PEDIA1 - Pediatric Dentistry 1 PDF

PEDIA1 – Pediatric Dentistry 1 First Grading Introduction to Pediatric Dentistry PEDIATRIC DENTISTRY - A positive professional attitude towards - The practice, and te...

PEDIA1 – Pediatric Dentistry 1 First Grading Introduction to Pediatric Dentistry PEDIATRIC DENTISTRY - A positive professional attitude towards - The practice, and teaching of and research in children, adolescents, and their parents. comprehensive preventative and therapeutic oral health care of children from birth through OBJECTIVES OF PEDIATRIC DENTISTRY adolescence. - Giving comfort, relieving pain, removing o PH: 0-18 years old infection and restoring functions. o 0-19 years old - Alleviating fear and anxiety and modifying the - Prevention is the cornerstone of pediatric child’s behavior. dentistry. - Promoting oral health by prevention and o Without preventive measures, education. treatments are deemed ineffective. - To develop a positive attitude and behavior towards oral health. PEDODONTIST o First appointment of a child in the - A specialist in the field of dentistry dealing dental clinic is at 6 months (first particularly with the oral health care of eruption of primary mn. central children, from infancy through the later incisors). teenage years. - Implement the principles of preventive - It also deals with medically, emotionally, and dentistry from birth. physically compromised patient. - Parental guidance and counseling regarding different facets of preventive dentistry and CHILD treatment modalities. - Biologically, anyone in the developmental - Early diagnosis of the diseases and treatment. stage of childhood, between infancy and - Managing children with special needs adulthood. (physically, mentally, and medically). - “Every human being below the age of 18 years unless, under the law applicable to the child, FIELD OF PEDIATRIC DENTISTRY majority is attained earlier.” 1. Preventive dentistry - Diet Children are different from adults in a number of ways: - Oral hygiene 1. Children are individuals in growth and - Fluoride application development - Pits and fissure sealants a. Physical - Sports appliance b. Psychological - Oral/facial development c. Social d. Cognitive *Mn. 1st molar – first tooth that gets destroyed e. Emotional 2. Attitudes and behavior relating to oral health. Main goal of preventive dentistry: to prevent 3. They are not able to foresee consequences of malocclusion (caused by premature extraction, their own decision and behavior. discrepancy between jaw size and tooth size, bad habits like thumb sucking, mouth breathing) CHILD COMPETENCY - A specific insight into the dental and oral 2. Operative dentistry health for the child and adolescent. - Restoration - An ability to communicate effectively with o Filling materials – amalgam and children, adolescents, and their parents. composite 1 PEDIA1 – Pediatric Dentistry 1 First Grading Introduction to Pediatric Dentistry 3. Endodontics EXTREMES OF PARENTAL BEHAVIOR - Pulpal treatment 1. Overprotection - Pulpotomy - Exaggeration of love and affection. - Pulpectomy - It may manifest as: o Extreme dominance Pulpotomy Pulpectomy o Extreme indulgence The crown part of the The pulp of both the pulp is removed and crown and the root is Characteristics of an overprotective parent to a child: filled removed and filled - Shy - Delicate 4. Prosthodontic - Submissive - Strip of crown (SOC) - Fearful o Applicable for anterior teeth NOTE: This may affect the initiative or decision-making. - Stainless steel crown (SSC) - RPD As a pediatric patient in the dental clinic: - CD - Ideal patient - Obedient 5. Surgery - Polite - Responsive RESPONSIBILITIES OF PEDIATRIC DENTIST 1. Manage and treat the average child patient 2. Rejection with confidence. - Constantly criticized 2. Promote positive and compliant behavior in - Nagged the child patients. - Tormented with overt displays of displeasure 3. Prevent and manage caries and periodontal - Resistance to spending money on child diseases in children. NOTE: It may manifest as delinquent child. 4. Monitor child’s developing occlusion. 5. Identify and manage dental Characteristics of a rejected child: infection/anomalies affecting children. - Inferior and neglected 6. Manage trauma affecting primary and young - Uncooperative permanent teeth. - Lack of love and affection - Suspicious PARENT COUNSELING AND BEHAVIOR - Aggressive Communication - Revengeful - Establish good rapport - Disobedient - Fix appointments - Restless - Keep them well informed - OH education to promote home care As a pediatric patient in dental clinic: - Difficult to control PARENT’S RESPONSIBILITY TOWARDS BEHAVIOR OF CHILD - Demanding Conditioning of the child towards the treatment in - Misbehaves to call attention terms of the following state: - Emotional status of the child - Psychological behavior of the child - Mental capability of the child 2 PEDIA1 – Pediatric Dentistry 1 First Grading Introduction to Pediatric Dentistry 3. Overanxiety - A result of some previous tragedy following: o Accident o Illness As a pediatric patient in dental clinic: - Difficulty overcoming their fears - Need more encouragement - Timid, fearful, and shy 4. Domination - Parents exemplify demand excessive responsibility which is incompatible to their chronological age. As a pediatric patient in dental clinic: - With kindness and consideration, they may end up as a good patient. 