1
Q
Behaviour management is a continuum of interaction with a child/parent directed towards communication and education. What is the goal? (2)
A
Its goal is to:
- Ease fear and anxiety
- Promote an understanding of the need for good dental health
2
Q
Communication between the dentist and patient is built on a dynamic process of what 3 things?
A
- Built on a dynamic process of dialogue, facial expression and voice tone
- (it is through this process that the dentist can allay fears and anxiety, and teach appropriate coping mechanisms and guide the child to be cooperative, relaxed and self confident in the dental setting)
3
Q
At the age of 2 what to children tend to be fearful of? (4)
A
- Fear of unexpected movements, loud noises and strangers
- The dental situation can produce fear in the child
4
Q
At what are do children begin to understand fear?
A
- At the age of 2 - this is a normal part of evolution
5
Q
What do children at the age of 3 react favourably to?
A
- React favourably to positive comments about clothes and behaviour
6
Q
At what age are children generally less fearful of separation from parents?
A
- At age 3
- Experience will however dictate reaction to separation
7
Q
What characteristic is often seen in 4 year olds but not 3 year olds?
A
- 4 year olds are more assertive but can be bossy and aggressive
8
Q
What do 4 year olds tend to be fearful of?
A
- Fear of the unknown and bodily harm is now at a peak
9
Q
What do 4 year olds tend to be less fearful of?
A
- Fear of strangers tends to of decreased
10
Q
What can make children at age 4 excellent patients?
A
- With firm and kind direction they will be excellent patients
11
Q
At what age can children tend to be readily separated from parents?
A
- Age 5
12
Q
At what age have fears usually diminished?
A
- At the age of 5
13
Q
What are children aged 5 usually proud of?
A
- Proud of possessions
- Comments on clothes will quickly establish a rapport
14
Q
At what age do children tend to seek acceptance?
A
- Age 6
- Success in this can affect self-esteem
15
Q
At age 6 if while at the dentist a child develops a sense of inferiority or inadequacy what might happen?
A
- Behaviour might regress to that of a younger age
16
Q
What must you never do to children?
A
- Extremely important that you don’t belittle them
- Need to understand why they don’t like things
- Ask the obvious questions and the child will reply
17
Q
From age 7-12 what do children learn to do?
A
- Learn to question inconsistencies and conform to rules of society
18
Q
Children aged 7-12 may still have fears, but what are they better at doing?
A
- They are better at managing their fears
19
Q
From age 7-12 if a child has dental fear how might this present in the dental setting?
A
- They might say they have a sore tummy, can’t be bothered or need the toilet (more often boys)
20
Q
What is the definition for ‘dental anxiety’?
A
- Occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences
- However can be due to parental preparation or medical experiences
21
Q
What is the definition for ‘dental fear’?
A
- Is a normal emotional response to objects or situations perceived as genuinely threatening
- This is to a specific threat e.g. needles, dental drill etc
22
Q
What is the definition for ‘phobia’?
A
- Is a clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviours and interference of daily life
23
Q
What are examples of physiological and somatic sensations related to dental fear and anxiety? (4)
A
- Breathlessness
- Perspiration
- Palpitations
- Feeling of unease
- Many patients don’t know that this is to do with their worries - important to say to them that this is normal for people who might be anxious or fearful of the dentist
24
Q
What are examples of cognitive features (how changes occur in the thinking process) related to dental fear and anxiety? (4)
A
- Interference in concentration
- Hypervigilance
- Inability to remember certain events while anxious
- Imagining the worst that could happen
25
If a patient is showing the cognitive feature of dental anxiety - hypervigilance, what should we do?
- Tell these children that you are going to show them everything and you will not put anything into their mouth without showing them first
26
What are examples of behavioural reactions related to dental fear and anxiety? (3)
- Avoidance i.e. postponing of a dental appointment, or with children disruptive behaviour in an effort to stop treatment being undertaken (biting, closing mouth frequently, might not stop talking)
- Escape from the situation which precipitates the anxiety
- Anxiety may manifest with aggressive behaviours especially in adolescents who are brought by their parents but do not want to be there
27
If a patient is showing aggressive behaviour, what should we do?
