Module 5

Question 1

What are the steps of systemic desensitisation for phobia related to dental LA?

Answer 1

Instructions on muscle relaxation and or relaxation breathing
Explanation of components of LA equipment
Look at assembled dental syringe
Explanation and demonstration of effect of LA
Information and facts about LA administration
Hold an assembled dental syringe on the palm of the patients hand
Hold an assembled dental syringe in the patients mouth
Hold an assembled dental syringe (needle guard removed) on th palm of the patients hand
Hold a syringe (guard removed) by the side of the face
Hold the syringe inside the patients mouth (guard removed)
Replace the guard and hold the end of the syringe against the mucosa overlying the injection site
Press the syringe (guard in place) over the injection site
Place topical LA
Remove the guard and hold the syringe inside the mouth
Place the needle in contact with mucosa over the injection site
Place the needle in contact with mucosa over the injection site
Place the needle in contact with the mucosa and apply pressure
Hold the needle in contact with the mucosa and inserting enough pressure for the needle to penetrate the mucosa
As in 14, but deliver a minute amount of LA
As in 14 but deliver the normal amount of LA.

Question 2

What are the nine NPBMT tools?

Answer 2

Tell show do
Enhancing control
Voice control
Modelling
Behaviour shaping and positive reinforcement
Distraction
Guided imagery
Negative reinforcement
Magic trick.

Question 3

What is tell show do?

Answer 3

Tell- a brief, age-appropriate description of the care to be completed
Show- demonstration of the care to be completed/equipment to be used
Do- carrying out the care required with minimal delay.

Question 4

What is enhancing control?

Answer 4

Provide the patient with a signal that allows them a degree of control over the situation eg. a stop signal.

Question 5

What is modelling?

Answer 5

A technique which involves watching others to learn about the environment first before experimenting it themselves. It can be a live model or a pre recorded model.

Question 6

What is behaviour shaping and positive reinforcement?

Answer 6

Behaviour shaping is a series of defined steps to achieve the desired behaviour. Reinforcement is the strengthening of the pattern of desired behaviour, thus increasing the likelihood of that behaviour being repeated in the future.

Question 7

What is a distraction technique?

Answer 7

A technique where the CYP attention is distracted from the dental setting in progress.

Question 8

What are some examples of distraction techniques?

Answer 8

Visual-audio distraction (watching a cartoon) combined with negative reinforcement (cartoon switched off when patient exhibits disruptive behaviour)
Audio distraction
Manual stimulation distractor devices.

Question 9

What is guided imagery?

Answer 9

The clinician helps the patient have a daydream to create a state of relaxation and well-being with there being three stages to the process: relaxation, visualisation and positive suggestion.

Question 10

What is systematic desensitisation?

Answer 10

A technique which helps the individual overcome specific anxieties/fears/phobias by gradual exposure to the specific high threat stimulus, most commonly LA administration but can often be the dental drill or other equipment.

Question 11

What is negative reinforcement?

Answer 11

It is the strengthening of a behaviour by removing a stimulus which the patient finds unpleasant. THIS IS NOT THE SAME AS PUNISHMENT which is the application of an unpleasant stimulus when inappropriate behaviour is displayed.

Question 12

What is the technique “magic trick”?

Answer 12

Proven to work effectively NPBMT in young individuals- gets them to sit in the chair for longer eg. fun magic colouring book.

Question 13

What are pros and cons of tell show do?

Answer 13

Pro- useful for almost all patiets who can communicate, especially those patients who are monitors
Cons- Stop is quite a definite word which to some CYP may suggest that the process will be completely over. Changing the terminology to a rest signal wheile subtle might reinforce that the aim is to complete the treatment and that the CYP can have a rest rather than aborting completly and or trying to find an easier or alternative way to complete the treatment that day or another day

ALTERNATIVE-CAN COUNT TO FIVE WHILE USING THE HIGH SPEED THEN TAKE A SMALL BREAK TO HELP PATIENT.

Question 14

What are the pros and cons of enhancing control?

