Behavior Management

Question 1

variables influencing children’s dental behavior

Answer 1

• maternal anxiety
• medical history
• awareness of dental problem

Question 2

maternal anxiety: characteristics

Answer 2

• high parental anxiety = negative child behavior
• can affect children of all ages

Question 3

age where maternal anxiety effects are greatest

Answer 3

under 4 years of age

Question 4

factors under medical history that can affect child’s cooperativeness with the dentist

Answer 4

• children who view medical experiences positively
• emotional quality of past visits
• past medical pain

Question 5

how to mitigate negative behavior for awareness of dental problem during a child’s first dental visit

Answer 5

educate parents about value of arranging child’s first dental visit

Question 6

can be used for modeling

Answer 6

• live patient models
• audiovisual aids

Question 7

modeling (according to Rimm and Masters)

Answer 7

• stimulation of new behavior
• facilitation of behavior in a more appropriate manner
• disinhibition of inappropriate behavior due to fear
• extinction of fears

Question 8

involved in behavior management

Answer 8

total dental health team

Question 9

2 means behavior management accomplishes for the child

Answer 9

• allows dental health team to effectively and efficiently perform treatment
• instills positive dental attitude

Question 10

types of communication & communicative guidance

Answer 10

• tell-show-do
• distraction
• non-verbal communication
• positive reinforcement
• voice control
• parental presence or absence

Question 11

tell-show-do

Answer 11

used with communication skills (verbal and non verbal) and positive reinforcement

Question 12

tell-show-do: tell

Answer 12

behavior shaping which involves verbal explanation of procedure and phrases

Question 13

tell-show-do: show

Answer 13

demo for the patient of the visual,
auditory and olfactory aspects of the procedure in a carefully defined, non-threatening manner

Question 14

tell-show-do: do

Answer 14

completing the procedure on the patient

Question 15

tell-show-do: objectives

Answer 15

• teach the patient important aspects of dental visits
• familiarize the patient to the dental setting
• shape patient response to procedure to desensitization and well-described expectations

Question 16

tell-show-do: indications

Answer 16

may be used in almost all patients

Question 17

tell-show-do: contraindications

Answer 17

none

Question 18

distraction

Answer 18

technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure

Question 19

distraction: examples

Answer 19

• watching TV/Youtube videos
• use of gadgets
• toys
• listening to music

Question 20

distraction: objectives

Answer 20

• decrease unpleasantness
• avert negative behavior

Question 21

non-verbal communication

Answer 21

reinforcement and guidance of behavior through appropriate contact, posture, facial expression and body language

Question 22

non-verbal communication: indications

Answer 22

any patient

Question 23

non-verbal communication: contraindications

Answer 23

none

Question 24

positive reinforcement

Answer 24

process of establishing desirable patient behavior

Question 25

2 types of positive reinforcement

Answer 25

- social reinforcement - non-social reinforcement

Question 26

social reinforcement: examples

Answer 26

- positive voice modulation - facial expressions - verbal phrase - appropriate physical demonstration of affection

Question 27

non-social reinforcement: examples

Answer 27

- toys and tokens (reward)

Question 28

reward

Answer 28

recognition of good behavior after completion of the operation

Question 29

bribery

Answer 29

promised to induce desired behavior

Question 30

voice control

Answer 30

controlled alteration of voice, volume, tone or pace to influence and direct the patients behavior

Question 31

voice control: benefit

Answer 31

avoids misunderstanding with parents

Question 32

voice control: indications

Answer 32

any patient

Question 33

voice control: contraindications

Answer 33

patients with hearing impairment

Question 34

voice control: objectives

Answer 34

- gain patient attention and compliance - avert negative or avoidance behavior - establish appropriate adult-child roles

Question 35

parental presence or absence

Answer 35

- requires good communication among dentist, parent and patient - child response can be very beneficial or very detrimental

Question 36

parental presence or absence: contraindications

Answer 36

parents who are unwilling or unable to extend effective support when asked

Question 37

parental presence or absence: objectives

Answer 37

- gain patient attention and improve compliance - avert negative or avoidance behavior - establish appropriate adult - child roles - enhance effective communication among dentist child and parent - minimize anxiety and achieve a positive dental experience

Question 38

aversive conditioning aka

Answer 38

hand-over-mouth exercise (HOME)

Question 39

aversive conditioning: purpose

Answer 39

gain attention of highly appositional child to establish cooperation for sage course of treatment

Question 40

aversive conditioning

Answer 40

not routinely used; method of last resort

Question 41

aversive conditioning: requirement

Answer 41

informed consent

Question 42

advanced behavior guidance: indication

Answer 42

- children who cannot cooperate - children with physical and emotional immaturities

Question 43

types of advanced behavior guidance

Answer 43

- protective stabilization - knee-to-knee/lap-to-lap

Question 44

protective stabilization

Answer 44

restriction of patient’s freedom of movement with or without the patient's permission

Question 45

protective stabilization: purpose

Answer 45

to decrease risk of injury and deliver procedure safely

Question 46

protective stabilization: considerations

Answer 46

- alternative behavior guidance modalities - dental needs of patient - effects of quality of dental care - patient’s emotional development - patient’s medical and physical considerations (i.e. scoliosis)

Question 47

protective stabilization: indications

Answer 47

- patient requires immediate diagnosis and for limited treatment - safety of the patient, staff, dentist or parent would be at risk - sedate patient

Question 48

protective stabilization: contraindications

Answer 48

- cooperative non-sedated patient - patient who cannot be immobilized safely (associated medical or physical conditions) - patient who has experienced previous physical or psychological trauma

Question 49

protective stabilization: objectives

Answer 49

- reduce or eliminate untoward movements - protect patient, staff, dentist or patient from injury - facilitate delivery

Question 50

protective stabilization: precautions

Answer 50

- careful review of patient’s medical history - tightness and duration of stabilization - not actively restrict circulation or respiration - stabilization should be terminated as soon as possible in patient whose experience is severe

Question 51

knee to knee/lap to lap

Answer 51

advanced behavior guidance that works for most younger children

Question 52

knee to knee/lap to lap: procedures

Answer 52

(non-invasive) - oral exam - fluoride application

Question 53

3 practical considerations

Answer 53

- scheduling - patient-child separation - dental attire

Question 54

best appointment for pediatric patients

Answer 54

short (30 mins or less) morning appointments

Question 55

practical consideration: dental attire

Answer 55

child-friendly

Question 56

practical consideration: scheduling

Answer 56

child should not be kept waiting in the reception area

Question 57

occurs when patient-child separation is not followed

Answer 57

- parent often repeats orders - parent injects orders, becomes barrier to development - dentist unable to use voice intonation - child divides attention between parent and dentist - dentist divides attention between parent and child