Behaviour Management Techniques

Question 1

what is behaviour management?

Answer 1

a continuum of interaction with a child/parent directed toward communication and education

The goal is to ease fear and anxiety and to promote an understanding of the need for good dental health

Question 2

what is communication between the dentist and patient built on

Answer 2

a dynamic process of dialogue, facial expression and voice tone

Question 3

describe the behaviour of a 2 year old

Answer 3

• fear of unexpected movements, loud noises and strangers

- the dental situation can produce fear in the child

Question 4

describe the behaviour of a 3 year old

Answer 4

• reacts favourably to positive comments about clothes and behaviour
• less fearful of separation from parents
• experience will dictate reaction to separation

Question 5

describe the behaviour of a 4 year old

Answer 5

• more assertive but can be bossy and aggressive
• fear of the unknown and bodily harm is now at a peak
• with firm and kind direction will be excellent patients
• important at this age that children are introduced to things in a way which they understand

Question 6

describe the behaviour of a 5 year old

Answer 6

• readily separated from parents
• fears usually diminished
• proud of their possessions
• comments on clothes will quickly establish rapport

Question 7

describe the behaviour of a 6 year old

Answer 7

• seeks acceptance
• success in this can affect self-esteem
• if while at dentist child develops a sense of inferiority or inadequacy, behaviour may regress to that of a younger age

Question 8

describe the behaviour of a 7 - 12 year olds

Answer 8

• learn to question inconsistencies and conform to rules of society
• still have fears but are better at managing them

Question 9

What is dental anxiety

Answer 9

occurs without a present triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experiences

Question 10

what is dental fear

Answer 10

a normal emotional response to objects or situations perceived as genuinely threatening

for instance, the fear of drills or needles

Question 11

what is a phobia

Answer 11

a clinical mental disorder where the subject displays a persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life

Question 12

what are the physiological and somatic manifestations of DFA

Answer 12

• breathlessness
• perspiration
• palpitations
• feeling of unease

Question 13

what are the cognitive features of DFA

Answer 13

• interference in concentration
• hyper vigilance (always trying to see whats happening)
• inability to remember certain events while anxious
• imagining the worst that could happen

Question 14

what are the behavioural reactions of a child with DFA

Answer 14

• avoidance (postponing dental appointment)
• disruptive behaviour to stop treatment
• escape from situations which precipitates anxiety (run out of the surgery)

Question 15

what are the signs of DFA in children

Answer 15

• younger children may time delay by using questions
• school children may complain of stomach aches/ or ask to go to toilet frequently
• older children may complain of headaches or dizziness
• boys may say they cant be bothered

Question 16

If you see a child has DFA what should you find out

Answer 16

ask them what it is they are scared of

may be

• fear of choking
• fear of injections
• past dental experience
• dental experience of friends and siblings
• parents attitude to dentist
• childs perception that something is wrong with their teeth

Question 17

what is Faces MCDAS

Answer 17

Faces Version Modified Child Dental Anxiety Scale

• quick and easy to use
• different aspects of dental experiences is rated
• base line levels of anxiety are established
• age 8 and above is most suitable

Question 18

what are the components of communication

Answer 18

verbal communication - 5%
paralinguistic - 30%
non-verbal communication - 65%

Question 19

how can you reduce a patients anxiety

Answer 19

• prevent pain (if they feel pain, be empathetic)
• being friendly and establish trust
• working quickly
• calm manner
• giving moral support
• being reassuring about pain
• empathy

Question 20

what can increase fear related behaviours

Answer 20

• ignoring or denying feelings (don’t be silly/you didn’t feel anything)
• inappropriate reassurance
• coercing
• humiliating
• losing patients with patient

Question 21

what is the expression of pain

Answer 21

• screwing up eyes
• lowering eyebrows
• mouth open in a squarish appearance

Question 22

what is the expression of fear

Answer 22

• opening eyes widely and raising eyebrows

- mouth open and tense

Question 23

what does the ‘letter to dentist’ ask

Answer 23

asks patient

• 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?

