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BDS3 Paediatrics > Behavioural Management > Flashcards

Behavioural Management Flashcards

1
Q

What is the goal of behaviour management?

A
  • ease fear and anxiety
  • promoting an understanding of the need for good dental health
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2
Q

What does behaviour management involve?

A
  • continuum of interaction with a child/parent directed towards communication and education
  • communication between dentist and patient build on a dynamic process of dialogue, facial expression and voice tone
  • dentist can alleviate fears and anxiety, teach appropriate coping mechanisms and guide child to be cooperative, relaxed and self confident in the dental setting
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3
Q

At the age of 2 what are the behaviours relevant to the dental environment?

A
  • fear of unexpected movements, loud noises and strangers
  • dental situation can produce fear in the child
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4
Q

At the age of 3 what are the behaviours relevant to the dental environment?

A
  • reacts favourably to positive comments about clothes and behaviour
  • less fearful of separation from parents
  • experience will dictate reaction to separation
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5
Q

At the age of 4 what are the behaviours relevant to the dental environment?

A
  • more assertive but can be bossy and aggressive
  • fear of the unknown and bodily harms is at a peak
  • fear of strangers may start to decrease
  • with firm and kind direction can be excellent patient
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6
Q

At the age of 5 what are the behaviours relevant to the dental environment?

A
  • readily separated from parents
  • fears have usually diminished
  • proud of possessions
  • comments on clothes will quickly establish a rapport
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7
Q

At the age of 6 what are the behaviours relevant to the dental environment?

A
  • seek acceptance
    • success in this can affect self-esteem
  • if while at the dentist child develops sense of inferiority or inadequacy behaviour may regress to that of a younger age
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8
Q

At the ages of 7-12 what are the behaviours relevant to the dental environment?

A
  • learn to question inconsistencies and conform to rules of society
  • still have fears but are better at managing them
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9
Q

How does dental anxiety occur in children?

A

occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences, can include parental influence

very common when proposed treatment has never been experienced before

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10
Q

How does dental fear occur in children?

A

normal emotional response to objects or situations perceived as genuinely threatening

reaction to a known danger, involves fight-flight-freeze response when confronted with threatening situation

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11
Q

How does dental phobia occur in children?

A

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

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12
Q

What are the components of dental fear and anxiety?

A
  • psychological and somatic sensations
    • breathlessness
    • perspiration
    • palpitations
    • feelings of unease
  • cognitive features
    • interference in concentration
    • hypervigilance
    • inability to remember certain events while anxious
    • imagining the worst that could happen (catastrophising)
  • behavioural reactions
    • avoidance
      - postponing appointments
      -disruptive behaviour
    • escape from the situation
      -precipitates anxiety
    • agressive behaviour
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13
Q

What are signs of dental fear and anxiety in children?

A
  • some anxious children are easy to spot
  • some children are more subtle
    • younger children
      - time delay by asking questions
    • school age children
      - complain of sore stomach
      -ask to go to toilet frequently
    • older children
      - complain of headaches/dizziness
      - fidgeting
      - stuttering
      - say they can’t be bothered
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14
Q

What are common dental fears in children?

A
  • fear of choking
  • fear of injections/drilling
  • fear of unknown
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15
Q

What can contribute to dental fear and anxiety?

A
  • past medical and dental experience
    • negative experience can increase fear and anxiety
  • dental experience of friends and siblings
  • attitudes of parents towards dental experience
    • parental anxiety
    • parenting style
  • preparation at home before dental visit
  • child’s perception that something is wring with their teeth
    • awareness increases fear and anxiety
  • behaviour of dental staff
    • should always endeavour to create positive experience
  • child temperament
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16
Q

How can dental fear and anxiety be managed in children?

A
  • allowing children some control during treatment
    • rest breaks
    • signals to stop
    • acknowledge patient’s need for information
17
Q

How can a child’s dental fear and anxiety be assessed?

A
  • ask about previous dental treatment
    • past experience
  • modified child dental anxiety scale - faces (MCDASf)
    • quick and easy to use
    • different aspects of dental experience rated
    • baseline levels of anxiety are established
18
Q

What questions are asked in the MCDASf?

A
  • how do you feel about…
    • going to the dentist
    • having your teeth looked at
    • having teeth scraped and polished
    • having an injection in the gum
    • having a filling
    • having a tooth taken out
    • being put to sleep to have treatment
    • having a needle put in the back of your hand
19
Q

What are the two categories of behaviour management?

