to become more comfortable with his surroundings. With time and patience he grew more confident, establishing a basis for trust.
I recall one particular instance when Sheri, a seven-year-old, came in for her first filling. I overheard Sheri ask her mother if we used a needle. The mother was speechless. She wasnt sure what her childs response to the truth would be. Immediately, I went into the waiting room and told Sheri I was going to explain exactly what we used and how it would sound and feel. I explained that everything was long in a dental office because if things werent long, the dentist would have to put his whole hand in her mouth and we didnt think it would fit. The child agreed wholeheartedly!
I told her we use a long cotton swab to apply a soft gel where the tooth is frozen. She learned that the cotton swab would stay in her mouth for about two minutes and that when we used the needle to completely freeze her tooth, the most she might feel was a mosquito bite. I showed her how much of the needle was actually used. I reassured Sheri that because her tooth was frozen, nothing would hurt her. I also promised that she could see and hear everything we used in her mouth.
I fortified her by telling her that we knew children were very brave and that we always told them the truth. Having established a connection, I offered to stay with her and explain everything as we went along. I also explained the breathing technique and why it was so helpful. Armed with facts and a reassuring presence, Sheri went willingly for her dental work.
Various forms of these methods, combined with a growing understanding of the importance of respecting our natural resistance to new experiences, have helped hundreds of our patients. Children are never pressured to go beyond their limits. If they panic during a procedure, we immediately stop and Im given time to speak with them. I try to find something they can make a decision about, such as whether we should complete one or two fillings today, and remind them how long the appointment will be based on their decision. Praise is profuse and courage acknowledged.
We record small details about our young patients, anything from pet names to whose birthday party theyre attending. Although this approach may appear time-consuming, we have noted that once initial trust is established, children remain connected to their positive experience. They often reward and encourage our efforts by remembering something we laughed about during a previous visit.
Over the last two years, this approach has produced astonishing results. Restorative work is completed on most children as young as four years old. Our staff uses these methods to help patients both young and old in managing their fear of dental procedures. Understanding, coupled with relaxation breathing, meditative imagery and large doses of humour, is the mainstay of our practice. Trust is the key. Respect and compassion are the catalysts.
Our childrens confidence in our ability to care for them is a privilege. We have scrapbooks and filing cabinets full of pictures they have coloured for us. One of our treasures is a shiny penny encased in an x-ray mount given to the dentist by a six-year-old girl. We share the rewards of being trusted.
Our patients tell us that they feel welcome from the moment they enter the office to the time they leave. One person told me she had heard good things about our office but never expected to leave laughing after every appointment a remarkable comment coming from someone who was having her remaining teeth extracted.
What I have learned and continue to learn is made possible by our dentist and the standard he has set for total patient care. You never treat a tooth. Always remember that you treat a whole person. This philosophy is the foundation of our dental practice.
These techniques have benefited our dentist and support staff. Stress reduction in the workplace affords us more time to develop as a team, focused on both patient care and consideration of one another. The growing ability of our staff to display compassion and a good sense of humour is paramount in implementing this philosophy.
The words of Herbert Otto best describe our continuing efforts: We are all functioning at a small fraction of our capacity to live fully in its total meaning of loving, caring, creating and adventuring. Consequently, the actualizing of our potential can become the most exciting adventure of our lifetime.
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Mrs. Tabakman is office manager for Maple Creek Dental, in Maple Creek, Sask.
The views expressed are those of the author and do not necessarily reflect the opinion or official policies of the Canadian Dental Association.
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