Minor Distractions

THE DENTAL CHAIR CAN BE A SCARY PLACE FOR CHILDREN. BUT TODAY’S MANUFACTURERS ARE COMING UP WITH ALL SORTS OF INVENTIVE WAYS TO MAKE IT A MORE KID-FRIENDLY PLACE. WE SURVEY THE FIELD OF PLAYFUL PRODUCTS THAT CAN MAKE BOTH DENTAL VISITS AND BRUSHING AT HOME MORE FUN.

How many of us of a certain vintage learned to fear the dentist? Back in the day, for some of us, nine times out of 10, it was some crotchety guy with little patience for children. And if he failed to administer enough Novocaine, well, you’d better just suck it up and keep your mouth shut … er … open. This probably led those of us who have kids to subconsciously pass on our fear of the dentist.

To be fair, screaming, flailing kids can pose a danger to all concerned, so misbehavior needs to be held in check. But today’s pediatric dentists — or those skilled in working with young patients — have a pretty good shot at gaining control of the situation before it gets out of hand. This is especially true nowadays, with the arsenal of child-oriented dental gadgetry aimed at bolstering children’s confidence or just plain distracting them.

Dental caries in children, though on the decline from a spike in the early 2000s, remains one of the most common, yet preventable, childhood diseases and a very real threat. In fact, according to the latest statistics available from the Centers for Disease 
Control and Prevention (CDC), from 2011 to 2012, approximately 23% of children between the ages of 2 and 5 and a whopping 55.7% of them between the ages of 6 to 8 had caries in at least one of their deciduous teeth. But the CDC also reports that decay can be reduced in the permanent molars of kids by as much as 81% for 2 years — and possibly up to 4 years — when sealants are applied.1

For reasons like this, experts agree that it’s vital parents establish a dental home at an early age. And, indeed, according to the National Center for Health Statistics, 84.7% of children aged 2 to 17 went to the dentist in 2015.2 But to gain cooperation from kids both for the dental visit and at-home care, up-to-the-second sales know-how and manufacturer innovation are invaluable.


Point of Sale | Child’s Play

  • Office decor with kid-friendly themes and bright colors can really help set the stage for welcoming children into dental care.
  • Chair accessories such as beanbags and pads can aid positioning and enhance the comfort of small children sitting in adult-size chairs.
  • Battery-operated toothbrushes and adjuncts are now enticing children with lights, sound effects, games and apps that make brushing fun.
  • Flavored topicals, prophy pastes and toothpastes are beneficial in gaining compliance in children.
  • Dental-oriented toys and books can help familiarize young patients with the process of oral care.
  • Studies show that audiovisual options can provide helpful distraction and reduce anxiety for children during treatment.

KIDIFYING THE OFFICE

By making the dental office an interesting and inviting place, oral health professionals, practiced in the art of treating children, replace the shun factor with the fun factor. Not just in the operatory, but in the waiting room too, to which games and books can be added to help alleviate stress in child patients. And, according to current American Academy of Pediatric Dentistry (AAPD) President James D. Nickman, DDS, MS, there are many products on the market to help clinicians make dental visits more child friendly.

Well acquainted with the challenges involved in treating children, Nickman operates several pediatric practices in Minnesota. He notes that options for decorations to make the office more entertaining range from overhead light covers, such as clouds, balloons and animals, to more elaborate three-dimensional characters and themes. “Offices commonly work with designers and local artists to create a child-friendly theme or environment,” he says.

In fact, adds Laredo, Texas-based pediatric dentist and AAPD President-Elect Joseph Castellano, DDS, “There are several companies that specialize in creating themes for dental offices — pretty much anything you can dream up. For example,” he says, “they can create an ocean theme complete with life-sized fish and underwater murals, or a jungle theme with a large tree in the center of the reception room, and animals, from small to life-size, that fill each area of the office. The whole idea is to create a nonthreatening place where kids have fun and feel safe.”

Castellano adds that some companies build gaming centers consisting of video games for learning or playing that give kids something to do as they wait for their appointments. In addition, he says that most offices will have some kind of a prize or reward for children when they leave. “Some use token machines that dispense prizes, while others may use a treasure chest where the child chooses a toy upon finishing his or her appointment. In my office, we have had great success giving the children a balloon and a sticker. They really look forward to receiving them each time they come in for a visit.”

