Behavioural management in children Flashcards
what is dental anxiety?
> Fear of pain or its anticipation
> Lack of trust, fear of betrayal
> Fear of loss of control
> Fear of the unknown
> Fear of intrusion
what is dental dear?
A reaction to a specific external threatening stimulus: this is a normal reaction to threatening stimuli in the dental situation
what are dental behaviour management problems ?
Uncooperative and disruptive behaviours resulting in delay of treatment or rendering treatment impossible
what are dental fears at the different age ranges?
> 9-12m = Loud noise. Separation
> 2-4 yrs = Imaginary objects
> 4 yrs = Dark. Unknown
> 5-6 yrs = Social and school fears
> 6-16 yrs = Injury, death, natural events, social anxiety
what is a dental Phobia?
> A special kind of fear out of proportion to the demands of the situation which will not respond to reason
> it is apparently beyond voluntary control and leads to the avoidance of dental treatment where this is necessary.
what are the complications of dental anxiety?
> Stress = for the Patient, Parent and clinical staff
> Compromises provision of dental care
> Persistence of unfavourable attitude into adulthood leading to avoidance.
what is the exogenous (things that have happened) aetiology behind dental anxiety?
> Previous dental treatment
> Dental health status
> SES
> Parental dental anxiety
> Siblings/peers
> PMH
what is endogenous aetiology behind dental anxiety?
> Gender
> general fears
> personality type
how do you recognise dental anxiety?
> Clinical affect
> Ask accompanying adult
> Ask child
> Questionnaires
- MCDASf |( most common)
- Venham’s Picture test
- CFSS-Dental Subscale
what are the different types of child dental patients?
> Co-operative
> Potentially co-operative
> Lacking in co-operative ability
- Specific disability affecting ability to cooperate
> Pre co-operative
- The very young
how do you set up for a child friendly practice?
> Pre-appointment information
> Child friendly waiting area
> See patient on time
> Consider introductory visit
> Good communication skills
what are signs of verbal and non verbal positive communication?
> 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.
what are the verbal principles of communication?
> Be understandable
> Questioning
> Listening
> Reassure
> Praise
> Humour
what are the non verbal principles of communication?
> Body language
> Proximity-personal space
> Eye contact
> Reinforcers
> Level and posture
> Empathy
what methods are used for dealing with a Childs dental anxiety?
> Tell-Show-Do (eg. 3 in 1)
> Reinforcement
> Parents
> Behaviour Shaping
> Voice control
> Distraction
> Modelling
> Other methods
> Desensitisation
what is positive reinforcement?
> The strengthening of a pattern of behaviour which increases the probability of that behaviour being displayed in the future
what positive reinforcement techniques are used?
> Praise appropriate behaviour
- mouth opening
- sitting still
> Timing of praise
> Don’t praise disruptive behaviour- withdraw praise
> Don’t use rewards as bribes
how can we use voice control to help manage dental anxiety?
> Variation in tone, 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
what is behaviour shaping and how is it used in managing dental anxiety?
> Influencing behaviour towards desired ideal by
- Planned introduction to procedures
- Move through stages at child’s pace
what is a distraction technique and name examples?
> Use of a distracting stimulus to divert attention away from disruptive behaviours and potentially unpleasant sensory stimuli
> Cartoons
Audio tapes
TV
Virtual reality
Video games
Stories
Lip holding
Leg raising
Talking whilst carrying out a procedure
what are some examples of modelling techniques used in managing dental anxiety?
> Live
- a non fearful child successfully receiving treatment
- e.g. sibling
- passive or participant
> symbolic
- video/cartoon
- same sex, similar age if possible
- additional equipment required
- passive or participant
what other methods are used for managing dental anxiety?
> Externalising
- short break in a different environment before resuming treatment
> Contracts
> Count down
- counting aloud along with procedures
> Stop signals
- hand raising.
what is desensitisation as a method of managing dental anxiety?
> Hierarchy of fear provoking stimuli presented to a relaxed patient
- time consuming
- psychologist
- hypnosis
how do you manage a pre- cooperative child?
> Examine with help from parent
> Tell them to ask you to stop at any time
> Limited intervention possible
> GA usually required for advanced treatment
how do you manage a patient who is gagging?
> Relaxation
> Breathing
> Chin position
> Care with instruments
> Patient watching in mirror
> Home practice kit
> Inhalation sedation
what are the alternatives and management techniques for patients with a needle phobia?
> EDA - electronic dental anaesthesia
> The ‘Wand’
> Computer Controlled pressure & flow injection system
‘Injex’ system – high pressure jet
> Desensitisation programmes
> Hypnosis
what are the alternative methods of caries removal if a patient has a drill phobia?
> Hand excavation – ART restoration
> Chemo-mechanical removal
- Eg Caridex or Carisolv
> Air abrasion
> Lasers
> Hall technique
what would you do if nothing seems to work in managing a patients anxiety?
> Consider pharmacological adjuncts
> Consider the need to refer the patient.
> Reasons for referral:-
- Specialised dentistry
- Special child
who can you refer to ?
> Colleague
- More experienced
- Sometimes a change of clinician is enough
> Specialist
- Community Dental Service = Remit varies between trusts
- Hospital Dental Service = Consultant led service
what details need included in a referral letter?
> 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.
> 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 previous records aid diagnosis and treatment planning.
> 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
