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Yr 3 Primary Care - Child dental health > Behaviour management > Flashcards

Behaviour management Flashcards

1
Q

Up to what % of the child population have dental fear & anxiety and dental behaviour management problems?

A

10%

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2
Q

What is dental fear?

A

a normal emotional reaction to one or more specific threatening stimuli in the dental setting

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3
Q

What happens to fears with age?

A

They change

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4
Q

How do fears change between a child 2-3 y/o vs. a child 7-8 y/o?

A

2-3 y/o: fear anything that differs from the norm

7-8 y/o: fewer fears in general but able to verbalise them

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5
Q

What may you be scared at at the dentists?

A 
Failure in front of strangers
Smell
Needles
Lack of control 
Self protection
= May be neurotic/disproportionate
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6
Q

What is dental anxiety?

A

a state of apprehension that something dreadful is going to happen in relation to treatment
= multidimensional consisting of somatic, cognitive and emotional elements

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7
Q

What is predictive of child onset dental anxiety?

A

A family history of dental anxiety

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8
Q

What is adoloscent onset dental anxiety usually characterised by?

A

Trait anxiety

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9
Q

What is adult onset anxiety?

A

= severe fears

Can indicate psychiatric problems

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10
Q

What is exogenous dental anxiety?

A

Through conditioning, learning and experiences e.g. from parents or due to bad previous dental experience

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11
Q

What is endogenous dental anxiety?

A

Due to constitutional vulnerability = due to internal stressors = typical of an anxiety disorder

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12
Q

What can determine the consequences of traumatic dental experiences?

A

The context in which they occurred e.g. pain occurred during treatment

n.b. there are often problems with accurate recall = false memory syndrome

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13
Q

What is dental phobia?

A

A severe type of dental anxiety = marked and persistent anxiety that is excessive and unreasonable

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14
Q

What causes most patients to have a dental phobia?

A

Fear of injections

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15
Q

What can dental phobias be in response to?

A

Either to specific situation or the dental situation in general

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16
Q

Because the person can recognise that the anxiety is excessive and unreasonable why is it still an issue?

A

The person cannot physically help themselves get over it

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17
Q

What are the behaviour management techniques?

A

Pharmacology (Sedation or GA)

Psychology

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18
Q

What is the IOSN used for?

A

Estimating the need for sedation

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19
Q

What is the IOSN based on?

A
  1. anxiety score
  2. medical history
  3. treatment complexity

n.b. these are all sliding scales and can change on any day of the week

20
Q

What are the different sources of guidelines for behaviour management?

A
  1. Non pharmacological behaviour management BSPD -2011
  2. Use of GA in pages BSPD 2008
  3. Sedation in children and young people NICE 2010)
21
Q

Name the different measurement techniques?

A
  1. Behavioural rating scale (Frankyl scale)
  2. Anxiety rating (dental anxiety scale)
  3. Pain rating (FACES)
22
Q

What is the behavioural rating scale (Frankyl scale)?

A

Observation of childs behaviour during treatment
Bx1 = definitely negative (not looking at you, crying, unable to walk in)
Bx2 & Bx3 = more hesitant
Bx4 = definitely positive (lovely pt.)

23
Q

What is the anxiety rating (dental anxiety scale)?

A

Reports of anxiety by child/parent using psychometric scales in a questionnaire
= 5 x questions with a total summed score of 5- 25, score >19 indicates highly anxious pt.

24
Q

With an anxious patient, what determines what treatment you carry out and how?

A

Level of anxiety

Presence of urgent treatment needed

25
Q

If a patient is highly anxious and needs urgent treatment what do we do?

A

Relative analgesia, conscious sedation or general anaesthesia

26
Q

If a patient is highly anxious but does not need urgent treatment what do we do?

A

Cognitive behavioural therapy

27
Q

If a patient is moderately anxious whether or not they need urgent treatment what do we do?

A

The same as for low levels of anxiety + provision of preparatory information

28
Q

If a patient is a low level of anxiety whether or not they need urgent treatment what do we do?

A 
Rapport building
Voice control
Distraction
Modelling
Memory reconstruction 
Environmental change
29
Q

Which interventions do we use for low levels of anxiety?

A 
Distraction
Voice control
Positive reinforcement
Modelling 
Show tell do
Behaviour shaping
Enhancing the sense of control
Environmental change 
Rapport building
30
Q

What is voice control?

A

A controlled alteration of voice volume, tone or pace to influence behaviour
= gains patient attention and compliance, alters negative or avoidance behaviour, establishes adult - child roles

31
Q

What is positive reinforcement?

A

Rewarding positive behaviour

32
Q

What is modelling?

A

One child observing a predictably reliable and well behaved patient having treatment (older siblings are often good = demonstrates the desired behaviour)

33
Q

What is tell-show-do?

A

= age appropriate verbal explanation of a procedure, demonstrating the procedure (auditory) and completion of procedure)
n.b. too much information can tip the balance
= helps familiarise the patient with the surroundings and shape the patient response

34
Q

Which interventions do we use for moderate anxiety?

A

Provide information about what will happen (procedural information), what the patient can do to cope, what sensations the individual will experience
Restraint
Parental acceptance

35
Q

How can restraint be used?

A

Parental, Papoose board (often sedated too to keep comfortable)
= to mobilise and protect them from harming themselves

36
Q

What is parental acceptance?

A

What a parent will allow you to do!
Tell show do, positive reinforcement, sedation, voice control, GA an physical restraint (increasingly unacceptable down this list)

37
Q

What is behaviour shaping?

A

A series of small steps towards ideal behaviour achieved with selective reinforcement

38
Q

What interventions do we use for high anxiety individuals?

A

Pharmacological
Cognitive behavioural therapy
Systemic desensitisation

39
Q

What are the different pharmacological interventions?

A

Nitrous oxide (inhale)
Midazolam
GA

40
Q

What is cognitive behavioural therapy?

A

Changes how you think about anxiety inducing things, and challenges your beliefs (more realistic and effects the thoughts)
n.b. change is not necessarily permanent

41
Q

What are the 3 steps of systemic desensitisation?

A
  1. Identification of an anxiety inducing stimuli
  2. learning coping techniques
  3. react towards and overcome situations in the heir achy
    n. b. goes through the heirachy of fear stimuli e.g. think about spider, look at picture of spider, look at it in a closed box, go into the closed box, touch it, let it crawl on your hand etc.
42
Q

What is the paediatric triangle?

A

The interactions between the child, dentist and parent (can be complex)

43
Q

What is important with the paediatric triangle?

A

Good communication is important to build trust and communication, parental presence can significantly affect the atmosphere and influence child behaviour (not necessarily in good way e.g. if parent anxious) also depends how confident you feel in sending the parent out

44
Q

What is an important indicator of behaviour?

A

Child parent interaction

45
Q

N.b. behaviour management problems are not a quality of the child… but…

A

the quality of the relationship between the dentist and child

Yr 3 Primary Care - Child dental health (11 decks)

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