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Behavioural management Flashcards

1
Q

Background of anxiety

A

 Fear of pain or its anticipation
 Lack of trust, fear of betrayal
 Fear of loss of control
 Fear of the unknown
 Fear of intrusion.

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2
Q

What is the background of dental fear?

A

A reaction to a specific external threatening
stimulus: this is a normal reaction to threatening
stimuli in the dental situation.

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3
Q

Dental Behaviour Management Problems

A

Uncooperative and disruptive behaviours
resulting in delay of treatment or rendering
treatment impossible.

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4
Q

Fears timing- loud noise and separation?

A

9-12 months

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5
Q

Imaginary objects

A

2-4 years

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6
Q

Dark/unknown

A

4 years

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7
Q

Social and school fears

A

5-6 years

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8
Q

Injury, death, natural events, social anxiety

A

6-16 years

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9
Q

What is the background of dental phobia?

A

special kind of fear out of proportion to
the demands of the situation which will not
respond to reason, is apparently beyond
voluntary control and leads to the
avoidance of dental treatment where this is
necessary.

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10
Q

What are the complications of dental anxiety?

A

Anxiety
 Stress
 Patient
 Parent
 Clinical Staff
 Compromises provision of dental care

 Persistence of unfavourable attitude into adulthood leading to avoidance.

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11
Q

Aetiology of dental anxiety, exogenous?

A

dental Previous dental
treatment treatment
 Dental health statusDental health status
 SES
 Parental dental Parental dental
anxietyanxiety
 Siblings/peers
 PMH

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12
Q

Aetiology of dental anxiety, endogenous?

A

Gender
General fears
Personality type

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13
Q

Recognising dental anxiety

A

Clinical affect
Ask accompanying adult
Ask child
Questionnaires
MCDASf
Venham’s Picture test
- CFSS Dental sub scale

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14
Q

Modified child dental anxiety Scale Faces Version (MCDASf

A

Questions and then smiley faces to quantify the extend of agreement

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15
Q

Venham’s picture test

A

Little boy doing stuff to quantify fear

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16
Q

Children’s Fear Survey Schedule-
Dental Subscale (CFSS-DS)

A

 Dentists
 Doctors
 Injections (shots)
 Having someone examine your mouth
 Having to open your mouth
 Having a stranger touch you
 Having somebody look at you
 The Dentist drilling
 The sight of the Dentist drilling
 The sound of the Dentist drilling
 Having somebody put instruments in your mouth
 Choking
 Having to go to hospital
 People in white uniforms
 Having the nurse clean your teeth

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17
Q

Types of child dental patients

A

Co-operative
Potentially co-operative
Lacking in co-operative ability
Specific disability affecting ability to
cooperate
Pre co-operative
The very young

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18
Q

Setting up a child friendly
practice

A

Pre-appointment information
Child friendly waiting area
See patient on time
Consider introductory visit
Good communication skills

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19
Q

Positive communication

A

Verbal and non-verbal
Respect
Show interest in the child as an individual
Give well-stated instructions
Communicate at child’s level
Focus on +ve
Show ethnic, cultural and gender sensitivity

20
Q

Principles of communication
Verbal

A

Be understandable
Questioning
Listening
Reassure
Praise
Humour

21
Q

Principles of communication
Non-verbal

A

Body language
Proximity-personal
space
Eye contact
Reinforcers
Level and posture
Empathy

22
Q

Methods of communication

A

Tell-Show-Do
Reinforcement
Parents
Behaviour Shaping
Voice control
Distraction
Modelling
Other methods
Desensitisation

23
Q

Tell show do

A

Universal use
3 in 1
Curing light
Drilling
Encapsulated GIC
Fissure sealants
LA

24
Q

Positive reinforcement

A

The strengthening of a pattern of behaviour
which increases the probability of that behaviour in the future

25
Q

Positive Reinforcement

A

Praise appropriate behaviour
mouth opening
sitting still
Timing of praise
Don’t praise disruptive behaviour- withdraw
praise
- Don’t use bribes

