Behavior Management Flashcards
True or false: nitrous oxide has a big effect on the respiratory system
False – there it little effect on the respiratory system
How does Nitrous oxide work for its analgesic effect?
NO activates opioid receptors – activation of GABA-A receptors/noradrenergic pathways that modulate nock petite processing at spinal level.
GABA-A receptors also induce an anxiolytic effect
What is the primary risk for Nitrous oxide?
NO is 34x more soluble than nitrogen in blood. Thus, the biggest adverse risk is diffusion hypoxia – rapid release of nitrous oxide from the blood stream into alveoli – diluting oxygen concentration.
Children desaturated more rapidly than adolescents – thus, you should administer 100% oxygen to the patient for 3-5 minutes
Name some general NO benefits
- reduces anxiety
- reduce untoward movement/reactions
- enhances communications
- increase pain threshold
- increase tolerance for longer appointments
- aid in treatment of mental/physically disabled or medically compromised patient
- reduce gagging
- important: potentials effect of sedatives
What are some contraindications for NO
- chronic obstructive pulmonary diseases
- severe emotional disturbances or drug-related dependencies
- first trimester of pregnancy
- middle ear infection
- reactive airway–asthma
- anatomic limitations: deviated septum, nasal polyps
Important:
- treatment with bleomycin sulfate – there will be increased incidence of pulmonary fibrosis during treatment for neoplasms with 100% oxygen
- methylenetetrahydrofolate reductase deficiency – nitrous will block the formation of myelin sheath, DNA synthesis, neurotransmitters
- cobalamin deficiency – may lead to neurological degeneration
Name 3 properties of oral conscious sedation
- goal is not to have patient sleeping in chair
- unpredictable and many times not reproducible effect
- cannot titration, once you give
Name the absolute contraindications for oral conscious sedation
- class III, IV ASA physical status classification
- airway anatomic abnormalities (extreme tonsillar hypertrophy)
- airway issues - retro gnashing jaws, facial deformities
- anyone who would not be an easy face for ambu-bag (treacher collins, Pierre robins)
When using sleep dentistry or complete immobilization, what is recorded in documentation?
- type of immobilization used
- time in use
- indications: mental or physical handicap; safety of patient/dentist/staff
- NOT to use as punishment
What are some immobilization techniques other than medications
- therapeutic restraint (papoose)
- tape, cloth wraps, sheets
- staff restraint
What are some indications for immobilizations?
- A patient requires immediate diagnosis and cannot cooperate due to emotional/cognitive/developmental levels OR medical/physical conditions
- Emergent care but patient displays uncontrolled movements – safety compromised
- Cooperative patient becomes uncooperative – safety compromised
- Sedated patient becomes uncooperative
- Special health care needs with uncontrolled movements – safety
True or false: immobilization can be used on non-emergent treatment in order to accomplish multiple quadrant treatment
False - do not use on non-emergent treatments
What is functional inquiry?
It is to learn about patients and parents concerns. Furthermore, to gather information about the cooperative ability of the child
How is functional inquiry information obtained?
Direct interview or questionnaire
What are the variable to dental behaviors? (4)
- Parental anxiety
- Medical experiences
- Awareness of dental problems
- General behavior problems
What are some important pre-appointment behavior modification factors?
- scheduling coordinators
- videotape and posters
- live patient modeling
- dental assitants (nice and welcoming)
- hygienist
How does the parental influence come into play regarding patient?
Parental attitudes:
- anxiety, fear
- dental IQ
Parental involvement:
- overbearing or relaxed
Parental presence
- behavior management technique shown by the parent
-informed consent for behavior management
What are the 4 classifications of the Frankl behavioral rating scale?
+/+: definitely positive; good rapport w/dentist, interest in procedures, laughter
+: positive; acceptance of treatment, cautious at times, willing but reserved, cooperative
- : negative; reluctance to accept, uncooperative, withdrawn (silent tears)
- /-: definitely negative; refusal of treatment, forceful crying, fearful
What does every Axium pediatric note contain in terms of behavior?
- patient behavior (Frankl scale)
- patient management (behavior management technique)
- comments (discussion with parent, OHI reviewed?, treatment plan reviewed?, behavior modifications?)
How would u classify and manage: 9 month male new patient that cries during exam with continuous head movement
-/-: crying and continual head movement
Management: knee-knee, bite block, head stabilization with hands during exam
How would you classify and manage 5 year old male for UL quadrant restorative that cries in waiting room, scream, and moves a lot but calm when leaving
-/-: defiant behavior, crying, screamed, calm when leaving
Management: TSD, NO, distraction during injection, voice control with parent permission, coaching for future visit, presented option for oral sedation
Properly define fear and anxiety
Fear - negative emotional state triggered by presence of a stimulus that has potential to cause harm
Anxiety - negative emotional state in which threat is not present but anticipated
Are there any contraindications to tell-show-do?
No
What are some non-pharmacological behavior management techniques?
- tell-show-do
- voice control
- non-verbal communication
- modeling
- distraction
- operant conditioning
- positive reinforcement
- parent presence/absence
What are the options for conscious sedation dentistry and sleep dentistry?
Conscious sedation:
- nitrous oxide
- oral conscious sedation
Sleep dentistry:
- I.V sedation
- general anesthesia
