A Parent's Perspective on Effective Dentistry:
Tips for Family-Centered Care

Many new professionals want a list of what to do and not do when providing services to patients with disabilities and their families. The list varies depending on the individual receiving care, his or her family, and of course, the practice itself. This list is based on the efforts and actions of dentists who have taught my family how we might view good dental care for my teenage daughter. Based on the success of professionals providing my daughter's dental care, here is a starting point for consideration on communication with families:

1. The most important way to communicate with families is to talk to the patient. The patient can give you important information and you can tell him or her all about the appointment and what you are doing. If it is not evident how to best communicate with the patient, talking with the family about communication is always a good way to start. Starting with the family may be especially appropriate in working with younger children and for children and adolescents who communicate through largely non-verbal means. A dentist who learned just a couple of my daughter's signs greatly increased his ability to work with her. One friend tells me that her adult son with a disability was encouraged by his pediatric dentist to be part of the communication process regarding dental care. For him, it has meant that he is not only a better dental patient; he is also a young adult who accepts personal responsibility for his health and other aspects of his life.
2. Dentists can highlight with families that the goal is very good health care. Families who have had their expectations shaken do not necessarily know if this is possible, unless they are told.
3. For a complex patient, good care varies daily and within the scope of what the problem of the day is. Wise dentists understand that dental care is very important to a patient and his or her family when there is not a bigger emergency to tackle! Open communication about the "crisis" of the day or month allows the dentist to provide valued input about the effect of certain options for dental care. I am aware that great professionalism is involved in recognizing that a cancelled appointment is an opportunity to collect important knowledge about a patient's medical status. I feel guilty about a cancellation, but my daughter's dentist office always inquires about what is going on and seems to value the information. This patience means that my daughter's dentist can return her to his quality-oriented focus as soon as possible.
4. How much intervention is possible? Communication allows the patient and family to have expectations that correlate with the care that your practice provides. For example, I was confused when a friend, a wonderful mom, did not share my positive view of the dental care our children were receiving from the same dentist. While I thought that this dentist did all of the right things, the other mom always seemed surprised by what came next. I eventually concluded that the communication between my friend and the dentist about what could be accomplished for her child was not as successful as it was in our case. A discussion in this area gives the dentist important information about what the family expects the child to experience at a dental visit. Families may "bolt and run" if they do not see their definition of quality care being met. As a more positive example, my daughter's first dentist talked about why her first few visits would seem very different from those of my husband and myself. It meant that we changed our expectations from intensive exams and cleanings to dental office adjustment visits that were experiential, informative and entertaining for our child. This communication also meant that we were not surprised when the visits later built in intensity.
5. Some families see doctors and dentists only when problems arise. Preventive care may be a new experience. Help families to understand that not all problems can be avoided, but that good dental care can assist in managing future issues. For example, getting sealants on my daughter's molars does not solve everything, but it is contributing to my child's lack of cavities.
6. Consistency from the dental office staff has resulted in my child knowing what to expect in an appointment. This consistency allows my child to feel like part of the team and act in a more responsible manner. For example, the use of a small dental mirror as a distracter each time my daughter's teeth are being cleaned has greatly reduced the time that she spends in the dental chair. That mirror also tells her that the dentist will be coming soon. Consistency can also be supported with use of such things as social stories or photographs of the dental office for the child to take with him or her. (See the example a "Going to the Dentist" Social Story, also in this Module).
7. Families will have experience assisting their child with behavior issues in a variety of settings. Ask them, "What are the things that work for your child?" "What are the things that will allow the appointment to go the best?" I remember a year when dental visits went well, but haircuts went very badly for my child, and the difference was in the communication about what works best. The dentist asked the right questions!
8. I really appreciate hints from a dentist office about what may allow me to improve my child's dental care and improve how her appointments go. Sometimes it is as direct as what kind of toothpaste or brush may be useful. Sometimes it involves explaining to my child and to me why certain things are happening as part of her dental visit and that allows us to generalize it to home.
9. Remember that the child and family who have never been to your practice have only their prior appointments elsewhere upon which to base their expectations. Extra communication is needed to describe what will occur, how your office works, and who everyone working in the office is.