SUGGES'T'IONS IN THE DENTAL CARE OF CHILDREN
From the very beginning, activity is directed to establishing rapport with the child. A child must be made to feel accepted and important almost immediately. Remarks of a complimentary nature, such as, "What a pretty dress!" "How nice your hair looks!" are a start in this direction.
From this point, efforts are aimed toward orienting the patient to the physical environment of the office. The child is introduced to the ''elevator" (the motorized dental chair). The parent or guardian is seated in the chair and the child is taught to operate the pedals that raise and lower the chair. It is then his turn to be seated. In most instances, he seats himself willingly in a chair that he has learned to operate.
The subject of counting is introduced. "Can you count?" the child is asked. The dentist opens his mouth and asks the patient to count his teeth. If he cannot count, he is asked to look at the dentist's teeth. Permission is then obtained to count or look at his teeth. This is usually granted by the voluntary opening of the patient's mouth. Progress is being made. A child has seated himself in a dentist's chair and is opening his mouth voluntarily for a dental examination.
The next step is to introduce the youngster to the "washing machine," which is the water-cooling apparatus attached to the handpiece. "Teeth become dirty and decayed. This is how we clean them." The control is pressed and water is allowed to spray on the patient's hand. Then he is asked to open his mouth. Water is sprayed from the attachment into the mouth. A round stone in the handpiece is gently revolved around a carious tooth. "That was kind of fun wasn't it?"
Now the child might be told, "It is time to learn about the Sleep Game. That is a lot of fun. It is a game where one closes the eyes and pretends to be asleep. In the pretend sleep, a child can watch a movie or television, or anything that he enjoys. Any child can learn how to play. Before playing tit genie, lie must lest m how to empty his mouth of the washing-machine water while his eyes are closed."
The child learns how the "water-pistol" (water syringe) works. He is asked to close his eyes and to keep them closed. The left hand is placed on the edge of the "sink" (cuspidor). The mouth is filled with water. The instruction is given to bend over the sink, but not to empty until told. When the head is over the center of the bowl, he is told to empty his mouth. "That's fine!" Then he is told, "Now lean back, keeping your eyes closed. We are going to see how smart you are. This time when I fill your mouth, lean over and empty it without my telling you when." It is gratifying that patients, so oriented, never miss the bowl even with their eyes closed; those with eyes wide open often miss the bowl and spatter the nurse, the walls, and the equipment.
Before starting the Sleep Game, the child's preferences in regard to movies, television programs and other pleasure activities are discussed. The usual routine is to encourage him to think of a technicolor cartoon on a movie screen and of the accompanying music.
But any imagery the patient elects to produce is used. He is then instructed: "Now close your eyes and keep them closed. Soon you will see that movie sharply and dearly. As the picture gets better, the hand gets light and starts to go up (lift the hand). The higher the hand goes, the better the picture gets. When your hand gets to your face, the picture will be perfect. That's fine. Keep your eyes closed. Keep watching the picture and listening to the music. Mark time to the music with your finger."
Some children take a little time starting the imagery. For these, the following is added: ''Perhaps you'll see just a dot at first; then perhaps eyes and a mouth; then some whole people and animals.'' If the hand does not start to rise rather soon, pick it up gently at the wrist with the tips of the thumb and middle finger. Repeat the suggestions of lightness until there is enough catalepsy to keep the hand raised.
By this time the patient is extremely relaxed, and/or hypnotized. and/or dissociated. If operative procedure is anticipated, such as an extraction or caries excavation, the site of am intended injection will have been painted with such a topical anesthetic as Xylocain ointment. Pushing a thumbnail into the guru tissue, one can say, "This pinches but it doesn't bother you, does it?" The patient may agree or he may say that he feels it. Counter with, "Yes, you feel it, but the hurt is gone." This is persisted in until the patient agrees that he feels it, but that it does not matter. At that time, the injection is made and that, too, does not matter. The dentist now has an anesthetized and hypnotized patient. There is no situation more ideal for effecting dental procedures with mutual satisfaction to doctor and patient.
The dentist may occasionally encounter parents who are emphatically opposed to the use of hypnosis for themselves or their children. Their wishes should be entirely respected and no effort made to hypnotize the child.
PARENT'S' PRESENCE DURING HYPNOSIS
As a general rule, the presence of parents is contraindicated. One dentist had a boy of about seventeen in the chair. He asked the mother if she would like to watch the trance induction. The boy started to go into an excellent trance—there was no question about his being a good subject. All of a sudden, the mother said, "Tsk, tsk, tsk," and that was the end of the trance. If one wishes after the child has been induced, he can call the mother into the office and say, "Would you like to come in for just a moment and see how nicely Johnny is sitting here?" Then she can be very much impressed with the way the situation has been handled. But she will not see the actual induction.
Another point of view is that the parent should be permitted in the operating room as long as the child does not use the parent's presence to control the situation. A parent's presence is often supportive for the very young child and parents are favorably impressed by the kindness and understanding of the dentist, necessary in the relationship that results in relaxed states and/or hypnosis.
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HYPNOTISM is by no means a new art. True, it has been developed into a science in comparatively recent years. But the principles of thought control have been used for thousands of years in India, ancient Egypt, among the Persians, Chinese and in many other ancient lands. Miracles of healing by the spoken word and laying on of hands are recorded in many early writings.