Pediatric Dentistry

Designing a Dental Clinic for Children

Designing a Dental Clinic for Children

Children relate to surroundings and react to people around them much differently from adults.

– In order to treat them comfortably in the dental clinics, the approach of the dental clinic staff and the clinic atmosphere thus have an important role.

Children do have a ‘place memory’.

This can be both advantageous as well as disadvantageous to us.

Children do not like to visit a place where they have experienced discomfort previously.

– Also, children like to be in places and catch up with people that are fun for them! Often,
medical set-ups are stereotype and hence are not liked by children.

A child-friendly dental set-up, thus, has to be a little different from a routine clinic.

Children behave, expect and imagine much differently from adults.

– Keeping this in mind, we have to design a clinic as well as formulate a system of functioning!

Pleasant visits to the dental office promote the establishment of trust and confidence in
a child that last a lifetime.

– The goal of a dental team must be to help all children feel good about visiting the dentist and to teach them how to care for their teeth.

From the office design to the style of communication, the main concern of the dental team must be what is best for a child.

Also, since about one third of the nations’ population is children, the onus would always be with the general dental practitioners to treat children in their clinics and therefore their clinics must be ‘child-friendly’.

Furthermore, we live in a ‘child-centered’ society today and hence in the dental clinics too, children should be considered important visitors.

The dentist must not only have a child-friendly dental clinic design, but also possess
a child-friendly approach in the clinical practice.

Both verbal and non-verbal messages can help portray child-friendliness in a dental clinic.

Often, many dentists overlook a few simple considerations that are required for child
friendliness in the design of the clinic and approach.

A few of these are discussed below:

1. At times, the dental clinics are designed in such a manner that a child has no ‘attractions’ in the waiting area! The child has to remain seated along with other patients ‘quietly’ until his/her turn for the treatment comes!

2. The child in the waiting area is able to see a patient undergoing dental treatment inside
(if there is such a glass partition that it does not isolate waiting area sufficiently from the
operatory or if the door between the waiting room and the operatory frequently opens for movements of people).

3. Often, children accompanying their parents for the parent’s dental treatments are allowed to watch the parents undergoing procedures such as administration of local anesthesia,
extractions, etc. A child can imbibe fear and develop negative attitude towards dentistry.

4. At times, an operatory has two or more chair units without enough separation between the chair units; a child seated on one chair for his/her dental treatment can easily watch
another patient being treated on the adjacent chair.

To make our dental clinics child-friendly, following aspects must be considered important:

1. Compartmentalization

2. Space-provision

3. Reception at the front desk

4. The waiting area

5. Attire and presentation of the clinic staff

6. Colors, smells and sounds

7. Instructions for children/parents

8. Readiness to accept children as they are

9. Gifts and rewards

10. Audio-visual aids for entertainment

11. Team approach

1. Compartmentalization

The clinic should have 4-5 compartments such as:

• Reception/front desk

• Waiting area for parents which may or may not be an extension of play area for children

• Play area for children

• A consulting/Conference room

• Dental operatory

The dental operatory should be well isolated from other areas and the last place to be
introduced to the child during the first visit.

As the child enters the clinic, he/she must find the place attractive and not like another clinic or hospital that reminds him of pain and discomfort.

The play area and the waiting area should keep children engaged in various activities until they are ready to be called in for the consultation.

The consulting room is the area where the dentist gets an opportunity to interact with
parents with or without children.

It should be separated from the operatory in such a manner that the child does not get to see the dental set-up or any other child undergoing dental treatment.

If a child with past negative experience of dentistry walks in, most of the first visit routine can be completed in the consulting area itself; without the child being forced to sit on a dental chair.

Only after the initial history taking and child’s behavior assessment, must the child be
escorted to the operatory along with parents.

– After a brief examination on the dental chair (the child may be sitting alone or with parents), the child may be accompanied back to the consultation area.

The child may be allowed to play in the waiting/play area and the dentist may now continue the discussion with parents in absence of the child.A corner in play area Consulting area and operatory with a sliding glass partition Dental operatory with assistant's work station separated A notice board displaying instructions to parents

2. Space provision

Children require free, empty spaces to move around! They usually don’t sit in one place.

– They often stand near windows, keep going near reception table or keep looking for
interesting things around.

Therefore, it is necessary to have at least a corner or two in the waiting area free without any chairs, corner tables and other things.

A fish tank, a black board or a slide may be kept (depending upon the space available) in such a corner.

Also, remaining busy in an interesting activity helps relieve their anxiety by the time they are ready for their turn of dental check-up or treatment.Clinic design The reception and waiting area A part of play area

3. Reception at the front desk

The receptionist should take interest and possess communication skills to deal with children effectively.

She/he must call each and every child by his/her name and start conversation about the
topics of his/her interests.

Often, lack of interest on the part of the clinic staff to deal with children fails to generate any excitement in the child about what is going to happen to him/her.

– Also, some time children in our society are threatened by their parents of a doctor’s visit or of injections, for not behaving properly (or a dentist’s visit for eating too many chocolates, for example)! Hence, before their initial dental visits, they are unsure of what is going to
happen.

If a friendly welcome, cheerful conversation and playful atmosphere greets a child, the child feels that he/she is no longer brought here for any punishment and that in turn, makes the job of the clinician easy!

4. The waiting area

It is necessary that the waiting time of a child in the dental clinic is pleasant. Often, children having to wait for long are bored by the time they are taken in for treatment.

– Also, a 5-10 minutes waiting time spent in playing can distract them from the fact that they have been brought for some treatment and is ‘refreshing’ for them.

A child, who is in a happy mood just before entering the dental clinic operatory, is more likely to be cooperative for the treatment than a child who is either bored of waiting in a dull
clinical waiting room or is anxious about dentistry.

