BEHAVIOUR

MANAGEMENT(WR

IGHT 1975)-IS

DEFINED AS THE

MEANS BY WHICH

THE DENTAL

HEALTH TEAM

EFFECTIVELY AND

EFFICIENTLY

PERFORMS DENTAL

TREATMENT AND

THEREBY INSTILLS

A POSITIVE

DENTAL ATTITUDE.

PARENTAL ANXIETY-maternal anxiety and child’s co

operative behaviour at the first dental visit has significant

corelation.it is because of child parent symbiosis that begins in

infancy and gradually diminishes.

The effect is greatest with those younger than 4yr of age.

MEDICAL EXPERIENCES-

children who view medical experiences positively are more

likely to be co-operative.

Surgical experiences adversely influence behaviour at the first

dental visit.

RATING1:DEFINITELY NEGATIVE-complete refusal of treatment,forceful crying,fearfulness

RATING2:NEGATIVE-uncooperativeness,some evidance of negative attitude but not pronounced

RATING3:POSITIVE-acceptance of treatment,cautious behaviour,is cooperative but may become uncooperative once treatment starts.

RATING4:DEFINITELY POSITIVE-good rapport with dentist,interested in dental procedure

1)COMMUNICATION

2)BEHAVIOUR SHAPING

-DESENSITIZATION

-MODELLING

-CONTINGENCY MANAGEMENT

3)BEHAVIOR MANAGEMENT

-AUDIO ANALGESIA

-BIOFEEDBACK

-VOICE CONTROL

-HYPNOSIS

-HUMOR

-COPING

-RELAXATION

-AVERSIVE CONDITIONING

The means by which the dentist gets his point across,making himself understood by use of words or expressions.

TYPES OF COMMUNICATION--

1)VERBAL COMMUNICATION(SPEECH)

2)NON-VERBAL COMMUNICATION which includes-body language,eye contact,showing concern,smiling,giving a hug or a pat

Communication should be comfortable and relaxed sitting and speaking at the eye level allows a friendlier atmosphere.address him by his name compliment him about his appearance.Ask questions about his class his likes/dislikes.

Use of euphemisms-euphemism are substitute words which can be used in presence of children

1)Anesthetic solution is referred as water to put teeth to sleep

2)Rubberdam as rain coat

3)Radiograph as tooth picture

Reframing-by this both original threat and the threatened situation can be handled

DEFINITION:is the procedure which slowly develops behaviour by reinforcing a successive approximation of desired beaviour untill the desired behaviour comes into being.

1)state the general goal or task to the child at the outset.

2)explain the necessity for the procedure.

3)divide explanation for the procedure.

4)give all explanation at childs level of understanding. Use euphemisms.

DESENSITIZATION(tell-show-do)technique

A)Tell and show every step and instruments and explain what is going to be done.

Continuosly and in grades from the level fear promoting objects or procedure move to higher grades to more fearfull objects.

INDICATION-

1)first visit

2)subsequent visits when introducing new dental procedure

3)fearful child

4)apprehensive child because of information received from peers/parents

TSD TECHNIQUE IS APPLIED AS FOLLOWS:

A)The dentist uses the language that child can understand and tells the patient what is to be done.

B)the dentist demonstrates the procedure to the child using model or himself.

C)dentist proceeds to do the dental procedure exactly as described.

Procedure involves allowing a patient to observe one or more individual (models) who demonstrate a positive behavior in a particular situation therefore, the patient will frequently inact the models behavior.

IT CAN BE DONE BY

A) live model – siblings.

B) Filmed models

C) Posters

D) Audiovisual aids

It is a method of modifying the behavior of child by

presentation or withdrawal of reinforces. Reinforces

can be:

Positive reinforcer is one whose contingent

presentation increases the frequency of behavior

Negative reinforcer is one whose contingent

withdrawal increases frequency of behaviour.

