Module 5 Flashcards
What are the steps of systemic desensitisation for phobia related to dental LA?
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.
What are the nine NPBMT tools?
Tell show do Enhancing control Voice control Modelling Behaviour shaping and positive reinforcement Distraction Guided imagery Negative reinforcement Magic trick.
What is tell show do?
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.
What is enhancing control?
Provide the patient with a signal that allows them a degree of control over the situation eg. a stop signal.
What is modelling?
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.
What is behaviour shaping and positive reinforcement?
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.
What is a distraction technique?
A technique where the CYP attention is distracted from the dental setting in progress.
What are some examples of distraction techniques?
Visual-audio distraction (watching a cartoon) combined with negative reinforcement (cartoon switched off when patient exhibits disruptive behaviour)
Audio distraction
Manual stimulation distractor devices.
What is guided imagery?
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.
What is systematic desensitisation?
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.
What is negative reinforcement?
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.
What is the technique “magic trick”?
Proven to work effectively NPBMT in young individuals- gets them to sit in the chair for longer eg. fun magic colouring book.
What are pros and cons of tell show do?
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.
What are the pros and cons of enhancing control?
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.
What are the pros and cons of voice control?
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.
What are the pros and cons of modelling?
Pros- useful for all patients who can communicate, helpful for all patients particularly those with limited dental experience and or monitor CYP.
What are the pros and cons of behaviour remodelling and negative reinforcement?
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.
What are the pros and cons of distraction?
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.
What are the pros and cons of guided imagery?
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.
What are the pros and cons of systematic desensitisation?
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.
What are the pros and cons of negative reinforcement?
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.
What are the pros and cons of a magic trick?
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.
There is millions of examples in the research documents provided.
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What are different factors that can affect child anxiety?
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.
What are some recommendations for non-pharmacological behaviour management technqiues?
Preparatory information Non-verbal communication Voice control Tell show do Coping strategies Memory restructuring strategy Hypnosis Motivation interviewing Empathy etc
What us motivational interviewing?
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.
What is memory restructuring strategy?
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.
What is hypnosis?
Artificially induced altered state of consciousness in which the individual becomes more susceptible to suggestion.
What is Snoezelen environment?
It consists of a partially lit room with lightning effect and deep pressure and vibroacoustic stimuli.
A tip: use different names for the dental instruments like calling the high speed a hoover etc (not is autistic patients).
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