Year : 2017 | Volume
: 35 | Issue : 1 | Page : 2--5
Sharath Asokan1, Sivakumar Nuvvula2,
1 Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
2 Department of Pedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode - 637 215, Tamil Nadu
Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”
|How to cite this article:|
Asokan S, Nuvvula S. Pediatric Dentistese.J Indian Soc Pedod Prev Dent 2017;35:2-5
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Asokan S, Nuvvula S. Pediatric Dentistese. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2017 Jul 22 ];35:2-5
Available from: http://www.jisppd.com/text.asp?2017/35/1/2/199225
The success of a dental care depends not only on the quality of treatment provided but also in instilling a positive attitude toward dental care, and this is strongly influenced by the dentist's communication with the patient. Lamb reported that 25% of patients were lost due to poor dentist-patient communication over a period of 5 years. Establishing communication with children in the dental operatory is an art. Research is headed toward making dentistry painless and easy for children. However, a positive attitude is brought about by the impressions made by the dental care professionals during their first dental visit. Pediatric dentists should be trained to read the child's mind and instantly pick up both the overt and subtle nuances in their behavior. We should keep in mind that children are smart enough to sense disinterested behavior toward them. Interaction and communication differ based on factors such as age, gender, cognition, cultural, and social background. Newborns prefer to hear speech over other sounds. The simple high pitched repetitive words that adults speak to infants are called “baby talk.” It is also known as parentese, motherese, mommy talk, daddy talk, infant- or child-directed speech. Baby talk is not preferred by older children and a need for an age-specific communication is warranted. Hence, we have coined a new terminology “Pediatric dentistese” and have defined it as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”
Communication is a complex multisensory process which has an ability to listen, empathize, and ultimately establish a trusting dentist-patient relationship. It is a two-way process with verbal utterances and non-verbal cues. Mehrabian (1972) stated that 55% of communication is through nonverbal elements such as gestures, facial expressions, postures; only 7% is in words and 35% in vocal elements. Vocal elements include tone, volume, and pacing.
Active listening is an important part of effective communication. The aim of active listening is to engage, facilitate, and encourage the child to speak. Listening, unlike hearing is voluntary, and it indicates that the dentist is interested and cares about the children Empathy is the ability to see things from the other person's perspective. The pediatric dentist should accept and understand the child's emotional reality. Children need empathy and not just sympathy.
Nonverbal communication forms the key aspect of communication. Versloot and Craig reported that, when dealing with vulnerable populations such as toddlers and preschoolers who have limited verbal abilities, nonverbal communications become crucial. Some of the nonverbal forms of communication are given as follows.
Facial expressions form the major part of nonverbal communication. Information can be conveyed just with a smile or a frown. The success of voice control technique depends on the appropriate use of facial expressions. In fact, voice control can be used with facial expressions alone.,
Gestures are deliberate movements and signals to communicate without words. Common gestures include waving, pointing, and using fingers.
Paralinguistics refers to vocal communication that is different from actual language. This includes tone of voice, loudness, inflection, and pitch. When words are said in a strong and confident tone, children show approval and enthusiasm. If the same words are said in a hesitant tone, it might convey disapproval and lack of interest. The tone and pitch of voice play a vital role in voice control technique.
Body language and posture
A slumped posture indicates low spirits or fatigued nature. An erect posture shows high spirits and confidence. A forward and up posture implies open, dynamic, interested, and friendly attitude. Forward and down posture indicates decisive and powerful attitude. Back and up posture depicts a thoughtful and perceptive attitude. Back and down posture shows a caring and supportive attitude. To intercept misbehavior or potential misbehavior, the forward and down posture has to be used. This posture is very effective while using voice control or hand over mouth exercise.
Proxemics is the study of spatial distances between individuals. People often need their “personal space” which is also an important aspect of nonverbal communication. Dentistry involves working on the patient in the intimate and/or personal zones (<4 feet) which can lead to unpleasant feeling. Fear of intrusion is one of the important factors of dental fear in children. Hence, it is important to make the child feel comfortable and at home in the dental operatory.
It is important to make and maintain eye contact with children. Sitting and speaking at eye level shows a friendlier and less authoritative nature of the dentist.
Communicating through touch is another important nonverbal behavior. Touch can be used to communicate affection, familiarity, and sympathy/empathy. There has been substantial research on the importance of touch in infancy and early childhood. A handshake or a pat on the shoulder act as good social reinforcers in the dental office. This kind of physical contacts helped 7–10-year-old children relax.,
Colors used in the dental office, attire of the dental team, hairstyles, and appearance of the dentist can influence the emotions of the child. Research on color psychology has demonstrated that different colors can evoke different moods. Umamaheshwari et al. have shown that use of child-friendly colors such as yellow and blue in the dental office can enhance a positive attitude in the child's mind.
Communication includes a transmitter (pediatric dentist), a medium (spoken word/language), and a receiver (child). The message should be clear so that it is understood the same way both by the dentist and the child. “What you say, when you say it, and how you say it?” are important. The message has to be conveyed differently for different age groups of children, and this depends on their maturity in language. For a normal child, the process of maturity in language by way of conversation occurs between 2 and 4 years of age.
Communication based on a/ge
The first form of communication used by the newborn is crying. They prefer to listen to “baby talk,” once referred to as motherese. This type of speech is now known as child-directed speech. Child-direct speech attracts infants' attention more than the adult-directed speech due to its slower pace and accentuated changes provide the infant with more salient language cues. This helps the infants to perceive the sounds that are fundamental to their language.
