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Flashcards in 1. Behavioral Management Deck (78):
1

The AAPD encourages parents an other care providers to help every child establish a dental home by what age

No earlier than 6 months no later than 12 months

2

What is the most common chronic childhood disease

dental caries

3

Dental caries are _ time more common than hayfever and _ times more common than asthma

7... 5

4

What are the three components of the pedo treatment triangle for ideal conditions (well behaved kid) and describe their arrangement

Apex of the triangle= Child patient
Family (mother)
Dentist and environment
Society is in the middle of the triangle

5

Why is society in the middle of the treatment triangle

society impacts how the child and parent respond and influenced much of what we do

6

Why is the child at the top of the triangle

Because they are the focus of the appointment

7

The personalities of the people at the corners of the treatment triangle are always_

changing

8

T/F Hand over mouth exercise used to be an accepted practice by the AAPD

t- it no longer is

9

Purpose of hand-over-mouth exercise

gain attention of highly oppositional child so that communication can be established

10

Poor maladaptive acts (like screaming, kicking, etc.) are linked to what at home?

restraint

11

Cooperative behavior is related to what at home?

Removal of the restriction and the use of positive reinforcement (praise)

12

Describe how the treatment triangle changes when less-than-ideal circumstances occur

Dentist is at the apex
Triangle is inverted
Conflict and tension exist rather than harmony and trust

13

Behavior guidance techniques (pharmacological and non-pharmacological) are used to...

-Alleviate anxiety
-Provide safe and quality treatment
-Nurture positive dental attitude

14

Predictors of child behavior

-Patient attributes (i.e how verbal are they, developmental level, etc.)
-Parental Influences
-Orientation to dental environment (friendly play area)
-Patient assessment (Past experiences, current emotional state)
-Dentist/Dental team behaviors

15

Potential patient attributes that may be a reason for non-compliance are

-developmental delays
-chronic disease
-physical disability
-Cultural and linguistic factors

16

Easing a patient into the dental environment can be achieved by....

-Giving the a pre-appointment tour of the office
-Friendly waiting room environment

17

What method of listening is good to establish trust with kids

reflective listening

18

What are some basic behavior guidance techniques

-Direct observation
-Tell-show-do
-Ask-tell-ask
-Voice control
-Non-verbal communication
-Positive reinforcement and descriptive praise
-Distraction

19

What is direct observation

patients are shown either a live example or a video of a well behaved patient undergoing dental treatment

20

Describe tell-show-do

Tell
-Verbally explain the procedure

Show
-Demonstrate the visual, auditory, olfactory and tactile aspect of the procedure

Do
-Without deviating from the explanation complete procedure

21

Describe Ask-Tell-Ask

Ask
-Ask about the feelings of the patient toward the visit

Tell
-Explain the procedure
-Use demonstrations
-Provide information pertaining to their concerns

Ask
-Ask again how the patient feels about the procedure

22

Describe voice control

-Alteration of voice, volume, tone, or pace to direct behavior
-Way want to explain this to the parents before doing it to prevent misunderstanding

23

Contraindications for voice control

hearing impaired patients

24

Describe non-verbal communication

-contact
-posture
-Facial expression
-Body language

25

What is descriptive praise

emphasizes specific cooperative behaviors

26

Examples of social reinforcers are.... and non-social reinforcers

Social reinforcers
-verbal praise
-facial expressions

Non-social reinforcers
-toys
-tokens

27

Effective distractions

-Giving the kid a break during a stressful procedure
-audiovisual eyeglasses
-story telling

28

What does HOME stand for

hand over mouth exercise

29

What are the rules of Learning theory for good and bad behavior

-Maladaptive acts (kicking and screaming) are linked to restraint (HOME)
-Cooperative behavior is related to removal of the restriction and the use of positive reinforcment (praise)

30

T/F HOME is still a part of the AAPD clinical guidelines

f

31

How do dentists decide what behavior management techniques to use

Depends on
-Skill of practitioner
-Patient

32

T/F now-a-days there are an increasing number of kids with poor coping skills and can't adapt to new environments as well

T- reason being are evolving parenting styles

33

What are advanced behavior guidance techniques

-Protective stabilization
-Sedation
-General anesthesia

34

What is memory restructuring

Behavioral approach when a negative memory is restructured into a positive memory after the event has taken place

35

Memory restructuring involves what four components

-Visual reminders
-Positive reinforcement through verbalization
-Concrete examples to encode sensory details
-Sense of accomplishment

36

Which of the four components of memory restructuring is this:

-Praising the child for specific positive behavior (i.e keeping their hands on their lap or opening wide)

Concrete examples to encode sensory details

37

Which of the four components of memory restructuring is this:
-Photo of the child smiling at the visit

visual reminder

38

Which of the four components of memory restructuring is this:
-Ask child to demonstrate behaviors

Sense of accomplishment

39

Which of the four components of memory restructuring is this:
-Asking if the child told their parent about what a good job they did at the last appointment

positive reinforcement through verbalization

40

Which of the four components of memory restructuring is this:
Ask the child to role play and tell the dentist what she had told the parent

positive reinforcement through verbalization

41

T/F A wide diversity exists in practitioner philosophy and parental attitude regarding the parent's presence or absence during the dental treatment

t

42

Challenges in open and clear communication between the dentist and parent are

-Socioeconomic status
-Stress level
-marital discord
-Cultural differences
-Linguistic skills

43

What techniques can be used to enhance communication between the dentist and parent

-Ask tell ask
-Teach back
-Motivational interviewing

44

Nitrous oxide sedation with (increase/decrease) child's communication

increase

45

T/F Nitrous can't be titrated

f it can (titration technique v.s rapid induction)

46

Children requiring advanced behavior guidance technique often can't cooperate for what reasons

