Dental behavior management of children

introduction of children behavior
classification of children behavior
methods of behavior management

1. Dental Behavior Management Of Children presented by : محمد عصام حسن محمد يقظان طاهر علي سالم محمد حمزة عبد الساده

2. Introduction: Behavior : Is an observable act, which can be described in similar ways by more than one person. Emotion is a state of mental excitement characterized by physiological, behavioral changes and alterations of feelings.

3. Types of children emotions : Cry: Obstinate cry Frightened cry Hurt cry Compensatory cry Anger Fear: It is defined as an unpleasant emotion or effect consisting of psycho-physiological changes in response to realistic threat or danger to one's own experience. Types of fear: Subjective fear Objective fear

4. OBJECTIVE FEAR:- They are the responses to stimuli that are felt, seen, heard, smelt or tasted and are not liked or accepted. SUBJECTIVE FEAR:- These are based on the feelings and attitudes that have been suggested to child by others about dentistry without the child having had the experience personally. SIGNS AND SYMPTOMS OF FEAR: Anxiety Phobia

5. Anxiety Is an emotion similar to fear arising without any objective source of danger. Is a reaction to unknown danger. It is often been defined as a state of unpleasant feeling combine from within rather than from without . It is a learned process being in response to one's environment. As anxiety depends on the ability to imagine, it develops later than fear. with an associated feeling of impending doom or danger   Types of anxiety

6. PHOBIA: Defined as persistent, excessive, unreasonable fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object. Simple Situational Social

7. CLASSIFICATION OF CHILDREN ’ S BEHAVIORS:- 1- CO-OPERATIVE BEHAVIOR:- Reasonably relaxed, have minimal apprehension and can be treated by a straight forward behavior shaping approach. 2- LACKING CO-OPERATIVE BEHAVIOR:- -This behavior is contrast to co-operative child. -Includes very young child (<2.5years) or with specific debilitating or handicapping conditions.

8. 3- POTENTIALLY CO-OPERATIVE BEHAVIOR: - Differs from a child lacking cooperative ability in that this child is able to cooperate and is physically and medically fit. - Potentially cooperative group are further categorized as follows: A- Uncontrolled behavior:- • Seen in 3-6 years. • Tantrum may begin in the reception area or even before. • Tears, loud crying, physical lashing out and flailing of hands and legs all suggestive of a state of acute anxiety or fear. B- Defiant behavior:- • Can be found in all ages, more typical in the elementary school group. • Distinguished by “ I don ’ t want to ” or “ I don ’ t have to ” or “ I wont ” . • Once won over, these children frequently become highly cooperative .

9. C- Timid behavior :- • If they are managed incorrectly, their behavior can deteriorate to uncontrolled. • May be from an overprotective home environment or may live in an isolated area having little contact with strangers. • Needs to gain self confidence of the child. D- Tense cooperative behavior:- • Accept treatment, but are extremely tense. • Tremor may be heard, when they speak. E- Whining behavior:- • They do not prevent treatment, but whine throughout the procedure. • Great patience is required while treating such children.

10. FACTORS INFLUENCING CHILD ’ S BEHAVIOR:- 1-FACTOR INVOLVING THE CHILD:- A. Growth and development B. Past dental experience C . Social and adaptive skill D . Position of child in the family 2- FACTORS INVOLVING THE PARENTS:- A. Family influence B. Parent-child relationship C. Maternal anxiety D. Attitude of parents to dentistry

11. 3- FACTORS INVOLVING THE DENTIST:- A. Appearance of the dental office B. Personality of the dentist C. Time and length of appointment D. Dentist ’ s skill and speed E. Use of fear promoting word F. Use of subtle, flattery, praise and reward.

12. BEHAVOUR MANAGEMENT: Behavioral pedodontics :- It is a study of science which helps to understand development of fear, anxiety and anger as it applies to child in the dental situations. Objectives of Behavior Management :- Establishes effective communication with the child. Gains child’s confidence and acceptance of dental treatment Provides a comfortable environment for the dental team to work in.

13. Behavior management can be achieved by basically two methods:- A- Non pharmacological methods B-pharmacological methods 1- Communication. Conscious sedation: 2-Tell-show do technique. * Nitrous/Oxide Inhalation 3-Modelling. 4-Positive and negative reinforcement 5-Distraction 6-Voice control 7-Retraining 8-HAND OVER MOUTH TECHNIQUE 9-Physical immobilization

14. A-NON-PHARMACOLOGICAL METHODS:- 1-COMMUNICATION:- The hallmark of successful dentist in managing children is his ability to communicate with them and win their confidence. Effective communication with children is critical for gaining the child’s cooperation to receive dental care.