- This is because they feel they are not being listened to
- Take a step back and say the dentistry here is second, the most important thing at present is to discuss how you are feeling at the dentist
- The dentist should always ensure the safety of patients and staff if this type of behaviour happens
28
Some anxious children are easy to spot, however some signs are more subtle. Give examples of these? (3)
- Younger children might time delay by asking questions
- School aged children may complain of stomach aches/or ask to go to the toilet frequently
- Older children may complain of headaches or dizziness, may fidget or stutter, can't be bothered
29
What are common factors/fears that patients may have? (8)
- Fear of choking
- Fear of injections/drilling
- Fear of the unknown
- Past medical and dental experience
- Dental experience of friends and siblings
- The attitudes of parents towards dental experience
- Preparation at home before the dental visit
- The child's perception that something is wrong with their teeth
30
In order to allow the patient to feel like they are in control, what can we do? (3)
- Give rest breaks
- Allow them to have a stop signal
- The patients need for information (give them what they need to be satisfied)
31
What does good dentist/patient communication do/enable? (4)
- Improves the information obtained from the patient
- Enables the dentist to communicate information to the patient
- Increases the likelihood of patient compliance
- Decreases patient anxiety
32
What % does verbal communication contribute to overall communication?
- 5%
33
What % does paralinguistic communication contribute to overall communication?
30%
34
What % does non-verbal communication contribute to overall communication?
65%
35
How can we contribute to reducing patients anxiety? (7)
- Preventing pain
- Being friendly & establishing trust
- Working quickly
- Having a calm manner
- Giving moral support
- Being re-assuring about pain
- Empathy
36
What should we avoid doing that would increase fear related behaviours in patients? (5)
- Ignoring or denying feelings
- Inappropriate reassurance
- Coercing/coaxing
- Humiliating
- Losing your patience with the patient
37
What is the expression of fear?
Opening eyes widely and raising eyebrows with mouth open and tense
38
What is the expression of pain?
- Screwing up the eyes and lowering the eyebrows with the mouth open and in a squarish appearance
39
The 'letter to dentist' is very helpful to determine why patients are scared and expecting pain. What questions are included in this? (5)
- How worried are they?
- How painful do they think treatment will be?
- What do they want to happen?
- How will they cope?
- What is their stop signal?
40
Research suggests that the child's behaviour is unaffected by parental presence or absence. What is the exception to this?
- The exception would appear to be children less than 4 years of age who have been shown to behave better with a parent present
41
With an infant or toddler parental presence is of benefit for several reasons. Give examples of these? (2)
- Patient is incapable or unwilling to sit for examination (positioning the child in the lap of the dentist and parent permits the child to be in direct visual and physical contact with the parent)
- Opportunity exists for the parent to witness the behaviour the clinician must contend with
42
Give examples of behaviour management techniques? (8)
- Positive reinforcement
- Tell show do
- Acclimatisation
- Desensitisation
- Voice control
- Distraction
- Role modelling
- Relaxation/hypnosis
43
What is positive reinforcement?
- The presentation of a stimulus that will increase the likelihood of a behaviour being repeated
44
In positive reinforcement, what are social reinforcers? (3)
- Facial expressions, verbal praise & appropriate physical contact
- Verbal praise has to be specific
45
In positive reinforcement, what are non-social reinforcers? (3)
- Stickers, colouring poster and clever certificates
46
When would you tell a patient they have been 'clever'?
Clever:
For example: if they have had a check up or if they have done something that we would expect them to do and we want them to do it again
47
When would you tell a patient they had been 'brave'?
Brave:
| For example: if they are very nervous/fearful but manage to cope with getting an extraction etc
48
What is the technique 'tell show do'?
- The TELL involves an age appropriate explanation of the technique
- The SHOW is demonstrating for the patient aspects of the procedure in a non threatening setting
- The DO phase is initiated with minimal delay
49
What is acclimatisation?
