Behavior Management Techniques for the Pediatric Dental Patient
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Transcript of Behavior Management Techniques for the Pediatric Dental Patient
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Behavioral Management Techniques for the
Pediatric Dental PatientJacey Sheckler, RDH, MS
Fall 2017
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Behavior Management
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Behavior Management
•Goals of communication and education
• Process of dialogue, facial expression, and voice tone
•Build a relationship between dentist and patient
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To maintain compliance
• Skills of verbal guidance
• Expectation setting
• Extinction of inappropriate behavior
• Reinforcement of appropriate behavior
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Objectives
•To effectively and efficiently perform treatment for the child
•To instill a positive attitude
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Behavior in the 2000’s
•Fewer children living in traditional family setting
•Women: bearing less children and later in life
•Those living in family households: now less stable, more heterogeneous
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Pediatric Dental Triangle
• Patient should always be your highest concern
• Continuum of interactions between all three persons
Child
Parent Dentist
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Behavior in the 2000’s
• > 50% of all children likely to experience living with a single parent
•More organized facilities here to meet needs of employed parents
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Practice Parameters
•General dentists must follow same guidelines as pediatric dentists
• If you do not have many patients who require premed, cannot justify purchase of pulse oximeters, precordial stethoscope, etc.
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Practice Parameters
•Recent AAPD Work Force statistic: 80% of dental procedures performed on children are done by general dentists
•Good reason to become more adept with behavior management skills
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Dental Profession• Professional profile is
changing
•Women have entered profession in significant numbers and may have a different behavior management style
• Insurance companies may not approve conscious or IV sedations
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Dental Profession
• Society is more litigious
• Parents are not consenting to physical and mechanical restraints
• Dentist may be portrayed as the abuser
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Physical Restraint
• An example of protective stabilization
• Will be discussed in depth at a future lecture
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Now is the time to reacquaint ourselves to behavior
management skills
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Communicative Management
• Used with both the cooperative and uncooperative child
• Basis for establishing a relationship with the child to allow successful completion of dental procedures
• Helps child to develop a positive attitude toward dentistry
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Cooperative vs. Uncooperative
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Communicative Management•Voice Control
•Nonverbal communication
•Tell-Show-Do
•Positive Reinforcement
•Distraction
•Parental Presence/Absence
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Voice Control
•Controlled alteration of voice volume, tone or pace to influence and direct the patient’s behavior
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Voice Control
•Note the proximity of the dentist to the patient
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Voice Control
•To gain the patient’s attention and compliance
•To avert negative or avoidance behavior
•To establish appropriate adult-child roles
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Nonverbal Communication
•The reinforcement and guidance of behavior through appropriate contact, posture, and facial expression
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Nonverbal Communication
•To enhance the effectiveness of other communicative management techniques
•To gain or maintain the patient’s attention and compliance
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Tell-Show-Do
•Tell: involves verbal explanations of procedure in phrases appropriate to the developmental level of the child
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Tell-Show-Do
• Show: Demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, non-threatening setting
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Tell-Show-Do
• “Showing” the procedure on the child’s baby doll
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Tell-Show-Do
•Do: Then, without deviating from the explanation and demonstration, completion of the procedure
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Tell-Show-Do
•To teach the patient important aspects of the dental visit
•To shape the patient’s response to procedures through desensitization and well described expectations
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Positive Reinforcement
• To establish desirable patient behavior it is essential to give appropriate feedback
• Effective method to strengthen the occurrence of desirable behavior
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Positive Reinforcement
• Social reinforces include:
• Verbal praise
• Voice modulation
• Facial expression
• Appropriate physical demonstration of affection
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Positive Reinforcement
• Non-social reinforces include:
• Tokens such as stickers
• Small toys
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Positive Reinforcement
•The primary goal is to reinforce desired behavior
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Distraction
• Technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure
• Used to increase attention span
• Giving a child a hand mirror to hold while a dental procedure is being done
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Distraction
Sunglasses to block out the intensity of the light as well as being protective
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Distraction
• To decrease the perception of unpleasantness
• To avert negative or avoidance behavior
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Parental Presence/Absence
• Technique involves using the presence or absence of parent to gain cooperation for treatment
•Wide diversity exists in practitioner philosophy and parental attitude regarding parents’ presence or absence
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Parental Presence/Absence
Would you want this parent watching over you while you treated his son?????
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Parental Presence/Absence
• Communication between dentist and child is paramount
• Communication demands focus on the part of both parties
• Children’s responses to parents’ presence may be beneficial or detrimental
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Pediatric Dental Triangle
Child
Parent Dentist
Presence could be beneficial or detrimental
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Language may be a barrier to communication with the dentist so parental presence is needed.
Parental Presence/Absence
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Parental Presence/Absence
“I told him you were an ice cream vendor. You take it from there.”
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Parental Presence/Absence
• Each dentist needs to determine the communication methods that best optimize the treatment setting
• Recognize his/her own skills
• Recognize the abilities of the child
• Desires of the specific parent involved
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Parental Presence/Absence
• Gain the patient’s attention and compliance
• Avert negative or avoidance behaviors
• Establish appropriate child-adult roles
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Parental Presence/Absence
• One of the most controversial issues in pediatric dentistry
• Generally speaking, pediatric dentists keep them out
• Generally speaking, pediatricians keep them in
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Parental Presence/Absence
• For parental absence:
• Tend to repeat requests
• Become upset if child misbehaves
• Attempt to draw you in conversation
•May “test” you
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Parental Presence/Absence
• Recent studies:
• Kamp (1992) 66% of parents wanted to stay with child
• Certo and Bernat (1992) 75% desired to accompany child
• Bouchner et al (1989) 78% wanted to be with child while IV placed
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Parental Presence/Absence
• For presence:
• Can become a “silent” helper
• Good educational tool
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Parental Presence/Absence
• Let the parent know:
• The child is the focus of your attention
• Questions will be answered either pre- or post-treatment
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Establishing Communication and Authority
•Your main goal should be to prevent uncooperative behavior
•Need to listen to child’s questions
•Acknowledge by repeating them back
•Also need to establish authority
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Effective Dentists
•Establish rules for patients to follow
•Teach their patients
•Demonstrate kindness