behaviour management techniques Flashcards
1
Q
what is behaviour management
A
- continuum of interaction with a child/parent directed toward communication and education
- all about communication
2
Q
what is the goal of behaviour management
A
- ease fear and anxiety for child and parent
- promoting an understanding of the need for good dental health
3
Q
what is communication built on
A
- dynamic process of dialogue, facial expression and voice tone
- how you say things and the expression you use
4
Q
what can you teach patient with anxiety
A
- coping mechanisms
5
Q
at age 2 what is expected of a child
A
- fear of unexpected movements, Lous noises and strangers
- beginning to understand fear
- dental situation can produce fear in the child
- many things are strange and unexpected
6
Q
what is expected of a child age 3
A
- at nursery
- rants favourably to positive comments about clothes and behaviour
- less fearful of separation from parents
7
Q
what is expected of a child age 4
A
- could be starting school
- more assertive but can be bossy and aggressive
- fear of the unknown and bodily harm is now at a peak
- fear of strangers decreased
- if parent there then they are usually very good patients
8
Q
what is expected of a child age 5
A
- readily separated from parents
- fears have usually diminished
- proud of possessions
9
Q
what is expected of a child age 6
A
- seeks acceptance
- success in this can affect self esteem
- understand social norms
- engage them
10
Q
what is expected of a child age 7-12
A
- learn to question inconsistencies and conform to rules of society
- still have fears but are better at managing them - may already have coping mechanisms
11
Q
at what age are children validated to use MCDAS
A
- age 8-9
12
Q
what is dental anxiety
A
- occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences
- no specific stimulus
13
Q
what is dental fear
A
- normal emotional response to objects or situations perceived as genuinely threatening
- very specific
14
Q
what is 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
- do their best to avoid dentist
15
Q
what are the components for dental fear and anxiety
A
- physiological and somatic sensations
- cognitive features
- behavioural reactions
16
Q
what is included in physiological and somatic sensations
A
- breathlessness
- perspiration
- palpitations
- feeling of unease
17
Q
what cognitive features are part of DFA
A
- interference in concentration
- hyper vigilance
- inability to remember certain events while anxious
- imagining the worst that could happen
18
Q
what behavioural reactions are part of DFA
A
- avoidance
- escape from situation which precipitates the anxiety
- biting
- children are good negotiators
- anxiety may manifest with aggressive behaviours
19
Q
subtle signs of DFA
A
- younger children may delay by asking questions
- school age children may complain of stomach aches/ask for toilet
- older children may complain of headaches or dizziness, may fidget or stutter, or ‘can’t be bothered’
20
Q
what factors can influence fear an anxiety
A
- fear of choking
- fear of injections/drilling
- fear of unknown
- past medical and dental experience
- dental experience of friends or family
- parents attitudes to dentistry
- preparation at home before visit
- child’s perceptions that something is wrong with their teeth
21
Q
how can you help DFA
A
- give children control with rest breaks, signals to stop etc.