Infants (up to 18 months)
Infants generally communicate with cries, coos, gurgles, and grunts, nonverbal gestures such as facial expressions, bodily movements (cuddling and arching), eye movements, and movements of limbs. Between 2 and 4 months, infants begin making sounds or cooing, that are more pleasant and language-based. The communication more is a prelanguage “conversation” with parents as the baby coos and the parent talks back; the baby looks and laughs; the parent smiles and talks. Babies begin to learn how to use language even before they can speak in this fashion. At 4–6 months, infants begin making speech-like sound that has no meaning; cooing turns into babbling. One-syllable sounds, such as ba and da are made, and they begin to combine these words (baba, dada) when they are 6–8 months old. Babbling incorporates sounds learned from their native language environment, over the next few months. By their first birthday, infants usually say their first words, which is an extension of babbling. Adults (parents or dentist) should respond quickly to infant's communication and give meaning to their communicative efforts (e.g., you are showing the tooth, I know that tooth hurts you a bit). The dentist must know the limitations of the infant's vocabulary and hence, must use more of appropriate nonverbal communication. Nonverbal communications such as facial expressions and tone of voice form the key for them to express or communicate. When we talk to infants and young children, we usually talk in a higher-pitched voice and overstress the ups and downs of our pitch, like a roller coaster. Echolalia is a word or phrase repeated without much understanding of context. This language can also be used by the dentist to capture the attention of these young children.
Toddlers (up to 3 years)
Toddlers communicate with a combination of gestures, grunts, and one or two-word sentences. They have increased learning of words, and a vocabulary burst occurs around 18 months for some and for others it may be gradual. These children start stringing words together for communication. During the 2nd year, children begin to understand that, words are symbols that stand for objects in the world. This provides a strong incentive for them to acquire and use language. At around a year and a half, children begin to combine words in phrases. This is the beginning of their use of grammar, which demonstrates that children create their own grammar, rather than simply making mistakes in using adult grammar. At this stage, all children around the world use language in the same way, by including only the most basic information in what they say. For example, they may say, “Open mouth,” but generally do not say, “Open your mouth” or “Please open your mouth.” We need to respond quickly to their communicative efforts and expand their one or two-word communication into sentences using their words. Labeling their emotions about teeth, appearance, or pain should be done. The sequence in which the dental appointment will be finished has to be informed, and they have to be involved in the act. One instruction is given at a time, and necessary warnings have to be provided before transitions during the dental procedures. Use of symbolic play, euphemisms, and nonverbal communication is effective in this age group of children. They like to explore and move around. They generally get impressed and excited with the newness of the dental operatory.
Preschoolers (3–6 years)
By age 3, most children begin to talk in full sentences. Interestingly, they use both the correct and the incorrect words in the same sentence like I “goed” to school and then went to the dentist. By 6 years, they form grammatically correct sentences. Children of this age group are curious, talkative, and verbally enthusiastic to talk about their experiences. It is important to avoid interruptions or distractions when the child talks. Open-ended questions must be posed so that the conversation continues. Preschoolers should be encouraged to talk about their positive and negative feelings as well as the possible reasons for those feelings. Children must be asked to make words on what they can see/collect from the dental environment such as teeth, brush, paste, and floss. Active listening and appropriate responses should be effectively used to manage these children. These children experiment with fantasy and pretend play. They have imaginative fears and are scared of bodily injury and injections. They may misinterpret words they hear and worry about being in trouble. It is important to avoid words or actions that can increase their anxiety toward dental procedures. One of the characteristic features of preschoolers is role playing, and hence modeling can be used to enhance communication.
Middle years' child (6–12 years)
Children of this group master skill in school and learn conversation and talk much like adults. They ask more questions, relate to past experiences. They can understand the perspective of others and can handle more pieces of information at the same time under the adult guidance. Their thinking becomes more logical. They want to be treated as “big kids” but may still have “baby” insecurities. The child should be questioned directly in simple terms but not in babyish style. It is important to allow them to express their fears and emotions. These children feel comfortable with touch, pat, or handshake. Common interests such as sports or favorite cartoon/movie characters can be used to communicate with them. Anxiety can be dealt with simple behavior guidance techniques. Some children use delaying tactics (e.g., wants to drink some water or to use the restroom) during dental procedures. Care has to be taken to prevent avoidance learning.
Adolescents (12 years and up)
Adolescence is the stage at which children typically act more negative and have conflicts with adults such as parents or dentists. These individuals are neither a child nor an adult, and we should be flexible with them. We should show empathy, and seek to understand their perspective first, before trying to be understood ourselves, as modern adolescent language, has been influenced by electronic communication, such as instant messaging and text messaging. As communicators try to make interactions as efficient as possible, they have developed shorthand methods., These youngsters usually respond in an appreciative manner to the dentist. Eye contact must not be forced unless it is important to make a point. Adolescents can spot fake smiles and gestures. Communication through touch should be done only when it is welcome. Their reactions can be under- or over-exaggerated. Identity and peer relationships are key issues of this age. Hence, it is important not to behave like one in their group unless you really are.
Children are usually accompanied by their parents and communication with the parents is an added challenge to the pediatric dentist. Every parent likes their child to be treated as the most special, beautiful, and smartest baby in the world and not as patients. Taking care of this need also becomes important in the pediatric dental practice.
The word “Pediatric Dentistese” may be new, but the concepts involved are the age-old communication skills which help the pediatric dentist to multitask as a dentist, a psychologist, and a behavior therapist. We should be an ontological coach, guiding the child's way of being/behavior in the dental operatory using appropriate verbal, paralinguistic, and nonverbal communication skills. A healthy communication thus builds the child's trust, instills a positive attitude, and leaves a lasting impression.
The authors would like to thank Dr. P.R. Geetha Priya, Reader in the Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode for helping in preparing and editing this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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