Non-Pharmacological Interventions

• Non-pharmacological interventions (NPIs) in behaviour management
• Foundation in Clinical Skills Practice

Intended Learning Outcomes

• Aims to introduce you to non-pharmacological interventions used in behaviour management
• By the end of the session, you should be able to describe common non-pharmacological interventions used for behaviour management
• You should also be able to reflect on how and when to use these techniques in the clinical setting

Assessment

• Formative assessment includes a workbook and a glossary of terms
• Summative assessment includes OSCE which draw on communication skills, e-assessment, and clinical care
• Future learning will involve dental therapy and effective and quality oral health care provision

Definition of Non-Pharmacological Interventions (NPIs)

• Non-pharmacological interventions (NPIs) are techniques used to manage behaviour
• They help instill positive attitudes towards oral health care and behaviours and ultimately improve oral health
• NPIs link back to Psychology in Clinical Practice, Pain management and communication lectures
• NPIs are achieved through communication skills and a patient-professional relationship, improving education

Purpose of Non-Pharmacological Interventions

• They reduce anxiety and manage pain
• NPIs manage behaviour and lead to a positive experience
• Consider signs of dental anxiety and examples of poor behaviour

Intervention Types

• Interventions: pharmacological and non-pharmacological
• Pharmacological includes Anaesthesia, Conscious sedation, and Medication
• Non-pharmacological: Communication skills, Behaviour modification, and Psychotherapeutics

Evidence-Base and Guidance

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

Communication Skills

• Communication Skills use OARS (open questions, affirmations, reflections and summaries) and non-verbal skills
• Language used should be age and patient appropriate versus professional
• Tone of voice is important
• Links back to lectures on Communication and Behaviour Change

Communication With Children and Special Needs Patients

• Centre communication around the patient
• Communication must occur between the patient's parent/carer and professional support staff

Tell-Show-Do

• A method of communication which involves telling explaining, demonstrating/modelling and then action

Activity 1 In Your Workbook: Apply The Tell-Show-Do Technique For

• 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 autism aged 30 years

Distraction

• Help shift patient's focus from the procedure or environment that may be unpleasant, to something/somewhere else more pleasant

Guided Imagery

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

Relaxation

• Reduce anxiety with guided breathing techniques and guide patient to take 5 deep breaths
• Also consider the patient may listen to music or have a conversation to relax.

Positive Reinforcement

• Acknowledge appropriate behaviour to encourage it to be repeated.
• Ignore inappropriate behaviour so as not to draw attention to it and discourage it.

Enhancing Control

• Patients can feel out of control during a dental visit; therefore, dentists can give back some control
• Rehearse to gain your patients' trust

Modelling

• Learning by observation of someone important to them such as a sibling, parent, or favourite TV character
• Could form part of preparatory information; for example, a video of a dental visit

Structured Time

• Patients' tolerance of a procedure can increase if they know how long it will take
• It is better to give definite estimates e.g. "just a bit more", or "vs 5 seconds to count down"
• Needs to be appropriate to patients' development

Activity 2 In Your Workbook

• Building on the previous activity scenarios, discuss what other techniques you could use in conjunction to the tell-show-do approach

When to Apply NPI?

• Explain procedures, apply to children at the first clinical encounter
• Apply NPI to patients with special needs, patients that are dentally anxious
• No single intervention works effectively in isolation; a combination of interventions is usually appropriate
• Every patient is different; therefore, NPI is not appropriate for every situation
• Apply NPI naturally, others need more thought and conversation

Other Advanced Techniques

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

Workbook and terms

• Complete the table in the workbook by adding definitions, examples, and situations for when you might use non-pharmacological interventions
• You can add a Glossary of Terms to include language appropriate terms
• The workbook can be submitted on Moodle for feedback by Friday 13/05/22

Activities

• Activity 3 look for do you notice any NPIs throughout the finding Nemo video and write them down.

• Reflect on the impact of the patients in the reception area.

• Activity 4 reflect on why these may need to implement NPI

• 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

Summary of Non-pharmacological interventions

• Summary of context, evidence-based guidelines, types and how and when to apply
• Future learning includes dental Psychology in Year 2, Paediatric oral health care in Year 2 and 3 and Clinical care