Communication strategies to help disheartened parents try again

As dental hygienists and resident dental professionals among our close families and friends, we all get texts and calls asking for advice. Perhaps the most frequently asked questions center around oral hygiene care for children. Many parents are desperate for solutions to help a child learn to tolerate toothbrushing. Tired of the consistent tantrums, parents may grow weary and throw in the towel. They may start to dread their child’s dental appointments because they feel guilty.

Additionally, they worry about how we as dental professionals will react to their child’s oral health. They may leave the office feeling judged and with a treatment plan that includes several hundred dollars’ worth of fillings for their child who still refuses to brush their teeth.

Fellow dental hygienists: we can and must do more to help our discouraged parents! The American Dental Hygiene Association (ADHA) Code of Ethics states that we have a responsibility to “educate clients about high-quality oral health care” and to “communicate with clients in a respectful manner.”¹ We know tricks that can help children be more receptive to brushing, but until we learn to carefully communicate those suggestions to parents, we risk upsetting or discouraging those who may already be at their wits’ end. This article offers some suggestions on how to encourage parents whose children struggle to tolerate toothbrushing.

Encourage the discouraged parent

The manner in which dental hygienists approach a discouraged parent about their child’s brushing habits is very important. As anxiety and depression continue to plague mothers in particular, social scientists have discovered that the “fear of negative evaluation by others” (e.g., dental professionals) can enhance feelings of shame, guilt, and fear of reproach.² Additionally, patients value dental professionals who listen to concerns, respect them, and do not place blame for their (or their families’) oral health status.³ So what communication techniques should we use to help educate and encourage patients without eliciting blame or guilt?

Ask open-ended questions

Asking questions is the way to open up communication with parents. The way questions are asked is crucial to helping conversations be productive and lead to positive interaction. Closed-ended, pointed questions directed at the parent will often result in defensiveness. For example: “Are you good about making sure Tommy brushes his teeth?” elicits guilt because of the accusatory nature of the question. Instead, asking an open-ended question that focuses on the child’s behavior is more productive. For example: “Tell me about how Tommy reacts to toothbrushing” allows parents to express how a child handles oral hygiene at home without feeling cornered or judged. This also leads to insightful information with which you can more specifically direct additional questions and comments.⁴ Open-ended questions allow dental hygienists to get a more thorough understanding of the frequency of oral hygiene, the child’s attitude, and a parent’s current thoughts or concerns about their child’s oral health.

Use language that elicits solidarity

Solidarity is defined as unity or agreement of feeling or action, especially among individuals with a common interest.⁵ Both parents and dental hygienists can work together to achieve and maintain appropriate at-home oral hygiene habits for children because it is a common interest for both parties. One technique that can be used to help bring about a feeling of solidarity is to let a parent know they are not alone in their struggles. This type of social support provides protection against depression because parents (especially mothers) are consoled by the fact that they are not alone in their parenting struggles.⁶ Additionally, choose words that are not accusatory or blaming in nature. A helpful approach would be to “acknowledge that behavior change is difficult” and tell parents (and children) what they are doing right in order to build their confidence.⁷ Also, may we not forget the responsibility we have to encourage our pediatric patients to be helpful and cooperative when it is time for them to get their teeth brushed.

Examples

Examples are always helpful when it comes to discussing how to approach sensitive topics with our patients and their families. Here are some cringe-worthy examples of what not to say, followed by alternative statements that are far more encouraging for a parent. (Note: the bad examples are really bad. I believe that most dental hygienists have tact and are kind when having these discussions with parents. Nevertheless, perhaps some of the statements or phrases may provide some self-reflective feedback.)

What not to say

“Wow, it has been a long time since I have seen a kid with that many cavities! None of my pediatric patients all week have had cavities until Tommy. Honestly, I think Tommy would catch on really quick if you could just manage to get that toothbrush in his mouth every night. Do you think you can do that?”

“Tommy has a lot of plaque on his teeth. Are you brushing his teeth at home?”

“My nieces are so good about brushing their teeth. My sister just tells them when it is time to brush, and they go do it without any problems. They are both younger than Tommy too. What are you doing that makes him freak out so bad?” 

“Honestly, you could just go online and search for ideas that help moms brush their kids’ teeth.”

What to say

“So many parents have children who struggle when it comes time to brush their teeth. You are not alone in this, and you should be proud of your consistent efforts at home. And, for what it is worth, I am proud of you too!”

“Dr. Thomas came in to check Tommy’s teeth. He noticed that there is more plaque buildup on the top teeth than on the bottom teeth. That means that you are doing a fantastic job cleaning his bottom teeth. Bravo, keep it up! The top teeth can be harder to clean at home because they are harder to see, and kids tend to squirm a little more when we try to brush up there. I have a suggestion that is worth a try…”

The brushing battle is so hard! I am a dental hygienist and my children refuse to brush all the time. Do you have a few minutes to brainstorm some ideas together? I would be happy to share some of the things that have worked from some other parents…”

“Tell me more about what tricks you have tried at home to try to help Tommy like brushing...”

Do not give up

Above all, we must encourage parents not to give up. Studies show that “tooth brushing habits which [are] learnt during early years of life [are] deeply ingrained in the child’s mind”⁸ and eventually lead to an adoption of good oral hygiene in their later life. Let parents know that you are there to encourage, help, and support while withholding all judgment. When it feels right, guide parents toward trying a variety of methods to help make brushing more comfortable and rewarding for their children. Let them know they are not alone. Encourage them to be diligent, creative, consistent, and patient with their little ones. 

References

1. American Dental Hygienists’ Association. ADHA Code of Ethics. June 2019. https://www.adha.org/resources-docs/ADHA_Code_of_Ethics.pdf
2. Liss M, Schiffrin H, Rizzo K. Maternal guilt and shame: The role of self-discrepancy and fear of negative evaluation. J Child Fam Studies. 2012;22(8):1112-1119.
3. Sbaraini A, Carter SM, Evans RW, Blinkhorn A. Experiences of dental care: what do patients value? BMC Health Serv Res. 2012;12:177. doi:10.1186/1472-6963-12-177
4. Hashim MJ. Patient-centered communication: basic skills. Am Fam Physician. 2017;95(1):29-34.  https://www.aafp.org/afp/2017/0101/p29.html. Accessed October 1, 2020.
5. Solidarity. Lexico. https://www.lexico.com/en/definition/solidarity. Accessed October 1, 2020.
6. Teti DM, Gelfand DM. Behavioral competence among mothers of infants in the first year: the mediational role of maternal self-efficacy. Child Dev. 1991;62(5):918-929. doi:10.1111/j.1467-8624.1991.tb01580.x
7. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd ed. Guilford Press; 2002.
8. Pullishery F, Panchmal GS, Shenoy R. Parental attitudes and tooth brushing habits in preschool children in Mangalore, Karnataka: a cross-sectional study. Int J Clin Pediatr Dent. 2013;6(3):156-160. doi:10.5005/jp-journals-10005-1210

Rebecca “Becca” Neilson, BS, RDH, grew up in Provo, Utah. She graduated from Brigham Young University in 2014 with a bachelor of science in biology and from Indiana University in 2020 with a bachelor of science in dental hygiene. She is happily married and has two little puppies, whom she dearly loves. In her free time, you can find her arranging flowers and sewing. Becca loves to work with her hands. She practices in a private dental office in Elkhart, Indiana. She thrives on interpersonal relationships and finds satisfaction in helping others learn. You can reach Becca at [email protected].