behavioural management Flashcards

1
Q

give examples of pharmacological behaviour management

A

inhalation sedation with N20
intravenous sedation with midazolam or propofol
general anaesthetic

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2
Q

describe the use of inhalation sedation with nitrous oxide

A

will not change child’s wish or want to avoid something
will allow sufficient anxiolysis to increase suggestibility and relaxation
helps with ability to tolerate treatment

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3
Q

describe the use of intravenous sedation with propofol or midazolam

A

good option for complex treatment in anxious adolescents
depending on maturity and size, usually used from age 12

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4
Q

when is the term ‘pre-cooperative’ used?

A

very young children with whom communication can’t be established

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5
Q

what are the 4 categories of cooperativeness?

A

pre cooperative
children who lack cooperative ability
potentially cooperative
cooperative

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6
Q

describe the behaviour and development of a child aged 3-4 months

A

interested in people, places and objects

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7
Q

describe the behaviour and development of a child aged 6-8 months

A

share and express emotions
crawling and discover surroundings
fear and stranger awareness becomes important
understanding of spoken words and non-verbal communication develops

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8
Q

describe the behaviour and development of a child aged 9-12 months

A

two way conversations about feelings
become aware of others sharing their thoughts and feelings
separation anxiety begins until 18 months

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9
Q

describe the behaviour and development of a child aged 1-3 years

A

develop sense of self and explore autonomy
may become noncompliant
begin to assert themselves and gain independence
language develops
sharing and cooperative play challenging
fear of movements, strangers, loud noises
dental environment can invoke fear
too young to be reached by words alone- hand them objects to help understanding

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10
Q

describe the behaviour and development of a child aged 3 years

A

less egocentric- like to please adults
active imagination and like stories
some capacity for reasoning
praise for adherence and distraction to capture attention helpful

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11
Q

describe the behaviour and development of a child aged 4-5 years

A

exploring new environment and relationships
prefer 1-2-1 friendships
like fantasy play
familiar with please and thanks
labelled praise helpful
direct commands helpful

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12
Q

describe the behaviour and development of a child aged 6-8 years

A

established at school and move away from security of family
increasingly independent (can cause anxiety and distress)
seek acceptance

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13
Q

describe the behaviour and development of a child aged 8-12 years

A

part of larger social groups- strongly influenced by them
growing concerns of embarrassment
become ‘followers’
can hide feelings
intellect becomes important
respond well to discussions about need to engage in independence

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14
Q

describe the behaviour and development of a child in adolescence

A

can be perceived incorrectly as self-absorbed
believe they are invulnerable and their actions wont have consequences
greater rapport developed with dentists who are nonjudgemental, non-preaching and respectful
treat them as their own person- separate from parent
emphasise importance of self-dental care to maintain their smile

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15
Q

what methods work best in order to communicate effectively with a child?

A

treat them as an individual
use their name often to develop rapport
only use jargon with an older child with interest
only one person speak at a time- younger children can only concentrate on one individual
non-verbal communication is key

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16
Q

name physiological and somatic sensations of dental fear and anxiety

A

breathlessness
perspiration
palpitations
feeling of unease

17
Q

name cognitive features of dental fear and anxiety

A

interference in concentration
hypervigilance
inability to remember events when anxious
catastrophising

18
Q

name behavioural reactions of dental fear and anxiety

A

avoidance of treatments and appointments
escape from situations
aggression

19
Q

name factors affecting child and adolescent anxiety (9)

A

previous medical history
previous dental history
social history factors
parental anxiety
parenting style
parental presence
child awareness of dental problem
behaviour of dental staff
child temperament

20
Q

how do we measure dental fear and anxiety?

A

MCDASf modified child dental anxiety scale- faces

21
Q

explain tell-show-do

A

T- age appropriate explanation of procedure
S- demonstration of procedure
D- perform procedure with minimal delay

22
Q

explain enhanced control

A

allows the child a degree of control over your behaviour
give the child stop, go and rest signals
let them know you might not always be able to stop immediately
ask them which tooth they want to start with etc.
giving options makes the child feel more in control

23
Q

describe positive reinforcement

A

the strengthening of a pattern of behaviour, increasing the probability of that behaviour being displayed in the future
includes social stimuli (e.g. smiling/verbal praise), stickers, dental charts etc.

24
Q

name common behaviour management techniques

A

use of the word ‘magic’
cognitive behaviour therapy
hypnosis
systematic desensitisation
motivational interviewing
gamification

25
Q

explain the use of topical anaesthetic

A

don’t hide the taste/ask what flavour they want
dry mucosa
warn them about numbness of tongue, throat, palate
5% lidocaine
18-20% benzocaine
not recommended under 2 yrs

26
Q

name non-pharmacological pain control techniques

A

hypnosis/relaxation techniques
distraction
controlled language
guided imagery
systematic desensitisation
computer controlled LA devices
control parent behaviour

27
Q

what is the maximum dose for lidocaine?

A

1 x2.2ml cartridge per 10kg of patient (who is fit and well)

28
Q

what is the max dose of articaine?

A

0.8 x2.2ml cartridge per 10kg of patient (who is fit and well)

29
Q

explain the chasing technique for local anaesthesia

A

topical anaesthetic buccally
give buccal infiltration
allow time for papilla to become anaesthetised
reposition needle perpendicular to papilla, inject into papilla
check palatal or lingual side papilla for blanching
inject into palatal or lingual blanched mucosa
chase blanched mucosa around until area fully anaesthetised

30
Q

what order should extractions/restorative treatment with LA be completed?

A

either upper then lower or most painful to least painful

31
Q

describe 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

32
Q

describe dental fear

A

is a normal emotional response to objects or situations perceived as genuinely threatening

33
Q

describe dental phobia

A

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