parents have any particular worries or concerns, to settle the patient into the clinical
environment, and to assess the patient's emotional state. The following sequence
represents one way of maximizing the effect of the 'preliminary chat':
(a) Begin with non-dental topics. For children who have been before it is helpful to
record useful information such as the names of brothers/sisters, school, pets, and
hobbies.
(b) Ask an open question such as, 'How are you/are you having any problems with
your teeth?' Listen to the answer and probe further if necessary. All too often dentists
ask questions and then ignore the answer!
By talking generally and taking note of what the child is saying you are offering a
degree of control and reducing anxiety.
- Preliminary explanation. In this stage the aim is to explain what the clinical or
preventive objectives are in terms that parents and children will understand. This is a
vital part of any visit as it establishes the credibility of the dentist as someone who
knows what the ultimate goal for the treatment is, and is prepared to take the time and
trouble to discuss it in non-technical language.
While not wishing to labour the point, it must be stressed that sensible information
cannot be offered to the patient or parents until the clinician has a full history and a
treatment plan based on adequate information. This requires a broad view of the
patient and should not be totally tooth-centred. It is all too easy to lose the confidence
of parents and children if you find yourself making excuses for clinical decisions
taken in a hurried and unscientific manner.
Thus the preliminary chat sets the scene prior to actual clinical activity.
- Business. The patient is now in danger of becoming a passive object who is worked
on rather than being involved in the treatment. Many jokes are made about dentists
who ask questions of patients who are unable to reply because of a mouthful of
instruments! (Fig. 2.9). This does not mean that the visit should enter a silent phase. It
is important to remain in verbal contact. Check the patient is not in pain, discuss what
you are doing, use the patient's name to show a 'personal' interest, and clarify any
misunderstandings.
At the end of the business stage it is helpful to summarize what has been done and
offer aftercare advice. If the parent is not present in the surgery, the treatment
summary is particularly important, as it is a useful way of maintaining contact with
the parents.
- Health education. Oral health is, to a large extent, dependent upon personal
behaviour and as such it would be unethical for dentists not to include advice on
maintaining a healthy mouth. Although offering advice to parents and patients is
useful, in many instances the profession treat health education in a 'throwaway'
manner. This results in both patients and dentists being disappointed.
The key ways to improve the value of advice sessions are as follows: