| "You know too much", was the innocent response | | | | treating Justin without a papoose or with either one |
| from my dentist's receptionist to the questions I | | | | of us in the room. After ten minutes of heated |
| asked my dentist about my own dental treatment. | | | | debate, we left the office right before they were |
| Her words were ringing in my ears for days. Telling | | | | about to restrain my hysterical wife in a papoose and |
| readers to get information prior to treatment has | | | | throw us out. |
| always been a major focus of my articles. Yet, his | | | | A few weeks later, we took Justin to my dentist, a |
| hygienist had already caught me by surprise by doing | | | | general practitioner with a good reputation for |
| an "unauthorized" fluoride treatment on my | | | | treating children. In four half-hour visits, he was able |
| five-year-old. And, without my knowledge, the | | | | to do two fillings without, and two fillings with, local |
| dentist had previously placed a | | | | anesthetic. In twenty-five years of dentistry, which |
| formocresol-medicated cotton pellet into my tooth | | | | included treatment of many young children, I had |
| between root canal therapy visits. I was making an | | | | never seen a better child patient. All Justin cared |
| appointment to re-do a crown that had fallen out one | | | | about was making sure that he got his plastic toy. |
| month after it had been cemented. Attempting to | | | | In defense of the Pedodontist, his education and |
| increase the chances of success and decrease the | | | | training prepared him to handle the most difficult |
| possibility of another violation of my natural dental | | | | children, who are at times, untreatable without their |
| beliefs, I had merely been attempting to share my | | | | advanced knowledge. He even had his legitimate |
| extensive crown and bridge experience. | | | | reasons for routinely using a papoose on young |
| For the first time I understood how intimidated | | | | children and not allowing the parents into the room. It |
| patients must feel when trying to extract knowledge | | | | is true that it could be unsafe if the child moves too |
| that they can understand from a health professional. | | | | quickly and touches the dentist's hand or instruments. |
| Although dentists are required by law to explain | | | | The children and their parents always appreciate |
| treatment and receive "informed consent," these | | | | fewer visits and the Pedodontist always appreciates |
| explanations are often too brief or too technical for | | | | maximum income production per visit. |
| the layperson to comprehend. After all, how many | | | | When I had my general practice in Middletown, NY, I |
| patients know what an MODBL is. (Incidentally, after | | | | treated a number of children. Some, however, were |
| our discussion, my dentist did not use formocresol | | | | either just too young or too difficult for me to treat, |
| again and became more open to my crown and | | | | so I did refer to Pedodontists in my area. In an |
| bridge knowledge). | | | | emergency on a very young child or in situations |
| I was reminded of another incident in which my | | | | when young children are very difficult to treat and |
| family and I personally experienced a dentist's training | | | | there is no alternative, the papoose still has a place in |
| and philosophy replacing common sense and courtesy. | | | | dentistry. However, in my opinion, any impatience or |
| My son, Justin, had four very small cavities. I felt that | | | | laziness on the part of the dentist resulting in the |
| it would be better to take care of them while they | | | | routine use of the papoose to restrain a child based |
| were all still on one surface of the teeth. In the past | | | | on age, speed of treatment or maximizing income |
| I would have done the fillings myself, but, because I | | | | per hour, or even decreasing the number of visits, |
| was retired from the practice of dentistry, we did | | | | without any attempt to treat the child unrestricted, is |
| what most parents would do with in this situation. | | | | unacceptable in 2010 and even worse can produce a |
| Even though he was an hour's drive from | | | | lifetime of dental scars for the child. |
| Woodstock, we went to a recommended | | | | However, even if a papoose is ultimately necessary, |
| Pedodontist (children's dentist) | | | | the parents should be allowed in the room in most |
| At the first visit, all the proper child introductory | | | | circumstances. Dentists were taught that by not |
| techniques were used. We personally prepared him | | | | allowing any parents into the room, the dentist |
