non pharmacological management -2.pdf

“ Child management in pediatric dentistry 2 ” Presented by dr: Mohira Ezzeldin Non-pharmacological Techniques of Behaviour Management  Non aversive techniques Behaviour Shaping -It is that proce...

“ Child management in pediatric dentistry 2 ” Presented by dr: Mohira Ezzeldin Non-pharmacological Techniques of Behaviour Management  Non aversive techniques Behaviour Shaping -It is that procedure which very slowly develop behavior by reinforcing successive approximations of the desired behavior until the desired behavior occurs. -Define a series of steps on the path to the desired behaviour, and then to progress step by step to the goal.  The following is an outline for a behavior-shaping model: 1. State the general goal or task to the child at the beginning. 2. Explain the necessity for the procedure. A child who understands the reason is more likely to cooperate. 3. Divide the explanation for the procedure. Children cannot always grasp the overall procedure with a single explanation; consequently, they have to be led through the procedure slowly. An example of the steps that may be defined for the introduction of restorative treatment to an average school-aged child: 1. Examination and prophylaxis. 2. Fissure sealant or topical fluoride application. 3. Minimal occlusal restoration without local anesthesia. 4. Infiltration anesthesia and restoration. 5. Inferior dental nerve block and restoration. -The time spent on each step will depend on the child’s behavior. -The number of steps included in each session, or the number of sessions devoted to each step, will depend on how the child responds. Tell- Show- Do (TSD) -This simple technique is the backbone of the educational phase of developing an accepting relaxed child dental patient. -tell the child about the treatment to be carried out, -show at least some part of how it will be done, and then -do it. -must be followed by praise. -ensure smooth continuity through the T-S-D stages, no detailed explanation. -use language suitable to the child's age. -proper choice of words. -it lessens fears of the unknown and anticipation of pain.  Indications: 1) First visit. 2) When introducing new dental procedure. 3) Fearful child. 4) Apprehensive child. It is effective in children more than 3 years of age. Retraining -for those children who approach the dental office displaying considerable apprehension or negative behaviour as a result of previous dental visit or the effect of improper parental or peer orientation. -determine the source of the problem so that it can be avoided through another technique, or deemphasized, or a distraction can be used. This begins the retraining program which leads to behaviour shaping. -it may be joint with the use of sedation. Modeling -individuals learn much about their environment from observing the consequences of other people's behaviour. -models are either live models or videotapes of co-operative patients. -better to be same age and sex. - illustrate the rewards for performing appropriately. Reinforcement -strengthening a pattern of behaviour, which 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. --reward should be closely linked to the action. -approval is an important form of reward. -another form of reward is a present , Toys, games. --negative reinforcement: withdrawal of unpleasant stimulus after a response. (different from punishment). Distraction - attempts to shift attention from the dental setting towards some other kind of situation. -distracters e.g. cartoons, stories.  Desensitization used frequently by psychologists in the treatment of fears. -it involves three stages: 1. first, training the patient to relax; 2. second, constructing a series of fear- producing stimuli related to the patient's principal fear; 3. third, introducing each stimulus in the series in turn to the relaxed patient, starting with the stimulus that causes least fear and progressing to the next only when the patient no longer fears that stimulus. -the patient must be helped to relax before fear is overcome (classically this may need several sessions). -It is important to know the basis of the child’s fear, which may be general fear of the dentists, hospitals…, or a more specific fear of the needle, the drill…. Aversive techniques Voice Control -Voice control is a controlled alteration of voice volume, tone, or speed to influence and direct the patient’s behavior.  The objectives of voice control are to: 1. gain the patient’s attention and compliance; 2. avert negative or avoidance behavior; 3. establish appropriate adult-child roles.  Parents unfamiliar with this technique may benefit from an prior explanation to prevent misunderstanding. - Hand Over Mouth (HOM) - (HOME) is an aversive behavior modification technique used to modify a negative child’s behavior during his/her visit to a dental clinic. - -should not last for more than 20 – 30 seconds. - it has to be paired with voice control. - The dentist places his/her hand over child’s mouth and explains the kind of behavior which is expected from the child. - The child is informed that the hand would be removed only after required behavior begins. - As the child responds, the hand is removed. - If after removal of hand, negative behavior is shown, the process is repeated.  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 a necessary and effective way to diagnose and deliver dental care to patients who need help controlling their extremities, such as infants or patients with certain neuromuscular disorders., resistant patients. - It needs an informed consent.  Indication:  A patient requires immediate diagnosis and/or limited treatment and cannot cooperate because of lack of maturity or mental or physical disability.  A patient requires diagnosis or treatment and does not cooperate after other behavior management techniques have failed.  The safety of the patient, staff, parent, or practitioner would be at risk without the use of protective stabilization.  Contraindication:  A 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 nonemergent treatment requiring lengthy appointments.  Common mechanical aids for maintaining the mouth in an open position are:  wrapped tongue blades  Open Wide.  Molt Mouth Prop  Rubber bite blocks  The following are commonly used for protective stabilization:  Body  Papoose Board  Triangular sheet  Pedi-Wrap (The Medi-Kid Co., Hemet, CA, United States)  Beanbag dental chair insert  Safety belt  Extra assistant Pappose board Pedi wrap  Extremities  Posey straps (Posey Co., Arcadia, CA, United States)  Velcro straps  Towel and tape  Extra assistant  Head  Forearm-body support  Head positioner  Plastic bowl  Extra assistant