Like the waiting room, the operatory can also be geared for young patients through various means. Says Nickman, “For comfort in the chairs for smaller-sized children, there are several manufacturers producing small bean bags or small pads that help position the child closer to the adult-sized chair’s head rest,” he notes.

Audiovisual aids are also becoming a popular commodity among those who treat children. In fact, studies indicate that audiovisual distraction reduces dental visit stress and anxiety by a significant degree, even during administration of local anesthetics.3,4 Says Nickman, “There are several manufacturers who are providing audiovisual options to keep children distracted and entertained during their appointment.”

Castellano adds, “Many offices install video monitors above the patient in the treatment operatories so that the kids can watch movies while they undergo dental treatment. This helps distract and entertain the children while their treatment is being accomplished.”


A CLOSER LOOK AT THE CHILD-FRIENDLY ARMAMENTARIUM

VR

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While clinicians may find that instruments such as lasers and electric handpieces, which offer speed and quiet performance — and a flat-out cool factor — are great for treating anxious children, many innovations are designed specifically to ease children’s fears in the dental chair and encourage oral care at home. In-office products that can capture the hearts of children include prophy angles that are shaped like animals and colorful bibs sporting fun characters.

Another huge plus comes in the form of taste. Topical anesthetics, which can help curb pain from a needle stick, are available in a range of appealing flavors. The same goes for prophy pastes, as well as toothpastes and mouthrinses, which help encourage oral home care. Even exam gloves can be flavored these days.

Audiovisual aids, such as movies, can absorb a child’s interest to the point that he or she is not fully paying attention to what’s going on inside his or her mouth during treatment. In fact, some manufacturers offer three-dimensional eyeglass systems that can be connected to various devices ranging from DVD players to gaming systems, placing the action front and center, as if the child were watching a 60-inch LCD flat screen from a distance of about 6.5 feet.

For home care, brushing can become fun with colorful toothbrushes with cushioned, nonslip handles designed for little hands. Many of these now feature antibacterial bristles. Among other offerings are brushes with timer lights, and brushes that sing, sport cartoon characters, and turn into light sabers. For children ages 4 and younger, little finger brushes can be used by parents like tiny puppets to introduce the concept of brushing.

Even flossing, which begins when interproximal spaces begin to close, can be transformed through innovations such as flossing aids featuring brightly colored handles, or those with fun shapes. Water flossers can be festooned with colorful stickers. And don’t forget brush holders. There is even one that doubles as a “brushing coach” to ensure that children brush correctly and for the right amount of time in a follow-the-leader fashion.

Finally, familiarity with the kinds of things that occur during a dental visit can help to reduce anxiety in children. Clever ideas of accomplishing this include toys that let children play dentist, complete with dental chairs and armamentariums, and picture books for kids revolving around dental-related topics.


HEALTH BEGINS AT HOME

But great dental care is all for naught if brushing and flossing fall by the wayside on a day-to-day basis. By creating dental products geared for small patients and tiny hands, manufacturers can smooth the way to building good oral health habits at home. The same can be said of creative and inventive designs that appeal to children, some of which can make brushing fun.

Nickman points out, for instance, that some of the more traditional toothbrushes and other oral care devices are decorated with familiar characters, such as popular cartoon figures, while others might be shaped like cars or animals. “The exciting changes are starting to arrive with brushes that are integrated with their parents’ smartphones or other devices to help, at a minimum, measure the length of brushing,” he notes. “Some toothbrushes are used in effect as video game controllers, allowing the child to play a game while brushing to track the amount of brushing time and locations in the mouth. Some can even provide feedback to parents and the dentist on the effectiveness of brushing.”

“Dental product manufacturers are always coming out with new and improved products to help make home care easier and more efficient,” says Castellano. “We have toothbrushes that play music or have flashing lights that run for two minutes so the child will brush for the recommended timeframe. There are also myriad timers to help with length of brushing.”

