behaviour management Flashcards
define dental anxiety
occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences
define dental fear
normal emotional response to objects or situations perceived as genuinely threatening
define dental phobia
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 physiological sensations of DFA
breathlessness, perspiration, palpitations
what are the cognitive features of DFA
interference in concentration, hyper vigilance, inability to remember certain events, imagining that worst could happen
what are the behavioural reactions of DFA
avoidance (postponing dental appointment, disruptive behaviour to stop treatment), escape from the situation which precipitates the anxiety, aggressive behaviour (ensure safety of patient and staff if that happens)
what factors influence fear and anxiety
fear of choking, injections, unknown, past experiences, dental experience of peers (being told negative experiences), attitudes of parents towards dental experiences, preparation at home before the dental visit, child’s perception that something is wrong with their teeth
how can you assess patient fear and anxiety
faces version modified child dental anxiety scale (faces MCDAS) - quick and easy to use, different aspects of dental experience rated, base line levels of anxiety are established
why is good dentist and patient communication important
improves the information obtained from the patient
enable the dentist to communicate information to the patient
increases the likelihood of patient compliance
decreases patient anxiety
what actions may the dentist take that increase fear related behaviours
ignoring or denying feelings
inappropriate reassurance
coercing/ coaxing
humiliating
losing your patient with the patient
what will the patient include in the letter to dentist
how worried are they
how painful do they think treatment will be
what do they want to happen
how will they cope
what is their stop signal
what is the role of the parent in managing child anxiety
children under 4 have better behaviour with parent present
knee to knee exam
parent can witness the behaviour the clinician must contend with
discuss positive reinforcement
the presentation of a stimulus that will increase the likelihood of a behaviour being repeated
social reinforcers = facial expression, verbal praise specific to what the child did will
non social reinforcers = stickers, colouring poster, clever certificates
discuss tell show do
used to familiarise a patient with a new procedure
tell in age appropriate explanation
show for the patients aspects in a non threatening setting
do phase is initiated with minimal delay
discuss acclimatisation
the planned sequential introduction of environment/people/instruments/procedures
ie use 3:1 and CWR the the visit before a fissure sealant
discuss systematic desensitisation
this is based on the assumption that repeated non-distressing exposure to an anxiety provoking stimulus will eventually reduce anxiety
child reassured that they are in control
needle desensitisation is a good example
teach relaxation first so patient knows how to keep calm (ie the space exercise)
discuss voice control
a controlled alteration of voice volume, tone or pace to influence and direct the patient’s behaviour
to gain the patients attention and compliance or avert negative or avoidance behaviour
discuss distraction
the technique of diverting patients attention from what may be perceived as an unpleasant procedure
ie pulling upper lip, telling a story while giving LA
what would be an appropriate order of treatment for an anxious child
do the following over many appointments at the child’s pace:
simple exam, FV
TBI, take radiographs, explain F/S process
fissure sealants or dressings, introduce saliva ejector
remove carious tissue with hand excavator if immediate temporisation is required, use slow speed drill
introduce topical and give dam home for them to play with
restore upper teeth with topical and LA
restore lower teeth with topical and LA
pulp treatments then extractions last is patient is pain free