Helping the Family manage dental care

Question 1

What is treatment alliance?

Answer 1

• Based on trust between child, accompanying adult and dental team

Question 2

When can dental anxiety occur?

Answer 2

• Childhood or adolescence
• Children with high caries more likely to have dental anxiety
• Most obvious under age of 4
• Can arise from parent being dentally anxious and passing on to child

Question 3

What is the Modified Child Dental Anxiety Scale (MCDAS)?

Answer 3

• Self completion measure for children aged 8 and older
• 8 questions about specific dental procedure
• Aim is to reduce score over time

Question 4

How would you approach a dentally anxious child in your surgery?

Answer 4

• Consider child’s anxiety level when planning care and whether use of specific behaviour management strategies is indicated
• Consider anxiety questionnaire
• Some children respond to coaxing, but if child becomes distressed cease treatment immediately
• Consider treatment compromise in positive way i.e. fluoride varnish rather than no treatment
• Arrange later appointment to complete planned treatment
• Don’t force treatment on child who is unwilling or unable to cope with it

Question 5

What are some behavioural management strategies that facilitate provision of preventive care and treatment?

Answer 5

• Communication
• Enhancing control
• Tell, show, do
• Behaviour shaping and reinforcement
• Structured time
• Distraction, relaxation
• Systemic desensitisation

Question 6

What does communication consist of?

Answer 6

Non-verbal communication - which conveys emotion and attitude
Words - Which convey information
Tone - Which conveys emotion and attitude

Question 7

If a parent is anxious what can you do to help them and the child at their appointment?

Answer 7

• Discuss how to prepare child for visit and negotiating ground rules for how to behave and communicate
• Discuss whether another adult familiar to child should attend visits

Question 8

How does enhancing control help a dentally anxious child?

Answer 8

• Giving child a role in saying stop or go enhances their feelings of control
• Should be used all the time
• Gives child a degree of control , rehearse the signal
• Stop immediately when signal is given otherwise mistrust phobia can develop
• Useful for children of school age or older, younger children may not understand

Question 9

How is Tell, show, do useful for a child with dental anxiety?

Answer 9

• Tell phase using appropriate language that avoids technical and emotive terms
• Show them before actually performing the action
• Helps with subsequent visits

Question 10

Outline using the tell, show, do strategy how a dentally anxious 5year old will accept treatment involving highspeed for first time?

Answer 10

• Gain rapport
• Give control
• Tell child what you would like to do and show handpiece
• Show high-volume aspirator
• Ask to try and if say yes then get nurse to pop it in their mouth with tip
• Check child okay and tell them they’ve done well
• Tell them putting handpiece in mouth using language they understand, switch it on and count to 4 then remove
• Don’t touch tooth and they can practise staying big and wide whilst you wash tooth
• Next touch tooth for 4 and see how they manage
• Consider this technique for each new action

Question 11

What are the most powerful reinforces of good behaviour?

Answer 11

• Facial expression
• Positive voice modulation
• Verbal praise
• Approval by parent/carer with hug
• Stickers or badges

Question 12

How is structured time useful for dentally anxious children?

Answer 12

• Break down time into units the child can understand and a child is less likely to get upset

Question 13

How is distraction useful for dental procedures for children?

Answer 13

• Shift patients attention to another situation, from unpleasant to other action
• Cartoons
• Pulling lip as LA given
• Raise legs during radiographs or impressions
• Clinician talking can distract also

Question 14

How is relaxation strategy used for dental anxiety?

Answer 14

• Ask child to place hand on tummy and breath slowly to fill tummies then slowly out
• Praise them
• Do this three times any time they feel tense or worried
• Useful for children of school age and older

Question 15

Outline the method for Systemic Desensitisation for dental anxiety

Answer 15

• Discuss with child how to recognise signs of stress and anxiety that they may be experiencing (e.g. hyperventilation, tension)
• Teach child how to manage their anxiety, principally with breathing and other methods like guided imagery
• Teach child how to describe their anxiety, use scale 1-10
• Break procedure down into stages and describe them
• Give control and try first stage and go through relaxation technique
• If child continues to demonstrate significant anxiety, consider referral to specialist