Behavior and Ethics Flashcards
Patients who are at higher risk for pain?
π¦p.a.m
- Infants and young children π¦
Three Hx
- History of PREMATURITY
- History of ABUSE (physical, sexual, psycological)
- History of frequent MEDICAL procedures
Hx of PAM
What is FLACC?
FLACC
OBSERVATIONAL PAIN SCALE
Faces, Legs, Activity, Crying, Consolability
What age and over can the Wong-Baker scale be used for pain?
ππππ π’π
WONG-BAKER SCALE
βSIX FACESβ
πππππ’π
Children older than 3, THREE
What age and over can a Visual Analogue Scale (VAS) / Numeric Scale can be used?
0 - 10 scale
6, SIX years old
0-6-10
PIAGET
Behavior Theory
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DEVELOPMENTAL STAGE THEORY
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FOUR different COGNITIVE development stages:
- SENSORIMOTOR
- Birth - 24 months
- Infants gain knowledge of the world from the physical actions they perform within it.
- PRE-OPERATIONAL
- Ages 2 to 7
- Thinking in this stage is still egocentric, meaning the child has difficulty seeing the viewpoint of others.
- CONCRETE OPERATIONAL
- Ages 7 to 11
- characterized by the appropriate use of logic.
- FORMAL OPERATIONAL PERIOD
- Ages 12 to Adult
- person is capable of hypothetical and deductive reasoning. During this time, people develop the ability to think about abstract concepts.
FREUD
Behavior Theory
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PSCYHCOSEXUAL STAGES
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Psychoanalytic:
- Children progress through predictable psychosexual stages
- Childrenβs behavior is orientated towards certain parts of the body
ERICKSON
Behavior Theory
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PSYCHOSOCIAL CRISIS STEPS
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Psychoanalytic
- Psychosocial development proceeds by critical steps or psychosocial crisis that shape personality.
- basic trust β‘οΈ autonomy β‘οΈβ¦..integrity
SKINNER
Behavior Theory
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OPERANT - CONSEQUENCE
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Behaviorism
-Operant - consequence of behavior is in itself stimulus that can affect future behavior
PAVLOV
Behavior Theory
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CLASSICAL CONDITIONING
π€―Ex
Behaviorism
- One stimulus is associated with another through experience
- (white coat is associated with pain of injection)
What constitutes INFORMED CONSENT?
Must inform patient about
- NATURE of the PROCEDURE
- RISKS
- ALTERNATIVE TREATMENT OPTIONS
Including no treatment
FEES are NOT part of informed consent
Based on the ethical principle of AUTONOMY
FAILURE to do so could result in ASSULT AND BATTERY.
MINORS CONSENT
Minors younger than 18 can give IMPLIED CONSENT or ASSENT but not Actual Consent.
EXCEPTIONS
- Emancipated
- Emergency situation
ACTUAL CONSENT if
- Married
- Parent themselves
- Pregnant
- Military
What is the most important in RISK MANAGEMENT?
DOCUMENTATION
- Be Specific With FACTS
- Be Objective, no personal opinions of pt
- Be Complete
- Be Timely
- Never make or sign an entry for someone else.
- Never delete or change anything you wrote-instead provide an addendum
- All writings are discoverable so do not write anything you do not want read in court.
NON-MALEFICENCE
Primum non nocere = First Do No Harm
- Keep Skills and Knowledge up-to-date through continuing education
- Know your limitations and refer difficult cases to a specialist
BENEFICENCE
Professionals have a duty to act for the benefit of others
Provide service to the patient and the public at large
Promote patientβs welfare
The same ethical standard exists no matter the financial arrangement
JUSTICE
Be fair in dealings with patients, colleagues, and society
Deal with people justly and deliver dental care without prejudice
Never slander another dental professional
VERACITY
TRUTHFULNESS
Be honest and trustworthy in dealings with the public
Respect the position of trust inherent in the dentist-patient relationship
Must not represent care being rendered, fees being charged, or any form of advertising in a false or misleading way
STATUTE OF LIMITATIONS
Laws that set the MAXIMUM TIME after an event within which legal proceedings may be initiated.
varies state to state
OCCURRENCE RULE = statute of limitations starts to run after the injury or malpractice occurred
DISCOVERY RULE = stature of limitations starts to run after the injury or malpractice is discovered (more lenient)
WITNESSES
EXPERT TESTIMONY = an expert who has expertise in dentistry and can testify to the existing STANDARD OR CARE and how it was breached by defendant.
