Oral with arms restrained; the older infant and toddler

 Oral health should begin around the time where teeth are erupting. “The American Academy of Pediatric Dentistry (AAPD) recognizes that infant oral health is one of the foundations upon which preventive education and dental care must be built to enhance the opportunity for a lifetime free from preventable oral disease”. Every infant should receive an oral health risk assessment from his/her primary health care provider or qualified health care professional by six months of age. This initial assessment should evaluate the patient’s risk of developing oral diseases of soft and hard tissues, including caries-risk assessment, provide education on infant oral health, and evaluate and optimize fluoride exposure (Guideline on Infant Oral Health 2014). This paper will discuss the approach on infant or child for an oral exam.     Because oral examination is invasive for the infant or a small child, the timing is the best toward the end of the complete examination, along with ear examination (Jarvis, 2012). If the child is crying, seize the opportunity to examine the open mouth and oropharynx. Have the parents participate in the examination by letting dad or mom position the child; place infant supine on examining table, with arms restrained; the older infant and toddler may be held on parent’s lap with one of the parent’s hands holding the arms down and the other hand securing the child’s head against the parent’s chest. In case of young child a game can be use to help prepare him. For the preschool child, encouraging him to use a tongue blade to look into the puppet’s mouth. Placing a mirror so the child can see his mouth while examiner looks. And for the school age child often is cooperative showing his mouth. For example, showing caries, a new or missing tooth. Be discriminating in use of tongue blade; it may be necessary for a full view of oral structures, but it may produce a strong gag reflex in infant; it may be avoided the tongue blade completely with cooperative preschooler and school-age child. If that is the case, take advantage and ask the child to open the mouth with funny things, for example, open your mouth like a hungry tiger, then ask if he can stick the tongue out and move it in different directions. One more way to expose more the view of the oropharynx , ask the cooperative child to stick out the tongue and “pant like a dog”.     In case of uncooperative child who keeps the mouth closed, slide the tongue blade along the oral mucosa and turn it between the back teeth, then push down depressing the tongue, this stimulates the gag reflex, so the child opens the mouth momentarily, this is the moment to take a grief look of the mouth. Make it worth it.A visit to the dentist office or oral medical examination is not what everyone whishes for fun or relaxation. Especially for children, visiting an oral health care provider can be an anxiety experience.     Tips to make the oral exam more comfortable and less traumatic:        Start them young. The American Academy of Pediatric Dentistry recommends that all children see  a dentist by age one or within six months of their first erupted tooth. If parents maintain a routine kids will get familiar with dental chair, instruments, as a result young age are less likely to be fearful of the experience as they get older.         Prize boxes. A little treasure box goes a long way in keeping children motivated to cooperate in the oral exam, chair and excited to come to the dentist.  There are companies that cater to dental office prize needs and can keep you well stocked with toys, plushes, and stickers for a very reasonable price.        Designated area for kids. Have a place in your waiting room that is arranged just for kids. For example, a clubhouse, tree-house, or simply a room’s corner that is designated child friendly. Smaller furniture, engaging toys, books and a Disney movie playing will help children feel more comfortable and entertained while they are waiting for their turn in the chair.       Coloring or Activity Pages. Get kids excited and involved with your practice. For dentists send a dental themed coloring page home in their goodie bag or include a “Kid’s Corner” in your quarterly newsletter with dental themed activities for kids. Kids can bring in the completed sheet for an extra ticket to the treasure chest or some other incentive. Hang up the entries on the wall; everyone likes to see their work displayed!        Smiles Club for dentists. Recognize your great brushers kids with admittance to “The Smiles Club” if they go cavity free at their six month cleaning. A picture on the wall and certificate for your patient will make even older children feel great and keep them motivated to keep taking care of their pearly whites.         Communicate well with kids. Discuss ways to better communicate with kids in a staff meeting. A few basic ideas:           Make personal introductions. Teach your staff to introduce themselves to the parent and then to the child as well. This establishes trust. “Mom or dad knows or trusts this person and they care enough to introduce themselves to me too.”          When talking to a child, always try to kneel to be closer to their eye level, it makes you much less intimidating than towering over them while you speak.           Explain what you are going to do before you begin a procedure. Be sure to use age appropriate language. For a three year old, a “tooth-picture” or “tooth buzzer” makes more sense to say than an “x-ray” or a “drill.” On the other hand, a ten year old does not need you to tell him you are going to “tickle their teeth” with a polisher.           Show the kids you are interested in them. Ask questions about what they like and find similarities to make them more comfortable. For example: what brand of cars or colors, TV shows.           In short, speak in polite commands rather than asking the child to do something. If you say, “Do you want to have a seat in the chair?” In all reality, it’s a perfectly acceptable response for a child to say, “No.” You asked their opinion and they gave it to you. Now you have another obstacle to work around.  If instead you try, “Please take a seat in the chair. Thanks!” You are removing the easy opportunity for a conflict. You’ll get better results with telling (nicely) than with asking.Try building these kid-friendly strategies into your practice dynamic to make your office a more fun, positive experience for your youngest patients.