Pediatric Dentistry: Non-Pharmacological Behaviour Management

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Questions and Answers

What is the order in which the stimuli are introduced to the patient?

Starting with the stimulus that causes most fear

Starting with the stimulus that causes least fear (correct)

Starting with the most familiar stimulus

In a random order

Why is it important to know the basis of the child's fear?

To use aversive techniques

To ignore the fear

To understand the root cause of the fear (correct)

To prescribe medication

What is the primary objective of voice control?

To lecture the patient

To gain the patient's attention and compliance (correct)

To scare the patient

To ignore the patient

What is the maximum duration of the Hand Over Mouth (HOM) technique?

20-30 seconds Signup and view all the answers

What happens when the child exhibits negative behavior after removal of the hand in the HOM technique?

The process is repeated Signup and view all the answers

What is the purpose of the Hand Over Mouth (HOM) technique?

To modify negative behavior Signup and view all the answers

What is the goal of behavior shaping in pediatric dentistry?

To develop desired behavior by reinforcing successive approximations Signup and view all the answers

What is necessary for effective voice control?

Prior explanation to parents Signup and view all the answers

In which situation is the Hand Over Mouth (HOM) technique indicated?

For defiant or hysterical child behavior Signup and view all the answers

What is the first step in the behavior-shaping model?

State the general goal or task to the child at the beginning Signup and view all the answers

Why is it important to explain the procedure to the child?

So the child can understand the reason and cooperate Signup and view all the answers

What is the purpose of dividing the explanation for the procedure?

To break down the explanation into smaller steps Signup and view all the answers

What is the purpose of the Tell-Show-Do (TSD) technique?

To develop an accepting and relaxed child dental patient Signup and view all the answers

What is the correct order of the Tell-Show-Do (TSD) technique?

Tell, Show, Do Signup and view all the answers

Why is praise important in the Tell-Show-Do (TSD) technique?

To reinforce positive behavior Signup and view all the answers

What is the importance of using language suitable to the child's age in the Tell-Show-Do technique?

To ensure the child understands the procedure Signup and view all the answers

What is the primary goal of retraining in pediatric dentistry?

To determine the source of the problem and avoid it Signup and view all the answers

At what age is modeling most effective in pediatric dentistry?

More than 3 years of age Signup and view all the answers

What is the primary purpose of reinforcement in pediatric dentistry?

To strengthen a pattern of behavior Signup and view all the answers

What is an example of a distracter in pediatric dentistry?

A cartoon or story Signup and view all the answers

What is the purpose of desensitization in pediatric dentistry?

To reduce fear in children through relaxation techniques Signup and view all the answers

What is the difference between positive reinforcement and negative reinforcement?

Positive reinforcement is a pleasant consequence, while negative reinforcement is the withdrawal of an unpleasant stimulus Signup and view all the answers

What is an example of a reward in pediatric dentistry?

A toy or game Signup and view all the answers

Why is it important to use models that are the same age and sex as the patient?

To make the model more relatable Signup and view all the answers

Who may require protective stabilization during a dental procedure?

Infants Signup and view all the answers

In what situation is protective stabilization contraindicated?

When the patient is a cooperative non-sedated patient Signup and view all the answers

What is a common mechanical aid for maintaining the mouth in an open position?

Wrapped tongue blades Signup and view all the answers

Why might a patient require protective stabilization?

Because they require immediate diagnosis and/or limited treatment and cannot cooperate Signup and view all the answers

What is a type of device used for protective stabilization of the head?

Forearm-body support Signup and view all the answers

What should be obtained before using protective stabilization?

Informed consent Signup and view all the answers

Who should not be stabilized using physical restraints?

Patients who have experienced previous physical or psychological trauma from protective stabilization Signup and view all the answers

What is the primary purpose of protective stabilization?

To deliver dental care to patients who need help controlling their extremities Signup and view all the answers

Study Notes

Non-pharmacological Techniques of Behaviour Management

Non-aversive techniques aim to modify the child's behaviour without causing fear or anxiety.

