Pinkham - Chap 23 - Patient Management

Question 1

What are the 5 basic domains for securing the cooperation of children during dental tx?

Answer 1

Physical, pharmacologic, aversive(flooding), reward-oriented, and linguistic domain

Question 2

physical domain entails?

Answer 2

hand restraint by DA,mouth props, papoose board, reserved for unmangeable children, children unable to be reached by language or developmentally disabled children

Question 3

pharmacologic domain?

Answer 3

ranges from N20 to GA

Question 4

aversive domain(flooding)?

Answer 4

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

Question 5

reward oriented domain

Answer 5

reward used to secure childs cooperation(from parent or dentist)

Question 6

what are some problems with the reward oriented domain?

Answer 6

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.

Question 7

Linguistic domain?

Answer 7

conversation of the dentist with child and child w dentist

Question 8

what age do majority of normally developed and socialized children reach maturity in language

Answer 8

bw 2-4yo

Question 9

what roles does the linguistic domain require of the dentist?

Answer 9

teacher,coach,rewarder,psychologist,distractor, authority figure

Question 10

which speech act is most important in securing a childs cooperation?

Answer 10

requests and promises. dentist makes effective requests and child makes effective commitments

Question 11

what should be done if a child declines a dentists request?

Answer 11

dentist must reframe original request in order to get commitment and let the child know dentist is serious

Question 12

what type of coach must the dentist be?

Answer 12

Ontological coach(ontology=the way of being)

Question 13

the best way for a child to behave during a dental appt?

Answer 13

quiet, listening for requests, and cooperating with requests

Question 14

Pre appt experience entails doing what?

Answer 14

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

Question 15

Voice control?

Answer 15

dentist interjects more authority and an attitude of confidence into his communication. Facial expression must mirror attitude of confidence.

Question 16

when is voice control effective?

Answer 16

effective at intercepting inappropriate behaviors as they start to happen

Question 17

HOM?

Answer 17

dentist places hand over mouth of hysterically crying child

Question 18

when is HOM used? what other behav mangagement technique is it used with?

Answer 18

to intercept tantrums or other fits of rage, paired with voice control

Question 19

how should HOM be used and not used?

Answer 19

should not be used aversively. HOM intended to get childs attention and quiet child so they hear what the dentist is saying

Question 20

when is HOM contraindicated

Answer 20

disabled, immature or medicated children

Question 21

Physical restraint?

Answer 21

when paired with language, becomes part of the entire linguistic domain.

Question 22

Gentle physical restraint allows dentist to?

Answer 22

reframe a previous request

Question 23

Praise and communication?

Answer 23

language needs to be age appropriate, combine with TSD

Question 24

other methods of patient management?

Answer 24

pairing a frightened child with a brave child, play therapy, “time out” to listen to music, distraction, desensitization, gift giving, observation

Question 25

when is the nonverbal management of children measured as successful/effective?

Answer 25

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”)

Question 26

where is “the place?”

Answer 26

looking at the child in a downward and forward position

Question 27

When returning children to parents after procedures, some children like to make their parents feel _ and portray themselves _

Answer 27

guilty for making them go to the dentist and portray themselves as victims

Question 28

it is important to be aware of what when a frightening child comes to the office

Answer 28

these children often come from broken homes, are abused, grieving the death of family, etc..

Question 29

what external influences might cause a child to be frightened in the dental setting

Answer 29

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.

Question 30

how should the dentist respond if a child asks if INJ will hurt?

Answer 30

cannot lie to patient. Respond with “you will feel a little pinch”

Question 31

whats the best way to handle shy, introverted children? This requires what skill from the dentist?

Answer 31

Talk to them at their own level, use praise, and TSD, establish rapport, communication, trust, and become their friends. Requires patience from dentist

Question 32

the child who is averse to authority usually attempts to reach 4 misdirected goals, which are?

Answer 32

gardner undue attention, struggle for power(“they will pay attention to me or else”), retaliation and revenge, inadequacy

Question 33

Undue attention behavioral charactersitics

Answer 33

“to feel superior, i will through manipulative behavior get my parents to pay attention to me”. these kids are annoying, irritating, teasing, disruptive

Question 34

struggle for power behav chars?

Answer 34

“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

Question 35

retaliation and revenge behav chars

Answer 35

“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

Question 36

inadequacy behav chars

Answer 36

give up easily, rarely participate, acts if incapable to do anything, displays inadequacy