Sir, I read with interest the interview with Prof Tim Newton (BDJ 2012; 213: 423–425) and was especially interested in his top five tips for the dental team in dealing with patients' anxiety. The fifth tip was concerned with the treatment of children and Prof. Newton recommended getting children into the surgery to acclimatise them. I wonder whether I might be permitted to offer a couple of additional suggestions based upon over a quarter of a century of experience in treating children?
If it should ever become necessary to provide operative treatment for a child then I have found it invaluable to explain the entire procedure at the diagnostic appointment and then to get the child back for a second operative appointment (preferably in the morning when they are less tired). It is a very useful technique to desensitise the child by allowing them to handle the instruments which will be used on the second visit. I allow them to lick the end of a cotton wool bud which has been coated with flavoured surface anaesthetic and to feel the sensation of a needleless syringe pressing against their gum. I always use a Vibraject when giving locals and I always turn it on and let the child feel the buzzing sensation against their gum. If they are allowed to play with the syringe and Vibraject at the diagnostic visit then they will not be tempted to look when you repeat the procedure with a needle attached at the operative appointment. An injection given using Vibraject is virtually undetectable so the tooth can always be uneventfully anaesthetised and the child will not notice that second time round they actually had an injection. I also find it useful to demonstrate the slow and fast handpieces. If a large rosehead bur is placed in a slow handpiece the child can touch the rotating bur with the ball of their finger without feeling anything more than a tickle (try it on your own finger if you don't believe me!).The air rota can be safely demonstrated by touching the ball of the child's finger with either the side of a tissue-protecting end-cutting bur or alternatively the tip of a safe-ended endodontic access bur.
The two or three minutes spent doing these simple demonstrations can save many minutes and a lot of stress at the operative visit. One last tip – when talking to a child always kneel down so that you are at their eye level. This makes you much less threatening.