behaviour management

Question 1

define dental anxiety

Answer 1

occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences

Question 2

define dental fear

Answer 2

normal emotional response to objects or situations perceived as genuinely threatening

Question 3

define dental phobia

Answer 3

a clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life

Question 4

what are the physiological sensations of DFA

Answer 4

breathlessness, perspiration, palpitations

Question 5

what are the cognitive features of DFA

Answer 5

interference in concentration, hyper vigilance, inability to remember certain events, imagining that worst could happen

Question 6

what are the behavioural reactions of DFA

Answer 6

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)

Question 7

what factors influence fear and anxiety

Answer 7

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

Question 8

how can you assess patient fear and anxiety

Answer 8

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

Question 9

why is good dentist and patient communication important

Answer 9

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

Question 10

what actions may the dentist take that increase fear related behaviours

Answer 10

ignoring or denying feelings
inappropriate reassurance
coercing/ coaxing
humiliating
losing your patient with the patient

Question 11

what will the patient include in the letter to dentist

Answer 11

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

Question 12

what is the role of the parent in managing child anxiety

Answer 12

children under 4 have better behaviour with parent present
knee to knee exam
parent can witness the behaviour the clinician must contend with

Question 13

discuss positive reinforcement

Answer 13

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

Question 14

discuss tell show do

Answer 14

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

Question 15

discuss acclimatisation

Answer 15

the planned sequential introduction of environment/people/instruments/procedures
ie use 3:1 and CWR the the visit before a fissure sealant

Question 16

discuss systematic desensitisation

Answer 16

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)

Question 17

discuss voice control

Answer 17

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

Question 18

discuss distraction

Answer 18

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

Question 19

what would be an appropriate order of treatment for an anxious child

Answer 19

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