5. Over-identification - If the child does not respond favorably, it will lead to disappointment. As pediatric patient: - They are handled as in domineering patient. PARENTAL BEHAVIOR IN THE DENTAL OFFICE - Should have complete confidence in the dentist. - Should assume as a passive guest. - Should not speak to the dentist unless asked to do so. - Should not give misinformation extending sympathy. 3 PEDIA1 – Pediatric Dentistry 1 First Grading Behavioral Management in Pediatric Dentistry INTRODUCTION COMMONLY SEEN EMOTIONS IN A CHILD - It is a care directed toward communication 1. Fear and education of the pediatric patient. - An unpleasant emotion or effect consisting of psycho-physiological changes in response to Goals realistic threat or danger to one’s own - Maintain communication experience. - Reduce fear - Innate, subjective, objective - Extinguish inappropriate behavior - Elicit behavior consistent with the need for 2. Anxiety successful completion of dental treatment - A feeling of worry, nervousness, or unease, typically about an imminent event or BEHAVIOR MANAGEMENT something with an uncertain outcome. - It means by which dental health team effectively and efficiently performs treatment Types of Anxiety Trait anxiety Temperament, jittery, hypersensitive to for a child and at the same time, instills a stimuli positive dental attitude. Free floating anxiety Persistently anxious mode - Centers on the attitude and integrity of the Situational anxiety Seen on specific situations or objects entire dental team. General anxiety Chronic pervasive feeling of anxiousness whatever the external circumstances Relationship of dentist in pediatric and adult patients: 3. Phobia Pediatric patient Adult patient - A persistent fear of an object or situation in 3 people involved: 2 people involved: which the sufferer commits to great lengths in - Dentist - Dentist avoiding, typically disproportional to the - Parent - Patient actual danger posed, often being recognized - Patient as irrational. *Treatment cannot 4. Anger ensue without the - An emotion characterized by antagonism parent toward someone or something you feel has deliberately done you wrong. Different terms in Behavioral Management Behavior The way someone moves, 5. Cry functions, or reacts to a given - The shedding of tears in response to an situation or stimulus emotional state. Other definition The way in which a person acts in response to a particular Types of Cry environment Obstinate cry Shows temper tantrum to dental treatment, Behavior A study of science which helps to loud and high pitched, siren like wail, represents child’s external response to pediatric understand development of fear, anxiety dentistry anxiety, and anger as it applied to Frightened cry Accompanied by torrent tears, convulsive child in dental situations breath-catching sobs, they are overwhelmed by the situation Emotion A state of mental excitement Hurt cry Loud cries, more frequently accompanied characterized by physiological, by whimper, initially shows a single tear behavioral changes and from the corner of eye without making any alterations of feelings sound or resistance treatment procedure 4 PEDIA1 – Pediatric Dentistry 1 First Grading Behavioral Management in Pediatric Dentistry Compensatory cry Not a cry at all; sound that child makes to 3. Timid drown out the noise; cry is slow, monotone, - Usually seen in overprotected children sort of coping mechanism to unpleasant - Shy but cooperative stimuli 4. Tense cooperative - Border line between positive and negative behavior INFLUENCING CHILDREN’S DENTAL BEHAVIOR - Does not resist treatment but the 1. Parental (Maternal) anxiety child is tensed at mind 5. Whining - Form of anxiety manifested on the child by the - Complaining type of behavior mother towards the dental treatment. - Allow for treatment but complains throughout the procedure 6. Stoic 2. Medical history - Seen in physically abused children - Cooperative and passively - An experience based on the past medical accepts all the treatment without related visits which is translated during the any facial expression - Cooperative but do not dental visit. communicate 3. Awareness of dental problems Lampshire’s Classification of Behavior (1970) - Understanding the dental need for treatment Cooperative - Physically and emotionally relaxed with existing dental problem. - Adheres to the whole procedure Tense cooperative - Slight apprehension but Wright’s Classification of Children’s Behavior (1975) cooperative Outwardly apprehensive - Avoids treatment initially, usually Cooperative - Reasonably relaxed hides behind the mother, avoids - Minimal apprehension; may even looking