– Most children previously treated by a dentist satisfactorily/unsatisfactorily have memories of their dental visits.
– The nature and extent of dental care delivered and the child’s memories of the previous
dental visits are the factors deciding child behavior at the time of follow-ups.
– It is important that the child retains ‘good’ memories of their dental visits.
– Not only good dental care, but also good memories of them help instill a positive attitude
towards dentistry in children.
– The effective child management, thus, does not only aim at gaining cooperation for
a particular span of visits but also has a focus on building trust and confidence in the child’s mind regarding dentistry that will last a lifetime.
– considerations for developing a long-term positive dental approach in the child’s mind:
1. The child visiting at regular follow-up intervals (3-6 monthly), retains his/her cooperative
behavior and often appears motivated. The parents of the child also appear convinced and motivated regarding the dental care (including preventive measures).
2. The child visiting infrequently and after a long interval (> 1 year) has either lost the
motivation or the effect of ‘behavior modification’ has substantially reduced. The dental team often has to re-work on establishing the necessary rapport for further care.
3. Also, a child visiting a dentist infrequently, only for treatment of a painful condition may have memories of pain associated with the dental care and may remain a difficult patient.
4. The impression dentistry has left in the child’s mind is of great importance. If a child remembers only pain, pulling out of a few teeth, being held by people while undergoing treatment, etc., the dentist has to start the behavior modification all over again. However, if the child recollects the instances such as being praised, given toys and gifts, and privileges likes watching cartoon serial on TV; the child response would be positive, yet again.
5. The dental team has to reassess the child behavior on all follow-up visits and recommend treatment appropriately. Remember, a child’s cooperation at all subsequent visits should not be taken for granted.
6. Most children for whom the dental treatment has ended on a positive note (with simple procedures such as finishing composite restorations, fluoride varnish applications done in the end) have good memories of their ‘last’ visit .
However, if the treatment has abruptly ended after a traumatic extraction, the child retains some memories of the episode, longer than expected.
7. On follow-ups, it is important to begin conversation with sentences like: “…Oh! You have grown tall now! You are now looking a big boy!” or “My god! Are you really in the second standard? I remember you only as a small girl in kindergarten!” or “Now I can see your new teeth when you smile; you must show me your new teeth once!”
8. It is important to evaluate the effect of preventive care taken at home and recommend
further office preventive care (such as fissure sealing soon as first permanent molars have erupted) on follow-up visits. It is also a good idea to bring up topics such as the preventive measures with parents. The discussion with parents can be started with statements like: “I’d like to monitor the development of his/her new teeth. Considering he/she had
undergone a lot of treatment for his/ her milk teeth, I would like to suggest you appropriate preventive measures at the right age; such as fissure sealing soon after first permanent
molars have erupted, fluoride mouth rinses after the child turns 7.”
9. The parents may be asked to keep a 6 monthly follow-up during the vacations as most children are free during these periods. Summer vacations and Diwali (winter) vacations are more or less 6 months apart. Thus a habit can be inculcated for a dental check-up
throughout their schooling.
10. Sending follow-up reminders to patients is a good practice. Either a phone call or a letter or an e-mail is sufficient for this purpose. The dental team must believe in the fact that most children of and above a certain age (in the author’s opinion 3½ – 4 years) are either
cooperative or potentially cooperative. Only those few who are either pre-cooperative or uncooperative should be dealt with more preparation and conscious efforts or with
pharmacological aid. Thus, irrespective of whether they are visiting for the first time or for follow ups, children are mostly cooperative if the dental team believes in the principles of behavior science.