child (behaviour) management Flashcards
define dental fear
normal emotional reaction to one or more specific threatening stimuli in the dental setting
some reasons for fear in children
- self protection
- real/ unknown danger or pain
- may be neurotic/ disproportionate
- fear of failure in front of strangers
how fear changes with age
2-3yo: fear of anything that differs from norm
7-8yo: fewer fears in general and can verbalise them
define dental anxiety
state of apprehension that something dreadful is going to happen in relation to dental treatment
what influences dental anxiety
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)
2 things that contribute to traumatic dental experience
- link of pain to memory
- false memory syndrome: memories influenced by outside factors eg other people telling story
3 onsets of dental anxiety
- child onset: common with family history of dental anxiety
- adolescent onset: common in generally anxious ppl
- adult onset: severe fears, can indicate psychiatric problems
define dental phobia 4
- 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
what is ‘unco-operative’ used to describe
any disruptive behaviour (subjective)
what is the paediatric triangle & relevance to dental practice
child, parent, dentist
sometimes better to treat child without parent present eg is parent has dental anxiety
learn flowchart of level of anxiety/ urgency of tx needed
frankl behaviour scale
Bx1: definitely negative
Bx2: negative
Bx3: positive
Bx4: definitely positive
problem of frankl scale
subjective
modified dental anxiety scale (MDAS) how it works
5 questions, summed score of 25
score of 19 or more = highly anxious pt
indicator of sedation need IOSN 3 factors
- anxiety score
- medical history
- treatment complexity
10 interventions for individuals with low levels of dental anxiety
- tell show do
- modelling
- positive and negative reinforcement
- voice control
- distraction
- behaviour shaping
- enhancing control
- rapport building
- physical restraint (papoose board)
2 objective of tell show do
- familiarise pt with dental setting
- shape pts response to procedures through well-described expectations
3 steps of tell show do
tell: age-appropriate verbal explanation of a procedure
show: demo procedure eg blow air on arm
do: completion of procedure
3 objectives of voice control
- gain pts attention and compliance
- alter negative or avoidance behaviour
- establish adult-child roles
what is modelling
child observes reliable and well behaved pt having tx eg older sibling
define behaviour shaping
defined small steps towards ideal behaviour achieved by selective reinforcement
problem of positive reinforcement in dentistry
often food as reward- bad for teeth
6 things about dental environment which make it foreign and why this is worse for kids
smell taste light (senses heightened in kids) colour temp personnel (number of people confusing, overstimulation)
interventions for older children with moderate dental anxiety
INFO:
- procedural information
- sensory information (tastes, numbness, drills)
- coping information (eg breathing techniques, listen to music)
justification behind restraint
stop patient hurting themself
order of increasingly unacceptable (from parent POV) behaviour technique 6
- tell show do
- positive reinforcement
- sedation
- voice control (don’t like people shouting at their child)
- GA
- physical restraint
2 types of interventions for individuals with high anxiety levels
- pharmacological management (GA/NOS/ IV midazolam)
- cognitive behavioural therapy
most common type of CBT and explain
systematic desensitisation: hierarchy of fear-producing stimuli, pt exposed to least threatening stimuli first
3 steps of systematic desensitisation
- identification of anxiety inducing stimulus
- learning coping techniques
- react towards and overcome situations in established hierarchy
when is sedation used in paediatric dentistry
oral midazolam so can perform GA
