Behavior Guidance Techniques in Dentistry

Behavior Guidance for Pediatric Dental Patients

• This best practice guide provides information for predicting and guiding children's behavior during dental procedures.
• Successful treatment relies on effective communication and individualized behavior plans.
• Behavior guidance is a continuous process, using both non-pharmacological and pharmacological approaches, addressing informed consent, pain assessment, behavior documentation, and treatment options.
• Basic techniques include communication, positive imagery, observation, tell-show-do, ask-tell-ask, voice control, and positive reinforcement.
• Advanced techniques include sensory adaptations, animal-assisted therapy, and sedation/general anesthesia.
• Each option should be assessed for objectives, indications, contraindications, and precautions.

Purpose of the Guideline

• The American Academy of Pediatric Dentistry (AAPD) recognizes the necessity of dental care for preventing/treating oral diseases.
• Behavior guidance techniques aim to alleviate anxiety, promote positive attitudes, and ensure safe/effective care for infants, children, adolescents, and patients with special health care needs (SHCN).
• The AAPD recommends these techniques to educate healthcare providers, parents, and others.

Methods of Developing the Guideline

• Recommendations were developed by the Clinical Affairs Committee's Behavior Management Subcommittee, adopted in 1990, and revised from the 2015 version.
• The 2020 revision reviewed current research and professional expertise.
• A PubMed/MEDLINE search (see Appendix 1 after References) was conducted.
• Data was summarized on behavior guidance for patients and children, with special healthcare needs, including expert and consensus opinions.

Background

• Dental practitioners must effectively treat childhood dental diseases, understanding the child's/family's responses.
• Behavior guidance is a continuous interaction between the dental team, patient, and parent, focused on communication, education, and safety.
• Cultural and linguistic factors can influence patient cooperation.

Predictors of Child Behaviors

• Patient attributes (developmental stage, dental attitudes, temperament) influence responses to dental procedures.
• Factors like anxiety, previous experiences, inadequate preparation, pain, and parenting practices contribute to noncompliance.

Dentist/Dental Team Behaviors

• The dentist's attitude, body language, and communication skills are crucial in creating positive experiences.
• Clear instructions, empathy, verbal reassurance enhance patient cooperation.
• The scheduling coordinator/receptionist plays an important communication role (welcoming, information, and concerns).

Pain Assessment and Management

• Pain directly affects behavior and needs to be assessed and managed actively.
• Sources like self-report, behavioral observations, and biological measurements (heart rate, sweating) are helpful in pain assessment.
• Pain evaluation helps anticipate behavior problems and build trust.

Treatment Deferral

• Dental treatment urgency is crucial when a patient's behavior or cognitive skills hinder routine care.
• Treatment deferral may be considered in these cases, involving appropriate discussion of risks/benefits/alternatives.

Advanced Behavior Guidance Techniques

• Techniques like protective stabilization, sedation, and general anesthesia are considered for specific cases, requiring skilled assessment and informed consent.
• These advanced techniques address situations involving uncooperative patients, special health care needs, and potentially complex care.

Communication Techniques

• Many aspects of communication are crucial to effective interaction between the patient, practitioner, and family. Including consideration for cultural, linguistic, and emotional considerations.
• Tell-show-do, ask-tell-ask formats, voice control, and positive reinforcement are also included in this guideline.

Patient Assessment

• Assessing a child's potential for cooperation is essential prior to treatment planning.
• Information from parents (emotional state, behaviour history, and family dynamics) provides insights into predicted responses to dental procedures.
• Observing the child's reactions and interactions can aid in evaluating behavior during treatment.

Additional Considerations

• Sensory-adapted environments (SADE): these strategies help calm (dimmed lights, background music).
• Animal-assisted therapy (AAT): companionship reduces anxiety and stress for patients.
• Picture exchange communication systems (PECS): aids communication for those with limited verbal skills.
• Nitrous oxide/oxygen inhalation: provides rapid, reversible analgesia, amnesia, and gag reflex reduction.