guest editorial
     Any discussion of pediatric dentistry must involve or relate to the
     subject of managing children’s behavior in the dental setting. The
     American Academy of Pediatric Dentistry Guidelines for Behavior
     Management describe communicative management as “the basis for
     establishing a relationship with the child to allow the successful com-
     pletion of dental procedures, and simultaneously, help the child
     develop a positive attitude towards dental care.”1 The crux for achieving
     this goal in clinical practice and specialty education is the refinement
     of skills in scientifically substantiated methods of behavior manage-
     ment, which are carefully outlined in these guidelines.                     Clifton O. Dummett, Jr,
                                                                                 DDS, MSD, MEd
     Nonpharmacological methods may include:
                                                                                 Clifton O. Dummett, Jr, DDS, MSD,
       • Communication management techniques (voice control and                  MEd is currently professor and
         tell-show-do).                                                          head, Department of Pediatric
       • Hand-over-mouth (HOM) technique.                                        Dentistry at LSU School of Dentistry
                                                                                 in New Orleans, Louisiana. He is a
       • Treatment immobilization (physical restraints).
                                                                                 diplomate of the American Board
                                                                                 of Pediatric Dentistry, Fellow of the
     Pharmacological methods may include:                                        American College of Dentists, and
                                                                                 Fellow of the American Academy
       • Nitrous oxide/oxygen inhalation sedation.
                                                                                 of Pediatric Dentistry. He serves
       • Conscious sedation.                                                     as a consultant to the American
       • General anesthesia.                                                     Dental Association Commission on
         Although these six methods have been employed successfully for          Dental Accreditation for Advanced
                                                                                 Education Programs in Pediatric
     decades, several have recently come under scrutiny and have received
     considerable attention by the news media. Since parenting styles,
     disciplinary practices, and family-unit restructuring have changed con-
     siderably over the past 30 years, hand-over-mouth and treatment
     immobilization techniques tend to be less acceptable to parents and
     legal guardians in today’s society. Although there has been historical
     support for its effectiveness, pediatric dentistry teaching programs
     are rethinking the position of HOM techniques in the current options
     of behavior management techniques. Treatment immobilization

28     The Journal of Practical Hygiene
Guest Editorial

                                                                  Our         Just
   techniques are also being challenged by parents as
   behavior management options in many instances. It is
   therefore critical that careful parental education be pro-
   vided and informed consent be obtained when these
   two behavior management methods are considered. If
   selected, the appropriate use of these techniques must be
                                                                              Hygienist —
   carefully employed with sensitivity, compassion, and
   concern for the child’s safety and welfare.
                                                                                  Rita Carrels, RDH
        Conscious sedation has also received recent public
   scrutiny. This has been precipitated by media attention
   directed to several reports associated with morbidity and      The kind of hygienist patients adore
   mortality as a result of pharmacological techniques
   utilized in managing disruptive behavior in children.          Rita was nominated by coworker Debbie Miller, who runs
                                                                  the front desk and does the billing in Dr. Larry Black’s prac-
   Extensive efforts by the dental profession— particularly
                                                                  tice. According to Debbie, patients don’t want anyone else
   the American Academy of Pediatric Dentistry — have             treating them. “The patients love her. She remembers each
   been in place to enhance conscious sedation safety and         one; she remembers their families.” That’s understandable
   minimize the risk of negative treatment outcomes. These        because Rita has been working at the same practice in
                                                                  Flushing, Michigan for over 25 years. The current Dr. Black
   efforts include continuous evaluation of pediatric con-        is the son of Dr. Larry Black, Rita’s original employer. “She
   scious sedation agents, techniques of administration,          has probably treated two, going on three generations of
   appropriate dosages, patient medical risk factors, intra-      families,” Debbie says. No wonder her patients think of her
                                                                  as a member of their families.
   operative monitoring techniques, and the synergistic
                                                                       Rita always finds time to
   effects of local anesthetics with conscious sedation agents.
                                                                  talk with her patients before
   Conscious Sedation Guidelines developed by the Ameri-          she begins treatment, and
   can Academy of Pediatric Dentistry have been in place          she is careful to explain any
   since 1985 and have been continuously revised with             new technology. Her warm
                                                                  and welcoming personality
   input from the pediatric and anesthesiology communities
                                                                  ensures that new patients feel
   to assure maximum safety for the child.                        comfortable and secure in
        The critical concept in this entire discussion is         her treatment chair.
   education—not only for parents and guardians of the                 When she’s not in the dental office, Rita keeps busy as
   children we treat, but also for members of other health-       a CPR instructor and working with the Civil Air Patrol.
                                                                  Although she’s been working in dental hygiene for a long
   care disciplines. The role of the dental hygienist is criti-   time, she still finds it challenging and satisfying.
   cal when providing supportive information to parents                What makes her a Just Phenomenal Hygienist?
   who express concern about the behavior management              “She truly loves it,” Debbie says. “She’s going to go as long
   techniques that are currently being used when providing        as she can.”
   dental care for children. In most instances, well-informed
   parents are supportive of the prescribed management
                                                                  JPH salutes you, Rita Carrels!
   techniques appropriate for their child’s behavior. As a
   result, they will become dental provider allies rather
   than adversaries.

     1. J Pediatr Dent Reference Manual 1999-2000;21:42.
                                                                           is proud to sponsor
                                                                   JPH’s “Just Phenomenal Hygienist”

                                                                                                   January/February 2002           29

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