Child Management in Clinical Dentistry Ashwin Jawdekar
INDEX
×
Chapter Notes

Save Clear


1CHILD MANAGEMENT IN CLINICAL DENTISTRY
2CHILD MANAGEMENT IN CLINICAL DENTISTRY
Ashwin Jawdekar MDS (Pediatric Dentistry), PG Diploma (Hospital Administration) Associate Professor, Department of Pediatric Dentistry MGM Dental College and Hospital, Kamothe Navi Mumbai, India
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
Registered Office
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021
+91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
Offices in India
Overseas Offices
Child Management in Clinical Dentistry
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
9788184488739
Typeset at JPBMP typesetting unit
Printed at
4
To
All the children whom I have treated and shall be treating…
7Contributors
8
9Preface
Dentistry for children has been a satisfying, rewarding and exciting profession for me! The satisfaction comes to me when I see a child getting benefited from the treatment, the rewards are mainly financial and the excitement is entirely because of the child management skills that I have acquired and am still eager to learn!
Often, I hear my colleagues in dentistry talking negatively about pediatric dentistry. Many of them feel that treating children is difficult and time-consuming. Often, I am asked a question when I meet them, or whenever I interact with a group of dentists: How do you manage children for their dental treatments? This question is not an easy one to answer! The reason being that it cannot be answered in a sentence or in a minute!
Dentistry now has many advances that have been learnt and practised by most general dentists reasonably well. Endodontics, for example, has been the mainstay of most clinical practices due to a fact that most dentists are now assured of a certain predictability of endodontic success and are able to impart the confidence to their patients who opt for endodontic treatments. Why is endodontics successful and predictable? There exist a few rules, ‘ABC's of its success such as: adequate anesthesia, proper case selection, good access preparation, thorough cleaning and shaping, apical seal, and so on. As most dentists are now well versed with these ABCs of endodontics, the treatments are successful and yield predictable outcomes. Similarly, the ‘Child Management in Dentistry’ has its own set of rules (ABCs) that have to be studied and implemented for attaining similar success. What are these rules?
I have learnt these rules (ABCs) observing children while treating them, reading a few books and articles of eminent Pediatric Dentists from the Western world, and through interaction with my friends and seniors who are pediatric dentists.
Dental caries and its complications in children continue to be a serious health problem all over the world. The onus of treating most of them lies upon the general dentists who, therefore, need to be adept at child management in dentistry. The dentists, unfortunately, may not get enough knowledge and experience of pediatric dentistry during their training (graduation). Also, the use of sedation and general anesthesia for dental treatments is neither taught nor practiced much in many parts of the world for various reasons. As a result, the children, to a great extent, are deprived of comprehensive, quality dental care.10
I have been practicing dentistry exclusively for children at my clinic Little Smiles (Dental Care Center for Children) in Thane (near Mumbai in Western India). My clinical practice involves treating children non-pharmacologically (between ages 0–14 years) for their dental needs. Over the past seven years in practice, I have been implementing many skills learnt from different sources and I have, myself developed some methods and protocols for managing children requiring dental care. I feel happy and proud to see that most of the child management techniques that I practice work well for me as well as for those with whom I have shared them.
I have written several articles and delivered lectures on the practical aspects of child management in dentistry based on my personal experiences, and received a good feedback from dental surgeons and pedodontists all over India. (Most of the articles have appeared in the national bulletin of Indian Dental Association—‘IDA Times’.) This work is a compilation of these articles with a lot of additions and editing to make a concise book – Child Management in Clinical Dentistry.
This book provides a reader practical information related to various topics like the fundamentals of child management, assessment of child behavior, non-pharmacological behavior modification methods, controlling disruptive child behavior, designing child-friendly dental clinics as well as dealing with difficult situations in day-to-day practice such as treating children having hypersensitive gagging reflex, considerations for ‘Special Care Needs’, pediatric dental practice management, etc. in a step-by-step manner. The book, however, omits a few topics such as use of sedation and general anesthesia for dental treatments of children since I feel that it is inappropriate to include the same in ‘Clinical Dentistry’ as these procedures have to be necessarily performed in hospitals due to legal and safety concerns. This book aims at helping clinicians as well as students of dentistry acquire the skill of decision-making and problem-solving in relation to child management in clinical dentistry and can be regarded as a “practitioners’ handbook” on Child Management in Dentistry.
