Paediatric Dental Nursing

Paedeatric-dnDental nursing for children can be challenging but very rewarding. I became a dental nurse in 2006. My training involved rotation in different dental departments, and I was able to work with adults as well as children – but I knew I wanted to be a children’s dental nurse from the day of my graduation. 

I come from a small family; I have no brothers or sisters, and only few cousins. I used to get attached to children very easily, and I always wanted to take a challenge and work in a child-dominated environment. I was warned many times that it can be challenging to work in a dental practice full of children. 

I decided to take this challenge, and have been a dental nurse for a paediatrics department in one of the very busy London hospitals since 2007. I have loved my job from the start, and don’t regret a minute spent with my little patients.

Children and dentistry often do not go together easily. Some children are scared of dentists, and do not want to attend dental appointments. Common fears relate to pain, having teeth pulled out, injections, or just the unknown. Unfortunately, there are not many NHS paediatric dentists where time and play can be introduced into dental appointments. Many dentists do not specialise in treating children and try to help just because they are a family dentist of the child’s parents. 

The very first visit to the dentist for a little patient is a crucial one and will be remembered forever. The particular treatment needed and the way the appointment is conducted can make it either a very successful experience or a complete disaster.

The other very important factor in a child’s level of fear is the parents. If a parent is scared of the dentist, the fear is automatically projected onto the child. From a very early age, children can sense the fear and insecurity of their parents in many different situations - including visits to the dentist. 

Children should visit the dentist as early as when they are two years of age, and should have their teeth checked with the mirror. The sooner a child is introduced to the dental clinic, the easier it will be for them in the future. 

Children react in many different ways to stress. Most of my young patients have some kind of fear, and they need longer appointments to understand the reasons why they are afraid to sit in a dental chair. A very common sign of anxiety is withdrawn behaviour - the child does not want to talk to the nurse or the dentist, is very quiet, and does not communicate. Very often, children begin to cry before anything is done, and do not want to open their mouths for a simple examination with a plastic mirror.

At the other end of the spectrum are the chatterboxes and the children who cannot stop asking questions. In this way they can delay the treatment and not allow the dentist to do anything. Recently I was assisting my dentist with an extraction of a baby tooth. The patient was a ten-year-old girl, and she constantly asked the same question about why we use the mirror. I was trying to show her the spare mirror so that she was able to touch the equipment, but she was still very apprehensive about the dentist performing the treatment. 

The clinic in which I work is very busy, and I see children with different dental problems and levels of anxiety. I work closely with my dentists and take a very active role: I interact with my little patients as well as helping the dentist with the treatment. I take more or less initiative depending on the dentist I am working with, but I always play with the children and distract them during the dentist-parent conversation. 

At my dental clinic we use the ‘tell-show-do’ method to introduce our young patients to the dentist. I often spend time with individual patients to show them the equipment and materials we use for fillings. I show them the chair and how they can change the position of the light if it becomes too bright.

Different age groups need different types of language to be used. For older kids and teenagers I usually talk about fashion, music and which sports they play at school. For younger children, there are many words in paediatric dentistry which can be used to describe equipment in a nice, friendly way. We speak the language of our patients, not the language of their parents, using words like: sleepy juice (local anaesthetic), sally straw (suction), mashed potatoes (impression plaster), and bubble-gum gel (topical gel) – as well as referring to the tooth fairy, of course. Children like playing, so I try to play with them for as long as the schedule allows. We suck the water from the cup, we hoover the mouth, we catch the butterflies in the tummy, we dive in the sea using inhalation sedation, or we sing songs. 

It is very important that I spend most of my time talking with the child rather than the parent. Although we understand that parents want to know what the treatment plan is and they ask lots of questions, it is not advisable to ignore the child. Parents can be very anxious or ask questions in too direct a manner. They tend to name the things loudly in front of the child and push them to be brave. 

I like to show children new things and spend time with them prior to the actual treatment. Unfortunately, some parents do not like to waste time and demand to have most of the treatment done on the first visit. I get very upset when children are forced to obey, and I do not agree with parents who would like to use force. I understand the need to be firm in many other situations, but not when fear is taking over my little patient. However, I also have to be alert to the opposite situation – some children play with the emotions of the dentist and the parent, pretending to cry but with no tears coming down their cheeks. They are promised big presents and money for a tooth being taken out. 

I always keep my eyes wide open and try to assess the situation from the very beginning. I will never leave my dentist to deal with the situation on her own. Chaperoning is a part of my job and it is vital where there are controversial situations and disagreements over a treatment plan.

In situations which cannot be resolved easily where the child becomes uncooperative, they can be referred to our play specialist, who is trained in delivering dental education through play. She usually spends a few hours with a patient before each appointment. She uses role play and allows the patient to be a dentist. She looks for body language signs and explores previous experiences the child has had in a dental clinic. 

I think nurses who would like to work with children need time - time to learn the small steps small patients need in a dental chair. We must be very patient and happy to play. We need more time to build a bond between us and our patients. We must listen to patient needs and be able to tell good stories on demand. 

Dental nursing in a paediatric department can be a very physical job. There is running around involved, and siblings and parents of patients often need looking after as well, which can be very time-consuming. We need to remember that children can be unpredictable and we must protect ourselves. Children bite, shout, cry, run away, cannot sit still for a long time and lose concentration very quickly. 

However, nothing is more rewarding than a child’s smile. My patients laugh and joke with me. They draw for us, sing and play music. It is an amazing experience to work with children of so many different ages and to follow their individual stories. 

When I was a child, I spent long hours at the dentist’s surgery due to problems with my teeth. I never had a nurse to talk to or to hold my hand. I had to deal with fears on my own and in my own way. I always expected the worst and did not like the unknown. 

I want my patients to have a better experience, and I love what I am doing. I encourage any nurse who would like to try working with children. It is hard work, but full of fun and joy. 

Sylvia Bourgeois RDN

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