Behaviour management

Question 1

what is the aim of behaviour managment?

Answer 1

• instil a positive dental attitude and create a long time interest on the patient’s part to facilitate ongoing prevention and improved dental health in the future

Question 2

what are classifications of children’s behaviour?

Answer 2

• lack co-operative ability - children with specific abilities that cannot achieve co-operation in the usual manner
• pre co-operative - very young children, communication not yet established
• potentially co-operative - has the capability to accept treatment, behaviour modifiable
• co-operative - reasonable level of co-operation

Question 3

what are characteristics of a 2 year old and tips to deal with them?

Answer 3

• ego-centric, easily frustrated, easily distracted - lots of distraction
• attention span of 1-5 minutes - keep appointment times short
• concentrates on one thing at a time - concentrate only on child
• lives in present - focus on the now
• favourite word is no! - avoid questions that could be answered with no!

Question 4

what are characteristics of a 3 year old and tips to deal with them?

Answer 4

• independant, curious, imaginative - gain attention by arousing curiosity, describe procedures and ask them to add their own description
• attention span 4-8 mins - short appointment times
• eager to please - be positive “its better if you..” not “don’t do that”

Question 5

what are characteristics of a 4 year old and tips to deal with them?

Answer 5

• dominant, bossy, inpatient and insistent - engage the child’s help
• grasps simple reasoning, willing to accept change - explain simple procedures
• enjoys variety - keep working steadily, avoid pauses, don’t lose control

Question 6

what are characteristics of a 5 year old and tips to deal with them?

Answer 6

• poised, self-confident, aware of rules - encourage to take responsibility, let them take control, labelled praise
• likes to act grown up, less combative, accepts authority - direct commands
• proud of possessions - show interest in possessions/clothes
• creative - like fantasy and imaginary play

Question 7

what are characteristics of 6-8 year olds?

Answer 7

• increasing independancy
• transition to greater independence can cause considerable anxiety and distress
• marked increase in fear responses
• can have a decrease in co-operation in previously co-operating children
• seek acceptance

Question 8

what are characteristics of 8-12 year olds?

Answer 8

• strongly influenced by larger social group
• growing concerns of embarrassment
• become followers
• can hide their feelings and adopt a cool attitude
• intellect becomes important
• respond well to discussion and need to engage in independence

Question 9

what are characteristics of adolescents?

Answer 9

• forced with solving major questions e.g. who am i?
• can be percieved incorrectly as self-absorbed, excluding themselves, narcissistic
• looking for greater autonomy
• believe they are invulnerable or that adverse results from their actions won’t happen to them
• believe their actions are entirely unique
• greater rapport when dentists are non-judgemental, non-preaching and respectful
• discussion of non-dental topics to develop rapport
• emphasising importance of self-dental care to maintain their smile is helpful

Question 10

what is dental anxiety?

Answer 10

• occurs without a present triggering stimulus
• reaction to unknown danger
• very common when proposed treatment never experienced before

Question 11

what is dental fear?

Answer 11

• reaction to known danger
• involves flight-fight-freeze response when confonted with threatening situation

Question 12

what is dental phobia?

Answer 12

• displays persistent and extreme fear of objects or situations
• avoidance behaviour and **interference of daily life **

Question 13

what are some of the features of DFA?

Answer 13

physiological and somatic sensations
* breathlessness
* perspiration
* palpitations
* feeling of unease
cognitive features
* concentration inferference
* hypervigilence
* inability to remember certain events when anxious
* imagining the worst that could happen
behavioural reactions
* avoidance
* escape the situation

Question 14

what are the negative impacts of DFA on the child and caregiver?

Answer 14

• negative impact on the oral health related quality of life
• worse OH than peers
• can lead to pain and infection, toothache, missing teeth
• can be distressing for caregivers

Question 15

what factors affect a child’s DFA?

Answer 15

• previous MH
• previous DH
• SH factors
• parental anxiety
• parenting style
• parental presence
• child awareness of dental problems
• behaviour of the dental team
• child temperament

Question 16

what questionnaire is used to assess child dental anxiety?

Answer 16

modified child dental anxiety scale, faces version
* 8 self-reported measures
* best for 8-15 year olds
* 5 point severity point scale
* 1 = relaxed/not worried, 5 = very worried
* can give you specific areas of anxiety

Question 17

what are the limitations of the modified child dental anxiety scale?

Answer 17

• generates high number of incomplete questionnaires - child may be too anxious for the questions
• lack of understanding of dental scenarios
• may make child more anxious than before

Question 18

what verbal communications should you not use?

Answer 18

• it won’t be sore
• this isn’t going to hurt
• don’t be scared
• the needle will just be a second
• there is nothing to be afraid of
• try to relax - lets relax

Question 19

what are the two coping styles children with DFA may use?

Answer 19

• monitors - search and attend to information, prefer to know what is going to happen, able to focus on what is known and safe
• blunters - avoidance, prefer to be distracted, and have attention focussed elsewhere

Question 20

describe the tell-show-do management technique

Answer 20

• tell - brief, age-appropriate, description of the care to be completed
• show - demonstrate the care to be completed/equipment to be used
• do - carry out the care with minimal delay
• effective in reducing anticipation anxiety and physiological signs of anxiety
• useful in children with low-level anxiety and monitors

Question 21

describe the enhancing control management technique

Answer 21

• provide the child with a signal that allows them a degree of control over the situation
• found to reduce pain during dental treatment including injections
• regular scheduled breaks during actual treatment reduces disruptive behaviour
• consider a timed exposure - count backwards not forwards
• useful with children whose anxiety is in relation to loss of control

Question 22

describe the voice control management technique

Answer 22

• clinician modifies tone, volume or pace of voice to influence
• reduces disruptive behaviours without long-lasting negative effects
• facial expression important
• useful in IHS, relaxation and hypnosis

Question 23

describe the modelling management technique

Answer 23

• watching others to learn about the environment first before experiencing it themselves
• live model (sibling/parent or teddy) or watching a video
• useful for those with limited dental experience and monitors

Question 23

describe the distraction management technique

Answer 23

• child’s attention is distracted from the dental setting
• physical short term distractions - counting on fingers, wriggling toes during impressions
• verbal distractions - how many legs do animals have etc
• visual-audio - projector, choose music, cartoons

Question 24

describe the behaviour shaping and positive reinforcement behaviour technique

Answer 24

* series of **defined steps** to achieve the desired behaviour * **reinforcement** is the s**trengthening of that desired behaviour**, increasing likelihood of that behaviour being repeated in future * most positive reinforcers are **social stimuli** - facial expressions, verbal praise, approval from carer * **child-centric empathetic response** with **specific behaviour praised** directly after - "you are doing really good, sitting still with such a big, widde open mouth" * **rewards** - stickers, high fives

Question 25

describe the guided imagery management technique

Answer 25

* clinician helps the patient have a tailored 'daydream' to create a state of relaxation and wellbeing * stage 1: relaxation * stage 2: visualisation * stage 3: positive suggestion * use in conjuction with other techniques - muscle relaxation, controlled breathing * use child's imagination

Question 26

what order should the treatment plan be in?

Answer 26

1. examination, acclimatisation, fluoride varnish, diet advice, OHI 2. fissure sealants 3. minimise invasive techniques - Hall crown 4. restorative treatment under LA 5. extractions with LA - upper then lower or most symptomatic