early childhood caries

Or just in denial!

I recently had to have a good think about this when a patient complained that she felt she was being judged as a ‘bad parent’ by a staff member. I had previously advised the mum that her three-year-old daughter was suffering from a condition called Early Childhood Caries, i.e. severe decay of the baby teeth, often in very young children.

 Here is an example of what we see (this is not my patient, but a three-year-old with a parent problem)!

I believe there were probably two issues that would have been troubling the mother in question. Firstly the feeling of being ‘judged’ and secondly, the perception that she is a ‘bad parent’.

Being told you are judgemental does not sit comfortably with anyone so what does it mean exactly? … Apparently, the definition is “Having or displaying an overly critical point of view”. I thought I wasn’t until this day but then I sat down and took the time to actually think about the how judgemental I really am on a daily basis.

My job entails diagnosing problems, coming up with treatment options and providing a solution which ultimately prevents a similar situation from occurring in the future! Ah yes, that Utopia we dentists all strive for! So do I need to be critical – of course I do!  If I just agreed with everyone’s point of view and went along with the notion that the problem must have been caused by the antibiotics they had when they were six months old or grandmother’s treats when she looks after them occasionally, then, to be honest, I am not carrying out my job and in fact, providing my patients a disservice!

Being critical is an integral part of any decision-making process as we must be aware of the consequences of each of our daily actions. This is, after all, a basic way in which we learn. If the outcome was good, we may repeat the action. If not, then we have to review the decision to achieve a more favourable outcome next time.

As a dentist, I have to weigh up the evidence before me and make a judgement call on what I believe is wrong (or right) with the patient’s dentition and possibly more importantly, their attitude (receptiveness to change habits) so I can best advise them. This takes place on an individual basis and there is no guidebook on how to inform a patient or parent of the issues but common sense should prevail. It is a difficult emotional balancing act between empathy for the situation and frustration that a preventable disease is occurring! Sometimes I get it wrong and hopefully, I will learn from the experience! Or am I just becoming less tolerant and more grumpy in my old age!

So what is involved in my clinical decision making process?

Here is a brief list of what goes through my mind when, for example, a very young child comes in with an obvious dental decay problem…

• Are they in discomfort /pain (and if so how can I relieve it)?
• Is the patient apprehensive or would they be able to accept conventional treatment?
• What is the cause of the condition in this particular case?
• How can I advise that parents as to what options are available (although sometimes the patient listens better than the parents)?
• Do they have brothers or sisters that could be at risk of the same problem?
• Could they have a genetic predisposition?
• Did the parents have similar issues when young or do they also have currently active dental problems?
• Is the patient listening?
• Is the parent listening?

All this just takes place from the moment the family or patient enters the surgery, as I try and weigh up the overall situation, the specific dental complaint, the patient and the parents! I am constantly forming and changing my mental opinion as the patient and parents speak and act during the consultation. Each one of these ‘micro-thoughts’ involves a judgement call (critical or otherwise) as to how to proceed.

And that’s just for starters! As to the logistics of actually treating the young patient, well that is another blog altogether!

So I suppose, when a parent is asked by a dentist about personal issues like what their child is eating and drinking and at what times and when they teeth are cleaned and by whom, the parents may feel like they are in the Spanish Inquisition!  Relax, we are just trying to get to the bottom of the problem so we can advise you accordingly.

Unfortunately, many parents often tell me the answers that they think we want to hear rather than what is actually happening with their own child.  They often go on the defensive and say ‘my child never has sugar’ or ‘fizzy drinks’! I then try to list every drink in the local supermarket (as many have ‘hidden’ sugars), hoping it is the one! If only they were forward enough to just tell me what they DO drink, it would save a lot of time and frustration and judgement! This act alone shows me that they may know they are doing something less than optimal for dental health, but are too embarrassed or ashamed of what I may think of them. Get over it! Just give us the full story so we can help your child rather than judge you!

Personally, I DO NOT MIND if you are giving your child sugar or acids in one form or another, after all, it is your child and your life. But I can only advise you accordingly if I know the whole problem!

However, I DO MIND if parents blame their child’s dental health issue on the child’s ‘sweet tooth’, the grandparent who gives them treats once in a while or the antibiotic they had two years ago! Many parents need to take some responsibility and wake up to what is going on! Remember who buys the groceries!

Once they accept it is often a personal issue, they can learn how to remedy the situation and prevent the same thing happening to the next sibling! Being in denial mode and just burying your head in the sand achieves nothing!

When I meet parents like this, I, of course, need to make a judgement call on how receptive they seem to any advice I offer. Or, if they have already switched off, I may have to spend months or even years before they get the point or see the light!

The longer it takes, the more frustrating it becomes and possibly the more ‘judgmental’ I get! You may have noticed that I need work on my anger management!

Conversely, if a parent divulges information freely and honestly, then it makes treatment and prevention so much easier! I am a firm believer that being receptive to information will assist both the child and indeed the whole family, in their ongoing dental care.

So yes, I am constantly judging what kind of people I am talking to, so I can formulate an appropriate treatment plan and deliver it in a manner that suits the whole family and not just the individual. My approach may be too blunt and to the point, but some people need to be told this way, whether they like it or not. If they choose to go elsewhere for treatment then so be it. At least they now have something to base a second opinion on, which is undoubtedly a good thing.

Bad Parent?

The second issue is whether I perceive them to be a good parent or a bad parent! Well, of course, I don’t!

I look at it as forming an opinion as to whether they are a defensive or receptive parent which will certainly affect their child’s treatment!  It may take a long time to break down parental defences and spread the message about prevention. In this time, the disease process may continue for months or even years. This could also have a flow on effect to younger siblings exposed to the same diets or lack of oral hygiene care. If parents are not receptive and are in denial each time they come in, then it makes provision of preventative advice more difficult and can make the child’s treatment protracted. We can stop the ‘rot’ but parents need to be intimately involved in the process.

If we find the parents are indeed receptive, then treatment options seem easier to explain and preventive measures are more readily accepted, leaving the child and siblings with healthier teeth for the long term, rather than constantly returning for further active treatment.

We love it when children return for check-ups and we do not need to place fillings! It makes my day knowing the preventive advice has been heeded!

I will get off my high horse now and divulge a few secrets about my own (less than perfect) parenting skills in the next blog… “Am I A Bad Parent (part 2)”!

WARNING: There may be acts of violence and neglect but you can be the judge!