Paediatric patients can be one of the most rewarding patient groups to treat. Although an increasing amount of therapists qualify every year, the dental industry (in particular the NHS) is still however often failing to utilise this talent, with therapy roles still few and far between. The reasons for this are multifold:
The therapist’s role is still overlooked or misunderstood by dentists and at worst seen as a threat
Poor renumeration within the NHS, as the therapist has to share payment with the dentist (especially compared to the renumeration of a private hygiene appointment)
The therapist cannot work autonomously within the NHS as they cannot open a course of NHS treatment. ALL patients therefore need to be referred from the dentist
In the right circumstances, therapists can become the ‘go-to’ member of the dental team for paediatric care. This approach removes some of the burden from the dentist and further allows patient care to be streamlined allowing the dentist to focus on those with complex treatment needs.
DHTs flourish in paediatric care because they are drawing on innate people and communication skills that were further honed during training. It is these skills that can help them forge an ownable space for themselves in a practice: specifically patient management and communication skills:
1a. Patient management
Many therapists are drawn to the role in the first place because of the focus placed on patient management when treating children in particular.
Many paediatric patients can start their dental journey as non-cooperative with the referring dentist. The experience of being in the dental surgery can be overwhelming for many children, especially those who are younger and less able to communicate their emotions. Multifaceted fears accompany a dental visit for many. For example, fear of the unknown, fear of pain, fear of loss of control, fear transferred from parent or guardian.
The therapist can employ a number of non pharmacological techniques that help the process of patient management. These can be used individually or combined, with differing aims, from giving reassurance and gaining trust to encouraging positive behaviour.
There is therefore an onus on the practice (and indeed the parents/ guardians) to support the therapist employing these techniques. Multiple appointments may be required and some appointments, especially at first, might involve no active treatment.
Example techniques:
Verbal positive reinforcement: Using positive language cues to illicit more of a desired behaviour e.g.’ I like the way you are keeping your mouth nice and wide open’
Non-verbal communication: Verbal positive reinforcement is particularly successful if what is declared by the dental team can also be deduced by the child through the whole team’s body language and facial expressions.
Tell show do: This technique helps a patient to understand the treatment which is about to be conducted:
1. Tell: explanation of the procedure
2. Show: demonstration of the procedure
3. Do: the treatment is conducted in a timely fashion
Behaviour shaping: This technique breaks down the desired behaviour into clear steps which can be followed. Each step is explained in an age appropriate child friendly way so the child patient can understand it and display it back.
1b. Management of other groups
Managing other people in the room and understanding the emotions they are potentially experiencing is also key to successful patient treatment:
Parent
Multifaceted fear: on behalf of child, own dental fears and phobia, of being judged or reprimanded by the clinician
Guilt that they have ‘failed’ in their responsibilities (to child who needs treatment)
Other siblings
Curiosity
Fear
Potential boredom (at having been brought along)
2. Effective communication
Positive patient management is underpinned by effective communication. DHTs are highly effective communicators who are adept at assessing overt and covert communication cues and who are specifically trained in communication with children. This ability allows DHTs to swap between communication styles not only between patients but also other audience groups, motivating them in a non-judgemental fashion.
Example multiple audience educative tools
Many tools in the DHT’s armarium are particularly pertinent for paediatric patients and rely on the participation of other audiences, such a parents and guardians:
Oral Hygiene Instruction: Toothbrushing technique and plaque score
In surgery, used to highlight what areas of the mouth the child is ineffectively brushing and how to effectively access these areas
At home, used to underpin the need for parental involvement e.g. checking brushing has been effectively undertaken or justifying the need for continued assisted brushing
Health messages: Diet diary and diet advice
Enamel in primary dentition is thinner than in secondary teeth. A diet diary can be used to highlight consumption of sugars (especially hidden sugars), and acid to both child patient and adult
Diet advice can also be more holistic but still aimed at both groups (child and adult), focussing on the importance of the different food groups that make up a healthy balanced diet (Eatwell Guide and Change 4 Life messages)
Conclusion
All too often DHTs encounter paediatric patients in their role as Hygienist, where they are given a shortened appointment for a ‘quick scale and polish’, failing to utilise their innate abilities and specific training in patient management and communication. It is through these skills that the DHT can forge an ownable space within a practice (and one that isn’t seen as cannibalising the dentist’s work).
For those keen to work with children (and moreover utilise their Therapy skills) consideration of the following might prove useful in finding a job:
There is a shortage of NHS dentists in rural communities. Location therefore can play a key to finding a Therapy position
Applying for roles speculatively can prove fruitful. Not all dentists relish working with children
Orthodontics: a surprising number of orthodontic practices do not have a hygienist and often draw on the therapy skillset