UnitThirteen

THEAIMSOFDENTISTRYFORTHECHILDPATIENT

Overthepast20yearstherehasbeenanincreasingdemandfordentaltreatmentforchildren.AtpresentaboutaquarterofthedentalresourcesofBritainisspentonthetreatmentofthoseundertheageofsixteen.Thisexpendituremakesitimperativetoconsidercarefullywhatistobeachievedwiththistreatment.Apopulardemandforadentalserviceisarguablysufficientjustificationforitsprovision.However,moderndentistrygoesfurtherthanmerelyansweringapopulardemand;itattemptstocreateinthepopulationanawarenessofthebenefitsoforalhealth.

Beforeanefficientservicecanbeestablishedforanygroupofpatients,thedentistmustbeclearaboutwhatistobeachieved.Oncegeneralaimshavebeenestablished,manyofheproblems

oftreatmentplanningbecomemoreeasilyresolved,andworktakesonapurposetowardswhichtreatmentcanbedirected.Aimsaregeneralconceptsofwhatmustbeachieved.Inorderthatanindividualpatientmaybenefittheymustbeexpressedaspreciseobjectivesthatareturnedintospecificitemsoftreatment.Itisimportantthattheseaimsarekepttotheforefrontandreviewedinthelightofpersonalexperienceandthewisdomofothers.

Therearetwoproblemstoconsiderwhensupplyingaserviceofanykindtochildren.Thefirstistodeterminewhatisbestforthechildatthatmoment,andthesecondwhatisbestfortheadultintowhomthechildwilleventuallygrow.Untilrecentlyinoursocietythechildreceivedlittleconsideration.Effortswerealwayschanneledtowardsturninghimintoausefuladult.Childhoodwasmerelyapreliminarytogrowingupandtheendjustifiedthemeans.Todayitisrealizedthatachild,asahumanbeing,hasarighttoexpectasmuchconsiderationasanyotherperson,andthisisnolessthanindentistrythaninotherspheresoflife.

Achild'steethareasimportanttohimasanadult's.Wemustnotfallintotheerrorofthinkingthatthisisnotsomerelybecauseheisunabletoexpresshisneedsordesires.Afunctioningdentitionisdesirableduringaperiodofrapidgrowthanddevelopment.Itisalsoapparentthatappearanceisimportantthroughawishtoresembleotherchildren.

Asthechildwineventuallygainadulthood,thepurposeshouldbetolookforwardtothattimeandpreparethechildtomeetit.Whatisrequiredisahappycompromisebetweenthepresentneedsofthechildontheonehandandthefuturedentalhealthoftheadultontheother.Ifthispremiseisacceptable,thenwhatshouldbetheaimsthatguideoureverydaywork?

Ourfirstaimshouldbethehealthofthechildasawhole.Althoughasdentistswearemoreobviouslyresponsibleforthehealthofthemasticatorapparatus,inthebroadersensewearepartofahealthteamconcernedwiththetotalindividual.Adentist,receivingregularvisitsfromapparentlyhealthypeople,isinagoodpositiontowatchforearlysignsofdisease.Moreover,whiletreatingchildrenheisabletostudygrowthanddevelopmentofthewholeindividual,andtoreferthepatientforadviceandtreatmentifthisisnecessary.Inthisway,hehastheopportunityofassistinginmaintainingachild'sgeneralhealthandwellbeing.

Concernshouldnotceaseatshowinginterestinthechild'sphysicalcondition.Thereisanexcellentopportunityduringourworktoobserveachild'smentalandpsychologicaldevelopmentandtonoteanyapparentaberrationsthatmayoccur.Weshouldbeawarethatourworkmightinitselfrevealemotionalinstabilitythatmightotherwisehavegoneunnoticed.Wemustalsorememberthatourownunguardedactionscanproduceanemotionalupsetthatmaycauseneedlesunhappinessandanxietytoboththechildandtheparent.Thus,asamemberofahealthteam,ourfirstaimmustbethetotalphysical,mentalandemotionalwell-beingofourpatients.Weshouldappreciatethatourbackgroundinmedicalsciencehasgivenusknowledgeandexperienceabovethatofthelaypublic,andwecanusethesetothebenefitofourpatients,eventhoughtheirproblemsmaynotbedirectlydental.Wemustbeequallycertainthatoureffortstoimprovedentalhealtharealwaysinaccordwiththegeneralhealthofourpatients.Itispossible,especiallywhentreatingthehandicapped,toplacegeneralhealthatriskinanover-enthusiasticefforttocarefortheteeth.Thus,theprimaryaimofadentisttreatingchildrenisthetotalcareofhispatients.

Morespecificallyweareconcernedwithoralhealth,andoursecondaimshouldbetopreventdisease.Forthemostparthealthyoralstructuresaretobefoundonlyinyoungchildren,andtopracticepreventiontothefullwehavetobeginatthisstage.Ourearliestattemptatpreventionshouldbedirectedattheexpectantmother,and,asshefrequentlyattendsfordentalcareatthistime,wecanadviseheronthefuturedentalhealthofherunbornchild.

Afterthechildisbornweshouldencouragethemothertoreturnregularlysothattheadvicecancontinue.Seeingthechildfromanearlyagewillencourageandinterestthemotherstillfurther,andestablishthefacethatgoodoralhealthpracticescannotbegintooearly.

