Non-Pharmacological Interventions

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Questions and Answers

Which of the following interventions involves gradually exposing a patient to anxiety-provoking stimuli while they practice relaxation techniques?

  • Systematic desensitization (correct)
  • Clinical holding
  • Cognitive Behavioral Therapy (CBT)
  • Hypnosis

A dentist is preparing to treat a young child with dental anxiety. Considering the principles of non-pharmacological interventions (NPIs), what is the MOST important initial step?

  • Immediately starting the dental procedure to minimize distress.
  • Administering a mild sedative to reduce anxiety.
  • Creating a child-friendly environment in the waiting area.
  • Assessing the child's anxiety level and understanding their specific fears. (correct)

Which of the following techniques involves physical restraint to ensure safety?

  • Systematic Desensitisation
  • Clinical Holding (correct)
  • Hypnosis
  • Cognitive Behavioural Therapy

A dentist notices several patients displaying signs of anxiety in the reception area. What modification to the environment might MOST effectively reduce their anxiety?

<p>Providing comfortable seating and calming visual elements. (D)</p> Signup and view all the answers

In which of the following scenarios would Cognitive Behavioral Therapy (CBT) be MOST applicable as a non-pharmacological intervention?

<p>An adult with a phobia of dental procedures, exhibiting avoidance behavior. (A)</p> Signup and view all the answers

Which resource provides updated guidelines specifically for non-pharmacological behavior management in pediatric dentistry?

<p>British Society of Paediatric Dentistry (C)</p> Signup and view all the answers

Which of the following components is the MOST essential when documenting the use of non-pharmacological interventions?

<p>A detailed description of the specific techniques employed and the patient's response. (A)</p> Signup and view all the answers

Why is it important to include language appropriate terms in a glossary of Non-Pharmacological Intervention (NPI) terms?

<p>To facilitate clear communication and understanding with patients and their caregivers. (B)</p> Signup and view all the answers

What is the MOST appropriate way to apply non-pharmacological interventions in dental practice?

<p>Adapting techniques based on the patient’s specific anxiety triggers and developmental stage. (D)</p> Signup and view all the answers

When considering the environment of a dental practice, what is an important factor that can reduce patient anxiety?

<p>Aromatherapy scents, such as lavender, to create a calming atmosphere. (A)</p> Signup and view all the answers

Which communication technique involves using open questions, affirmations, reflections, and summaries?

<p>OARS (B)</p> Signup and view all the answers

What is the primary goal of using distraction techniques during a dental procedure?

<p>To shift the patient's focus away from unpleasant aspects of the procedure. (D)</p> Signup and view all the answers

In the 'Tell-Show-Do' technique, what is the purpose of the 'Show' step?

<p>To visually demonstrate the procedure or equipment to the patient. (A)</p> Signup and view all the answers

What is the key emphasis when using language to communicate with patients, especially children?

<p>Ensuring the language used is age-appropriate and easily understandable. (B)</p> Signup and view all the answers

Which of the following is the MOST effective way to guide a patient through a relaxation technique?

<p>Guiding the patient to take five deep breaths. (D)</p> Signup and view all the answers

A dentist is treating a 7-year-old patient. Applying the tell-show-do technique, after telling and showing, what would be the next step?

<p>Proceeding with the procedure. (B)</p> Signup and view all the answers

What does 'positive reinforcement' primarily aim to achieve in a dental setting?

<p>To increase the likelihood of appropriate behavior being repeated. (D)</p> Signup and view all the answers

What is the MOST important consideration when selecting a distraction technique for a patient?

<p>The patient's individual preferences and interests. (D)</p> Signup and view all the answers

During root surface debridement on a patient, if the patient appears anxious despite relaxation techniques, what would be the MOST appropriate next step?

<p>Pausing the procedure to reassess the patient's comfort and explore additional relaxation methods. (C)</p> Signup and view all the answers

A 30-year-old patient with autism spectrum disorder requires a BPE (Basic Periodontal Examination). Which modification to the standard communication approach would be MOST beneficial?

<p>Employing clear, simple language and visual aids; minimizing sensory stimulation. (D)</p> Signup and view all the answers

A dentist is preparing a 7-year-old patient for a sealant placement. Besides the 'tell-show-do' technique, which strategy would best enhance the patient's sense of control?

