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Toys and Games Ease Kids Into the Dentist's Chair

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By Mark Trainer
Special to The Washington Post
Tuesday, June 23, 2009

Just the idea of the dentist turns many adults into petulant children. Reasonable grown-ups leave that reminder postcard pinned up on the bulletin board for months before shuffling to the telephone like a mopey teenager to make the appointment. Once there, leaned back and incapable of anything more than gurgling sounds, we might as well be infants again. And when the power of speech is returned to us, we're capable of transparent, juvenile lies. ("I can't imagine why that is, since I floss every day . . . really.")

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But might our children be saved from lifelong dental anxiety? The business of looking after teeth has changed. Maybe dentists are tired of having their services be the go-to comparison for anything unpleasant ("about as much fun as having a tooth pulled"); maybe, thanks to all that fluoridation and improvements in preventive care, some other doctor can become the health-services bad guy.

Most adults I know had similar experiences to my own. The two dentists of my childhood worked out of their homes on leafy residential streets. You got a glimpse of their living rooms from the chair when they first entered the patient area. The first one spoke sternly about cavities and candy, then, paradoxically, gave you a stick of Juicy Fruit on the way out. The second would break off mid-procedure, raise the window that the chair faced, put out nuts for the squirrels, wash his hands and get back to work. The charm ended there. I had my share of cavities as a kid, and the allowance for my tender years boiled down to two utterances: "Hold still" and "We're almost finished." The first felt beyond my control to obey, and the second only served to illustrate the wide chasm that separated our concepts of time.

How things have changed. Any dentist who works with kids today is likely to have a waiting room stocked with toys and books, music, DVDs and other contraptions to distract from the unpleasant business of the chair and, for parting gifts, enough toys, stickers and balloons to make Bob Barker proud. Is this coddling? You bet. It turns a trip to the dentist into something like a visit to an overindulgent grandparent.

When should that first visit be? According to Sheila Samaddar, a family dentist on Capitol Hill, the American Academy of Pediatric Dentistry and the American Academy of Pediatrics are of different opinions on this. The AAP recommends the first visit at age 3, while the AAPD suggests a visit when the first tooth erupts, around six months after a baby is born.

Although Samaddar thinks most parents can see if something is amiss when babies are cutting their first teeth, she thinks waiting until age 3 is a little too long, saying most of her first-timers are between 18 months and 2 years old. Brian Brumbaugh, a pediatric dentist in Staunton, Va., prefers to see his patients on their first birthday. The idea, he explains, is establishing a "dental home," a place where parents can develop a relationship with the dentist, a place to bring their questions, and a place to call in an emergency. The thinking behind this is that the younger your child is when he first visits the dentist, the less likely he is to need an uncomfortable procedure that would trigger the bad associations many adults have with the dentist.

Whenever you begin your child's dental odyssey, you'll have the choice between a regular dentist and a pediatric dentist. Why choose a pediatric dentist? Children who have serious anxiety issues can benefit from the experience and training of a pediatric dentist. "I'm a little bit better able to handle a child with different abilities," says Dana Greenwald, whose practice is in Friendship Heights. "I'm more in tune with how to restore baby teeth," she says.

Any procedure that would require an anesthetic stronger than nitrous oxide will require a pediatric dentist. According to Greenwald, sedating children is challenging enough that many pediatric dentists will refer patients who need anesthesia to others with more experience in that field.

And there's the atmosphere. Whatever makes a family dentist kid-friendly is ramped up exponentially with a pediatric dentist. Brumbaugh's office boasts a 16-foot Thomas the Tank Engine play table in a large recreation area with a big-screen TV. Greenwald prefers to keep the toys low-tech ("Too many electronics can make kids zone out"), with stuffed animals, kid magazines and the house specialty: fingernail painting at the end of the visit.

My own children's first visits to the dentist were closer to age 3 -- up to 2 1/2 years late, depending on whom you ask. That means my wife and I join the 50 percent of the population Greenwald estimates wait until their children have a full set of baby teeth before making their way to the dentist. While it's possible that waiting until this age could leave some problems undetected, dentists told me it won't necessarily make the first visit more difficult.

"Three is a great age," Greenwald says. "They really want to please." We chose Tawann Jackson, a family dentist on Capitol Hill whose rapport with children was reported on a parents' e-mail discussion group.

I asked the dentists I spoke with what aspect of the first visit would be most likely to unsettle young patients. They all pointed to basic stranger anxiety. Chong Lee, who practices in Arlington, answered, perhaps most candidly, "It's the instruments." What with the goggles, gloves and the mask, the dentist has the potential to be one of the more unsettling strangers a child has ever encountered.

Jackson made a point of explaining to our daughter, Lela, why she was dressed this way. She asked Lela if she would be more comfortable in Mommy or Daddy's lap. (She was.) Jackson gave her an extensive tour of the tools -- well, not so extensive that it included the drill. She introduced her to the suction device, a.k.a. Mr. Thirsty (a name so ubiquitous in children's dentistry that it must be the answer to the first question on the comprehensive dental exam). She let Lela squirt some water and some air, and experience the giddy highs and lows of the chair's hydraulic system. Jackson seemed in no hurry about any of this; I soon realized that this first visit was going to be mostly an icebreaker.

When it came time to look at Lela's teeth, the doctor employed the approach at the heart of kids' dentistry: tell-show-do. She explained how she would be examining Lela's teeth and demonstrated on the tip of Lela's finger how she would use the instrument. Only then did she actually do the exam.

All of that thrilled Lela. It felt to her, I think, like a high-tech play date. As Lela was picking out toys and stickers in the outer office, Jackson told us what was going on behind the fun and games: A successful first visit includes an oral exam, counting of the teeth, soft tissue assessment (gum, tongue, lips), an oral cancer screening, an assessment of the child's bite, an evaluation of the teeth's spacing, a cleaning and a fluoride treatment. She discussed the family's dental habits. She wanted Lela's tooth-brushing to go on for two minutes and for us to do all we could to stop her thumb-sucking. The fun was over.

Twenty months later, my son, Finn, would have none of it. What had worked for Lela utterly failed to calm him. He screamed in a way that no ride in the chair or latex-glove balloon was going to silence. Jackson advised us to try again in a few months. She didn't want to do anything Finn didn't want to do. Hardly seems like the dentist, does it?

When interviewed for this article, my kids told me the dentist was fun. "It's good for your teeth," Lela, now almost 7, said. "And you get toys at the end," added Finn, now 5 and recovered from his first trip.

I asked which they preferred, the pediatrician or the dentist. "The dentist," Lela explained patiently. "The dentist doesn't give shots." "And," Finn reiterated, "you get toys at the end!"

I'm suddenly feeling like my own dentist isn't trying hard enough.

Mark Trainer is working on a story collection called "Bad Daddies." He lives on Capitol Hill. Comments: health@washpost.com.


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