or talking to the dentist be enthusiastic - Eventually accepts dental - Can be treated by a treatment straightforward, behavior- Fearful - Requires considerable support so shaping approach as to overcome the fears of dental Lacking cooperative ability - Includes very young children with treatment whom communication cannot be Stubborn/Defiant - Passively resists treatment by established and of whom using techniques that have been comprehension cannot be successful in other situations expected. Hypermotive - Acutely agitated and resorts to - Also children with specific screaming, kicking, and other debilitating or disabling forms of negative behavior conditions (special behavior guidance techniques are used for Handicapped - Physically/mentally, emotionally them). incapable of understanding - Immediate major positive treatment behavioral changes cannot be Emotionally immature - Very young children, not able to expected follow instructions - Unexpected apprehension - Not yet prepared to undergo Potentially cooperative - Have the capability to perform treatment cooperatively, but because of the inherent fears (subjective/objective), the child does not cooperate. - Child’s behavior can be modified = child can become cooperative Adverse (un-coopertive) reactions have been given specific labels: 1. Uncontrolled - Preschool children at their first dental visit - Temper tantrums 2. Defiant - In any age group - Spoilt or stubborn - Can be made cooperative 5 PEDIA1 – Pediatric Dentistry 1 First Grading Behavioral Management in Pediatric Dentistry Frankl Behavior Rating Scale TEAM ATTITUDE Rating 1: Definitely Negative Refusal of treatment, crying - Have a pleasant working environment with forcefully, fearfulness, or any other overt evidence of extreme your dental auxiliaries. negativism. - Children respond best to a natural and friendly Rating 2: Negative Reluctance to accept treatment, uncooperative behavior, some attitude. evidence of a negative attitude but o Casual greeting not pronounced (i.e., sullen, withdrawn). o Use of nicknames Rating 3: Positive Acceptance of treatment, at times o Noting school accomplishments or cautious, willingness to comply with the dentist, at times with reservation extracurricular activities but follows the dentist’s directions - Limiting the focus of conversations to the cooperatively. Rating 4: Definitely Positive Good rapport with the dentist, individual patient and his needs during the interested in the dental procedures, delivery of dental care can allow the patient to laughing and enjoying the situation. feel prioritized. FUNDAMENTALS OF BEHAVIOR MANAGEMENT ORGANIZED PLANS AND PROTOCOLS - Involves the total dental health team. - Every appointment should be planned ahead o All personnel have a stake in guiding a to deliver effective treatment child through the dental experience. - Each dental office must devise its own - Behavior guidance: the means by which the contingency plans, and the entire office staff dental health team effectively and efficiently must know in advance what is expected of performs treatment for a child and, at the them and what is to be done. same time, instills a positive dental attitude. o Increase efficiency and contribute to o Effectively – provision of high-quality successful dental staff-pediatric dental care. patient relationships. o Efficient treatment – a necessity in - Well-organized, written treatment plans must private practice be available. - Delays and indecisiveness can build The following fundamentals of behavior guidance apprehension in young patients. center on the attitude and integrity of the entire dental team. TRUTHFULNESS AND CREDIBILITY - Pediatric patient should be dealt without in- POSITIVE APPROACH between for discussion of dental treatment - The attitude or expectations of the dentist can - Most children see things as either “black” or affect the outcome of a dental appointment. “white.” o Approach the child in a friendly and - Important in building trust accommodating manner. - Recognizing and acknowledging a patient’s § Compliment child for showing fear and anxiety up o Empathizing such emotions helps § Show confidence in your provide assurance capabilities as a dentist - Clear communication is needed - The child will respond with the type of behavior expected. - Positive statements increase the chances of success with children. - It is important that the dentist anticipates success. 