child (behaviour) management

Question 1

define dental fear

Answer 1

normal emotional reaction to one or more specific threatening stimuli in the dental setting

Question 2

some reasons for fear in children

Answer 2

• self protection
• real/ unknown danger or pain
• may be neurotic/ disproportionate
• fear of failure in front of strangers

Question 3

how fear changes with age

Answer 3

2-3yo: fear of anything that differs from norm

7-8yo: fewer fears in general and can verbalise them

Question 4

define dental anxiety

Answer 4

state of apprehension that something dreadful is going to happen in relation to dental treatment

Question 5

what influences dental anxiety

Answer 5

multi-dimensional construct consisting of somatic, cognitive and emotional elements
mix of EXOGENOUS (outside influences eg conditioning by parents, learning, experiences) and
ENDOGENOUS (constitutional vulnerability, being a generally anxious person)

Question 6

2 things that contribute to traumatic dental experience

Answer 6

• link of pain to memory

- false memory syndrome: memories influenced by outside factors eg other people telling story

Question 7

3 onsets of dental anxiety

Answer 7

• child onset: common with family history of dental anxiety
• adolescent onset: common in generally anxious ppl
• adult onset: severe fears, can indicate psychiatric problems

Question 8

define dental phobia 4

Answer 8

• severe type of dental anxiety
• characterised by marked and persistent anxiety that is excessive and unreasonable
• can be in relation to one specific situation or the dental situation in general
• the person can recognise that the anxiety is excessive and unreasonable but cannot help it

Question 9

what is ‘unco-operative’ used to describe

Answer 9

any disruptive behaviour (subjective)

Question 10

what is the paediatric triangle & relevance to dental practice

Answer 10

child, parent, dentist

sometimes better to treat child without parent present eg is parent has dental anxiety

Question 11

learn flowchart of level of anxiety/ urgency of tx needed

frankl behaviour scale

Answer 11

Bx1: definitely negative
Bx2: negative
Bx3: positive
Bx4: definitely positive

Question 12

problem of frankl scale

Answer 12

subjective

Question 13

modified dental anxiety scale (MDAS) how it works

Answer 13

5 questions, summed score of 25

score of 19 or more = highly anxious pt

Question 14

indicator of sedation need IOSN 3 factors

Answer 14

• anxiety score
• medical history
• treatment complexity

Question 15

10 interventions for individuals with low levels of dental anxiety

Answer 15

• tell show do
• modelling
• positive and negative reinforcement
• voice control
• distraction
• behaviour shaping
• enhancing control
• rapport building
• physical restraint (papoose board)

Question 16

2 objective of tell show do

Answer 16

• familiarise pt with dental setting

- shape pts response to procedures through well-described expectations

Question 17

3 steps of tell show do

Answer 17

tell: age-appropriate verbal explanation of a procedure
show: demo procedure eg blow air on arm
do: completion of procedure

Question 18

3 objectives of voice control

Answer 18

• gain pts attention and compliance
• alter negative or avoidance behaviour
• establish adult-child roles

Question 19

what is modelling

Answer 19

child observes reliable and well behaved pt having tx eg older sibling

Question 20

define behaviour shaping

Answer 20

defined small steps towards ideal behaviour achieved by selective reinforcement

Question 21

problem of positive reinforcement in dentistry

Answer 21

often food as reward- bad for teeth

Question 22

6 things about dental environment which make it foreign and why this is worse for kids

Answer 22

smell
taste 
light (senses heightened in kids)
colour
temp
personnel (number of people confusing, overstimulation)

Question 23

interventions for older children with moderate dental anxiety

Answer 23

INFO:

• procedural information
• sensory information (tastes, numbness, drills)
• coping information (eg breathing techniques, listen to music)

Question 24

justification behind restraint

Answer 24

stop patient hurting themself

Question 25

order of increasingly unacceptable (from parent POV) behaviour technique 6

Answer 25

• tell show do
• positive reinforcement
• sedation
• voice control (don’t like people shouting at their child)
• GA
• physical restraint

Question 26

2 types of interventions for individuals with high anxiety levels

Answer 26

• pharmacological management (GA/NOS/ IV midazolam)

- cognitive behavioural therapy

Question 27

most common type of CBT and explain

Answer 27

systematic desensitisation: hierarchy of fear-producing stimuli, pt exposed to least threatening stimuli first

Question 28

3 steps of systematic desensitisation

Answer 28

1. identification of anxiety inducing stimulus
2. learning coping techniques
3. react towards and overcome situations in established hierarchy

Question 29

when is sedation used in paediatric dentistry

Answer 29

oral midazolam so can perform GA