Question 24

what is the role of the parent

Answer 24

• parent is present to support their child
• research suggests that the child’s behaviour is unaffected by parental presence of absence
• the exception would appear to be in children less than 4 years of age who have been shown to behave better with a parent present

Question 25

if the child is younger, why is it important for a parent to be there?

Answer 25

- patient is incapable or unwilling to sit for examination | - opportunity exists for the parent to witness the behaviour the clinician must contend with

Question 26

what are the 8 behavioural management techniques

Answer 26

- positive reinforcement - tell show do - acclimatisation - desensitisation - voice control - distraction - role modelling - relaxation/hypnosis

Question 27

Describe the positive reinforcement technique

Answer 27

The presentation of a stimulus that will increase the likelihood of a behaviour being repeated Social reinforcers - facial expression, verbal praise, appropriate physical contact non-social reinforcers - stickers, colouring poster, clever certificates Reinforce positive behaviours by giving praise when patient behaves well. Must be specific so patient knows what they are being praised for

Question 28

describe the tel show do technique

Answer 28

used to familiarise a patient with a new procedure - the tell involves an age appropriate explanation of the technique - the show is demonstrating for the patient aspects of how the procedure is a non-threatening setting - the do phase is initiated with minimal delay An example would be asking/telling the child what you're going to do, using slow speed bur on child finger nail (they can feel it and know its not something to be worried about). Ask if you can do same on tooth and do so (great introduction to the slow speed and having a filling)

Question 29

describe the acclimatisation technique

Answer 29

the planned, sequential introduction of environment, people, instruments and procedures gradually introduce children to an environment in a timely manner an example would be introducing the 3:! suction and cotton rolls on the visit before you plan a figure sealant (let child suck water out cup with 3 in 1) Give rubber dam home on the visit before you plan to use it. Introduce topical one visit before using LA for the first time.

Question 30

describe the systemic desensitisation technique

Answer 30

based on the assumption that repeated non-distressing exposure to an anxiety provoking stimulus will eventually reduce anxiety To do so, the child must be reassured that they're in control Done in an ordered manner from what they perceive as the least anxiety provoking to the most anxiety provoking Systemic needle desensitisation is a good example, always teach child relaxation first, make sure they know how to cope and stay calm (do mental maths in head)

Question 31

describe the technique of voice control

Answer 31

a controlled alteration of voice volume, tone or pace to influence and direct the patient's behaviour - to gain the patient's attention and compliance - to avert negative or avoidance behaviour

Question 32

describe the distraction technique

Answer 32

the technique of diverting the patient from what they may perceive as an unpleasant procedure - pulling upper lip - telling a story while giving local anaesthetic - letting an older child bring in music to listen to

Question 33

describe the role modelling technique

Answer 33

child watches someone else undergo the procedure that they're about to undergo children should be - similar age - undergoing similar treatment - presence of an older sibling is best for children 3 to 5 years

Question 34

describe the hypnosis technique

Answer 34

- 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 experienced by the subject as having a quality of involuntariness or effortlessness

Question 35

Describe an ideal treatment plan

Answer 35

1. simple exam, fluoride varnish application, give diet sheet, ask child to bring toothbrush next visit. Explain radiographs 2. Brush teeth using child's brush, invite to sit on chair. Check diet. Take radiographs. Polish teeth and dry teeth, introduce slow speed and syringe 3. Fissure sealants. Introduce saliva injector 4. Remove carious tissues with hand excavator immediate temporisation is required. Use slow speed drill, for small buccal and cervical cavities. Introduce topical and give rubber dam home to play with 5. Restore upper teeth under LA, using topical prior to injection 6. Restore lower teeth with LA, using topical prior to injection 7. pulp treatments and then extractions last if patient is pain free