Theconceptofpreventionmustpervadeeverythingwedo,sothatachildandparentarenotjustcontenttoleavedentalcareinourhands.Theyshouldbeeducatedtoconducttheirlivesinsuchawaythatdentalhealthbecomesaroutine.Dentalhealthdependsmoreontheindividual'sstyleoflifethanontheworkofdentists.Onlybyappreciatingthiscanoureffortsbereallyworthwhile.Thesecondaimis,therefore,thepreventionofdentaldiseaseandthedevelopmentofanawarenessoftheimportanceofdentalhealthbyeffectivedentalhealtheducation.

However,ifdiseasedoesoccurthenourthirdaimmustbetorestorethemouthtogoodhealth.Whenrestorativetreatmentiscarriedoutonchildrenwhatmustbeachieved?Firstandforemostistheneedtoconvincepatientsandparentsthatdentaltreatmentisworthwhile.Onlyworkofthehighesttechnicalstandardswillsucceedintheprimarydentition,andthesameskillsmustbeappliedtoyoungpermanentteethiffurtherdentaldiseaseistobeavoidedasadirectresultoffrestorativeprocedures.However,thismustatthesametimebe,atthebest,enjoyableandattheworstacceptableforthepatient.Ifdentaltreatmentisunpleasantforchildrenthenthiswillbuildaresistanceinthemtofuturetreatment.Acompromiseonstandardsinordertoovercomethiswillresultintechnicalfailure.Thiswillmakedentistryforchildrenappearineffectualandthwartoutultimategoalofproducingadentalconsciousperson.

Inordertoovercometheseproblemsearlydiagnosisleadingtothesimplesttreatmentmethodsisrequired.Regularattendance,sounddiagnosis,localanalgesiaandmodemcuttingequipmentareallimportant,buttheseonlyassisttheessentialempathythatmustdevelopbetweendentistandchild.Neitheriscariestheonlyproblem.Itisbecomingmoreapparentthatperiodontaldiseaseisestablishedmuchearlierinlifethanwasoncethought,andatthisstageitisoftencompletelyreversible.Althoughearlydiagnosisandtreatmentiscritical,itisequallyimportantnottoovertreatchildren.Errorsofdiagnosis,over-enthusiasticapplicationofdentaltechnology,andstrivingforperfectionbeyondtheneedsofthepatient,orthecapabilitiesofthepractitioner,willleadtounnecessaryhardship.Thethirdaimcan,thus,bestatedastheeradicationoforaldiseasebyearlydiagnosisandtreatmentinsuchawaythatpatientswillhappilyreturninanefforttomaintainthehighstandardsthattheyhavecometoappreciate.

Thefourthaimistoobserve,andcontrolwhennecessary,thedevelopingdentitionsofourchildpatients.Ageneraldentalpractitioner,seeingachildregularlyand,inallprobability,treatinghisparentsandsiblings,isinanexcellentpositiontostudyhisoraldevelopmentandtointerveneorreferforspecialisttreatmentifthisseemsnecessary.Thecorrecttimingandtypeoftreatmentforanyparticularchilddependonmorethingsthanpurelydevelopmentalfactors.Thegeneraldentalpractitionerwhohaslookedafterthechildandhisfamilyforanumberofyearsisofteninapositiontoassistanorthodontistindecidingwhatlineoftreatmentmightbemorelikelytosucceed.

Howeverharddentistsmightstrivetoachieveperfection,theywillalwaysbecalledupontoadministercareinanemergencyforthereliefofpainandsepsis.Onceagainthemainconsiderationshouldbeforthegoodofthechildasawhole.Wemustnotactunnecessarilyunderthepressureofadistraughtmotherorjeopardizethepatient'sdentalfutureforthesakeofanight'sunbrokensleepfortheparents.Thefifthaimis,therefore,torelievepainandsepsisasandwhennecessary,bearinginmindthepatient'stotalwell-being.

Lastbutnotleast,thereisoneaim,whichiscommontoallprofessions,andthatisthefurtheranceofourknowledgeofthesubject.Thosepracticingdentistryforchildrenarepatentlyawareoftheshortcomingsinourtechniquesandthegapsinourknowledge.Wemustallstrive,bycarefulobservationandpainstakingrecording,toaddtothesumtotalofourwisdom.Opinionbasedonexperienceisnotenough;itmustbebackedbyevidencethatwillconvinceourcolleaguesofitsvalue.Inthisway,thesubjectwillexpandandgrowonafirmfoundationofestablishedfactratherthanoscillatefromonefashionablebelieftoanother.

Ifwedoallinourpowertomaintainafunctionalandcompletedentitionduringchildhood,whatotherbenefitswillaccrue?Thefuturestatusoftheprofessionreliesonitsabilitytopersuadethewholecommunitythatoralstructuresareworthcaringfor,Dentalhealtheducation,initswidestsense,aimsattheheartofthisproblem.Thegeneralignoranceofdentalmattersthatiscurrentinourpopulationmaystemfromanunderlyinganxietyaboutdentistrywhich,thoughitmayneverbecompletelyovercome,canbereducedtoaninsignificantamountwheretheknowledgeofthebenefitstobegainedoutweightheminoranxietiesthatmaystillremain.Thiswouldappeartobeachievablebycorrecttrainingfromayoungage.Therealizationoftheimportanceofahealthydentition,andtheenthusiasmtoregulateone'sdailylifetoachievethis,stemfromsoundhabitsoforalhealthstartedearlyinlife.Thesoon