Dr can we please have a shot today!?

Our experiences in childhood often change how we feel about dentistry years later. One interesting twist occurred some years ago in our practice.

A family of Russian immigrants with a number of children ranging from 5 to 17 had made appointments for their dental care needs. The eldest of those children spoke the best English, and acted as the translator for the family.

After some discussion amongst them, the older children decided that their five year old little girl (the youngest child) would “go first” for the treatment of her cavities.

When it came time for the first filling appt. the five year old and the 17 year old girls were the only ones in the room. The five year old was as “as good as gold” through the injections and the rubber dam placement and all-the-while, her older sister was translating. During the entire process, she was no fuss and all smiles until we were ready to drill out the decay. At this point, the eldest said something to her younger sister, and the little one became tearful and distressed. We couldn’t figure out what was wrong, and when we asked about the dam, the clamp etc. she confirmed that all was fine.

Finally, we asked what the eldest had told her and why the little one was so upset. The eldest said that she told her that no matter how badly it hurt she shouldn’t move, so the dentist could fix her teeth. Not understanding the context I asked her why something like that was said!?

She said that she wanted the little one to be polite and stay still. I stated that it wouldn’t hurt since we gave her a local anesthetic. She didn’t believe us and was quite perturbed with us when “we made her lie to her little sister” about it not hurting when we drilled.

After more discussion, we got the little one calm and starting drilling—still smiles and no tears or distress. The eldest stopped us and heavily questioned her younger sister about what was going on as she couldn’t believe that she was not in pain! She left for a minute and all of a sudden all five of the other children were in the dental operatory. They were all amazed that the little one was reporting having a filling done without any pain. Their context from going to the dentist in their country was that local anesthetic was not given for drilling and filling of a cavity. They had all experienced pain with fillings and were absolutely amazed that drilling could be done without pain. These children all politely learned to happily sit in my chair and say in broken English, “Doctor may I please have a shot today!?” Their context was that they were so happy to have no pain during excavation of decay that the injection process was a huge positive!

This was an unusual circumstance but still helps to point out that our early childhood experiences can alter the way we feel about things like dental care for a long way into the future. These experiences can create avoidance behaviors and anxiety. I (Dr. Yaremko) had bad experiences in my teenage years and it has stuck with me to this day. This is why we do not feel that our patients are defective in any way, but have been made into what they are and why we work so hard at providing anxiety managed care, be it giving a simple injection to an immigrant adolescent to general anesthesia to a traumatized adult.