26
Q

Voice Control

A

Variation in tone, pace or volumetone, pace or volume to influence
and direct child’s behaviour
Bright and airy when behaviour good
Even and low to calm anxiety
Low and quiet if poor behaviour

27
Q

Behaviour Shaping

A

Influencing behaviour towards desired
ideal by,
Planned introduction to procedures
- Move through stages at the child’s pace

28
Q

Distraction

A

Use of a distracting stimulus to divert attention away from
disruptive behaviours and potentially unpleasant sensory stimuli

29
Q

Distractors

A

 Cartoons
 Audio tapes
 TV
 Virtual reality
 Video games
 Stories
Lip holding
Leg raising
Talking whilst carrying out a procedure

30
Q

Modelling - live

A

 a non fearful child
successfully receiving
treatment
 e.g. sibling
 passive or participant

31
Q

Modelling- symbolic

A

Symbolic
 video/cartoon
 same sex, similar age if possible
 additional equipment required
 passive or participant

32
Q

Other methods

A

Externalising
 short break in a different environment before resuming
treatment
ContractsContracts
Count downCount down
 counting aloud along with procedures
Stop signals

33
Q

Desensitisation

A

Hierarchy of fear provoking stimuli presented to a relaxed patient
Time consuming
psychologist
Hypnosis

34
Q

Systematic desensitisation - LA

A

Preamble & hierarchy
Relaxation techniques
LA components
Patient handles syringe
- sheathed & unsheathed
Operator
- sheathed & unsheathed
Administer

35
Q

Specific Management problems

A

Pre-cooperative child
Tantrums
Gagging
Specific phobias

36
Q

Pre co-operative patients

A

Examine with help from
parent
Tell them to ask you to
stop at any time
Limited intervention
possible
GA usually required for
advanced treatment

37
Q

Exam with parental help

A

Knee to knee exam

38
Q

Management of Gagging

A

Relaxation
Breathing
Chin position
Care with instruments
Patient watching in mirror
Home practice kit
Inhalation sedation

39
Q

How can you avoid using a “needle”? (Needle phobia)

A

EDA - electronic dental anaesthesia
The ‘Wand’
Computer Controlled pressure & flow injection system
‘Injex’ system – high pressure jet
Desensitisation programmes
Hypnosis

Injex System= needle free LA

40
Q

Drill phobia

A

Consider alternative methods for caries removal
include,
Hand excavation – ART restoration
Chemo-mechanical removal
Eg Caridex or Carisolv
Air abrasion
Lasers
Hall technique

41
Q

What do you do if nothing seems to work?

A

Consider pharmacological adjuncts
Consider the need to refer the patient.
Reasons for referral:-
* Specialised dentistry
* Special child

42
Q

Pharmacological adjuncts

A

Conscious sedation
General anaesthesia

43
Q

Who to refer to?

A

Colleague
- More experienced
- Sometimes a change of clinician is enough
Specialist
- Community Dental Service
—Remit varies between trusts
Hospital Dental Service
- Consultant led service

44
Q

Details to include in referral
letter

A

Patient Details
-Personal details including social history.
Presenting complaint
- Patient, parent and your perception
- Your concerns
- Details of examination, differential diagnosis
and reason for referral and urgency of the referral

45
Q

Details to include in referral
letter

A

 Previous dental history
 Previous medical history (include family history)
 Specify what you are requesting
- Advice or treatment?
- Indicate what aspects of treatment are within the scope of your skills.
 Your details
- Remember to sign letter yourself
 Enclosures
- Avoids repeating and repeating and previous records aid diagnosis and treatment planning

46
Q

What to include in referral
letter

A

When referring for treatment under GA, the
referring dentist has a responsibility to and
must include in the letter of referral:-
That the risks associated with GA and the
alternative methods of pain control have been
discussed
Clear justification for the use of general
anaesthesia

 Remember to keep a copy of your referral letter!

paeds (11 decks)

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