Standard of Care = LOWEST ACCEPTABLE level of care among members of the dental professions
FACT WITNESS = Someone who was there
GOOD SAMARITAN ACT
Offers LEGAL PROTECTION to health professionals and others who provide βREASONABLE ASSISTANCEβ to individuals who are
- Injured
- Ill
- In Peril
- Incapacitated
What does Bulimia do to the Salivary Glands?
When gastric acid from the stomach is constantly passing through the digestive tract in the wrong direction, it greatly damages tissues lining the esophagus and mouth. When the body is preparing to vomit, the salivary glands increase production of saliva to lubricate the esophagus and mouth in an effort to protect the tissues from the acidity of the vomit. Because patients with bulimia typically induce vomiting multiple times a day, they are FORCED to produce EXCESS amounts of SALIVA which causes their PAROTID salivary glands to become OVER-STIMULATED In order to keep up with the amount of work that is being asked of them, the glands increase in size which is defined as parotid HYPERTROPHY.
- SIALADENTIS - Inflammation
- SIALLORHEA - Drooling / excess salivation
- SIALOLITH - Salivary Stones
What is Apraxia?
A neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement. Both the desire and the capacity to move are present but the person simply cannot execute the act.
Childhood apraxia of speech (CAS) is an uncommon speech disorder in which a child has difficulty making accurate movements when speaking.
What is Articulation?
The act of expressing in coherent verbal form
What is Dysprosody?
Refers to the loss of normal rhythm or melody of SPEECH.
It is usually the result of neurological damage such as brain trauma, severe head injury, stroke, brain vascular damage or brain tumors.
Frankl Behavior Rating Scale
1 = Definitely Negative (Refusal/Distress)
2 = Negative Resistance (Uncooperative/Reluctant)
3 = Positive Acceptance (Cooperative/Reserved)
4 = Definitely Positive (Interested/Enjoyed)
What is Anticipatory Guidance?
AGE-APPROPRIATE COUNSELING for patients and their parents focused on PREVENTION.
FIRST DENTAL VISIT should be by 1 YEAR OLD
What is Familiarization?
NO TREATMENT DENTAL VISIT with an emphasis on introducing the dental setting and common instruments
What is Functional Inquiry?
Questionnaire or Interview
Allows you to learn chief complaints and estimate behavior
What is Behavior SHAPING?
SHAPING
Slowly develop behavior by REINFORCING SUCCESSIVE APPROXIMATIONS to a desired goal.
Reinforcement should always be IMMEDIATE AND SPECIFIC to the DESIRABLE BEHAVIOR
Ex: Ask to open wide -> patient only opens a little bit -> instill positive reinforcement
What is AVERSIVE CONDITIONING?
Punish with the purpose of extinguishing or improving negative behavior.
Not for Timid and Tense-cooperative
Ex:
Voice Control
Hand-Over-Mouth
HOM- gently place hand over mouth to gain attention of uncontrolled
ADHD
Inattentive (AD) and hyperactive (HD)
More common in BOYS
Most commonly first appears age 3-6
Three most common psychstimulant medications
- Methyphenidate (Ritalin)
- Atomoxetine (Strattera)
- Amphetimine (Adderall)
All three have same side effects:
(Dry mouth, Nausea, Hypertension)
AUTISM
Condition related to Brain π§ Development that impacts how a person perceives and socializes with others
Spectrum refers to WIDE RANGE of symptoms
COMMONLY DEMONSTRATE
- Repetitive Behavior (body movements, questions)
- Heightened Sense of light and sound
Bruxism
Symptoms?
Nerves Responsible?
Oral parafunctional activity.
Excessive teeth grinding or jaw clenching.
Symptoms:
hypersensitive teeth, aching jaw muscles, headaches, tooth wear, and damage to dental restorations.
Nerves:
CN - 5, 9, 10