3.4 EXAMINATION
3.4.1 First impressions
An initial impression of the child's overall health and development can be gained as
soon as he or she is greeted in the waiting room or enters the surgery. In particular, it
is useful to note:
- general health⎯does the child look well?
- overall physical and mental development⎯does it seem appropriate for the child's
chronological age? - weight⎯is the child grossly under- or overweight?
- co-ordination⎯does the child have an abnormal gait or obvious motor impairment?
While the history is being taken, the clinician should also be making an 'unofficial'
assessment of the child's likely level of co-operation in order that the most appropriate
approach for the examination can be adopted right from the start (hopefully saving
both time and tears). Broadly speaking, prospective young patients may fall into one
of the following categories:
- happy and confident⎯this child is likely to hop into the chair for a check-up
without further coaxing; - a little anxious or shy but displaying some rapport with the dental team⎯this child
will probably allow an examination after some simple acclimatization and reassurance
(if the child is very young, the option of sitting on the mother's knee could be given); - very frightened, crying, clutching their parent, avoiding eye contact, or not
responding to direct questions⎯this child is unlikely to accept a conventional
examination at this visit (though the child may allow a brief examination while sitting
on a non-dental chair, perhaps even in the waiting room); further acclimatization will
be required before a thorough examination can be undertaken; - severe behavioural problem or learning disability⎯in a few cases, this may preclude
the child from ever voluntarily accepting an examination; restraint (with or without
pharmacological management) may be indicated to facilitate an intraoral examination.
3.4.2 Restraint
Key Point
It is not good practice to formulate a definitive treatment plan, especially one
involving a general anaesthetic, without first performing a thorough examination.
In an ideal world, unco-operative children would be given the time and opportunity to
voluntarily accept a dental examination over a series of desensitizing visits. In reality,
if a child presents with a reported problem but remains unco-operative after gentle
coaxing and normal behaviour management strategies, restraint may be necessary.
Physical restraint should only be considered for infants/very young children, or
children with severe learning difficulties (providing they are not too big or strong to
make any restraint potentially dangerous or uncontrolled). The issue of informed
consent is important here, as it is imperative that the need for the examination and the