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QUESTION
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I have great difficulty convincing the parents of children in my pediatric practice that the deciduous teeth are important and that care for them, both preventive and active, is important. How can I convey that their children’s health depends on being completely healthy and they must commit to maintaining their children’s dental health?
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ANSWER
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As conscientious dentists, with the necessary intellectual and clinical skills required to treat children, we share common goals with the parents of these young patients. We love children and want to do everything possible to optimize their health and welfare. Why, then, do we experience such difficulty when attempting to communicate to a parent the important role that early dental care plays in the overall health of a developing child?
"Why fix baby teeth? They all fall out, don’t they?" "I don’t want X-rays unless you see something wrong." "Fluoride treatments? I thought there was fluoride in the water!" "He has no cavities! Why sealants?" "Can you just fill the bad ones?" "I never heard of crowns on baby teeth!" "Are you sure those are cavities?" "Does my insurance cover it?" These comments and a myriad of others are expressions of disbelief and reluctance we hear every day from well-meaning parents, who are either misinformed or expressing anxiety about the possible financial ramifications of dental care.
GAIN PARENTAL ACCEPTANCE
The key to gaining parental acceptance of the program you are proposing is to place yourself in the role of educator, not salesperson. You are not "selling a case." The objective is to present the factual dental information in a dynamic story form, putting parents in the position of empowered consumers. By equipping them with knowledge, you are, in fact, enabling them to make the correct choices for their children. The storytelling can be enhanced by using radiographs, study models, photographs and intraoral camera images. The axiom of one picture being worth a thousand words is true, but you need the oral explanation as well.
Do not use overly technical terms. Use "gums," not "gin-givae," and "decay," not "caries." The conversation should take place in a one-on-one setting, with the dentist and parent sitting close to each other, not separated by the barrier of a desk. Give the parents all the time and information they require, and anticipate the questions they might have.
Here is an example of how to present information to parents: "The last baby tooth does not fall out until 11 years of age. If we extract the tooth now, we’ll have to make a space maintainer to prevent the surrounding teeth from shifting and causing problems later, with the eruption of the permanent teeth. Whenever possible, it is preferable to preserve a natural tooth. That is why it is necessary to do the nerve treatment and place a crown, even though it is a primary tooth."
It is imperative from the outset that you not place undue emphasis on the financial aspects of treatment. Cost often is the biggest obstacle in overcoming parental resistance. If the treatment was free, there would be little discussion. It is your responsibility to give parents the opportunity to consider the best treatment alternative for their children. Although there might be several ways to approach any clinical situation, there usually is a best or an ideal choice, and that is the one every child deserves. If providing the best treatment means arranging a reasonable payment plan, then do so.
Even though great emphasis is placed today on consumer rights, we should never compromise our principles when it comes to patient care, and that is the message I convey to parents. If they ask, "Wouldn’t it cost less if you extracted the tooth?", I say, "Yes, it would, but that’s not what’s best for your son. So I do not recommend that alternative." It is a matter of setting priorities.
EMPHASIZE IMPORTANCE OF PREVENTIVE TREATMENT
When it comes to recommending preventive treatment, our burden of proof is heavier than it is with the more obvious concept of active treatment. A parent can visualize a carious tooth or a crowded lower arch requiring treatment (especially when shown radiographs or study models). But how can you assist them in visualizing the more intangible long-term benefits of fluoride treatments, diet modification, sealants or space maintenance? This is when you must be most persuasive and inspire trust. "An ounce of prevention is worth a pound of cure" is not a fairy tale. Do you believe that early attention to a child’s dental health has a direct bearing on that child’s dental health over a lifetime? If so, say it with conviction and enthusiasm, and the parent will accept it.
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