<p>Rehearsing aspects of the procedure in advance. (A)</p> Signup and view all the answers

A young patient is particularly anxious about their upcoming dental appointment, during which they will receive a fluoride treatment. Drawing from the concept of modeling, what is the MOST effective preparatory method?

<p>Showing a video of a favorite cartoon character undergoing a similar procedure calmly. (C)</p> Signup and view all the answers

When treating a child, a dentist uses 'structured time' by informing them that the procedure will only take 'just a bit more'. What critical consideration must the dentist keep in mind while doing so?

<p>Whether the timeframe aligns with the child’s developmental comprehension. (B)</p> Signup and view all the answers

A dentist is preparing to administer local anesthesia to a 16-year-old patient. Aside from the 'tell-show-do' approach, what additional strategy can help manage anxiety?

<p>Rehearsing the steps of injection and employing relaxation techniques. (A)</p> Signup and view all the answers

In applying non-pharmacological interventions (NPIs) during dental treatment, which approach is generally MOST effective?

<p>Customizing a combination of interventions based on the individual patient's needs. (B)</p> Signup and view all the answers

A dentist notices a child patient becoming increasingly anxious during a routine check-up. Which initial action is MOST appropriate according to the principles of enhancing control?

<p>Taking a break and asking the child about their feelings. (D)</p> Signup and view all the answers

What is the primary goal of using modeling as a behavioral technique in pediatric dentistry?

<p>To alleviate anxiety by demonstrating a positive experience through observation. (D)</p> Signup and view all the answers

For a patient undergoing a lengthy dental procedure, how does the concept of 'structured time' MOST directly improve their experience?

<p>By increasing patient tolerance through clear expectations of duration. (A)</p> Signup and view all the answers

A dentist is performing root surface debridement on a 55-year-old patient. Building on the 'tell-show-do' approach, what additional technique/step could be implemented to help manage patient discomfort or anxiety during the same procedure?

<p>Providing noise-canceling headphones or listening to music. (B)</p> Signup and view all the answers

Which of the following scenarios exemplifies an inappropriate application of Non-Pharmacological Interventions (NPIs)?

<p>Using the same NPI for every patient. (C)</p> Signup and view all the answers

Which of the following best describes the primary aim of using non-pharmacological interventions (NPIs) in oral health care?

<p>To manage patient behavior and foster positive attitudes toward oral health, ultimately improving oral health outcomes. (B)</p> Signup and view all the answers

A dental practitioner notices a patient exhibiting signs of dental anxiety. According to the context provided, what is the MOST appropriate initial step the practitioner should consider?

<p>Employ non-pharmacological interventions to manage the patient's anxiety. (B)</p> Signup and view all the answers

In the context of clinical care, what is the MOST direct purpose of non-pharmacological interventions (NPIs)?

<p>To manage behavior and instill positive attitudes towards oral health care. (B)</p> Signup and view all the answers

Which of the following is NOT a typical component of formative assessment related to non-pharmacological interventions?

<p>Clinical care observation. (C)</p> Signup and view all the answers

What key area is assessed via OSCE (Objective Structured Clinical Examination) in the context from the text?

<p>Communication skills. (C)</p> Signup and view all the answers

A clinician is treating a young patient with a history of dental anxiety. Which approach aligns BEST with the principles of non-pharmacological interventions?

<p>Using a tell-show-do technique combined with positive reinforcement throughout the appointment. (B)</p> Signup and view all the answers

According to the information provided, which organization's guidelines were updated to inform the evidence-base and guidance on non-pharmacological interventions in dentistry?

<p>British Society of Paediatric Dentistry. (C)</p> Signup and view all the answers

What did systematic review evidence demonstrate regarding NPIs and their effectiveness in adults?

<p>NPIs were effective at reducing mental distress in adults. (A)</p> Signup and view all the answers

Which of the following scenarios BEST illustrates the application of non-pharmacological interventions (NPIs) in a dental setting?