Answer 14

pros- useful for all patients that can communicate, particularly helpful for those patients whose anxiety is related to feeling loss of control

cons-alternative rest signals to raising a hand will be required for those who have physical difficulties where this is not feasible, introduving the stop/rest signal too early can suggest there is something to be concerned about- therefore for those who are extremely fearful already, the signal should be introduced early on at the initial examination consultation.

Question 15

What are the pros and cons of voice control?

Answer 15

Pros- can be useful in young children who respond more to the tone of voice rather than the actual words used

cons- not appropriate for children with intellectual or emotional impairment or too young to understand, not necessarily acceptable to all carers or clinicians.

Question 16

What are the pros and cons of modelling?

Answer 16

Pros- useful for all patients who can communicate, helpful for all patients particularly those with limited dental experience and or monitor CYP.

Question 17

What are the pros and cons of behaviour remodelling and negative reinforcement?

Answer 17

Pros- useful for all patients who can communicate and those with limited communication but who understand reward-based behaviour systems

Cons- positive behaviour should be routinely acknowledged to encourage repetition of good behaviour while avoiding the temptation to comment on negative behaviour
Can be seen as a bribe- “horse has already bolted”- giving a reward to stop bad behaviour.

Question 18

What are the pros and cons of distraction?

Answer 18

Pros- useful for all patients that can communicate, effective for patients with low or moderate levels of anxiety/blunter patients

Cons- for those patients with a high level of anxiety and or monitoring patients, this technique is likely to be less effective than other NPBMT.

Question 19

What are the pros and cons of guided imagery?

Answer 19

Pros- useful for all patients that can communicate, effective for patients with low or moderate levels of anxiety/blunter patients

Cons- for those patients with a high level of anxiety and or monitoring patients, this technique is likely to be less effective than other NPBMT.

Question 20

What are the pros and cons of systematic desensitisation?

Answer 20

Pros- the technique is useful when a CYP can specifically identify what aspect of dental care they are fearful about, useful for all patients that can communicate

Cons- can require a number of appointments to overcome the CYP fear.

Question 21

What are the pros and cons of negative reinforcement?

Answer 21

Pros- can be useful for all patients that can communicate, can be of benefit particularly for those with moderate levels of anxiety and or with some dental experience

Cons- not suitable for younger children who will experience separation anxiety, unlikely to be useful or a practice builder at new patient appointments, not acceptable to all carers.

Question 22

What are the pros and cons of a magic trick?

Answer 22

Pros- useful for all patients who can communicate, useful in most young children

Cons- need to be slick with whatever magic trick is employed, unlikely to have much effect on older children.

Question 23

There is millions of examples in the research documents provided.

Answer 23

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Question 24

What are different factors that can affect child anxiety?

Answer 24

Previous medical history eg. hospital appointments and treatments
Social history factors eg. many children that have been referred might have a troubled life and family situation Parental anxiety
Parenting styles
Parental presence
Childs awareness of a dental problem
Behaviour of dental staff
Child temperament.

Question 25

What are some recommendations for non-pharmacological behaviour management technqiues?

Answer 25

Preparatory information
Non-verbal communication
Voice control
Tell show do
Coping strategies
Memory restructuring strategy
Hypnosis
Motivation interviewing
Empathy 
etc

Question 26

What us motivational interviewing?

Answer 26

A type of counselling which can employed by individuals trained in this technique and within the behavioural science literature has been found to be especially effective at overcoming adolescent ambivalence to behaviour change. This is useful for patients who can verbally communicate- no contraindications but need a qualified individual.

Question 27

What is memory restructuring strategy?

Answer 27

It is a technique which aims to help children develop positive memories of their dental treatment and as such may be effective in reducing fear and improving behaviour. This is useful for patients who can verbally communicate- no contraindications but need a qualified individual.

Question 28

What is hypnosis?

Answer 28

Artificially induced altered state of consciousness in which the individual becomes more susceptible to suggestion.

Question 29

What is Snoezelen environment?

Answer 29

It consists of a partially lit room with lightning effect and deep pressure and vibroacoustic stimuli.

Question 30

A tip: use different names for the dental instruments like calling the high speed a hoover etc (not is autistic patients).

Answer 30

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