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Recently, I bought a slim book called "Building a No Fear Practice". I think the dentist who wrote this book was extremely brave in openly admitting to his past actions. This may provoke some strong emotional reactions, which is why I decided to post this under "discussion and debates".
The second chapter is called "My Story", and here is an excerpt:
"In the early years of my practice, when a child would "misbehave", I would wrap them up in a restraint and tough it out. I was always careful not to hurt them and I always gave an anesthetic, but sometimes they cried for the whole appointment. In retrospect, I never really knew for sure whether they were just scared or if the anesthetic didn't work.
Rather than "give in" to the child, I assumed the responsibility of getting the child's teeth restored no matter what. In addition, I assumed the responsibility of being the parent while the child was in my office. In fact, if the parent had done a poor job of teaching the child to behave and mind adults, I thought it was my job to correct that deficiency by whatever means necessary, so I could get the treatment done. In the end, I was exhausted, my assistant was drained, the parent rarely appreciated my effort, and the child, needless to say, was very unhappy.
And how do you think I acted when the next patient came in a few minutes later? I was still trembling from the last one, and my patience had already worn thin.
When the crying child had left, I used to rationalize away my feelings of distress. What a spoiled brat! Why weren't his parents teaching him to be mindful of adults? Besides, it couldn't have hurt - I gave him an anesthetic. Well, even if it did hurt a little, he'll forget it. Sadly I know now that this is not true. The children didn't forget and neither did I.
In the beginning, I hated doing things that way, but as the years went by, I got accustomed to the crying. I never liked it, but I thought it was simply something that I couldn't avoid. I had to get the job done and to teach the child that I was in charge and they'd better get used to it.
Unfortunately, what they really learned was to avoid the dentist whenever possible. When it was time for their six-month checkup, I noticed that some didn't want to come back. Big surprise! I remember a few times having to go out to the parking lot and help their mothers pull them out of the car. They usually had to go straight back into the crying room. It's sad for me to admit that I thought all this was necessary. Sadder still to admit that it took me almost two decades to change those methods.
...
For the first two decades, I myself sometimes succumbed to these pressures. I felt that if I let a child get away without doing any treatment, he would not only get spoiled, but he would likely try the same tactic the next time. I was convinced that kids needed to learn who was in charge.
Looking for a better solution, I made an extensive study of tranquillizers and sedatives, but as I tried them, they only seemed to work about half the time. When they didn't work, the child had to go back into the crying room. I continued to look for the perfect drug, one that would always work. I never did find it. I did notice that if I increased the dose, the success rate went up; that is, the child was heavily sedated and I could do treatment. However, some of those kids were pretty hard to wake up. That made me uneasy. Even with a reversal drug, I felt uncomfortable. Light sedation didn't work that well and heavy sedation had a potential for serious danger. There had to be a better way.
Occasionally I'd see a study in a dental journal about the long-term effects on children who had had a bad experience with a dentist. Data was beginning to accumulate that frightening childhood experiences were not soon forgotten. As adults, these people often avoided going to a dentist for routine care, which resulted in many of their teeth becoming so badly decayed that they had to be removed. I simply had to find a way to have children leave my office with a good memory of their visit.
Then it hit me. All I had to do was decide in my own mind that the child's memory was more important than fixing the tooth. I really didn't need to worry about spoiling the child; that's a parenting issue. My job was to repair teeth in a way that made the child feel safe, comfortable, and not afraid to come back. That's when my approach to children began to change. I got rid of my restraining board and took the door off the quiet room. My focus shifted from relationships based on authority to pleasant memories and trust. With many years behind me now of using this different approach, I believe that it is never necessary to use fear-producing methods of behavior management."
The second chapter is called "My Story", and here is an excerpt:
"In the early years of my practice, when a child would "misbehave", I would wrap them up in a restraint and tough it out. I was always careful not to hurt them and I always gave an anesthetic, but sometimes they cried for the whole appointment. In retrospect, I never really knew for sure whether they were just scared or if the anesthetic didn't work.
Rather than "give in" to the child, I assumed the responsibility of getting the child's teeth restored no matter what. In addition, I assumed the responsibility of being the parent while the child was in my office. In fact, if the parent had done a poor job of teaching the child to behave and mind adults, I thought it was my job to correct that deficiency by whatever means necessary, so I could get the treatment done. In the end, I was exhausted, my assistant was drained, the parent rarely appreciated my effort, and the child, needless to say, was very unhappy.
And how do you think I acted when the next patient came in a few minutes later? I was still trembling from the last one, and my patience had already worn thin.
When the crying child had left, I used to rationalize away my feelings of distress. What a spoiled brat! Why weren't his parents teaching him to be mindful of adults? Besides, it couldn't have hurt - I gave him an anesthetic. Well, even if it did hurt a little, he'll forget it. Sadly I know now that this is not true. The children didn't forget and neither did I.
In the beginning, I hated doing things that way, but as the years went by, I got accustomed to the crying. I never liked it, but I thought it was simply something that I couldn't avoid. I had to get the job done and to teach the child that I was in charge and they'd better get used to it.
Unfortunately, what they really learned was to avoid the dentist whenever possible. When it was time for their six-month checkup, I noticed that some didn't want to come back. Big surprise! I remember a few times having to go out to the parking lot and help their mothers pull them out of the car. They usually had to go straight back into the crying room. It's sad for me to admit that I thought all this was necessary. Sadder still to admit that it took me almost two decades to change those methods.
...
For the first two decades, I myself sometimes succumbed to these pressures. I felt that if I let a child get away without doing any treatment, he would not only get spoiled, but he would likely try the same tactic the next time. I was convinced that kids needed to learn who was in charge.
Looking for a better solution, I made an extensive study of tranquillizers and sedatives, but as I tried them, they only seemed to work about half the time. When they didn't work, the child had to go back into the crying room. I continued to look for the perfect drug, one that would always work. I never did find it. I did notice that if I increased the dose, the success rate went up; that is, the child was heavily sedated and I could do treatment. However, some of those kids were pretty hard to wake up. That made me uneasy. Even with a reversal drug, I felt uncomfortable. Light sedation didn't work that well and heavy sedation had a potential for serious danger. There had to be a better way.
Occasionally I'd see a study in a dental journal about the long-term effects on children who had had a bad experience with a dentist. Data was beginning to accumulate that frightening childhood experiences were not soon forgotten. As adults, these people often avoided going to a dentist for routine care, which resulted in many of their teeth becoming so badly decayed that they had to be removed. I simply had to find a way to have children leave my office with a good memory of their visit.
Then it hit me. All I had to do was decide in my own mind that the child's memory was more important than fixing the tooth. I really didn't need to worry about spoiling the child; that's a parenting issue. My job was to repair teeth in a way that made the child feel safe, comfortable, and not afraid to come back. That's when my approach to children began to change. I got rid of my restraining board and took the door off the quiet room. My focus shifted from relationships based on authority to pleasant memories and trust. With many years behind me now of using this different approach, I believe that it is never necessary to use fear-producing methods of behavior management."