1. Behavioral Management Flashcards
The AAPD encourages parents an other care providers to help every child establish a dental home by what age
No earlier than 6 months no later than 12 months
What is the most common chronic childhood disease
dental caries
Dental caries are _ time more common than hayfever and _ times more common than asthma
7… 5
What are the three components of the pedo treatment triangle for ideal conditions (well behaved kid) and describe their arrangement
Apex of the triangle= Child patient
Family (mother)
Dentist and environment
Society is in the middle of the triangle
Why is society in the middle of the treatment triangle
society impacts how the child and parent respond and influenced much of what we do
Why is the child at the top of the triangle
Because they are the focus of the appointment
The personalities of the people at the corners of the treatment triangle are always_
changing
T/F Hand over mouth exercise used to be an accepted practice by the AAPD
t- it no longer is
Purpose of hand-over-mouth exercise
gain attention of highly oppositional child so that communication can be established
Poor maladaptive acts (like screaming, kicking, etc.) are linked to what at home?
restraint
Cooperative behavior is related to what at home?
Removal of the restriction and the use of positive reinforcement (praise)
Describe how the treatment triangle changes when less-than-ideal circumstances occur
Dentist is at the apex
Triangle is inverted
Conflict and tension exist rather than harmony and trust
Behavior guidance techniques (pharmacological and non-pharmacological) are used to…
- Alleviate anxiety
- Provide safe and quality treatment
- Nurture positive dental attitude
Predictors of child behavior
- Patient attributes (i.e how verbal are they, developmental level, etc.)
- Parental Influences
- Orientation to dental environment (friendly play area)
- Patient assessment (Past experiences, current emotional state)
- Dentist/Dental team behaviors
Potential patient attributes that may be a reason for non-compliance are
- developmental delays
- chronic disease
- physical disability
- Cultural and linguistic factors
Easing a patient into the dental environment can be achieved by….
- Giving the a pre-appointment tour of the office
- Friendly waiting room environment
What method of listening is good to establish trust with kids
reflective listening
What are some basic behavior guidance techniques
- Direct observation
- Tell-show-do
- Ask-tell-ask
- Voice control
- Non-verbal communication
- Positive reinforcement and descriptive praise
- Distraction
What is direct observation
patients are shown either a live example or a video of a well behaved patient undergoing dental treatment
Describe tell-show-do
Tell
-Verbally explain the procedure
Show
-Demonstrate the visual, auditory, olfactory and tactile aspect of the procedure
Do
-Without deviating from the explanation complete procedure
Describe Ask-Tell-Ask
Ask
-Ask about the feelings of the patient toward the visit
Tell
- Explain the procedure
- Use demonstrations
- Provide information pertaining to their concerns
Ask
-Ask again how the patient feels about the procedure
Describe voice control
- Alteration of voice, volume, tone, or pace to direct behavior
- Way want to explain this to the parents before doing it to prevent misunderstanding
Contraindications for voice control
hearing impaired patients
Describe non-verbal communication
- contact
- posture
- Facial expression
- Body language
What is descriptive praise
emphasizes specific cooperative behaviors
Examples of social reinforcers are…. and non-social reinforcers
Social reinforcers
- verbal praise
- facial expressions
Non-social reinforcers
- toys
- tokens
Effective distractions
- Giving the kid a break during a stressful procedure
- audiovisual eyeglasses
- story telling
What does HOME stand for
hand over mouth exercise
What are the rules of Learning theory for good and bad behavior
- Maladaptive acts (kicking and screaming) are linked to restraint (HOME)
- Cooperative behavior is related to removal of the restriction and the use of positive reinforcment (praise)
T/F HOME is still a part of the AAPD clinical guidelines
f
How do dentists decide what behavior management techniques to use
Depends on
- Skill of practitioner
- Patient
T/F now-a-days there are an increasing number of kids with poor coping skills and can’t adapt to new environments as well
T- reason being are evolving parenting styles
What are advanced behavior guidance techniques
- Protective stabilization
- Sedation
- General anesthesia
What is memory restructuring
Behavioral approach when a negative memory is restructured into a positive memory after the event has taken place
Memory restructuring involves what four components
- Visual reminders
- Positive reinforcement through verbalization
- Concrete examples to encode sensory details
- Sense of accomplishment
Which of the four components of memory restructuring is this:
-Praising the child for specific positive behavior (i.e keeping their hands on their lap or opening wide)
Concrete examples to encode sensory details
Which of the four components of memory restructuring is this:
-Photo of the child smiling at the visit
visual reminder
Which of the four components of memory restructuring is this:
-Ask child to demonstrate behaviors
Sense of accomplishment
Which of the four components of memory restructuring is this:
-Asking if the child told their parent about what a good job they did at the last appointment
positive reinforcement through verbalization
Which of the four components of memory restructuring is this:
Ask the child to role play and tell the dentist what she had told the parent
positive reinforcement through verbalization
T/F A wide diversity exists in practitioner philosophy and parental attitude regarding the parent’s presence or absence during the dental treatment
t
Challenges in open and clear communication between the dentist and parent are
- Socioeconomic status
- Stress level
- marital discord
- Cultural differences
- Linguistic skills
What techniques can be used to enhance communication between the dentist and parent
- Ask tell ask
- Teach back
- Motivational interviewing
Nitrous oxide sedation with (increase/decrease) child’s communication
increase
T/F Nitrous can’t be titrated
f it can (titration technique v.s rapid induction)
Children requiring advanced behavior guidance technique often can’t cooperate for what reasons
Lack of….
