Case 1 Jim is a five-year-old boy. He had toothache. Father had been told that a local dentist was 'good with children' and would be willing to see a child in pain at any time. An appointment was duly arranged. On entering the surgery the dentist took father aside and obtained Jim's dental and medical history. He then turned his attention to Jim. He explained how he would numb and then extract Jim's tooth. He allowed Jim to see and touch the forceps so that Jim would understand what was happening to him. Father had been impressed by the dentist's management skills and at Jim's next appointment decided to register his two other younger children for dental care with this dentist.
Case 2 Jessie arrived for her first appointment with her mother. She held tightly onto mother's hand refusing to leave her side. Jessie ignored the dentist's overtures and remained curled up on her mother's lap. With mother's agreement it was decided that Jessie would return to meet the dentist and dental nurse without any treatment being imposed upon her. Gradually over several visits Jessie left her mother's side and walked round the surgery. On one occasion she took the dentist's hand telling her that she had brought 'Dolly-dolly' who was not frightened of the dentist. Jessie climbed into the chair. At this fourth visit Jessie's teeth were examined and prophylaxis completed. Jessie had her treatment completed within several visits with her mother being present in the surgery at the time of treatment.
Case 3 Mother brought Maura to the surgery for the extraction of two upper premolar teeth for orthodontic reasons. Maura had previously coped well with dental treatment and it was decided that the teeth would be extracted immediately. After the extraction of one tooth Maura had a panic attack. She felt sick, faint and cried for mother. The intensity of the attack destroyed Maura's ability to accept any further treatment. It was decided to leave the other extraction for another time. A phone call from mother informed the dentist of Maura's psychological difficulties. As a three-year-old she had become so frightened and panicky of life in general that she had been referred to a child psychiatrist. Maura's old fears were returning. She was finding it difficult to leave her mother at any time and gradually becoming phobic of school. Mother had been so shocked by the return of Maura's anxieties that she felt that Maura would not be able to withstand the extraction of the other tooth. The intensity of Maura's panic attack had shocked both the dentist and mother. Maura was referred for secondary level hospital dental care.
Case 4 Sandra, aged 9-years-old, was considered to be a 'good' patient being quite compliant with the dental treatment provided for her by her dentist. She had had several restorations but seemed to have taken all these in her stride. Sandra's grandmother usually brought her to the dentist and remained with her during the operative procedures. However, for Sandra's last appointment her mother also came along and like grandmother sat in the surgery. As the dentist was about to drill Sandra's tooth, mother stated nervously, 'I just hate it!' Sandra froze, became tearful and it was impossible to continue treatment. A new appointment for Sandra was made. The intervening time interval allowed the dentist to reflect upon Sandra's reaction to her mother's previous verbal outburst. A phone call ensured that grandmother would bring Sandra on her next visit. This allowed Sandra to complete her dental care.
Case 5 The young dentist could not understand Peter's anxieties and felt irritated at the thought of treating him. She had tried many times to provide dental care but Peter had always refused. This latest appointment was his 'last chance'. Otherwise he would be referred elsewhere. Despite her sense of hopelessness about caring for Peter the dentist decided to speak to his mother and this proved fruitful. Peter had been so frightened at the thought of treatment that he had not slept for the previous three nights and vomited before leaving the house. Mother had told the dentist that she had told Peter that he 'must try hard', that she would be with him during treatment. After receiving this information the dentist felt less concerned about treating Peter knowing that mother was supportive of her treatment plans. The dentist asked Peter why he was so frightened and he responded by saying, 'It was the injection'. The dentist now spent some time explaining how his gum and tooth would be numbed. Peter's mother sat beside him, encouraging him and holding her son's hand tightly when the local anaesthetic was administered. Peter was given a face mirror with the instruction to raise his hand if he wanted the dentist to stop. These simple procedures (activities) helped Peter combat his fears of passivity. With the treatment alliance restored the course of treatment was completed.
Case 6 Janet a four-year-old girl arrived as an emergency patient. She clung to her mother and refused to let the dentist examine her. As the dentist put her hand up to touch Janet's swollen face, Janet started to cry.
Case 7 The woman dentist, who treated Nora was kind and patient, encouraging her through her treatment experiences and in this regard had been helped by Nora's mother. Nora was frightened by the dentist sitting behind her. Her mother remembered that when Nora was 4-years-old she had a general anaesthetic to have a tonsillectomy. For that operation a female anaesthetist had also sat behind Nora whilst administering the inhalation anaesthetic. This had been a traumatic experience for Nora.