Castellano says that battery-operated toothbrushes are big sellers. “Some children like the fact that the toothbrush spins and does a lot of the work for them,” he notes. “This can help some kids do a better job keeping their teeth clean. There are themed toothbrushes featuring characters from shows kids know and love. It makes the toothbrush more attractive and appealing to children. And, when they like it, they use it.”

Castellano further notes that flossing aids can also be themed and/or flavored. “These can be helpful to both parents and the child to make the task of flossing easier, more efficient, and hopefully more frequent. Finding a product that the child likes and wants to use is the key to helping him or her achieve optimal oral health.”

OVERALL STRATEGIES

Aside from employing imaginative products to lure children into good oral health, pediatric dentists have other tricks up their sleeves to win over their young patients, and some of them involve parents. “Every child deserves a great start in life,” says Nickman. “To help parents provide their child with the best oral health care, the AAPD recommends that the first visit to a pediatric dentist occur by age 1. During that visit, the pediatric dentist and staff meet with the parents and child, and check the teeth and gums, discuss diet and provide instructions to care for the child’s teeth and oral structures. The goal of the visit is to prevent cavities from occurring, and if present, catch them at a stage that’s easier to treat.”

Nickman notes that because dental visits can be a stressful time in a child’s life, the most important thing is for the parent to relax. He says that while it’s not uncommon for children to be anxious in a new setting, a nervous parent can elevate the child’s anxiety.

“The pediatric dentist is trained to work with children from birth to adulthood, and individuals with special health-care needs,” says Nickman. He suggests that pediatric dental offices can be a tremendous resource for parents as far as how to prepare for the dental visit, enlisting them as partners in their child’s care.


LEXICON

  • Caries: A bacterially based disease that results in demineralization of teeth.
  • Deciduous teeth: Primary teeth, which fall out to make room for permanent teeth.
  • Dental home: A dental office that a child can be introduced to early and can grow up with.
  • Interproximal: Space in between teeth.
  • Operatory: Room where treatments are performed.
  • Prophy: Prophylaxis or cleaning.

“The information provided by the parents can also help the pediatric dental office prepare for their child and tailor the appointment to the child’s interests and needs,” says Nickman. “For some children, there are books or videos to learn about their first visit to the dentist. There are also a growing number of smart phone or device applications to help prepare the child for the dental visit.”

One method of calming misgivings in young patients that is used by a number of practitioners is “Show, Tell, Do,” in which a clinician explains what will happen and introduces kids to dental instruments that will be used during their stay in the chair. Instruments may be given fun, imaginative names, such as “Tooth Tickler,” that kids can relate to and understand. The idea is to cultivate familiarity, and show youngsters that there is nothing to fear.

“Showing and telling children about what is going to take place, and allowing them to ask questions helps build trust. Gaining the trust of children is very important. Once you gain their trust, you can build a relationship and begin the process of helping these patients develop good oral habits that will last a lifetime,” says Castellano. He adds, however that in his opinion, nothing can beat a warm, friendly, child-centered environment. “For me,” he adds, “trying to make children feel welcome by warmly greeting them and talking to them on their level — with lots of smiles — can help break the ice.”

At such a point, the line between child-friendly and child-savvy dental treatment blurs. Clinicians who take the time to understand the psychology of their young patients can not only help them feel at ease, but make the whole process easier for everyone involved. Just imagine: dentistry based on friendliness rather than fear. If only Dr. Crotchety had known.

For more information on pediatric oral health, visit aapd.org or mychildrensteeth.org.

References

  1. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012. Centers for Disease Control and Prevention. Available at: cdc.gov/nchs/data/databriefs/db191.htm. Accessed October 5, 2017.
  2. National Center for Health Statistics. Health, United States, 2016: with chartbook on long-term trends in health. Available at: cdc.gov/nchs/data/hus/hus16.pdf#078. Accessed October 5, 2017.
  3. Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children’s behavior during dental treatment: a randomized controlled clinical trial. Acta Odontol Scand. 2016;74;494–501.
  4. Nuvvula S, Alahari S, Kamatham R, Challa RR. Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a randomized clinical trial. Eur Arch Paediatr Dent. 2015;16:43–50.

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Featured image by TOMWANG112/ISTOCK/GETTY IMAGES PLUS

From MENTOR. November 2017;8(11):34-38.

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