15. 2-TELL-SHOW –DO TECHNIQUE TELL: The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient. SHOW : demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, non threatening setting. DO: and then, without deviating from the explanation and demonstration, completion of the procedure. The tell-show-do technique is used with communication skills ( verbal and nonverbal ) and positive reinforcement.

16. TELL-SHOW - DO TECHNIQUE

17. 3-MODELLING The basic modeling procedure involves allowing a patient to observe one or more individuals (models) who demonstrate appropriate behavior in particular patient Stimulated models as live models (siblings or parents) , films, clips, posters, audiovisuals, or videos can be used to reinforce the desired behavior.

18. 4-Reinforcement Reinforcement can be :- Positive reinforcement :- presentation of reinforces which increases the frequency of desired behavior. Negative reinforcement :- withdrawal of reinforces which increases the frequency of desired behavior.

19. Types of Reinforcement

20. Reinforcement Social reinforces :- include positive voice modulation ,facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team. praise ( Good, Excellent, Thank you ) Facial expression ( Smiling , laughing ) Physical Contact ( patting on shoulder or shoulder , hugging , shaking / holding hands ) Nonsocial reinforces :- include tokens and toys.

21. 5-Distraction It is a technique used to divert the patient’s attention during the unpleasant procedure such as:- Music Video Talking White noise…. Hypnosis Breathing

22. 6-Voice control Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient’s behavior to:- Gain the patient’s attention and compliance avert negative or avoidance behavior establish appropriate adult-child roles.

23. 7-Retraining If a child have an unpleasant experience in the previous dental office, the child still tends to generalized that an unpleasant event will occur in his new dental office also. This is non as stimulus generalization. To remove this the dentist has demonstrate a difference and create new stimulus which is pleasant and replaces the old.

24. 8-HAND OVER MOUTH TECHNIQUE:- This method is establish communication with children who are able to cooperate, but exhibit a hysterical behavior to avoid treatment. A hand placed over the child’s mouth and is told that the hand will be removed as soon as appropriate behavior begins. When the child responds, the hand is removed and the praised for his appropriate behavior. Contraindicated in immature frightened, or the child with a serious physical, mental or emotional handicap

25. 9-Physical immobilization:- Are used to provide partial or complete immobilization of the patient to protect the patient and dental staff from injury while providing dental care, this is done by :- dentist/staff/parents Physical restraints ● Papoose board ● Triangular sheet ● Pedi wrap ● Mouth prop or bite block

26. Papoose board Pedi wrap Mouth prop

27. B-Pharmacological methods:- Conscious Sedation: What is C.S ? Minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by pharmacologic and non-pharmacologic methods alone or in combination, (NO LOSS OF CONSCIOUSNESS)

28. Nitrous Oxide Nitrous Oxide is a very quick acting inhaled sedation medicine that decreases discomfort and anxiety. Oxygen and nitrous oxide is given through a small breathing mask. Relaxing, but without putting them to sleep. Very safe and effective Sometimes called “laughing gas” Often given at the dentists office Nitrous Oxide is a sweet-smelling, colorless gas. It is heavier than air or oxygen Onset Anywhere from a few seconds up to 3-5 minutes Crosses the blood-brain barrier rapidly

29. The objectives of nitrous oxide/oxygen inhalation 1. Reduce or eliminate anxiety. 2. Reduce unwanted movement and reaction to dental treatment. 3. Enhance communication and patient cooperation. 4. Raise the pain reaction threshold. 5. Increase tolerance for longer appointments. 6. Aid in treatment of the mentally/physically disabled or medically compromised patient. 7. Reduce gagging. 8. Potentiate the effect of sedatives.

30. Review of the patient’s medical history should be performed prior to the decision to use nitrous oxide/oxygen analgesia/ anxiolysis . This assessment should include: 1. Allergies and previous allergic or adverse drug re- actions. 2. Current medications including dose, time, route, and site of administration. 3. Diseases, disorders, or physical abnormalities 4. Previous hospitalization to include the date and purpose. 5. Recent illnesses ( eg , cold or congestion) that may compromise the airway.

31. Indications for use of nitrous oxide/oxygen analgesia/ anxiolysis 1. A fearful, anxious patient 2. Certain patients with special health care needs. 3. A patient whose gag reflex interferes with dental care. 4. A patient for whom profound local anesthesia cannot be obtained. 5. A cooperative child undergoing a lengthy dental procedure.

32. Contraindications for use of nitrous oxide/oxygen inhalation 1.Some chronic obstructive pulmonary diseases. 2. Severe emotional disturbances or drug-related dependencies. 3. Treatment with bleomycin sulfate.

33. T h a n k y o u