3 weeks, 20 teeth, and an experience to remember

My Healthy Smiles Experience I have worked with kids of all ages in different settings since I was a young teenager. I've coached volleyball, worked at the YMCA, baby sat, led youth groups, and worked as a camp counselor on several occasions. I am also one of four children in my family. But even with all my experiences being around and handling kids, I was still apprehensive, and nervous about going to Healthy Smiles.  If anyone else is feeling this way, I am here to tell you that everything will be okay!

Having done several prophies on adults, I felt comfortable about my abilities in dental hygiene, but this was different. I had no idea what to expect cleaning a child's teeth.  As I walked up to greet my very first peds patient, my mind was moving in a million different directions.

A brief synopsis of my thoughts during the first 10 minutes of that appointment:

What do I say when I get them?

They are so small!

What do I do when they ask me questions?

Is 30 kg a lot?

They need bitewings, how do I do that?

There isn’t a RINN instrument, how do I take a bitewing??

What chair am I in again?

Wait, I don’t have an assistant today… say whaaat?

After I had that internal battle and sat my first patient down in the chair, the only thing I could do was laugh at myself:  Here is this tiny human, sitting on a pillow because they are too short for the dental chair, chatting away with their high pitched voices.  They're telling me about their first day of school, their favorite color, what they did yesterday, what they ate for breakfast… totally composed and happy to be there.  All the while I am sitting beside them sweating bullets.

After asking some oral hygiene questions I applied disclosing solution and taught them how to brush their teeth.  I did the prophy, filled out their forms and note, got them checked by an attending, and off they went.

So simple!

The worst part about the prophy is the limited time frame and completing all of the notes/tabs/talking to the parent etc. The best part is the patient! Almost every single kid I had for a cleaning was great and unique in his or her own way.

A couple days of doing cleanings I got used to the atmosphere and felt more comfortable. I would ask my patients questions and then build my conversation off of their answers.

My favorite has to be the response of a 7 year old patient to what his favorite animal was. The answer…tiger shark, voiced in a way that made it seem like ‘duhhh, everyone’s favorite animal is a tiger shark!’ My initial thought was, "Perfect, sharks have a lot of teeth and have big mouths." I used it as my way of teaching him about his teeth, how to not lose his teeth like sharks do and how to keep them healthy and “sharp”.

I learned how to speak to different age groups. The young ones like fun and simple terms; “Sugar bugs”, “sugar bug neighborhoods are called plaque”, and the number two, “two times a day, two minutes, two sides of teeth, top teeth and bottom teeth”. I also learned how to be magic by guessing their favorite color solely by looking at their outfit. If they are wearing a lot of the same color...hint, hint. This worked around 10 times when I was there. Their shocked expression is priceless. Try it!

For the slightly older kids I would start asking more specific questions.   Do they know what cavities are? What causes them?  How many surfaces do teeth actually have? When they would answer two or three sides I would show them the sides they need to brush and the sides they can only reach when they floss.

Lastly, to the older ones I would say something like “the ladies won't like that…” when decay and cavities were brought up.

Every child has a completely different personality, you can't treat them all the same.

The day of my first full day of operator session I was again sweating profusely plus or minus some heart palpations and tunnel vision…. Just kidding. I was really nervous though.

I got there an hour early just to make sure I could calm my nerves because that day was a day of many firsts: first time extracting teeth (three of them!), my first IA block, my first crown (SCC) and my first time challenging a competency.  The only non-first was a restoration.... I had only ever done one before!

Once again, a thousand thoughts were spinning through my head that morning:

I haven't done an IA block since stab lab in January... and my first is going to be on an eight year old!?

IA entrance point is higher and more posterior, right? Yes, I looked it up.

27 long is what we still use. I researched that too, so why am I so apprehensive?

The kid is small…I have already calculated the max dose of 2% Lido 1:100 epi for a 46kg kid but is that right?

How do I extract a tooth? What do I do?  What if it breaks in half? What if the kid swallows it? Where are the Magill forceps?

Wait what, they need an interpreter?

I was nervous to say the least. But guess what? I survived and more importantly so did my patients.

Oh, and nitrous helps, trust me!

Remain confident, they are like little blood hounds. They are already scared; they are already on high alert, if you are nervous they can sense it I swear. It’s going to increase their anxiety and just make the appointment worse.

Another word of advice: kids wiggle.  There isn't anything you can do about it, so be prepared. If you were 7 years old and was told to lay down with your mouth open for an while your face "falls asleep," with a lot of strange noises you'd be wiggling, too.  Mouth props are used 100% of the time in an operative session, and the faster you make it through the appointment, the better.

Again, nitrous helps.  A lot.

For the most part things will go great, but just like in normal clinic things do always go as planned. My worst experience at Healthy Smiles involved a mother who refused nitrous for her 8 year old child. He was also the same patient I was going to be doing my first IA block on.  The tooth I was working on was banded for a space maintainer and the kid had more saliva than anyone I've ever seen. While delivering the IA block, the harpoon popped out of the rubber plunger when I aspirated, scaring the kid. My eyes doubled in size and I about had a heart attack.  Whatever confidence I had was gone. I removed the syringe and needle and attempted to redo the IA block on an anxious kid without any nitrous in a pool of saliva.  In the end, I successfully completed the restoration (my second ever!) and learned how to manage the unexpected.

During your first time few times working on pediatric patients, it is okay to be nervous. You will be nervous! Just don’t show it. Sometimes things will go great and sometimes things will not go according to plan.

Overall, my experience at Healthy Smiles was great. It takes a couple days to learn all of their rules and the different ways they do things.  It takes a week to be at least semi-competent in note taking and time management. It takes until the very last day until you think you kind of know what you're doing. Don’t be afraid to ask for help, I did many times.

Learn to love working with the kids! They are the most hilarious, brutally honest, imaginative and innocent people we will ever have the opportunity to work with. You will think to yourselves many times, this is a person??  How?  They are so small! Make jokes and have fun, but make sure they also understand the importance as to why they are there and the importance of what you are doing. Think tiger sharks and teeth!

You will be exhausted at the end of each day and borderline sleep-walking at the end of the rotation, but the three weeks go by so fast!

I hope you have a great experience like I did at Healthy Smiles.