- Psycological maturity
- Emotional maturity
- Mental/physical/medical disability
Describe the goal of protective stabilization
restrict patient’s freedom of movement to allow safe completion of treatment
Restriction for protective stabilization may come from
- Another human
- A stabilization device
- A combination
Does protective stabilization require consent
yes
What are the adverse consequences of protective stabilization
- Physical harm
- Psychological harm
- Loss of dignity
- Violation of patient rights
Protective stabilization is indicated when
- Patient’s require immediate Dx and or urgent limited treatment and can’t cooperate due to lack of maturity or mental or physical disability
- Emergent care is needed and uncontrolled movements risk saftey of the patient, staff, dentist, or parent
- Sedated patients require limited stabilization to help reduce untoward movement
- Previously cooperative patient becomes uncooperative and used to expedite completion of treatment
Protective stabilization should be used with caution in what types of patients
- Respiratory compromise (i.e asthma)
- Patients on meds that cause respiratory depression (i.e LA or sedatives)
Patients under protective stabilization must be monitored (continuously/intermittently)
continuously
General anesthesia is a state of (consciousness/unconsciousness)
unconsciousness
T/F Patient is often able to maintain protective reflexes when under GA
f
Signs of pain during treatment are
- Facial expressions
- Crying
- Complaining
- Body movement
What is the more reliable and frequently used scale to record a child’s behavior during visits
frankl scale
In addition to the frankl scale what other documentation should be included regarding the child’s behavior
- Verbal or non-verbal
- Things you said that made them cooperate
Describe a kid who is Frankl 1
- Definitely negative
- Refusal of treatment
- Forceful crying
- Fearfulness
- Any other over evidence of extreme negativism
Describe a kid who is Frankl 2
- Negative
- Reluctant to accept treatment
- Uncooperative
- Some evidence of negative attitude but not pronounced (sullen, withdrawn)
Describe a kid who is Frankl 3
- Positive
- Accepted treatment
- cautious behavior at times
- Willing to comply (at times with reservation)
- Patient follows dentist instructions cooperatively
Describe a kid who is Frankl 4
- Good rapport with dentist
- Interest in the dental procedures
- Laughter and enjoyment
Why do we want to record behavior
as a diagnostic aid in future visits
Informed consent is needed for which of the following
- Protective stabilization
- Sedation
- GA
All the about (all advanced behavior guidance techniques require consent)
What types of therapeutic interventions can be use to help get the kid out of pain while being able to defer treatment to another day until child can cooperate better
- Intrim intervention (i.e intrim therapeutic restoration (ITR))
- Fluoride varnish
- Antibiotics
When should treatment deferral be considered
- Treatment is in progress and kid becomes uncontrolable
- When a temporary treatment can be done to get the child out of pain til definitive treatment is rendered
Contraindications for pulpotomy
- Swelling or pulpal origin
- Fistula
- Pathologic mobility
- Pathologic external root resorption
- Internal root resorption
- Periapical or interradicular (ferrcal) RL
- Pulp calcification
- Excessive bleeding from the amputated radicular stumps
- *History of spontaneous or nocternal pain to percusion or palpation**
- Need at least 2/3rds the root remaining*
ASD stands for
autism spectrum disorder
ASD is characterized by
- Social-interaction difficulties
- Social communication challenges
- Tendency to engage is repetitive behaviors
The aspects of social interaction with kids with autism includes…
- Poor eye contact
- Lack of facial expressions
- Inability to read facial expressions or understand gestures
- Difficulty with social reciprocity (i.e failure of normal back/forth conversation, failure to respond)
- Difficulty with developing, maintaining, and understanding relationships (difficulties in sharing imaginative play or in making friends to an absence of interest in peers)
What percent of ASD people are non-verbal
40%
Do non-verbal individuals necessarily not know language
no
In addition to difficulties in social situations kids with autism also have what other issues
sensory processing issues
- hypersensitive to sounds, smells, sights, tastes, textures, human touch
- However some are HYPOsensitive to those things
Repetitive behaviors such as…
- Repetitive body movements or using objects in repetitive manner rather than using the objects in ways they are intended to be used
- Highly sensitive to changes in their environment
- Intensely focused or attached to unusual objects
- *Should see the same dentist and other staff members at each visit**
What are the six areas of impairment in ASD
Social communication
- Intelligence
- Social anxiety
- Use of language
- Form of language
Narrow Interests (including sensory and repetitive motor behaviors and mannerisms)
- Repetition
- Stickiness (don’t want their environment to change)
T/F ASD patients have higher rates of caries than non ASD pateints
F- lower
Depending on the severity of autism what oral conditions may exist
- Bruxism –> wear
- Non-nutritive chewing
- Tongue thrusting
- Self-injury
- Erosion
- Xerostomia
- Hypergag reflex
Patients with autism may have significant anxiety about going to the dentist how can you make it better
- Give them a tour before their appointment
- Tell them what they can expect to see
- Sent the parent an initial intake form
- Does child prefer dimly lit room? Do certain tastes bother them? Do they perfer quite?
- Consider scheduling at a time the office is less busy
- People with ASD respond well to advanced preparation or pre-teaching
- Consider where they should wait (lobby v.s car)
- Bring another child or adult to help
- Comfort object
- Create a series of short dental office visits
- Consider their reaction to sensory stimuli
- May benefit from wearing headphones
- May like lead apron during treatment
- Dim operating lights
- Have kid wear subglasses
- Ensure a clutter free environment
give an example of descriptive praise
-Specific verbal praise for an action “you did a great job opening wide for me”
