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BDS3 - Paediatrics > behaviour management techniques > Flashcards

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
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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

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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
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4
Q

what can you teach patient with anxiety

A
  • coping mechanisms
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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
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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
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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
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8
Q

what is expected of a child age 5

A
  • readily separated from parents
  • fears have usually diminished
  • proud of possessions
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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
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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
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11
Q

at what age are children validated to use MCDAS

A
  • age 8-9
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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
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13
Q

what is dental fear

A
  • normal emotional response to objects or situations perceived as genuinely threatening
  • very specific
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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
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15
Q

what are the components for dental fear and anxiety

A
  • physiological and somatic sensations
  • cognitive features
  • behavioural reactions
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16
Q

what is included in physiological and somatic sensations

A
  • breathlessness
  • perspiration
  • palpitations
  • feeling of unease
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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
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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
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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’
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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
Q

what are the components of communication

A
  • a lot of it is how you say things rather than what you say
  • verbal communication 5%
  • paralinguistic 30%
  • non-verbal communication 65%
26
Q

how can we reduce patients anxiety

A
  • preventing pain
  • being friendly and establish trust
  • working quickly
  • having a calm manner
  • giving moral support
  • being reassuring about pain
  • empathy
27
Q

what are some increasing fear related behaviours

A
  • ignoring or denying feelings
  • inappropriate reassurance
  • coercing/coaxing
  • humiliating
  • losing patience with your patient - if do then stop what you are doing
28
Q

what is expression of pain

A
  • 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
Q

what is expression fo fear

A
  • opening eyes widely and raising eyebrows with mouth open and tense
30
Q

what is the role of the parent

A
  • 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
Q

what are some behaviour management techniques

A
  • positive reinforcement
  • tell show do
  • acclimatisation
  • systemic desensitisation
  • voice control
  • distraction
  • role modelling
  • hypnoses
  • HOMAR
32
Q

what is positive reinforcement

A
  • 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
Q

what is tell show do

A
  • 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
Q

what is acclimatisation

A
  • planned sequential introduction of environment, people, instruments and procedures
  • integral part of treatment plan
  • gradually introduce child to environment
35
Q

what is systematic desensitisation

A
  • 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
Q

what is voice control

A
  • 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
Q

what is distraction

A
  • technique of diverting the patient from what may be perceived as an unpleasant procedure
  • used a lot
  • telling story when giving LA
38
Q

what is role modelling

A
  • 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
Q

what is relaxation

A
  • progressive muscle relaxation
  • space exercise
  • breathe in for 3 out for 5
  • very effective
  • practice it ourselves
40
Q

what is hypnoses

A
  • 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
Q

what is HOM/HOMAR

A
  • 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
Q

what order should treatment plans be done

A
  • 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
Q

what is done on first visit

A
  • simple exam, fluoride varnish, diet sheet, take radiographs or explain for next visit
44
Q

what is done on second visit

A
  • 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
Q

what is done on third visit

A
  • fissure sealants or dressings

- introduce saliva injector

46
Q

what is done on fourth visit

A
  • 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
Q

what is done on fifth visit

A
  • restore upper teeth with LA, using topical prior to injection
48
Q

what is done on sixth visit

A
  • restore lower teeth with LA, using topical prior
49
Q

what is done on seventh visit

A
  • pulp treatments and then extractions last if patient is pain free
  • extraction is the last thing you want to do

BDS3 - Paediatrics (20 decks)

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