- The planned, sequential introduction of environment, people, instruments and procedures
- An integral part of the treatment plan
- This is when we are gradually introducing a child to an environment (might do similar with an instrument)
50
Give examples of acclimatisation in the dental setting? (4)
- Introduce the 3:1, suction & cotton rolls on the visit before you plan a fissure sealant
- Introduce topical one visit before using LA for the first time
- Use the slow speed first with a prophy cup, later with a bur and later introduce the high speed
- Give rubber dam home on the visit before you plan to use it
51
What is systematic desensitisation?
- This is based on the assumption that repeated non-distressing exposure to an anxiety-provoking stimulus will eventually reduce anxiety
- The child must be reassured that they are in control
- This is done in an ordered manner from what they perceive as the least anxiety provoking to the most anxiety provoking, in imagination of in real-life until no anxiety is produced
- Systematic needle desensitisation is a good example
52
What is voice control?
- A controlled alteration of voice volume, tone or pace to influence and direct the patient's behaviour
- To gain the patients attention and compliance
- To avert negative or avoidance behaviour
53
What is distraction?
- The technique of diverting the patient from what may be perceived ad an unpleasant procedure
- Pulling the upper lip
- Telling a story while giving LA
- Letting older child bring in music to listen to
54
What is role modelling?
- Child of similar age getting similar treatment
- Patient can watch them getting it done to show them other people coping
- Presence of an older sibling is best for children aged 3-5
55
Give 2 examples of relaxation techniques?
- Progressive muscle relaxation (where you are testing and relaxing)
- Space exercise (get them to concentrate on breathing in for 3 then out for 5)
56
What is hypnosis?
- An interaction between one person, the 'hypnotist' and another person or people, the 'subject'
- The hypnotist attempts to influence the subjects perception, feelings, thinking and behaviour by asking them to concentrate on ideas and images
- The verbal communications that the hypnotist uses to achieve these effects are termed 'suggestions'
- The response is experiences by the subject as having a quality of involuntariness or effortlessness
57
What is HOMAR and why is it unacceptable?
- Hand over mouth technique
Problems:
- Adverse psychological effects
- Parental consent
- Professional acceptance
- Litigation
58
How might we build a treatment plan by thinking in advance of wat the patient needs? (4)
- The gradual introduction of dental equipment and procedures
- This is done in a predetermined manner
- Some aspects can be completed while other instruments and procedures are being introduced
- Tell-show-do is an effective wat to introduce instruments, in this way the child is acclimatised as treatment progresses
59
We need to ensure that we are trying to give the patient painless treatment. How can we do this? (4)
- Care should be taken not to hurt any child
- Restorative care is usually carried out under LA
- A painless technique of administering LA is of vital importance with topical an integral part of treatment
- Upper carious teeth are normally restored with LA before lower
60
When building a treatment plan what are the first things we would cover with the patient?
- Simple exam, fluoride varnish application, give diet sheet, ask child to bring toothbrush next visit. Take radiographs or explain for next visit
61
When building a treatment plan what are the second things we would cover with the patient?
- Brush teeth using child's brush, invite to sit on chair. Check diet. Take radiographs. Polish teeth and dry teeth, and so introduce slow speed and air syringe. Explain F/S process
62
When building a treatment plan what are the third things we would cover with the patient?
Fissure sealants or dressings. Introduce the saliva injector
63
When building a treatment plan what are the fourth things we would cover with the patient?
- Remove caries tissue with hand excavator if immediate temporisation is required. Use slow speed drill, for small buccal and cervical cavities. Introduce topical & five rubber dam home to play with
64
When building a treatment plan what are the fifth things we would cover with the patient?
- Restore upper teeth with LA, using topical prior to injection
65
When building a treatment plan what are the sixth things we would cover with the patient?
Restore lower teeth with LA, again using topical prior to this
66
When building a treatment plan what are the seventh things we would cover with the patient?
- Pulp treatments and then extractions last if patient is pain free
67
Read dental fear and anxiety n paediatric patients
- Explains the fight and flight response in chapter 8 & 9
