local analgesia requires time and patience. With the use of a topical anaesthetic paste
and slow release of the anaesthetic solution most 'injections' should be painless. There
is no excuse for the 'stab and squirt method' (Fig. 2.12).
Children are not 'little adults', they are vulnerable and afraid of new surroundings so
effective time management is important. Try to see young patients on time and do not
stress yourself or the child by expecting to complete a clinical task in a short time on
an apprehensive patient.
Despite the dental team's best efforts anxiety may persist and routine dental care is
compromised. Other options will then have to be considered to help the child. An
increasingly popular choice is the use of pharmacological agents; these will be
discussed in Chapter 4. The alternatives to the pharmacological approach are:
(1) reducing uncertainty;
(2) modelling;
(3) cognitive approaches;
(4) relaxation; and
(5) systematic desensitization.
(6) hand over mouth exercise (HOME).
These are discussed in more detail below.
Fig. 2.12 Stab and squirt has no place in our anaesthetic technique. (With
thanks to David Myers and kind permission of Eden Bianchi Press.)2.6.1 Reducing uncertainty
The majority of young children have very little idea of what dental treatment involves
and this will raise anxiety levels. Most children will cope if given friendly reassurance
from the dentist, but some patients will need a more structured programme.
One such structured method is the tell-show-do technique. As its name implies it