How many children display anxiety different to adults
More irrational
Less restrained
What is the importance in treating dental anxiety in children
Childhood dental anxiety may cause anxiety in adulthood
How do you assess the child when taking a history
- Current Pain
- Dental History
- Relevant past medical history
- Social history
- Levels of understanding and potential co-operation
- Levels of anxiety eg. FrankL Behaviour Rating Scale
How can you evaluate patient’s cooperative ability
- Frank L Scale
- Cognitive level
- Temperoment
- Personality
- Anxiety
- Fear
- Whether the child is approachable or shy determines treatment difficulty
Describe FrankL Scale. Number, name, (+/-) and behaviour
1 (- -) Definitely Negative
- Child refuses tx
- Cries forcefully, fearfully or displays any agitated, overt evidence of extreme negativism
- Combative, thrashing, verbal, unable to be restrained, need to terminate procedure
2 (-) Negative
- Reluctant to accept treatment and some evidence of negative attitude but not pronounced
- Slightly combative, verbal, slightly agitated, able to be restrained and procedure safely completed
3 (+) Positive
- Child may accept treatment but may be cautious
- Child willing to comply with dentist but may have some reservations
- Quiet, not combative, cooperative, nonverbal
4 (+ +) Definitely positive
- Child has a good rapport with dentist and is interested in dental procedures
- Happy, helpful
How can children’s behaviour be characterised. How can you manage these patients
1) Cooperative
2) Potentially cooperative
3) Lacking cooperative ability (pre-cooperative) eg. very young children and special disabilities
Behaviour management techniques can be used for 1 and 2
GA and sedation might be required for 3
What is the role of the dentist in management of children and why is effective dentist-child communication so important
- Critical in creating a positive environment for child
- Gains trust between them
- Improves information obtained from the patient
- Enables dentist to communicate info to patient
- Increases likelihood of pt compliance
- Decreases patient anxiety
What are the main ways of communicating with patients and percentages
1) Verbal Communication (5%)
2) Paralinguistics (30%) eg tone of voice
3) Non-verbal communication (65%)
How can dentist reduce child anxiety
- Avoid emotive words
- Prevent pain
- Friendly and establish trust
- Work quick
- Calm manner
- Moral support
- Re-assuring about pain
- Empathy
How can dentist increase fear related behaviour
- Ignoring or denying feelings
- Inappropriate reassurance
- Coercing/coaxing
- Humiliating
- Losing patience
DO NOT (with child)
- Bribe
- Lie
- Shout
- Coerce
- Bully
- Threaten
- Allow child to have their own way
- Inappropriately reassure
What is the role of the parent
- Prepare for a visit to the dentist
- Dentist should provide parent how to prepare child
- Rehearsal
- Supportive care prior to each stressful procedure
What is definition, aim and method of behaviour management
- Behaviour management is the means by which the dentist effectively and efficiently performs treatment for a child
- Aim is to instill a positive dental attitude
- Methods are related to communication and education
Name some behavioural management techniques
- Tell show do
- Positive reinforcement
- Appropriate language
- Role modelling
- Giving the child control (hand signal)
- Appropriate touch
- Distraction
- Reward
- Acclimatisation
- Desensitistion
- Voice control
What is positive reinforcement and egs
-Presentation of a stimulus that will increase likelihood of a behaviour being repeated
-Rewards desired behaviour
-Failing to reinforce a behaviour may result in it being eliminated
-Dentist must make it clear what is being rewarded
-Delivered immediately
-Eg. Positive voice modulation
Facial expression
Verbal pause
Thank u for keeping still
What is tell show do
- method of introducing dental equipment and procedures
- tell child about instrument
- Show child instrument and describe any sensation that might be felt in positive or neutral terms
- do what has been demonstrated with minimal delay and in a matter of fact manner
Explain acclimatisation and eg
- Planned sequential introduction of environment, people, instruments and procedures
- At each appt, child should be introduced to a more challenging procedure
- introduce topical one visit before using la for the first time
- give rubber dam home on visit before u plan to use it
- introduce 3 in 1, suction and cotton rolls on visit before you plan fissure sealant
- use the slow speed first with a trophy cup, later with a bur and later intro high speed
What is systematic sensitisation and how do u do it
- Based on assumption that repeated non-distressing exposure to an anxiety-provoking stimulus will eventually reduce anxiety
- Construct a hierarchy of anxiety provoking situations
- encourage them to relax (sometimes with aid of hypnosis)
- present least anxiety provoking stimulus either in imagination or in real life until no anxiety is produced
- repeat for next least anxious stimulus
what is voice control, aim and examples
- controlled alteration of voice, volume, tone or pace to influence and direct pt behaviour
- young children often respond to tone rather than words
- aim to improve attention and compliance as well as gain authority eg abrupt change from soft to loud to gain attention of child who is not complying
- technique is not appropriate for children too young to understand or with intellectual or emotional impairment
how can hand signals be used to enhance control
- provides patient with a degree of control over dentists behaviour through use of a stop signal
- shown to reduce pain during routine dental tx
what is distraction technique, aims and examples
- Aims to shift patient attention from dental setting to another situation or from a potentially unpleasant procedure to some other action
- verbal distraction eg. dentist who talks while applying topical paste and administering la
- short term distraction eg diverting attention by pulling lip as local anaesthesia is given or have patients raise legs to stop gagging during radiographs
what happens if more than behaviour management is needed
- ga
- oral sedation if simple sextant extraction
- nitrous oxide
- iv sedation
what is nitrous oxide sedation, how is it administered, what is the mean age used for, severity of anxiety used
- inhalation sedation
- 6-11 years
- successful in mild to moderate anxiety
- treatment completed in 3-10 sessions, 1-5 months
- patients demonstrate continued anxiety reduction
why may nos fail
young age
multiple xlas
irregular attendance
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Behaviour Management40
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Dental Development21
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Prevention37
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History and Examination27
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Pharmacological Pain Control and LA26
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Primary Tooth Trauma45
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Review on Restoring Primary Carious Teeth17
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Hall Technique17
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Caries48
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Pulp Therapy39
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Molar Incisor Hypomineralisation30
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General Anaesthesia28
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Inhalation Sedation30
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Child Protection 132
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Child Protection 212
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Operative Techniques for Dental Trauma18