Only a few items such as a blackboard, a slide, some soft toys or games make a world of
difference in child management in dental clinics.A blackboard keeps children busy A child in the play area A slide can be simultaneously used by many children Children at the fish tank Children busy in their own world! Parents often like child-friendly clinics

5. Attire and presentation of the clinic staff

According to Finn, A good children’s dentist has grace, skill, knowledge and intelligence.

A pediatric dentist or a dental surgeon has to play roles of behavior therapist and
a counselor!

– A typical attire of dental staff comprising of cap, apron, mask and gloves is certainly not
child-friendly! Make an attempt to meet a child casually, and preferably not around the dental chair.

If possible, the consulting room should be separated from the operatory; where the dentist first meets the child casually, takes a brief history, assesses the child’s behavior and
then directs the child to dental chair after touring the clinic
and introducing other staff members as friends.

The dental chair could also be either a ‘Pedo’ chair with attractive features or having
a ‘customized’ look.The customized ‘Tiger’ chair The ‘Pedo’ chair

6. Colors, smells and sounds

Children imagine and accept bold, bright fresh colors such as yellow, red, blue, green,
orange, pink
and may dislike grey, black and white, wooden, brown, etc.

Also, smell of spirit, eugenol, acrylic, waxes may not really go well with children.

The noise of an air-rotor handpiece, a compressor or an ultrasonic cleaner can be disturbing, too!

Sudden movements of big arms of machines like X-ray machine, movements of the chair
(specially the back-rest), or the tray arm coming too close are disliked by most children.

It is important to understand that the child has been brought to a new place and these
objections are valid.

A proper planning and efficient working can help deal with them effectively.

The dentist can incorporate use of colorful gloves with mint smell, drapes of bright colors with cartoon pictures; allow the child to smell substances like local anesthesia gel or
an impression material in order to make these things acceptable.

7. Instructions for children/parents

A lot depends on how the children are prepared at home for their dental visits.

– It is important for us to inform and educate them well.

The notice boards in the waiting room must carry instructions to parents before dental visits of children as well as certain post treatment instructions.

– Also, a booklet or a brochure as a pre-treatment communication is made available to parents beforehand or delivered to them soon as they enter.

8. Readiness to accept children as they are

– Children love fun.

They enjoy being admired, interacting with others and making their ‘world’ of people and nonliving things such as places, toys, games, cartoon films, etc.

We have to accept them as they are and more importantly become a part of their world by communicating with them verbally as well as non-verbally (with an eye-to-eye contact, physical contact like shaking hands, patting on the back, giving a clap, etc.).

The child can be asked to sing, tell stories, praised and the dental team must create
opportunities to praise children.

Children are also emotionally different and are susceptible for distraction, friendship, feeling guilty, praise, emotions of other people, etc.

During initial visits, therefore, the dental team should focus on communicating with children properly to win their confidence and progress to carrying out treatments gradually.

Also, children do cry at times! The dental staff should not panic due to a child crying.

A child may cry due to various reasons in a dental clinic. Noise of certain machines, taste of certain medicines (anesthetic spray, for example), not wanting to get the treatment done, getting bored, are a few examples.

As long as the child does not cry due to pain, there is nothing to worry at all.

Crying does not cause any bodily harm to a child! We must be prepared to listen to it!

– However, with a proper protocol of child management followed, such ‘crying’ instances are rare.

9. Gifts and Rewards

Give a child a token of appreciation for good work with a small gift at the conclusion of
a visit.

– Never bribe them beforehand, although.

Even calling a child a “good boy” or a “good girl” or drawing a ‘star’ on his/her hand can work like rewards and excite children and leave with them fond memories of dental visits.

The dentist must have stocked a variety of gifts that can be handed over to children such as small cars, dolls, tattoos, stickers, pencils, erasers, toy animals, toothbrushes, crayons,
medals, soft toys, balls, etc.

Getting a different gift at each appointment is exciting for any child!

10. Audio-visual aids for entertainment

Children forget themselves while watching cartoon films.

The TV set in front of the dental chair can distract the child enough to forget the dental
treatment while it is being carried out!

– Also, once a child is cooperative, it reduces the need of talking on the part of the dental team.

– It is a good idea to have a camera attached to a TV set displaying the child on the chair.

Children do love watching themselves!

11. Team approach

The whole team should work with a plan for each visit of a child.

– The plans however, should have certain flexibility.

The initial (1-2) visits are usually sufficient for ascertaining the child cooperation and diagnosis and treatment planning.

Plan for the subsequent visit (if an uncooperative child is to be scheduled for his first
restorative work, have his/her appointment after a cooperative child whom you can model for a certain procedure).

It is important to plan procedures, which require minimal cooperation, initially; and the
complicated ones later.

It’s a good idea to have a separate session of pediatric patients in a busy general practice.

The team should work with a flexible approach, learn communication skills to deal with
children effectively and be positive.

To make a clinic child-friendly, a dentist has to budget his expenses in two categories.

1. Fixed assets: A wall painting or wall paper, toys such as a slide, a fish tank, a black board, soft toys, wall hangings, etc.

2. Running expenditure: Gifts to be given to children, greeting cards to be sent on the birthdays for children, etc.

Both the capital and running costs incurred are quite low as compared to the overall
establishment and running costs of dental clinics.

Thus it is only a matter of desire on the part of a dentist that matters in making a clinic
child-friendly.

“The foundation of practicing dentistry for children is the ability to guide them through their dental experiences” (McDonald).

It is important to plant seeds for the future dental health early in life and to promote positive approach towards dentistry during childhood (children are keys to the future)!

– In order to facilitate this, a dental clinic must be child-friendly.

 

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