BEHAVIOURAL MANAGEMENT IN PEADIATRIC DENTISTRY

Behavior management, similar to behavior modification, is a less-intensive form of behavior therapy. Unlike behavior modification, which focuses on changing behavior, behavior management focuses on maintaining positive habits and behaviors and reducing negative ones.

2. CONTENTS

DEFINITION :

- BEHAVIOUR
-BEHAVIOUR MANAGEMENT
-BEHAVIOUR SHAPING

Py -BEHAVIOUR MODIFICATION

3. >» NON-PHARMACOLOGICAL BEHAVIOUR MANAGEMENT

+ COMMUNICATION
* USE OF SECOND LANGUAGE

* TELL-SHOW-DO

* DESENSETIZATION

* MODELING

BEHAVIOUR SHAPING

4. CONTINGENCY MANAGEMENT

EXTERNALIZATION

DISTRACTION

ASSIMILATION AND COPING

PARENTAL PRESENCE OR ABSENCE

RETRAINING

VISUAL IMAGERY

5. -FLOODING TECHNIQUE

-VOICE CONTROL

-USE OF POETRY AND DRAWINGS
-HYPNOSIS

-HAND OVER MOUTH TECHNIQUE

-PROTECTIVE STABILIZATION

6. DEFINITION

BEHAVIOUR is any activity that can be
observed , recorded and measured.

BEHAVIOUR management is the means
by which dental health team effectively and
efficiently performs treatment for a child and
at the same time instills a positive dental
attitude.(WRIGHT,1975)

7. It is the procedure , which slowly develops
BEHAVIOUR by reinforcing a successive
approximation of desired BEHAVIOUR until desired
BEHAVIOUR comes into being.

a It is definedas the attempt to alter human
El BEHAVIOUR and emotion in a beneficial manner
en A according to laws of modern learning
theory.(EYSENCK,1964)

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8. CLASSIFICATION OF BEHAVIOR
MANAGEMENT

* -COMMUNICATION
* -USE OF SECOND LANGUAGE

Pl N + -TELL-SHOW-DO
*Y . - DESENSITIZATION
+ -MODELING

* -BEHAVIOUR SHAPING
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+.

9. CONTINGENCY MANAGEMENT
-EXTERNALIZATION

-DISTRACTION

-ASSIMILATION AND COPING
-PARENTAL PRESENCE OR ABSENCE
-RETRANING

-VISUAL IMAGERY

10. * VOICE CONTROL

+ USE OF POETRY AND DRAWINGS
* HYPNOSIS

* HAND OVER MOUTH TECHNIQUE
* PROTECTIVE STABILISATION

* PRE-MEDICATION
* CONSCIOUS SEDATION
* GENERAL ANESTHESIA

11. NON PHARMACOLOGICAL
BEHAVIOR MANAGEMENT

* Communicative management is universally used in
pediatric dentistry with both the cooperative and
uncooperative child (chambers,1976)

-By involving in conversation, the dentist not only
A learns about the patient but may also relax the
* _* Z patient

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12. 1. Verbal communication by speech
2.Nonverbal communication -
Expressions without words like hand shaking ,

eye contact , smiling.

-Both verbal and non verbal

13. * communication should be comfortable and
relaxed.

° Communication with children aged 3 to7 years
should be based on Piagetian

* Concept which involves life like name to dental
instruments like hand piece called whistling
Charlie.

* The most important aspect of communication is
getting the child to respond to dentist's command.

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14. * The three most important facets of communication
are source, medium and receiver . In reference to
dentistry , dentist isthe source , dental clinic is the
medium and child is the receiver

» -If the dentist is good , sympathetic , confident and
honest; dental is neat ,quiet , familiar to children
‚full of toys; the automatically child is
communicating and is well managed.

16. EOP SE D LANGUAGE
(EUPHEMISM)

+ Euphemisms are substitute words, which can be
used in the presence of child.

» The dental staff as well as dentist should oriented to
the use of second language .

17. ETS

Anesthetic * Sleepy medicine or sleepy water
Bur * Brush or pencil

Impression material * Pudding or mashed potatoes
Caries + Brown spot : sugar bugs
Matrix + Fence for filling

Rubber dam + Hat for tooth
stainless steel crown . Raincoat

= X-ray + Camera

PO : Radiograph . picture

- Hand piece . Whistling train

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The cornerstone of behaviour management was given
by Addleston in 1959.

O Specifically , the dentist tells the child what is
going tobe done in words the child can understand
«Second , the dentist demonstrates to child exactly
how the procedure will be conducted . Finally
‚practitioner performs the procedure exactly as it
was described and demonstrated

À -To teach the patient aspect of dental
visit and to familiarize him with the dental
settings.

