Behavior Management Flashcards
variables influencing children’s dental behavior
- maternal anxiety
- medical history
- awareness of dental problem
maternal anxiety: characteristics
- high parental anxiety = negative child behavior
- can affect children of all ages
age where maternal anxiety effects are greatest
under 4 years of age
factors under medical history that can affect child’s cooperativeness with the dentist
- children who view medical experiences positively
- emotional quality of past visits
- past medical pain
how to mitigate negative behavior for awareness of dental problem during a child’s first dental visit
educate parents about value of arranging child’s first dental visit
can be used for modeling
- live patient models
- audiovisual aids
modeling (according to Rimm and Masters)
- stimulation of new behavior
- facilitation of behavior in a more appropriate manner
- disinhibition of inappropriate behavior due to fear
- extinction of fears
involved in behavior management
total dental health team
2 means behavior management accomplishes for the child
- allows dental health team to effectively and efficiently perform treatment
- instills positive dental attitude
types of communication & communicative guidance
- tell-show-do
- distraction
- non-verbal communication
- positive reinforcement
- voice control
- parental presence or absence
tell-show-do
used with communication skills (verbal and non verbal) and positive reinforcement
tell-show-do: tell
behavior shaping which involves verbal explanation of procedure and phrases
tell-show-do: show
demo for the patient of the visual,
auditory and olfactory aspects of the procedure in a carefully defined, non-threatening manner
tell-show-do: do
completing the procedure on the patient
tell-show-do: objectives
- teach the patient important aspects of dental visits
- familiarize the patient to the dental setting
- shape patient response to procedure to desensitization and well-described expectations
tell-show-do: indications
may be used in almost all patients
tell-show-do: contraindications
none
distraction
technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure
distraction: examples
- watching TV/Youtube videos
- use of gadgets
- toys
- listening to music
distraction: objectives
- decrease unpleasantness
- avert negative behavior
non-verbal communication
reinforcement and guidance of behavior through appropriate contact, posture, facial expression and body language
non-verbal communication: indications
any patient
non-verbal communication: contraindications
none
positive reinforcement
process of establishing desirable patient behavior
2 types of positive reinforcement
- social reinforcement
- non-social reinforcement
social reinforcement: examples
- positive voice modulation
- facial expressions
- verbal phrase
- appropriate physical demonstration of affection
non-social reinforcement: examples
- toys and tokens (reward)
reward
recognition of good behavior after completion of the operation
bribery
promised to induce desired behavior
voice control
controlled alteration of voice, volume, tone or pace to influence and direct the patients behavior
voice control: benefit
avoids misunderstanding with parents
voice control: indications
any patient
voice control: contraindications
patients with hearing impairment
voice control: objectives
- gain patient attention and compliance
- avert negative or avoidance behavior
- establish appropriate adult-child roles
parental presence or absence
- requires good communication among dentist, parent and patient
- child response can be very beneficial or very detrimental
parental presence or absence: contraindications
parents who are unwilling or unable to extend effective support when asked
parental presence or absence: objectives
- gain patient attention and improve compliance
- avert negative or avoidance behavior
- establish appropriate adult - child roles
- enhance effective communication among dentist child
and parent - minimize anxiety and achieve a positive dental
experience
aversive conditioning aka
hand-over-mouth exercise (HOME)
aversive conditioning: purpose
gain attention of highly appositional child to establish cooperation for sage course of treatment
aversive conditioning
not routinely used; method of last resort
aversive conditioning: requirement
informed consent
advanced behavior guidance: indication
- children who cannot cooperate
- children with physical and emotional immaturities
types of advanced behavior guidance
- protective stabilization
- knee-to-knee/lap-to-lap
protective stabilization
restriction of patient’s freedom of movement with or without the patient’s permission
protective stabilization: purpose
to decrease risk of injury and deliver procedure safely
protective stabilization: considerations
- alternative behavior guidance modalities
- dental needs of patient
- effects of quality of dental care
- patient’s emotional development
- patient’s medical and physical considerations (i.e. scoliosis)
protective stabilization: indications
- patient requires immediate diagnosis and for limited treatment
- safety of the patient, staff, dentist or parent would be at risk
- sedate patient
protective stabilization: contraindications
- cooperative non-sedated patient
- patient who cannot be immobilized safely (associated medical or physical conditions)
- patient who has experienced previous physical or psychological trauma
protective stabilization: objectives
- reduce or eliminate untoward movements
- protect patient, staff, dentist or patient from injury
- facilitate delivery
protective stabilization: precautions
- careful review of patient’s medical history
- tightness and duration of stabilization
- not actively restrict circulation or respiration
- stabilization should be terminated as soon as possible in patient whose experience is severe
knee to knee/lap to lap
advanced behavior guidance that works for most younger children
knee to knee/lap to lap: procedures
(non-invasive)
- oral exam
- fluoride application
3 practical considerations
- scheduling
- patient-child separation
- dental attire
best appointment for pediatric patients
short (30 mins or less) morning appointments
practical consideration: dental attire
child-friendly
practical consideration: scheduling
child should not be kept waiting in the reception area
occurs when patient-child separation is not followed
- parent often repeats orders
- parent injects orders, becomes barrier to development
- dentist unable to use voice intonation
- child divides attention between parent and dentist
- dentist divides attention between parent and child