Negative reinforcer is usually a termination of an

aversive stimulus Eg. withdrawal of mother

Social : Example: Praise, Positive facial expression, shaking hands, holding hands and patting shoulder.

Material: may be given in form of toy and game.

Activity Reinforces: Involving child in some activity, like watching tv show fixed on ceiling at eye level.

Child can be managed by following methods:

Audio Analgesia: Also called as white noise. It is method of

reducing pain. This technique, consists of providing sound

stimulus of such intensity that patient finds difficult to attend

anything else. Auditory stimulus such as music reduces stress

and reaction to pain.

Biofeedback :Involves use of certain instruments to detect

certain physiological process. Example: If blood pressure is

high instruments give stimulation, useful in anxiety and

echocardiogram can also be used.

Humor: Helps to elevate mood of child. Few

functions are:

-Social: forming and maintaining relationship

-Emotional: Anxiety release

-Informative: Transmits essential information.

-Motivation: It increases interest.

-Cognitive : Distracts from fearful stimulus.

Coping: It is defined as the cognitive and behavioral

effort made by individual to master, tolerate or reduce

stressful situation.

Coping effect is of two types:

Behavioral: Physical and verbal activities ,in which

child engages to overcome stressful situation.

Cognitive: The child may be silent and thinking in his

mind to keep calm.

Signal System: when it hurts, we ask child to raise his

hand.

It is modification of intensity and pitch of ones own voice in attempt to dominant interaction between dentist and child

Use of conjunction with some form of physical restrainer and hand over mouth exercise.

Change in tone from gentle to firm is effective in gaining child’s attention and reminding him that dentist is authoritive figure to be obeyed.

It is altered state of consciousness, when used in dentistry ,it is termed hypodontics.

Implosion Therapy: Sudden flooding with barrage of stimuli which has affected him adversely, and child has no option but to face stimuli, until negative response disappears.

Relaxation: It is technique to reduce stress and is based on principle of elimination of anxiety.

It can be safe and effective method of

managing extremely negative behavior.

2 important method used in clinical

practice are:

1) HOME

2) PHYSICAL RESTRAINT

HOME(hand-over-mouth exercise):behavior modification method of aversive conditioning is called HOME introduced by Evangeline jordan 1920

The purpose of home is to gain the attention of a child so that communication can be achieved

INDICATION:

A healthy child who can understand but who exhibits hysterical behavior during treatment

3 to 6yr old child

Children displaying uncontrollable behavior

CONTRAINDICATION:

Child under 3yrs of age

Frightened child

physical,mental and emotional handicap

It should not be set as routine procedure,inform the parent about the procedure

THE TECHNIQUE:

After determining the child’s behaviour,the dentist firmly places his hand over the child’s mouth and behavioral expectation are calmly explained close to child’s ear.when the childs verbal outburst is stopped and child indicates his willingness to co-operate,the dentist removes his hand.once the child co operates he should be complimented for being quite and praised for good behaviour.The whole procedure should not last for more than 20-30sec

SEVERAL VARIATIONS OF HOME

a)hand over mouth with airway unrestricted

b)hand over mouth and nose with airway restricted

c)towel held over mouth and nose

d)wet towel held over mouth and nose

The advantage behind airway restriction is that child will be quite so as to breath and sreaming will decrease.

Together with home,nostrils are pinched for 15secs only.

BELANGER believed that airway restriction was critical element and it should be avoided.

It is the last resort for handling uncooperative patient

physiological restraints involves restriction of head,hand,feet or body it can be

ACTIVE:restraints performed by the dentist staff or parent without the aid of restraining device

PASSIVE:with aid of restraining device

FOR BODY: pediwrap,papooseboard,sheets,beanbag with straps,towel tapes

For EXTREMITIES-velcro straps,posey straps,towel and tape

FOR HEAD-head positioner,forearm body support

FOR MOUTH-mouth blocks,banded tongue blades,mouth props