Ashwin Jawdekar
11Acknowledgments
The process of writing this book has really been enjoyable for me and I have to acknowledge all those who have been my companions in this journey. The contributors Dr MS Muthu, Dr Bhushan Pustake, Dr Amit Vanka, Dr Amar Katre, and Dr Sharat Chandra Pani have expressed their own views through their writing. Child management practices in dentistry can vary from person to person, place to place and situation to situation. Thus, on topics such as how to administer local anesthesia to a child, whether parents should remain present with children during their dental visits; the reader is presented with different approaches of dealing with these issues.
The staff of M/s Jaypee Brothers Medical Publishers (P) Ltd. has been very courteous and extremely professional in the making of this book especially Shri Jitendar P Vij, CMD, and his team of publishing professionals, in particulars, Mr Tarun Duneja (Director–Publishing), Ms Chetna Malhotra (Sr Manager: Business Development), Mr KK Raman (Production Manager), Ms Seema, Mr Nitin Maheshwari, Mr SK Choudhary, Mr Gopal Sharma and other staff of Delhi office and Mr Ramesh and other staff of Mumbai office.
Dr Jimmy Pinkham (Emeritus Professor of Pediatric Dentistry, University of Iowa, US) has written ‘INTRODUCTION’ to this book. A pat on my back by none other than the FATHER OF PEDIATRIC DENTISTRY means a world of happiness to me! I humbly accept his remarks on my work as blessings.
The entire book has been carefully read and evaluated by two very close friends Dr Sreenivasan V (who also taught me Oral Medicine and Radiology during my graduation) and Dr Rahul Rao (an Endodontist and Conservative Dentist practicing in Thane).
I am thankful to Dr SG Damle (my guide), for working as a student under him, immensely helped me writing this book. I am also thankful to my teachers of post graduation Dr Sunanda Sujan, Dr Shobha Deshpande, Dr Amita Tiku and Dr Adesh Kakade for inspiring me to practice dentistry exclusively for children through their training. I have been interacting with my seniors, PG colleagues and other Pedodontists frequently over the past eight years or so. The interactions with Dr Harsh Vyas, Dr Meenakshi Kher, Dr Uma Dixit (my UG teacher), Dr Asha Singh (my UG teacher as well), Dr Rupali Kale, Dr Sanchali Kapadia, Dr Prashant Bondarde, Dr Bhavsar, Dr Steven Rodrigues, Dr Vikas Bendgude, Dr Ujwal Kontham, Dr Vishal Arya, Dr Madhuri Joshi, Dr Tejashri Wadke, Dr Ritesh Kalaskar, Dr Mala Jagtiani, Dr Thejokrishna, Dr Shrirang Sevekar, Dr Subhadra, Dr Ashish Jain, Dr Sachin Gunda, Dr Rahul Choughule, etc. have been inspiring, too!12
I am extremely thankful to Indian Dental Association Secretary and Editor of IDA Times, Dr Ashok Dhoble, for encouraging me to write articles in IDA Times, and the Maharashtra State Branch President Dr Pramod Gurav and Secretary Dr Jayant Deshpande for making IDA a great platform for different academic activities.
I owe a lot to all the dentists with whom I worked or have been working as a Pediatric Dentist during the past eight years of practice: Dr Pravin Kshirsagar, Dr Shrikant Hegde, Dr Anish Naware, Dr Subodh Phadke, Dr Prakash Tekwani, Dr Priti Mehta, Dr Navin Kulkarni, Dr Nitin Bhat, Dr Sonali Bhat, Dr Ashok Parekh, Dr Ashok Shah, Dr Hemant More, Dr Kiran Patil, Dr Sanjay Mali, Dr Jyoti Jagasia, late Dr Paresh Dalal for keeping faith me and the science of Child Management in Dentistry.