| by telling him about the dentist and what was going | | | | replaces them as the authority figure. Therefore the |
| to happen. After watching videos in the waiting | | | | child is more likely to listen to the dentist and be |
| room, Justin, my wife and I were taken into a | | | | better behaved. In my experience, this separation is |
| treatment room. The dental hygienist gave him a ride | | | | only acceptable in rare situations where the parents |
| on the dental chair and showed him the mirror and | | | | do not want to be in the room or are a detriment to |
| explorer (tooth counter.) He had his teeth counted | | | | a positive treatment environment. In most cases, |
| and cleaned and he was given a toothbrush and an | | | | parents are an asset. To think otherwise is ludicrous, |
| appropriate toy for good behavior. The dentist came | | | | as long as parents are coached before the visit and |
| into the room and examined him. We talked about | | | | follow simple instructions: |
| the probable need to use a local anesthetic to numb | | | | |
| the teeth for the fillings and another appointment | | | | 1. Parents should allow the dentist to treat the child |
| was made. Justin had been a terrific patient. During | | | | unimpeded. |
| the ride home, he asked excitedly when he could go | | | | 2. If they speak, they should use calm, supportive, |
| back to the dentist. I knew the first visit had been a | | | | soft-spoken, reassuring language. |
| success. | | | | 3. They should be encouraged to replace certain |
| At the beginning of the second visit, my wife and I | | | | trigger words such as "hurt" or "pain" with |
| were handed a release form that would give the | | | | "discomfort" and "injection" or "shot" with "feel a |
| Pedodontist permission to restrain Justin in a papoose. | | | | pinch." |
| I was not a specialist, but I did treat a lot of children | | | | 4. Even though the child may move, cry or appear to |
| while I was practicing. I never used a papoose. To | | | | be uncomfortable, the parents need to trust that the |
| me, it is like a straitjacket for children and should only | | | | dentist is doing his or her best and allow them to |
| be used in difficult situations with difficult children. We | | | | continue. |
| were then told that neither one of us would be | | | | The philosophy of "love, trust and patience" instead |
| allowed in the room while he was being treated, even | | | | of "time is money" and the holistic belief that you |
| though 1) we were in the room for the initial | | | | don't just treat the teeth but the whole human being |
| examination, 2) our son behaved so well, and 3) I | | | | who is intimately connected to his parents, can result |
| was a dentist. As parents, we knew our son would | | | | in successful dental experiences for most children. |
| be a better patient if he was not restrained and we | | | | Often a traumatic dental experience, and I have |
| were in the room. He was an adopted child who had | | | | played my part in some; can teach us a lot about |
| lived in a crib in a Russian orphanage until he was | | | | ourselves. From these very personal and trying dental |
| thirteen months old. In the first week in our home, | | | | visits, I have learned that no matter how much |
| he jumped out of his crib and was never confined | | | | knowledge and expertise you possess, you must still |
| again. He had also been circumcised at eighteen | | | | ask questions until you have all the information you |
| months, ran around the hospital after the surgery | | | | need to make an informed decision. You can never |
| was completed, earned the nickname "the mayor" | | | | know too much. |
| from the nurses and did not skip a beat during his | | | | Addendum: For your information MODBL are the |
| post-operative recovery. | | | | initials for the five surfaces or parts of a tooth. Mesial |
| We were flabbergasted. We felt that we had been | | | | is the surface facing the front of the mouth, Occlusal |
| deceived because we had not been informed of | | | | is the part you chew on, Distal is the surface facing |
| these parameters at the first visit. If we had been | | | | the back of the throat, Buccal faces the cheek and |
| told of them, we never would have returned for | | | | Lingual faces the tongue. This knowledge is useful |
| treatment. He said that he could do more efficient | | | | because the number of surfaces very often |
| treatment by doing all four fillings in one visit on a | | | | determines the size of a filling and therefore the fee |
| "harnessed" patient. He was not even willing to try | | | | for the treatment. |