Lack of....
-Psycological maturity
-Emotional maturity
-Mental/physical/medical disability

47

Describe the goal of protective stabilization

restrict patient's freedom of movement to allow safe completion of treatment

48

Restriction for protective stabilization may come from

-Another human
-A stabilization device
-A combination

49

Does protective stabilization require consent

yes

50

What are the adverse consequences of protective stabilization

-Physical harm
-Psychological harm
-Loss of dignity
-Violation of patient rights

51

Protective stabilization is indicated when

-Patient's require immediate Dx and or urgent limited treatment and can't cooperate due to lack of maturity or mental or physical disability
-Emergent care is needed and uncontrolled movements risk saftey of the patient, staff, dentist, or parent
-Sedated patients require limited stabilization to help reduce untoward movement
-Previously cooperative patient becomes uncooperative and used to expedite completion of treatment

52

Protective stabilization should be used with caution in what types of patients

-Respiratory compromise (i.e asthma)
-Patients on meds that cause respiratory depression (i.e LA or sedatives)

53

Patients under protective stabilization must be monitored (continuously/intermittently)

continuously

54

General anesthesia is a state of (consciousness/unconsciousness)

unconsciousness

55

T/F Patient is often able to maintain protective reflexes when under GA

f

56

Signs of pain during treatment are

-Facial expressions
-Crying
-Complaining
-Body movement

57

What is the more reliable and frequently used scale to record a child's behavior during visits

frankl scale

58

In addition to the frankl scale what other documentation should be included regarding the child's behavior

-Verbal or non-verbal
-Things you said that made them cooperate

59

Describe a kid who is Frankl 1

-Definitely negative
-Refusal of treatment
-Forceful crying
-Fearfulness
-Any other over evidence of extreme negativism

60

Describe a kid who is Frankl 2

-Negative
-Reluctant to accept treatment
-Uncooperative
-Some evidence of negative attitude but not pronounced (sullen, withdrawn)

61

Describe a kid who is Frankl 3

-Positive
-Accepted treatment
-cautious behavior at times
-Willing to comply (at times with reservation)
-Patient follows dentist instructions cooperatively

62

Describe a kid who is Frankl 4

-Good rapport with dentist
-Interest in the dental procedures
-Laughter and enjoyment

63

Why do we want to record behavior

as a diagnostic aid in future visits

64

Informed consent is needed for which of the following
-Protective stabilization
-Sedation
-GA

All the about (all advanced behavior guidance techniques require consent)

65

What types of therapeutic interventions can be use to help get the kid out of pain while being able to defer treatment to another day until child can cooperate better

-Intrim intervention (i.e intrim therapeutic restoration (ITR))
-Fluoride varnish
-Antibiotics

66

When should treatment deferral be considered

-Treatment is in progress and kid becomes uncontrolable
-When a temporary treatment can be done to get the child out of pain til definitive treatment is rendered

67

Contraindications for pulpotomy

-Swelling or pulpal origin
-Fistula
-Pathologic mobility
-Pathologic external root resorption
-Internal root resorption
-Periapical or interradicular (ferrcal) RL
-Pulp calcification
-Excessive bleeding from the amputated radicular stumps
**History of spontaneous or nocternal pain to percusion or palpation**
***Need at least 2/3rds the root remaining***

68

ASD stands for

autism spectrum disorder

69

ASD is characterized by

-Social-interaction difficulties
-Social communication challenges
-Tendency to engage is repetitive behaviors

70

The aspects of social interaction with kids with autism includes...

-Poor eye contact
-Lack of facial expressions
-Inability to read facial expressions or understand gestures
-Difficulty with social reciprocity (i.e failure of normal back/forth conversation, failure to respond)
-Difficulty with developing, maintaining, and understanding relationships (difficulties in sharing imaginative play or in making friends to an absence of interest in peers)

71

What percent of ASD people are non-verbal

40%

72

Do non-verbal individuals necessarily not know language

no

73

In addition to difficulties in social situations kids with autism also have what other issues

sensory processing issues
-hypersensitive to sounds, smells, sights, tastes, textures, human touch
-However some are HYPOsensitive to those things

Repetitive behaviors such as...
-Repetitive body movements or using objects in repetitive manner rather than using the objects in ways they are intended to be used
-Highly sensitive to changes in their environment
-Intensely focused or attached to unusual objects
**Should see the same dentist and other staff members at each visit**

74

What are the six areas of impairment in ASD

Social communication
-Intelligence
-Social anxiety
-Use of language
-Form of language

Narrow Interests (including sensory and repetitive motor behaviors and mannerisms)
-Repetition
-Stickiness (don't want their environment to change)

75

T/F ASD patients have higher rates of caries than non ASD pateints

F- lower

76

Depending on the severity of autism what oral conditions may exist

-Bruxism --> wear
-Non-nutritive chewing
-Tongue thrusting
-Self-injury
-Erosion
-Xerostomia
-Hypergag reflex

77

Patients with autism may have significant anxiety about going to the dentist how can you make it better

-Give them a tour before their appointment
-Tell them what they can expect to see
-Sent the parent an initial intake form
-Does child prefer dimly lit room? Do certain tastes bother them? Do they perfer quite?
-Consider scheduling at a time the office is less busy
-People with ASD respond well to advanced preparation or pre-teaching
-Consider where they should wait (lobby v.s car)
-Bring another child or adult to help
-Comfort object
-Create a series of short dental office visits
-Consider their reaction to sensory stimuli
-May benefit from wearing headphones
-May like lead apron during treatment
-Dim operating lights
-Have kid wear subglasses
-Ensure a clutter free environment

78

give an example of descriptive praise

-Specific verbal praise for an action "you did a great job opening wide for me"