<p>Using guided imagery and deep breathing exercises to help a patient manage anxiety during a dental procedure. (A)</p> Signup and view all the answers

A patient expresses concern that dental treatment will cause them significant pain, influencing their willingness to undergo the procedure. What BEST represents an appropriate NPI strategy in this scenario prior to commencement of treatment?

<p>Fully explaining each step, demonstrating equipment, and collaboratively establishing stop signals. (A)</p> Signup and view all the answers

Flashcards

Non-Pharmacological Interventions (NPIs)

Techniques to manage patient behavior, instill positive attitudes towards oral health care, and ultimately improve oral health.

Purpose of NPIs

To manage behaviour and instill positive attitudes towards oral health care.

Guidance for NPIs

British Society of Paediatric Dentistry guidelines and systematic reviews.

Effectiveness of NPIs

NPIs effectively reduce mental distress in adults.

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Reasons for NPI use

Poor behavior management, dental anxiety, and types of pain.

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OSCEs

Drawing on communication skills.

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Benefits of understanding NPIs

Improved patient management and oral health outcomes.

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Formative Assessment examples

Group discussions during lecture session, Workbook, Glossary of terms.

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Aim of Session

To introduce students to non-pharmacological interventions used in behaviour management.

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Future

Effective and quality oral health care provision.

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OARS

A set of communication techniques: Open questions, Affirmations, Reflections, Summaries.

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Non-verbal communication

Facial expressions, body language, and eye contact are non-verbal cues.

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Patient-appropriate language

Use vocabulary suitable for the patient's age and understanding, avoiding technical jargon.

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Tone of voice

The way you say something can impact how it's received.

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Tell-Show-Do Technique

A method involving describing the procedure, showing how it's done, and then performing it.

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Distraction

Shifting a patient's attention from an unpleasant procedure to something more pleasant.

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Guided Imagery

Guiding a patient to visualize a calming scene to ease anxiety.

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Relaxation techniques

Using breathing exercises to reduce patient anxiety.

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Positive Reinforcement

Acknowledging good behavior to encourage its repetition.

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Ignore inappropriate behavior

Ignoring unwanted actions to reduce them from happening again.

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Enhancing Control

Giving patients a sense of control during dental visits to ease anxiety.

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Modelling

Learning by watching someone important, like a parent or TV character.

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Structured Time

Improving patient tolerance by informing them how long a procedure takes.

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NPI Application

Combining multiple techniques for maximum effectiveness in NPI.

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Individualized Approach

Every patient is different, No single intervention will work in every situation.

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Building Trust

Rehearsing to ensure you gain your patients’ trust

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Preparatory Information Through Modelling

A preview video of what will happen during the dental visit

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Time perception

Comparing ‘Just a bit more’ vs 5 seconds count down can help with tolerance during the procedure.

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Combined strategies

Several strategies are best applied together.

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When to apply NPI?

Apply NPI from the first clinical interactions.

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Advanced NPIs

Advanced behaviour management techniques including systematic desensitisation, CBT, and hypnosis.

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Environmental Impact

Consider the environment and its impact on patients, noting any Non-Pharmacological Interventions (NPIs) in use.

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NPI Workbook Task

Workbook task to define NPIs with suitable examples and scenarios.

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Glossary of Terms

Glossary for defining terms related to non-pharmacological interventions, including appropriate communication language.

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BSPD Guidelines

BSPD guidelines offer recommendations for non-pharmacological behaviour management.

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SCDEP Guidance

SCDEP guidance provides direction on managing dental caries in children.

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Systematic Review Role

Systematic reviews can provide definitions related to non-pharmacological interventions.

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Context

The context in which a procedure takes place is important when using non-pharmacological interventions.

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NPI Types

Non-pharmacological interventions include a range of types, the application of which depends on the situation.

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Study Notes

  • Introduction to Non-Pharmacological Interventions in Clinical Skills Practice.
  • Intended learning outcome: non-pharmacological interventions are introduced for behavior management.
  • Learners will be able to describe common non-pharmacological interventions used for behaviour management, and reflect on how and when to use these techniques in the clinical setting.

Assessment

  • Formative assessment include group discussions during lecture sessions, workbook activities, and the glossary of terms.
  • Summative assessment includes OSCE to assess communication skills, and clinical care assessment.
  • Future learning include dental therapy, and effective and quality oral healthcare provision.