A
  • pharmacological behaviour management
  • non-pharmacological behavioural management
20
Q

What does pharmacological behaviour management involve

A
  • local anaesthetic
  • premedication
  • inhalation sedation
    • nitrous oxide
    • sufficient anxiolysis increases suggestibility and relaxation
    • combined with non-pharmacological techniques
  • intravenous sedation
    • midazolam, propofol
    • good for complex treatment in anxious anaesthetics
    • over 12 years old
    • combined with non-pharmacological techniques
  • general anaesthetic
    • requires justification
21
Q

How can children’s ability to tolerate treatment be described?

A
  • pre-cooperative
  • children who lack co-operative ability
  • potentially cooperative
  • co-operative
22
Q

What is the purpose of preparatory information and what does it include?

A
  • decrease anxiety for both the child and parents
  • welcome letters
  • social stories
  • dental widgets
  • patient information leaflets
  • acclimatisation
23
Q

What does non-verbal communication and role-modelling involve?

A
  • happy smiling team
  • gentle pats or squeezing shoulder
  • environment
  • eye contact
  • modelling most effective when child of similar age and same family
    • live or by video
    • can work with dentist, dental nurse, parent or cuddly toy
24
Q

What does voice control involve?

A
  • alteration of voice to influence and direct behaviour
    • volume
    • tone
    • pace
  • improves attention and compliance
  • establishes authority
25
Q

What is tell-show-do?

A
  • tell
    • age appropriate explanation of procedure
  • show
    • demonstration of procedure
  • do
    • perform procedure with minimal delay
  • widely used to familiarise patients with new procedures
  • emotive and negative words avoided
  • make it fun
26
Q

What is enhanced control?

A
  • allows patients a degree of control over treatment
  • shown to reduce pain during routine dental treatment and injection
  • stop, go, rest signals
  • very effective anecdotally
  • provide caveat (cannot always stop immediately)
  • structured time and timed treatment (work for set time)
  • ask which tooth they would like to start with
  • ask this or that questions
27
Q

What is behavioural shaping and positive reinforcement?

A
  • defined series of steps towards ideal behaviour
    • reinforcement is strengthening of behaviour pattern
    • increases probability of behaviour in future
  • positive reinforces
    • social stimuli (smiles, positive voice modulation, praise)
    • stickers
    • badges
    • tick charts
    • dental passports
  • child centred phrases
    • use name
28
Q

What is distraction?

A
  • video glasses
  • music
  • ceiling projectors
29
Q

What other behavioural management techniques exist?

A
  • ‘magic’
  • motivational interviewing
    • particularly adolescents
  • gamification
    • make procedures fun
  • cognitive behavioural therapy
    • ‘your teeth, you’re in control’
    • particularly adolescents
  • hypnosis
    • only trained practitioners with explicit consent
    • semi-hypnotic (relaxation and breathing techniques)
  • snoezelen environment
    • multi sensory environment
  • systemic desensitisation
    • for systemic fears
    • repeated, graded exposure
30
Q

Provide examples of inappropriate behaviour management techniques

A
  • negative reinforcement
    • chastisement or punishment
  • hand over mouth technique
    • gloved hand placed over mouth
    • absolutely not appropriate, not taught in UK
  • selective parental exclusion
    • parent asked to leave
  • bribery
31
Q

How can topical anaesthetic be used in local anaesthetic administration?

A
  • do not hide the taste
    • describe it as like toothpaste
  • dry mucosa
    • warn of temporary tongue numbness
    • apply for adequate time
  • 5% lidocaine or 18-20% benzocaine
    • not recommend for under 2 year olds
32
Q

What non-pharmacological pain control is used with local anaesthetic administration?

A
  • hypnosis
    • semi-hypnosis
    • relaxation techniques
  • distraction
    • shaking cheek
    • counting on fingers
    • audio and visual (music/tv programme)
  • controlled language
  • guided imagery
  • systematic desensitisation
  • computer controlled LA devices
    • wand
  • control parental behaviour
    • parent squeezing leg
    • high tone of voice
    • concern
33
Q

How is local anaesthetic delivered in paediatric dentistry?

A
  • lidocaine 2%
    - first line
    - max dose is 1x2.2ml cartridge per 10kg body mass
  • articaine 4%
    • first line
    • profound anaesthetise
    • younger patients for mandibular pulpal anaesthesia
    • alternative to lidocaine IDB
    • max dose is 0.8x2.2ml cartridge per 10kg body mass
  • IDB
    • never use articaine
    • always aspirate
    • short needle often required for children
  • palatal and lingual injections
    • chasing techniques
    • topical anaesthatic administered buccally
    • buccal infiltration administered
    • infiltration into papilla once tissue is blanched
    • infiltration on palatal or lingual once tissue is blanched
  • ultra-short anaesthetic needle

BDS3 Paediatrics (6 decks)

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