22
Q
how can you assess DFA
A
- devote some time to dental history - ask about past experience
- use faces MCDAS
23
Q
what is MCDAS
A
- modified child dental anxiety scale
- quick and easy to use
- different aspect of dental experience rated
- base line levels of anxiety are established
- validated from children age 8 and over
- 1 happy face, 5 crying face
24
Q
why is good communication important
A
- improves information obtained from patient
- enable dentist to communicate information to patient
- increases likelihood of patient compliance
- decreases patient anxiety
25
what are the components of communication
- a lot of it is how you say things rather than what you say
- verbal communication 5%
- paralinguistic 30%
- non-verbal communication 65%
26
how can we reduce patients anxiety
- preventing pain
- being friendly and establish trust
- working quickly
- having a calm manner
- giving moral support
- being reassuring about pain
- empathy
27
what are some increasing fear related behaviours
- ignoring or denying feelings
- inappropriate reassurance
- coercing/coaxing
- humiliating
- losing patience with your patient - if do then stop what you are doing
28
what is expression of pain
- screwing up eyes and lowering the eyebrows with the mouth open in a squarish manner
- look at child and check to see any pain
29
what is expression fo fear
- opening eyes widely and raising eyebrows with mouth open and tense
30
what is the role of the parent
- support their child
- always have parents in rooms till child is 10
- need to be there for a knee to knee exam
- patient can witness behaviour clinician must contend with
- important that if you need to refer a child on, parent is there to understand
31
what are some behaviour management techniques
- positive reinforcement
- tell show do
- acclimatisation
- systemic desensitisation
- voice control
- distraction
- role modelling
- hypnoses
- HOMAR
32
what is positive reinforcement
- presentation of a stimulus that will increase likelihood of a behaviour being repeated
- social reinforcers - verbal praise, smile
- nonsocial reinforcers - sticker, colouring poster
- when reinforce with a verbal phrase need to be specific
33
what is tell show do
- used to familiarise a patient with a new procedure
- tell involves an age appropriate explanation of the technique
- show is a demonstration for the patient aspects of the procedure in a non-threatening setting
- do phase is initiated with minimal delay
34
what is acclimatisation
- planned sequential introduction of environment, people, instruments and procedures
- integral part of treatment plan
- gradually introduce child to environment
35
what is systematic desensitisation
- based on assumption that repeated non-distressing exposure to an anxiety-provoking stimulus will eventually reduce anxiety
- child must be reassured that they are in control
- done in an ordered manner from least anxiety provoking to most
- always make sure child is calm and control
- always teach child relaxation first
36
what is voice control
- controlled alteration to voice volume, tone or pace to influence and direct patient behaviour
- to gain the patient attention and compliance
- to avert negative or avoidance behaviour
37
what is distraction
- technique of diverting the patient from what may be perceived as an unpleasant procedure
- used a lot
- telling story when giving LA
38
what is role modelling
- needs to be someone of similar age, similar treatment, presence of an older sibling is best for children aged 3-5
- coping model
- see someone else managing
39
what is relaxation
- progressive muscle relaxation
- space exercise
- breathe in for 3 out for 5
- very effective
- practice it ourselves
40
what is hypnoses
- hypnotist and subject
- hypnotist attempts to influence the subjects perception, feelings, thinking and behaviour by asking them to concentrate on ideas and images
- verbal communications that hypnotist uses is called 'suggestions'
- response is experienced by subject as having quality effortlessness
- patient is so relaxed that subconscious brain is more open to suggestions
41
what is HOM/HOMAR
- not used anymore
- put hadn't over patient mouth and whisper in ear that you weren't going to stop until they began behaving
- problems - adverse, psychological effects
42
what order should treatment plans be done
- think about what you're doing in advance
- OHI, fissure sealants first
- procedures without LA
- introduce LA
- upper fillings before lower - easier
- restoring lower teeth that might need IDB after infiltrations
- can do most teeth other than lower 7's with single tooth LA
43
what is done on first visit
- simple exam, fluoride varnish, diet sheet, take radiographs or explain for next visit
44
what is done on second visit
- brush teeth using childs brush, invite to sit on chair
- check diet, take radiographs, polish and dry teeth and introduce slow speed and air syringe
- explain F/S process
45
what is done on third visit
- fissure sealants or dressings
| - introduce saliva injector
46
what is done on fourth visit
- remove carious tissue with hadn't excavator if immediate temporisation is needed
- use slow speed drill, for small buccal and cervical cavities
- introduce topical and give rubber dam home to play with
47
what is done on fifth visit
- restore upper teeth with LA, using topical prior to injection
48
what is done on sixth visit
- restore lower teeth with LA, using topical prior
49
what is done on seventh visit
- pulp treatments and then extractions last if patient is pain free
- extraction is the last thing you want to do
