Behavioural management in children

Question 1

what is dental anxiety?

Answer 1

> Fear of pain or its anticipation

> Lack of trust, fear of betrayal

> Fear of loss of control

> Fear of the unknown

> Fear of intrusion

Question 2

what is dental dear?

Answer 2

A reaction to a specific external threatening stimulus: this is a normal reaction to threatening stimuli in the dental situation

Question 3

what are dental behaviour management problems ?

Answer 3

Uncooperative and disruptive behaviours resulting in delay of treatment or rendering treatment impossible

Question 4

what are dental fears at the different age ranges?

Answer 4

> 9-12m = Loud noise. Separation

> 2-4 yrs = Imaginary objects

> 4 yrs = Dark. Unknown

> 5-6 yrs = Social and school fears

> 6-16 yrs = Injury, death, natural events, social anxiety

Question 5

what is a dental Phobia?

Answer 5

> A special kind of fear out of proportion to the demands of the situation which will not respond to reason

> it is apparently beyond voluntary control and leads to the avoidance of dental treatment where this is necessary.

Question 6

what are the complications of dental anxiety?

Answer 6

> Stress = for the Patient, Parent and clinical staff

> Compromises provision of dental care

> Persistence of unfavourable attitude into adulthood leading to avoidance.

Question 7

what is the exogenous (things that have happened) aetiology behind dental anxiety?

Answer 7

> Previous dental treatment

> Dental health status

> SES

> Parental dental anxiety

> Siblings/peers

> PMH

Question 8

what is endogenous aetiology behind dental anxiety?

Answer 8

> Gender

> general fears

> personality type

Question 9

how do you recognise dental anxiety?

Answer 9

> Clinical affect

> Ask accompanying adult

> Ask child

> Questionnaires
- MCDASf |( most common)
- Venham’s Picture test
- CFSS-Dental Subscale

Question 10

what are the different types of child dental patients?

Answer 10

> Co-operative

> Potentially co-operative

> Lacking in co-operative ability
- Specific disability affecting ability to cooperate

> Pre co-operative
- The very young

Question 11

how do you set up for a child friendly practice?

Answer 11

> Pre-appointment information

> Child friendly waiting area

> See patient on time

> Consider introductory visit

> Good communication skills

Question 12

what are signs of verbal and non verbal positive communication?

Answer 12

> Respect

> Show interest in the child as an individual

> Give well-stated instructions

> Communicate at child’s level

> Focus on +ve

> Show ethnic, cultural and gender sensitivity.

Question 13

what are the verbal principles of communication?

Answer 13

> Be understandable

> Questioning

> Listening

> Reassure

> Praise

> Humour

Question 14

what are the non verbal principles of communication?

Answer 14

> Body language

> Proximity-personal space

> Eye contact

> Reinforcers

> Level and posture

> Empathy

Question 15

what methods are used for dealing with a Childs dental anxiety?

Answer 15

> Tell-Show-Do (eg. 3 in 1)

> Reinforcement

> Parents

> Behaviour Shaping

> Voice control

> Distraction

> Modelling

> Other methods

> Desensitisation

Question 16

what is positive reinforcement?

Answer 16

> The strengthening of a pattern of behaviour which increases the probability of that behaviour being displayed in the future

Question 17

what positive reinforcement techniques are used?

Answer 17

> Praise appropriate behaviour
- mouth opening
- sitting still

> Timing of praise

> Don’t praise disruptive behaviour- withdraw praise

> Don’t use rewards as bribes

Question 18

how can we use voice control to help manage dental anxiety?

Answer 18

> Variation in tone, pace or volume to influence and direct child’s behaviour

> Bright and airy when behaviour good

> Even and low to calm anxiety

> Low and quiet if poor behaviour

Question 19

what is behaviour shaping and how is it used in managing dental anxiety?

Answer 19

> Influencing behaviour towards desired ideal by
- Planned introduction to procedures
- Move through stages at child’s pace

Question 20

what is a distraction technique and name examples?

Answer 20

> Use of a distracting stimulus to divert attention away from disruptive behaviours and potentially unpleasant sensory stimuli

> Cartoons
Audio tapes
TV
Virtual reality
Video games
Stories
Lip holding
Leg raising
Talking whilst carrying out a procedure

Question 21

what are some examples of modelling techniques used in managing dental anxiety?

Answer 21

> Live
- a non fearful child successfully receiving treatment
- e.g. sibling
- passive or participant

> symbolic
- video/cartoon
- same sex, similar age if possible
- additional equipment required
- passive or participant

Question 22

what other methods are used for managing dental anxiety?

Answer 22

> Externalising
- short break in a different environment before resuming treatment

> Contracts

> Count down
- counting aloud along with procedures

> Stop signals
- hand raising.

Question 23

what is desensitisation as a method of managing dental anxiety?

Answer 23

> Hierarchy of fear provoking stimuli presented to a relaxed patient
- time consuming
- psychologist
- hypnosis

Question 24

how do you manage a pre- cooperative child?

Answer 24

> Examine with help from parent

> Tell them to ask you to stop at any time

> Limited intervention possible

> GA usually required for advanced treatment

Question 25

how do you manage a patient who is gagging?

Answer 25

> Relaxation

> Breathing

> Chin position

> Care with instruments

> Patient watching in mirror

> Home practice kit

> Inhalation sedation

Question 26

what are the alternatives and management techniques for patients with a needle phobia?

Answer 26

> EDA - electronic dental anaesthesia

> The ‘Wand’

> Computer Controlled pressure & flow injection system
‘Injex’ system – high pressure jet

> Desensitisation programmes

> Hypnosis

Question 27

what are the alternative methods of caries removal if a patient has a drill phobia?

Answer 27

> Hand excavation – ART restoration

> Chemo-mechanical removal
- Eg Caridex or Carisolv

> Air abrasion

> Lasers

> Hall technique

Question 28

what would you do if nothing seems to work in managing a patients anxiety?

Answer 28

> Consider pharmacological adjuncts

> Consider the need to refer the patient.

> Reasons for referral:-
- Specialised dentistry
- Special child

Question 29

who can you refer to ?

Answer 29

> Colleague
- More experienced
- Sometimes a change of clinician is enough

> Specialist
- Community Dental Service = Remit varies between trusts
- Hospital Dental Service = Consultant led service

Question 30

what details need included in a referral letter?

Answer 30

> Patient Details
- Personal details including social history.

> Presenting complaint
- Patient, parent and your perception
- Your concerns = Details of examination, differential diagnosis and reason for referral and urgency of the referral.

> Previous dental history

> Previous medical history (include family history)

> Specify what you are requesting = Advice or treatment? Indicate what aspects of treatment are within the scope of your skills.

> Your details = Remember to sign letter yourself

> Enclosures = avoids repeating and previous records aid diagnosis and treatment planning.

> When referring for treatment under GA, the referring dentist has a responsibility to and must include in the letter of referral:-
- That the risks associated with GA and the alternative methods of pain control have been discussed
- Clear justification for the use of general anaesthesia