juvenile dentistry
by Walter C. McBride, DDS (1941)

This dental textbook was a major find, dug out of the bottom of a box in a used book store in Washington, D.C. Most of the 410-page book, which was owned by a Navy dentist during the war, details the mundane task of filling cavities. But the first chapter, The Management of the Child, is worth the price of admission. There's instructions to handle the distracting, cooperative, courage-building and sympathy- extending parent as well as shy, timid, frightened, hysterical, retarded and any other variety of child patients. Most of the advice can be boiled down to using tricks, guilt and verbal persuasion to get the kid to open his or her mouth. My favorite child, of course, is the incorrigible kind. Here are Dr. McBride's instructions for handling those little pests:

A child who is incorrigible, with the proverbial "chip on his shoulder," who will not open his mouth and who makes drastic expostulations, must necessarily be dealt with alone. The parent must be excused. It takes but a few moments alone to convince this type of patient that he will do just as you dictate — the work will be done pleasantly or unpleasantly, just as he chooses. Every child of this temperament, if he is convinced by your attitude that you mean business, responds at once. It is merely a manner of "calling his bluff."

A girl of eight was referred to me by a dentist who had had her in his office four times. There she had consented to getting in the chair for rides up and down but not for examination. In my reception room the mother was given a free hand in inducing the child to come to the operating room, to no avail. When the mother had exhausted all her possibilities, I appeared and remarked, "What's the trouble?" The child was sprawled in a big chair with one foot on the floor and the other up in the air, pointed at me. She remarked rebelliously, "If you come near me I'll kick you. She was promptly picked up bodily and hurried into the operating room amid a few kicks and verbal rebuffs, and seated (thrust) in the chair with a gesture indicative of action and intent and this remark: "In my office I'll tell you what's going to be done. Now you sit there and let's not hear a word from you. I'll tell you what to do. Open your mouth and let's see your teeth." The child was so amazed at my audacity that she was completely deflated. There was no resistance whatsoever to any remark or command thereafter, and she proved an excellent patient.

At times, in his practice, to break down the iron will of an incorrigible patient, the author has resorted to the towel procedure. It is drastic, but "the spirit must be conquered before the flesh can be subdued." The mother must necessarily be excused, and, as she leaves the room, the latch should be turned on the door — otherwise, she will be back at the crucial moment and destroy all that has been accomplished. To proceed, take a towel in your left hand. Put that arm around the headrest, placing the towel over the child's mouth while holding his two hands in your right hand, which is also pressed down against the body, holding him firmly in the chair. Talk directly into his ear, saying, "As soon as you stop crying, I will let go." If, after a minute or two, no response is given, close the thumb and finger of the towel hand over the nose, shutting off the air supply. In a few seconds he will exhibit symptoms of reasoning and will agree to submit, but the moment the hand is released he will yell loudly for his mother. Immediately replace the towel and proceed again. This time pay no attention to the initial overtures, and hold him until he experiences some discomfort. Prior to releasing him say, "Will you help? Are you sure? Are you sure? Sure?" This time when he agrees to cooperate he will be as good as his word, and the crying will be but momentary. Immediately take the mirror and, in a gruff tone, remark, "Now open your mouth and let me look at your teeth." Almost before the child realizes it, the mouth will open like a trap suddenly sprung, and one may proceed with the examination. The rest is easy.

It is recognized that there is a great deal of criticism of this so-called manhandling procedure. However, the reader must bear in mind that it is only the very rare child who must be treated in this manner; it does not occur with greater frequency than once or twice a month. Certainly it is not a pleasant thing to do, yet when a child has a history of having created an embarrassing scene in three or four difference offices, it is necessary if anything is to be accomplished. It should be a means of last resort, the last card in the operator's deck of possibilities.