volunteered until this point!) This is a particularly useful approach in relation to
children who suffer from behavioural or learning problems, such as attention deficit
and hyperactivity disorder (ADHD) or autism.
Key Point
Sensitive questioning is required if the child appears to have a behavioural problem
that has not been mentioned by the parent during the formal medical history.
It is important to bear in mind that many children with significant medical problems
will have been subjected to multiple hospital admissions/attendances. These
experiences may have a negative effect on the attitude of both the child and his or her
parents towards dental treatment; in addition, dental care may not be seen as a
priority in the context of total care.
Finally, a brief enquiry should also be made regarding the health of siblings and close
family. Significant family medical problems, for instance problems in relation to
general anaesthesia, may not only alert the practitioner to potential risks for the child,
but may also be factors to consider when treatment planning. Likewise, if the patient
has a sick sibling, it may not be possible for the parents to commit to a prolonged
course of dental treatment.
3.3.5 Dental history
A child's previous dental experiences may affect the way in which he or she reacts to
further treatment. Evaluation of a child's previous behaviour requires the dentist to
obtain information about the kind of dental treatment a child has received (including
the method of pain and anxiety control which has been offered) and the way in which
he or she has reacted to this. In so doing, specific procedures may emerge as having
proved particularly problematic; such prior knowledge will enable the dentist to
modify the treatment plan appropriately.
The dental history should also identify factors that have been responsible for existing
oral and dental problems as well as those which might have an impact on future
health. These include dietary, oral hygiene, dummy/digit sucking, and parafunctional
habits. Specific questions should be asked about drinks (particularly the use of a bottle
at bedtime in the younger age group,), between-meal snacks, frequency of brushing,
and type of toothpaste used.
Finally, a thorough dental history is an opportunity to evaluate the attitude of the
parent to his or her child's dental treatment. For example, the regularity of previous
dental care may be an indicator of the value that the parent places on his or her child's
dental health.
Key Point
Embarking on a treatment plan that is at significant variance with parental attitudes
and expectations without clear explanation and justification invites non-completion.