Introduction to the dental surgery

It is a common belief among many individuals that being ‘good with people’ is something you are born with and cannot be taught. It is true that some individuals have a more open disposition and can relate well to others. However, everyone can adopt approaches that put children and parents at ease. It is particularly important for dentists to learn how to help people relax, as failure to empathize and communicate will result in disappointed patients and an unsuccessful practising career. Communicating effectively with children is of great value, as ‘being good with younger patients’ is a practice-builder and can reduce the stress involved when offering clinical care. All dental training should include a thorough understanding of how children relate to an adult world, how the dental visit should be structured, and what strategies are available to help children cope with their apprehension about dental procedures. This chapter will consider these items, beginning with a discussion on the theories of psychological development and following this up with sections on parents and their influence on dental treatment, dentist–patient relationships, anxious and uncooperative children, and helping anxious patients to cope with dental care. The psychological development of children was originally viewed as a series of well-defined phases, but is now seen as a continuum. The phases of development may well differ from child to child, so cannot be rigidly applied, but for clarity are described as a series of psychological developmental milestones from infancy to adulthood. The most important theoretical perspective now influencing thinking about child development is John Bowlby’s attachment theory. Bowlby suggested that child development could best be understood within the framework of patterns of interaction between the infant and the primary caregiver. If there were problems in this interaction, the child was likely to develop insecure and/or anxious patterns that would affect the ability to form stable relationships with others, to develop a sense of self-worth, and to move towards independence. The other important concept to note is that development is a lifelong process—we do not switch off at 18—nor is it an even process. Development is uneven, influenced by periods of rapid bodily change.