Behavioral Management Flashcards
What is behavioral management
the continuum of interaction with a child/parent directed toward communication and education
What is the goal of behavioral management
○ Ease fear and anxiety
Promoting an understanding of the need for good dental health
What is the normal childhood development for a 2 year old
Fear of unexpected movements, loud noises and strangers
These children are not yet in nursery so the dental environment is unknown and strange which can cause fear
This reaction is a normal part in evolvement of a child as at age 2 they begin to understand fear and it stops them running away
What is the normal childhood development for a 3 year old
○ Many children of this age will be at nursery and so are receptive to positive comments
○ Reacts favourably to positive comments about clothes and behaviour
○ Less fearful of separation from parents due to nursery
○ Experience will however dictate reaction to separation
What is the normal childhood development for a 4 year old
○ May have been at nursery for a while or started school
○ More assertive but can be bossy & aggressive
○ Fear of the unknown and bodily harm is now at peak
○ Fear of strangers has now decreased
○ With firm and kind direction will be excellent patients
What is the normal childhood development for a 5 year old
○ At school and more likely to come in by themselves
○ Readily separated from parents
○ Fears have usually diminished
○ Proud of possessions so engage with them
○ Comments on clothes will quickly establish a rapport
What is the normal childhood development for a 6 year old
○ Seeks acceptance
○ Success in this can affect self-esteem
If while a dentist child develops a sense of inferiority or inadequacy behaviour may regress to that of a younger age so do not belittle them
What is the normal childhood development for a 7-12 year old
○ Learn to question inconsistencies and conform to rules of society
○ Still have fears but are better at managing them
○ Boys may feel the need to conform to social norms and hide their fears - this may present by them saying they are too tired, need to go to the toilet etc. the MCDAS is extremely good at getting boys to communicate their dental anxieties
How do anxiety and behavior link
- Anxiety, behaviour and compliance are all related
* From age 3-8 these are going to be linked
How do we communicate with anxious children
• We use MCDAS and message to dentist to communicate with anxious children and both of these are validated from the age of about 8 or 9
What is dental anxiety
occurs without a specific stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences
What is dental fear
normal emotional response or situations perceived as genuinely threatening, common specific threats include the sound of the drill or the needle
What is dental phobia
is a clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life
What are the components of DFA
physiological and somatic sensations (fight or flight)
cognitive features (Changes in the thinking process)
behavioral reactions
How do physiological and somatic sensations present
○ Breathlessness
○ Perspiration
○ Palpitations
○ Feeling of unease
How do cognitive features present
interference in concentration
hypervigilance
inability to remember certain events while anxious
imagining the worst could happen
How does hyper vigilance present
§ swivelling their heads trying to work out what’s happening. Explain to them you wont put anything in their mouth unless you have explained it first
What are the behavioral reactions for DFA
avoidance
escape from the station which precipitates anxiety
anxiety may manifest with aggressive behaviors especially in adolescence who are brought by their parents but don’t want to be there
How does avoidance present
§ The postponing of a dental appointment, or with children disruptive behaviour in an effort to stop treatment being undertaken
What should be done if a px turns aggressive
§ They may turn aggressive if they feel they are not being listened to
§ Ensure that you as the dentist are safe
§ The best thing to say if the patient is aggressive is that the dentistry is second and the most important thing is to discuss how the patient is feeling as nothing can be done until they are comfortable
What are signs of DFA
○ Younger children may time delay by asking questions
○ School age children may complain of stomach aches/or ask to go to the toilet frequently
○ Older children may complain of headaches or dizziness, may fidget or stutter, can’t be ‘bothered’
What are factors that influence fear and anxiety
- Fear of choking
- Fear of injections/drilling
- Fear of the unknown
- Past medical and dental experience
- Dental experience of friends and siblings
- The attitudes of parents towards dental experience
- Preparation at home before the dental visit
- The child’s perception that something is wrong with their teeth
What can be be asked to asses children dental fear
assess patient’s desire t influence course of tx w rest breaks, signal stops and info (control related)
ask about previous dental experience
ask about past experience
items relating to trust include attention to dentist/px relationship and perceptions to vulnerability