Dental procedures can be one of a child's most uncomfortable experiences if not handled correctly. They can have adverse psychological effects for the remainder of the child's life with regard to both future dental experiences, and how they relate to other healthcare professionals. Dentists need to be acutely aware of a child's feelings of vulnerability and fear of the unknown when coming to the dentist for the first time. Ideally the dentist should follow guidelines such as the standards of care of the Australasian Academy of Paediatric Dentistry.

Children should be introduced to the dental surgery in a nonthreatening manner, ideally when only an examination is necessary. However, on occasion a child requires treatment after they have been in pain for some time, and the expectation of treatment is overlayed by previous experience or embellished accounts of the experiences of their friends, siblings and most importantly the attitudes portrayed by adults, particularly their parents. The concerns and procedures outlined in the medical article (see article) are generally applicable to dental practice. Establishing rapport with the child and communicating at the appropriate developmental level leads to the use of behaviour management techniques such as 'tell, show, do', distraction and systematic desensitisation which should result in an atraumatic dental visit for the child.

Local anaesthesia has, in the past, been considered by some practitioners to be unnecessary for deciduous teeth; however it should be stressed that if a procedure is predicted to be painful anaethesia should be provided. Topical anaesthesia should be used, with the material localised onto dry mucosa for 60 seconds, minimising the amount that the child may taste by using the end of a cotton roll. Local anaesthesia should be introduced through tight mucosa for inferior alveolar blocks and buccal infiltrations. For palatal tissues, the needle can be inserted in the already anaesthetised buccal papilla and gently forwarded until the solution can be deposited into the palatal tissues. Care should be taken regarding dosage and toxic concentrations and practitioners should be aware of the signs of toxicity. Occasionally, referral to a specialist paediatric dentist and the use of sedation or general anaesthesia for lengthy and involved procedures may be the best approach for the long-term psychological well-being and positive health behaviour of the child.

Dr M McCullough

Australian Dental Association