- To shape the patients response to various
procedures,

19. » Tell the child before you do it, while you are
doing it and after you have done it . You voice
should be soft , yet firm.

* Confident , and continuous .You should be
truthful with the child and if the procedure is
going to be painful or uncomfortable , say so.

Demonstration of the visual,auditory,
- olfactory and tactile aspect of the procedure in
2 Ka carefully defined, nonthreatening setting
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3 * The dentist can either demonstrate on
u himself or an inanimate object.

20. + The noise of running hand piece shows the child

through the hearing medium . A pinch on the arm

before anesthesia administration demonstrate to the

cule how the pinch of the injection in the mouth might
eel.

* Bring equipment from behind the child or the visual
level is preferred.

* Without deviating from explanation and
demonstration dentist perform the previewed

operation .
PO : * In doing, do what you said you would do.
a * Do not do until the child has clear awareness
$ of what it is you are going to do.

21. TELL-SHOW -DO TECHNIQUE

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22. » DESENSITIZATION

- This technique was demonstrated by James and
popularize by Wolpe.

- It means take away ones sensitivity to a type of
behavior.

-This is used in children having pre-established fears
and uncooperative behavior .
. Desensitization accomplished by teaching
The child a competing response such as relaxation
and then introducing progressively more

u threatening stimuli.
4
ll Is an effective method for reducing maladaptive
behaviour

23. » MODELING

+ Introduced by Bandura ( 1969).

-It is based on one’s learning or behaviour acquisition
occurs through observation of suitable model
performing specific behaviour.

-Synonyms : imitation , observational learning ,
identification, internalization , coping .

-Modeling seems to improve of the apprehensive child
who have had no previous dental experience .

oj of modeling:
Audiovisual

Live modeling by parents , sibling etc.

24. Stimulates acquisition of new behavior .
facilitating the behavior already in the patients
in more appropriate manner.

- Elimination of avoidance behaviour .

- Extinction of fear.

Patient's attention is obtained.
“ Designed behavior is modeled.
PL XA- Physical guidance of the desired behaviour.
= - Reinforcement of the desired behaviour

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26. » BEHAVIOR SHAPING

* It is defined as a process which slowly develops a
behavior by reinforcing successive approximation of the
desired behavior

until the desired behavior is expressed(Lenchner and
wright ,1975)

- It is based on stimulus- response theory.

~~ x
-\whén shaping the behavior the dentist is teaching to a child
tojbehave ö

27. BEHAVIOUR MODIFICATION

28. » CONTINGENCY MANAGEMENT

- The presentation of positive reinforcers or
withdrawal of negative reinforcers is termed
contingency management.

- It include :
- Positive reinforcement
- Negative reinforcement
- Omisssion or time out
- Punishment

_. Positive reinforcement - is one whose

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contingent presentation increases the
frequency of behavior ( Henry W Fields ,1984)

2) Negative reinforcement - is one whose
contingent withdrawal increases the
frequency of behavior ( Stokes and
Kenndy,1980).

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Social - e.g. , praise , positive facial
expression , physical contact by shaking hand
, hug ,pat on shoulder.

Material - may be given in the form of games
‚toys.

. „Activity reinforcers - Involving child in some
& x "activity like watching TV shows , visit to park.

31. » EXTERNALIZATION

+ It Is the process by which child’s attention is
focus away from the sensation associated with
dental treatment by involving in verbal or
dental activity.

Cari To decrease perception of unpleasantness
n - to interest and involve children.

32. » DISTRACTION

* The patient is distracted from the sound and/or
sight of dental treatment thus reducing anxiety.

- Objective is to relax the patient and to reduce
anxiety during treatment.

- Use stories and fairy tales.

- Use slow instrumental music.

* - Types of distraction:

od Audio distraction

Fr x ». Audiovisual distraction.
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34. » ASSIMILATION AND COPING

- Stress can act to increase pain perception
while coping decrease it by process called
assimilation .
* Coping is defines as the cognitive and behavioral
efforts made by an individual to master, tolerate
or reduce stressful situations (Lazaue ,1980) .

1.Behavioral -
- are physical and verbal activity in which the
2 K child engages to overcome a stressful situation
‘ “ 2.cognitive -
v Efforts which involves manipulation of

emotions .

35. > PARENTAL PRESENCE OR ABSENCE

To avert avoidance behavior
* -To establish authority
* -To gain patient’s attention and compliance

a)
b)

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Overcoming parental conditioning
Avoiding communication interference
Avoiding parental interference

Supporting and communicating with the

child
Very young patients.

36. THANK YOU