I have been lucky to have a team of people that not only helps me practice dentistry for children but also actively contributes to its success. The doctors: Dr Sheetal Nipane, Dr Chirag Bagadia (presently working with me), and those who worked in the past (Dr Vinod Kudupudi, Dr Hemant Yadav, Dr Vishal Karkamkar and Dr Shweta Kulkarni) and the present auxiliary staff Sudhakar Takalkar, Pallavi Pawar, Prachi Champanerkar, Ashwini Dalvi have been contributing to my success in practice.
I express my gratitude to the Director Dr Sudhir Kadam and Dean Dr Poonja of MGM Dental College and Hospital, and the staff of the Department of Pediatric Dentistry Dr Sonal Patil, Dr Munita Naik, Dr Aarju Deshmukh, Dental Hygienist Sonali and the sister-in-charge Alice Vergis for helping me in all my activities.
My family has been looking forward to the release of this book. My wife Dr Prachi (a dental surgeon by profession), Ovee and Ukti (daughters) have appeared in many photographs of the book! My parents, Dr Muralidhar Jawdekar and Mrs Lalita Jawdekar, my elder brother Yogendra (Pediatrician) and his wife Savita (Surgeon), my brothers Abhinav and Kumar and their wives (Pradnya and Vishakha respectively), my in-laws Mr Sadanad Patkar and Mrs Sandhya Patkar, my brother-in-law Dr Vivek (Onchourgeon) and his wife Dr Kanchan (Anesthesiologist) – all have been responsible for the academic environment that we share in our family.
My dear friends Dr Kedar Bakshi, Dr Prasad Nayak, and Dr Bhushan Pustake have always kept me motivated for all my ventures. My neighbors Mr Parag Amin, Mrs Manjusha Amin and their son Hrishikesh and daughter Rama have all volunteered for the cause of this book by featuring in the photographs. Mr Shailesh Salvi has designed an attractive cover-page. Dr Chirag and Dr Radhika have helped correcting the final proof.
Lastly, I must thank all the children whom I have come across as a Pediatric Dentist, and their parents with whom I have interacted during all these years of practice. This book is an outcome of the trust and confidence they have shown in me while practicing dentistry for children. I sincerely dedicate this book to the children whom I have treated and shall be treating.
15Introduction
Dear Dr Jawdekar,
I had the opportunity to read your manuscripts again this afternoon. I have reviewed them critically… which means I wanted to find omissions, controversies, or other problems that might be useful to you as you prepare for publication of your book. I am delighted to respond that I enjoyed your writings, endorse your basic assumptions and assertions, and am certain that your publication will be well received by other critical eyes. Congratulations on your well done efforts. I share the following only for your consideration for I believe you have very adequately covered this complex dentist/child patient interface and “linguistic dance.”
  1. It may be useful to your students for you to emphasize how quickly children change and develop with age. Fears, vocabulary, communication skills and strategies, regard for parental protection or even observation, etc. change fast and so must the approaches of the dental team. Actually some 3 year olds who were determined to sabotage their dental appointment (NO MATTER WHAT!) may at 4 years behave simply because other children are appointed at the same time and they wish to show their best effort. (It is not a bad strategy to appoint a likely misbehaving child at the same time as reliably good children. This can also be advantageous to parent management if they see such well behaved children and their relaxed parents.)
  2. I completely endorse your advice for young practitioners to visit offices where proficient practice of dentistry for children can be observed. I would coach such visiting dentists to ask for visits when behavior management of misbehaving children is going to occur and to embrace the following facts: initially in an appointment misbehavior is not dependent on the dentist… it is the child's with his parental, developmental, and social histories; there is no perfect child's dentist, i.e. a dentist's sex, age, parental status, facial appearance (other than a smile), or any other variable are predictors of success in this field of dentistry… The important factors are desire, tenacity (Don't give up), reasonability and resiliency (Not every encounter is going to be even close to what was hoped for), education in this domain (Read your book), and experience. Bundle all of this into an enthusiasm to help children and success becomes a promise and not a hope.
16
Sir, you have done a good job and the children of India will benefit from your enthusiasm and desire to help your profession.
Sincerely,
Jimmy Pinkham
Emeritus Professor of Pediatric Dentistry
University of Iowa, USA