Our SDHCN playbook

Over many years working with patients and families and consulting with behavioral experts we’ve landed on a few tried and true approaches that set up successful outcomes:

Please let us know if we can answer any questions you may have about your own child’s treatment needs.

Phone: (302) 475-3110

Email: info@brandywinepediatricdentistry.com

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Special Dental Health Care Needs (SDHCN)

Special Dental Health Care Needs (SDHCN) are any physical, developmental, mental, sensory, behavioral, cognitive, or emotional conditions that require unique dental management. These include but are not limited to:

  • Phobias
  • Anxiety
  • Previous negative dental experiences
  • Neurodevelopmental disorders (e.g. autism spectrum disorder)
  • Congenital or acquired disorders (e.g. cerebral palsy)

Our mission is to deliver excellence in dental care for ALL children, regardless of abilities, sensitivities, phobias, or disabilities by caring for kids in the most humanistic and holistic way possible. All children are unique so we customize our dental treatment to address their comfort and confidence while developing trust and skills to gradually be comfortable receiving routine dental care in the office.

Dr. Jill and Dr. Blaire are both ABPD board-certified pediatric dentists. In addition to receiving two extra years of specialized training for the treatment of children in residency after dental school, they have taken extra education to ensure their level of care for children and young adults with special health care needs keeps up with the latest research, trends and standards of care.

Since opening Brandywine Pediatric Dentistry in 2019, treating children with SDHCN has become an unofficial subspeciality of the practice that we find rewarding in so many ways. To lean into our commitment to this growing part of our practice, Dr. Jill recently joined the Special Care Dentistry Association. This means we will be financially supporting the specialization of dentistry in this important avenue while also staying on top of the latest research and guidance on clinical best practices.

If your child has SDHCN, the first step to prepare for your visit is to schedule a virtual consultation with Dr. Jill or Dr. Blaire to discuss your concerns and goals for your child’s visit with us. This virtual check-in is our first step in helping us work with you and your child to develop a plan for your child’s care. 

If you think that your child may benefit from accommodations and would like to set up your virtual consultation please call us at (302) 475-3110, send an email to info@brandywinepediatricdentistry.com, or fill the form using the button below to get the process started.

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Our SDHCN playbook

Preparation

Nothing increases anxiety for young patients like fear of the unknown. So we find it is very beneficial to set expectations with children ahead of time to give them some idea of what is going to happen and how. For a child-friendly introduction to visiting our office, please share our first visit/office tour guidebook: Tilly’s Trip to the Dentist with your child.

Keep in mind that certain words like “needle”, “pain,” or “extraction” can trigger anxiety in children as well so try to avoid using words like these when referring to your dental visit.

Morning visits

Please try to schedule your child’s first visit with us in the morning. Children who are tired after a long day of learning and play are often too tired to try to learn new skills with us.

Extra visits

We may recommend that rather than coming in every 6 months, your child would benefit from more frequent visits to reinforce their home care and newly acquired skills as well as enable us to focus on prevention of caries with you and your child.

Shorter appointments

Our typical cleaning appointments vary by age and skills from 20 minutes to an hour. Many children benefit from short quick appointments because they get restless sitting in the chair too long. We can focus on one skill at their visit and not overwhelm them with too much information (even if the one skill is just walking into the waiting room that is how progress is made). Other kids prefer to take their appointments slowly and like to talk a bit before they get in the chair and throughout their visit. Some children may need some time in the waiting room to get comfortable before they even are ready to consider walking to the hygiene area. Some kids like to walk around the office and observe other children getting their teeth brushed so that they know what to expect before it’s their turn.

Repetition

We will try to use the same room, same hygienist and same doctor from visit to visit. We believe repetition is key to reassurance, reinforcing learning and developing comfort with receiving treatment.

Comfort Aids

We encourage you to bring your child’s favorite toy, doll, blanket, or whatever else that may help them feel more comfortable.

Tell Show Do

Tell show do (TSD) is an integral part of our teaching approach. We are here to help your child develop long term skills and comfort with oral health care. We prefer to focus on TSD rather than using restraints to help your child cooperate for care. This method requires patience, practice, time and reinforcement at home (and in school when possible). It is important that we as health care providers and family members adjust our expectations for their visits. Rather than focusing on “getting a cleaning and x-rays” in most cases we prefer to focus on attainable steps so that kids finish feeling proud rather than feeling like they disappointed us or you.

Safety techniques

In additional to teaching and coaching techniques to help prepare our patients to receive treatment, we also tools and techniques to safely administer our dental care. We will always discuss their use and benefits before using them with your child. They may include:

Mouth prop

A pediatric dentist places a mouth prop for a patient.

In some cases we use tools to enable us to examine or treat the teeth. One of these tools is called a mouth prop. Some children do not have the physical ability to open their mouths on their own during their cleaning, while others get tired during the treatment In these situations, we can place a mouth prop to enable us to examine the teeth to check for decay or infection or carry out the treatment. When we use a mouth prop, we give kids breaks so that they are not asked to have it in their mouth for an extended period of time.

Positioning

Another means of facilitating an exam is through positioning. We may ask you if you are comfortable in placing your child on our knees in a knee-to-knee position. We use this method most often with young pre-cooperative children but it can also be used whenever parents tell us their child prefers to feel secured. When they are leaning back into our laps their caregiver can hold their hands and this position may help them feel more comfortable rather than being in the chair on their own. Use of these techniques will be discussed with you and your child prior to introducing them.

Papoose

Another restraint available is called a papoose which is like a “sleeping bag” to prevent your child from moving their arms or kicking during emergency treatment. We use this restraining device only in the rare circumstance that a child presents to us with a true dental emergency (i.e. bleeding in the mouth that would necessitate a suture) that requires immediate attention and treatment and for which your child cannot cooperate. We never use a papoose without parental consent and will always offer the alternative option of referring your child to the emergency department at Nemours AI Dupont for care and possible sedation.

Silver Diamine Fluoride (SDF)

SDF is an anti-cavity liquid that is applied with a micro-brush (a mini paint brush) and is recommended for young children, fearful children and children with SDHCN because it is quick, painless and effective at preventing caries from progressing and causing dental sensitivity.

Nitrous Oxide (N2O) Sedation

Nitrous oxide, or “laughing gas”, helps kids feel calm for their in-office treatment. We frequently use N2O for restorative care, but it also helps minimize a strong gag reflex. So, if we are having trouble taking radiographs because a child is gagging, we may suggest trying to take them with N2O. Additionally, N2O helps children feel as though the appointment is not taking too long. For children who are nervous about how long their visit is going to last, N2O can put them at ease.

Hospital Dentistry

Our pediatric dentists are credentialed at Wilmington Hospital and Nemours AI Dupont Hospital for Children. So, if the safest and best treatment for your child’s extensive oral health needs are best met in the hospital under general anesthesia, we can provide that care as well. We will work with you and the hospital and in many cases with child life experts/liaisons as well to make sure that we have a plan for their visit to the hospital so that it goes smoothly and we minimize your stress about their care.