Behaviour Shaping

A procedure that develops behaviour by reinforcing successive approximations of the desired behaviour.
Involve dividing the explanation of the procedure into steps, leading the child through the procedure slowly, and progressing step by step to the goal.
The time spent on each step depends on the child's behaviour.
Examples of steps for introducing restorative treatment to an average school-aged child:
- Examination and prophylaxis
- Fissure sealant or topical fluoride application
- Minimal occlusal restoration without local anesthesia
- Infiltration anesthesia and restoration
- Inferior dental nerve block and restoration

Tell-Show-Do (TSD)

A technique used in the educational phase of developing an accepting relaxed child dental patient.
Involves telling the child about the treatment, showing at least some part of how it will be done, and then doing it.
Must be followed by praise to ensure smooth continuity through the T-S-D stages.
Indications:
- First visit
- When introducing new dental procedure
- Fearful child
- Apprehensive child
Effective in children more than 3 years of age

Retraining

For children who display considerable apprehension or negative behaviour due to previous dental visit or improper parental or peer orientation.
Determine the source of the problem and use a distraction or another technique to retrain the child.
May be joint with the use of sedation

Modeling

A technique where individuals learn from observing the consequences of other people's behaviour.
Models are either live models or videotapes of co-operative patients.
Better to use same age and sex models to illustrate the rewards for performing appropriately

Reinforcement

Strengthening a pattern of behaviour that increases the probability of that behaviour being displayed in the future.
Child's behaviour is a reflection of responses to the rewards and punishment of the environment.
Positive reinforcement: pleasant consequence follows response.
Negative reinforcement: withdrawal of unpleasant stimulus after a response.

Distraction

Attempts to shift attention from the dental setting towards some other kind of situation.
Distracters, such as cartoons, stories, can be used.

Desensitization

A three-stage process used to overcome fears:
- Train the patient to relax
- Construct a series of fear-producing stimuli related to the patient's principal fear
- Introduce each stimulus in the series in turn to the relaxed patient, starting with the stimulus that causes least fear

Aversive Techniques

Voice Control

A controlled alteration of voice volume, tone, or speed to influence and direct the patient's behaviour.
Objectives:
- Gain the patient's attention and compliance
- Avert negative or avoidance behaviour
- Establish appropriate adult-child roles

Hand Over Mouth (HOM)

An aversive behaviour modification technique used to modify a negative child's behaviour.
Should not last for more than 20-30 seconds.
Must be paired with voice control.
Indication: normal child exhibits defiant or hysterical behaviour.
Contraindication: disabled, immature, and medicated children whose understanding of the situation is compromised.

Physical Restraint

Protective stabilization of the patient is sometimes necessary to diagnose and deliver dental care.
Indications:
- Patient requires immediate diagnosis and/or limited treatment and cannot cooperate due to lack of maturity or mental or physical disability.
- Patient requires diagnosis or treatment and does not cooperate after other behaviour management techniques have failed.
- Safety of the patient, staff, parent, or practitioner would be at risk without the use of protective stabilization.
Contraindications:
- Cooperative non-sedated patient
- Patients who cannot be safely stabilized due to medical or physical conditions
- Patients who have experienced previous physical or psychological trauma from protective stabilization (unless no other alternatives are available)
- Non-sedated patients with non-emergent treatment requiring lengthy appointments.

Mechanical Aids and Protective Stabilization Devices

Common mechanical aids for maintaining the mouth in an open position:
- Wrapped tongue blades
- Open Wide
- Molt Mouth Prop
- Rubber bite blocks
Common protective stabilization devices:
- Papoose Board
- Triangular sheet
- Pedi-Wrap
- Body straps
- Velcro straps
- Towel and tape
- Extra assistant
- Head positioner
- Plastic bowl
- Extra assistant

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Description

This quiz covers non-aversive techniques of behavior management in pediatric dentistry, including behaviour shaping and reinforcing successive approximations.