4. Behaviour Management & Anxiety

Question 1

What are 5 pharmacological behaviour management approaches ?

Answer 1

LA techniques.
Pre-medication.
Inhalation sedation with nitrous oxide.
IV sedation with midazolam or propofol.
GA.

Question 2

From what age onwards can IV sedation be used ?

Answer 2

12+ y/o.

Question 3

Who are pre-cooperative children ?

Answer 3

Young children with whom communication of anxiety cannot be established.

Question 4

Who are children who lack cooperative ability ?

Answer 4

Specific intellectual learning disabilities i.e. severe autism, cerebral palsy.

Question 5

Who are children who are potentially cooperative ?

Answer 5

Previous GA treatment but never had treatment under normal anaesthetic measures.

Question 6

What % of communication is body, movements, face arms ?

Answer 6

55%

Question 7

What % of communication is voice, tone, modulation, pauses ?

Answer 7

38%

Question 8

What % of communication is words ?

Answer 8

7%

Question 9

Describe dental anxiety.

Answer 9

Reaction to unknown danger - common when proposed treatment never experienced before.

Question 10

Describe dental fear.

Answer 10

Reaction to known danger - involving flight-fight-freeze response when confronted with threatening situation - common when previous bad experience at dentist before.

Question 11

What is dental phobia.

Answer 11

Same as dental fear -
Reaction to known danger - involving flight-fight-freeze response when confronted with threatening situation - common when previous bad experience at dentist before.

Must stronger response.

Question 12

What are physiological and somatic sensations which are caused by dental fear and anxiety ?

Answer 12

Breathlessness.
Perspiration.
Palpitations.
Feeling unease.

Question 13

What are cognitive features which are caused by dental fear and anxiety ?

Answer 13

Interference with concentration.
Hyper vigilance.
Inability to remember events when anxious.
Catastrophising.

Question 14

What are behavioural reactions which are caused by dental fear and anxiety ?

Answer 14

Avoidance of treatment and appointments.
Escape situations.
Aggression.

Question 15

What factors might affect child and adolescent anxiety ?

Answer 15

Previous MH and DH.
SH factors.
Parental anxiety.
Parenting style.
Child awareness of dental problem.
Behaviour of dentist and staff and environment.
Child temperament.

Question 16

What scale can be used to measure dental fear and anxiety ? And when can it be given ?

Answer 16

Modified child dental anxiety scale (faces) - MCDASf.
While child is in waiting room when completing medical history.

Question 17

What are examples of non-pharmacological behaviour management techniques ?

Answer 17

Preparatory information.
Non-verbal communication and role modelling.
Voice control.
Tell-show-do.
Enhanced control.
Positive reinforcement.
Behaviour shaping.
Distraction.
Relaxation and breathing techniques.
Systematic densensitization.

Question 18

What is the lidocaine maximum dosage ?

Answer 18

1 x 2.2ml per 10kg patient.

Question 19

What is articaine maximum dosage ?

Answer 19

0.8 x 2.2ml per 10kg patient.