Pinkham - Chap 23 - Patient Management Flashcards
What are the 5 basic domains for securing the cooperation of children during dental tx?
Physical, pharmacologic, aversive(flooding), reward-oriented, and linguistic domain
physical domain entails?
hand restraint by DA,mouth props, papoose board, reserved for unmangeable children, children unable to be reached by language or developmentally disabled children
pharmacologic domain?
ranges from N20 to GA
aversive domain(flooding)?
a technique, which when used on a child is objectionable enough that the child will cooperate in order to avoid the technique. includes parental spanking and HOM. Avoid using this domain as a punishment
reward oriented domain
reward used to secure childs cooperation(from parent or dentist)
what are some problems with the reward oriented domain?
Child may think parent is offering a reward bc they think the dental appointment will be difficult, frightening, or scary.
When unusual rewards are mentioned, child may conclude that the more anxiety he/she builds up before the appointment, the greater the reward.
Linguistic domain?
conversation of the dentist with child and child w dentist
what age do majority of normally developed and socialized children reach maturity in language
bw 2-4yo
what roles does the linguistic domain require of the dentist?
teacher,coach,rewarder,psychologist,distractor, authority figure
which speech act is most important in securing a childs cooperation?
requests and promises. dentist makes effective requests and child makes effective commitments
what should be done if a child declines a dentists request?
dentist must reframe original request in order to get commitment and let the child know dentist is serious
what type of coach must the dentist be?
Ontological coach(ontology=the way of being)
the best way for a child to behave during a dental appt?
quiet, listening for requests, and cooperating with requests
Pre appt experience entails doing what?
giving child tour of office, child made aware that nothing will be done that day, introducing to dentist and personnel so they’re not strangers at next appt
Voice control?
dentist interjects more authority and an attitude of confidence into his communication. Facial expression must mirror attitude of confidence.
when is voice control effective?
effective at intercepting inappropriate behaviors as they start to happen
HOM?
dentist places hand over mouth of hysterically crying child
when is HOM used? what other behav mangagement technique is it used with?
to intercept tantrums or other fits of rage, paired with voice control
how should HOM be used and not used?
should not be used aversively. HOM intended to get childs attention and quiet child so they hear what the dentist is saying
when is HOM contraindicated
disabled, immature or medicated children
Physical restraint?
when paired with language, becomes part of the entire linguistic domain.
Gentle physical restraint allows dentist to?
reframe a previous request
Praise and communication?
language needs to be age appropriate, combine with TSD
other methods of patient management?
pairing a frightened child with a brave child, play therapy, “time out” to listen to music, distraction, desensitization, gift giving, observation
when is the nonverbal management of children measured as successful/effective?
When dentists make verbal requests to stop behavior but are able to re-request when needed with more verbal determination, appropriate facial exp, and form a bodily posture in which they know that they are competent(“the place”)
where is “the place?”
looking at the child in a downward and forward position
When returning children to parents after procedures, some children like to make their parents feel _ and portray themselves _
guilty for making them go to the dentist and portray themselves as victims
it is important to be aware of what when a frightening child comes to the office
these children often come from broken homes, are abused, grieving the death of family, etc..
what external influences might cause a child to be frightened in the dental setting
Child may be intellectually unable to comprehend the dental appt bc of age(36-40months) or mental retardation, child was sold a set of fears by siblings,parents,friends,child is emotionally ill or had a previous negative experience.
how should the dentist respond if a child asks if INJ will hurt?
cannot lie to patient. Respond with “you will feel a little pinch”
whats the best way to handle shy, introverted children? This requires what skill from the dentist?
Talk to them at their own level, use praise, and TSD, establish rapport, communication, trust, and become their friends. Requires patience from dentist
the child who is averse to authority usually attempts to reach 4 misdirected goals, which are?
gardner undue attention, struggle for power(“they will pay attention to me or else”), retaliation and revenge, inadequacy
Undue attention behavioral charactersitics
“to feel superior, i will through manipulative behavior get my parents to pay attention to me”. these kids are annoying, irritating, teasing, disruptive
struggle for power behav chars?
“to feel superior, i am prepared to have a power struggle with my parents about getting attention, they will pay attention to me or else”. behav chars: argues and contradicts, does opposite of instructions, makes people angry, throws temper tantrums
retaliation and revenge behav chars
“if i dont get what i want i will get even with my parents and punish them” behav chars: violent temper, says hurtful things, seeks revenge, gets even
inadequacy behav chars
give up easily, rarely participate, acts if incapable to do anything, displays inadequacy