6 PEDIA1 – Pediatric Dentistry 1 First Grading Behavioral Management in Pediatric Dentistry TOLERANCE AND EMPATHY - Use successive approximations (TSD) - The dentist’s ability to cope rationally with - Reinforce appropriate behavior misbehaviors while maintaining composure. - Tolerance level varies from person to person What is the best behavior management techniques and fluctuate for a given individual. to be done? TELL-SHOW-DO FLEXIBILITY CONSIDERATION OF CHOICE OF BEHAVIOR MANAGEMENT - Every dentist should be able to treat the child - Urgency of care as adaptable and can be able to adjust to - Need for cooperation every situation if needed. - Skill of the practitioner - The dental team must be prepared to change - Options available at each clinic its plans at times. - Parental considerations COMMUNICATION WITH CHILDREN’S BEHAVIOR FACTORS PRIOR TO CHOOSING A BEHAVIORAL Multisensory - Use of different senses that the patient or MANAGEMENT TECHNIQUE communication child can relate during treatment. - There are 3 factors to consider: - Alternative methods, including referral o Transmitter - Dental needs (dentist/clinician) o Medium (office environment) - Expectations of the parents or caregiver o Receiver (child/patient) - Emotional development of the child Problem ownership - By showing the patient to send the - Past medical history message of giving the proper treatment than showing the problem to the child. - Ability of caregiver or person accompanying - Constant reminder or affirmation is very child to give consent important Active listening More on the older child that a dentist should be able to understand the problem being presented and Prior to doing the behavior management… treated. Appropriate In every action, there is suitable reaction when INFORMED CONSENT is a process for getting response communicating while treating the patient. permission before conducting a healthcare Message clarity Let the patient understand what the treatment to be and Voice control done in the way the child can understand. intervention on a patient/child. Establishment of Involve the child in the treatment by conversing communication Establishment of Make sure to address the patient your authority during BEHAVIORAL MODIFICATION METHODS the communicator treatment. Tell-show-do Positive reinforcement Voice control Modeling BEHAVIOR SHAPING Playful humor Fading - A procedure which very slowly develops Distraction Systemic desensitization behavior by reinforcing successive approximations of the desired behavior until 1. TELL-SHOW-DO the desired outcomes. - Objectives - AKA: STIMULUS-RESPONSE o Teach the patient important aspects - Most effective: TELL-SHOW-DO of the dental visit and familiarize with the dental setting. OUTLINE FOR BEHAVIOR-SHAPING MODEL o Shape the patient’s response to - State the general goal or task to the child procedures through desensitization - Explain the necessity for the procedure and well-described expectations. - Divide the explanation for the procedure - Let the patient be involved - Explain each procedure at the level of understanding of the child 7 PEDIA1 – Pediatric Dentistry 1 First Grading Behavioral Management in Pediatric Dentistry TELL: verbal explanations in phrases appropriate to the 5. POSITIVE REINFORCEMENTS developmental level of the patient - Social reinforcers SHOW: demonstrations for the patient to o Positive voice modulation visually, auditory, and tactile presentation of o Facial expression the procedure in a careful manner and non- o Verbal praise threatening o Appropriate physical demonstration DO: without deviating from the of affection explanation and the patient is read to - Nonsocial reinforcers have the application of the procedure o Tokens o Toys 2. VOICE CONTROL - Objectives 6. MODELING o Gain patient’s attention and - Allowing the patient to observe one or more compliance individual o Avert negative or avoidance of - Patient frequently imitates the models behavior o Live o Establish appropriate dentist-child o Filmed roles o Posters - A controlled alteration of voice, volume, tone o Audiovisuals or pace to influence and direct the patient’s behavior. 7. FADING - Both a communication and a management - Providing an external means to promote technique. positive behavior and then gradually removing the external control. 3. PLAYFUL HUMOR - To make use of having a positive condition of Types of Behavioral Management Technique in showing different means to introducing a Pediatric Dentistry procedure in fun label and using imagination. Non- - By the use of physical or mechanical means of pharmacologic restraining the patient to effectively and o Costumes management efficiently to do dental treatment. o Play Pharmacologic - By the use of different drugs and their routes to management overcome anxiety, apprehension, fear and o Dental set-up other negative behavior towards effective and efficient dental treatments. 4. DISTRACTION Types of Non-pharmacologic Management - Objectives Physical Immobilizing the patient using a person or person’s body to o Decrease the perception of restraints limit movement of the patient during treatment. - Head holds/locked unpleasantness - Knee-to-knee o Avert negative or avoidance of - Hand guarding - Hug guard/Lap locked behavior - Hand-over-mouth-exercise (HOME) § Music Mechanical Immobilizing the patient using tools, equipment, or restraints instruments to limit the movement of the patient during § Video treatment. § Talking - Oral (mouth props, bite blocks, tongue-wrap) - Body (head papoose board, pedi-wrap, sheets, § White noise straps and seat belts, towels, vests, wrist § Hypnosis bracelets) § Breathing 8