Context for Non-Pharmacological Interventions in Clinical Care

  • Non-pharmacological interventions (NPIs) are techniques use to manage behavior, instilling positive attitudes towards oral health care and behaviors, and ultimately improve oral health.
  • NPIs relate to Psychology in Clinical Practice, Pain management, and communication lectures.
  • The purpose behind NPIs is to reduce anxiety, manage pain, manage behaviour to create a positive experience.

Intervention Types

  • Pharmacological interventions include anaesthesia, conscious sedation, and medication.
  • Non-pharmacological interventions include communication skills, behavior modification, and psychotherapeutics.

Evidence-base and guidance

  • British Society of Paediatric Dentistry (Campbell et al 2011) updated Royal College of Surgeons Guidelines (2002).
  • Systematic review protocol on NPIs are available for managing dental anxiety (Anthonappa et al 2017)
  • Systematic review evidence demonstrated NPIs is effective at reducing mental distress in adults (Burghardt et al 2018).

Communication skills

  • Use OARS (open questions, affirmations, reflections and summaries).
  • Use non-verbal skills.
  • Language should be age and patient-appropraite.
  • Tone of voice is important.
  • Communication is important with children and special need patients, including patients' carers and support staff

Tell-Show-Do Technique

  • The steps include explanation, demonstration, and action.
  • Apply the tell-show-do technique for the placement of a fissure sealant for a 6-year-old patient.
  • Apply the tell-show-do technique for injections of local anaesthetic for a 16 year old patient.
  • Apply the tell-show-do technique root surface debridement for a 55 year old patient.
  • Apply the tell-show-do technique BPE for an adult patient with austism aged 30 years.

Distraction

  • Distraction helps shift a patient's focus from a procedure/environment that may be unpleasant, to something that is more pleasant.

Guided imagery

  • Use visual imagery to distract a patient by making them think of a happy place.

Relaxation

  • Reduce anxiety with guided breathing techniques.
  • Instead of telling patients to "just relax," guide patients to take 5 deep breaths.
  • Listen to music, and have a conversation to find out about ways that the patient uses to relax.

Positive reinforcement

  • Acknowledge appropriate behavior to increase its repetition.
  • Ignore inappropriate behavior so as not to draw attention to it while discouraging its repetition.

Enhancing control

  • Patients can fell out of control, therefore control can be given back, and rehearse to gain patients' trust.

Modelling

  • Learning can occur by observation of someone important ie sibling, parent, favourite toy, tv chracter etc.
  • This can form part of preparatory information like video of dental visit.

Structured time

  • Patients' tolerance of a procedure can increase knowing how long it will take.
  • 'Just a bit more' vs 5 seconds count down.
  • Needs to be appropriate to patients' development.

Activity 2

  • Apply to the previous activity Scenarios, and discuss what other techniques you could use in conjunction to the Tell-Show-Do Approach:
    • Placement of a fissure sealant for a 6 year old patient
    • Injection of local anaesthetic for a 16 year old patient
    • Root surface debridement for a 55 year old patient
    • BPE for an adult patient with austism aged 30 years

When to apply NPI

  • Apply for first time clinical encounters for children, special needs, those who are dentally anxious, explain procedures.

How to apply

  • No single intervention works effectively in isolation; the combination of interventions is usually appropriate.
  • Every patient is different, therefore it is not appropriate for every situation.
  • Some will be applied without thinking is natural, however others need some more thought and conversation.

Other advanced techniques:

  • Systematic desensitization
  • CBT
  • Hypnosis
  • Clinical holding
  • More will be covered in Year 2 Psychology

Environment

  • NPIs noticed throughout the clip.
  • Reflect on the impact of the patients in the reception area.

Summary

  • Non-pharmacological interventions context, evidence-based guidelines, types and how & when to apply.

Future Learning.

  • Dental Psychology in Year 2
  • Paediatric oral health care in Year 2 and 3
  • Clincial care

Workbook + glossary of terms

  • Complete table in workbook that includes definitions, examples and situations for when to use non-pharmocological interventions.
  • Terms to including language appropriate terms in the glossary.

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