BEHAVIOR MANAGEMENT

CONTENTS

• INTRODUCTION
• DEFINITIONS
• CLASSIFICATION OF CHILD BEHAVIOR
• MATERNAL INFLUENCE ON CHILDREN’S BEHAVIOR IN THE DENTAL SITUATION
• CHILDREN’S REACTIONS TO DENTISTRY
• ATTITUDINAL AND ENVIRONMENTAL INFLUENCES ON CHILDREN’S BEHAVIOR IN THE
DENTAL SITUATION
 INTRODUCTION

• BEHAVIOR MANAGEMENT OF THE PEDIATRIC PATIENT IS AN ESSENTIAL PART OF

PEDIATRIC DENTAL PRACTICE.
• A SIGNIFI CANT PERCENTAGE OF CHILDREN DO NOT CO-OPERATE IN THE DENTAL
CHAIR, HENCE CAUSING AN OBSTACLE TO LIBERATION OF QUALITY DENTAL CARE.
 CLASSIFICATION OF CHILD BEHAVIOUR

• CO-OPERATIVE BEHAVIOR
• LACKING CO-OPERATIVE BEHAVIOR
• POTENTIALLY CO-OPERATIVE BEHAVIOR
 CO-OPERATIVE BEHAVIOR

• REASONABLY RELAXED, HAVE MINIMAL APPREHENSION AND CAN BE TREATED BY A

STRAIGHT FORWARD BEHAVIOR SHAPING APPROACH.
 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.
 POTENTIALLY CO-OPERATIVE HYSTERICAL OR
UNCONTROLLED
• 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
B- DEFIANT BEHAVIOR
C- TIMID BEHAVIOR
D- TENSE COOPERATIVE BEHAVIOR
E- WHINING BEHAVIOR
 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.
 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.
 FACTORS INFLUENCING CHILD’S BEHAVIOR

1-FACTOR INVOLVING THE CHILD

2- FACTORS INVOLVING THE PARENTS
3- FACTORS INVOLVING THE DENTIST
 FACTOR INVOLVING THE CHILD:

• GROWTH AND DEVELOPMENT

• PAST DENTAL EXPERIENCE
• SOCIAL AND ADAPTIVE SKILL
• POSITION OF CHILD IN THE FAMILY
 FACTORS INVOLVING THE PARENTS

• FAMILY INFLUENCE
• PARENT-CHILD RELATIONSHIP
• MATERNAL ANXIETY
• ATTITUDE OF PARENTS TO DENTISTRY
 FACTORS INVOLVING THE DENTIST

• APPEARANCE OF THE DENTAL OFFICE

• PERSONALITY OF THE DENTIST
• TIME AND LENGTH OF APPOINTMENT
• DENTIST’S SKILL AND SPEED
• USE OF FEAR PROMOTING WORD
• USE OF SUBTLE, FLATTERY, PRAISE AND REWARD
• DEVELOPMENT AND A VARIETY OF OUTLOOK TOWARD DENTAL TREATMENT, IT IS VERY
IMPORTANT THAT DENTISTS HAVE AT THEIR CLEARANCE A WIDE VARIETY OF BEHAVIOR
MANAGEMENT TECHNIQUES AND COMMUNICATION TECHNIQUES TO MEET THE NEEDS
OF THE EVERY CHILD.
THE OBJECTIVES OF CHILD MANAGEMENT ARE LISTED BELOW:
1. TO ASSEMBLE THE CHILD COMFORTABLE
2. TO OFFER FREEDOM FROM PAIN
3. TO EXECUTE THE PROCEDURES SAFELY
4. TO HOLD OUT THE TREATMENT CAPABLE AND
5. TO BOAST THE CHILD AND THE PARENT AGREEMENT TO THE PROCEDURES.
 GUIDELINES ON BEHAVIOUR MANAGEMENT

1. A DENTIST SHOULD HAVE WIDE RANGE OF MANAGEMENT TECHNIQUES TO MEET THE NEEDS
OF AN INDIVIDUAL CHILD
2. ESTABLISH AND MAINTAIN “TEACHER-STUDENT” RELATIONSHIP
3. ALL MANAGEMENT DECISIONS MUST BE BASED ON A SUBJECTIVE EVALUATION OF BENEFIT &
RISK
4. DECISIONS MUST INVOLVE A LEGAL GUARDIAN, & IF APPROPRIATE, THE CHILD
5. WRITTEN INFORMED CONSENT MUST BE MAINTAINED IN THE PATIENT’S DENTAL RECORD
6. IMPLIED CONSENT IS APPLICABLE IN AN EMERGENT SITUATION
 BEHAVIOUR MANAGEMENT METHODS

• NON PHARMACOLOGICAL (PSYCHOLOGICAL) APPROACH

1. PSYCHOLOGICAL
2. PHYSICAL
• PHARMACOLOGICAL APPROACH
 NON-PHARMACOLOGICAL METHODS

1. COMMUNICATION
2. BEHAVIOR SHAPING/ MODIFICATION DESENSITIZATION
TELL-SHOW-DO MODELLING CONTINGENCY MANAGEMENT
3. BEHAVIOR MANAGEMENT AUDIO ANALGESIA
VOICE CONTROL COPING RELAXATION
HYPNOSIS DISTRACTION
 COMMUNICATION

1. VERBAL COMMUNICATION – BY SPEECH

2. NON-VERBAL (MULTISENSORY) COMMUNICATION – BY APPROPRIATE CONTACT,
POSTURE AND FACIAL EXPRESSION
 VOICE CONTROL

• WHAT YOU SAY IS NOT AS CRITICAL AS HOW YOU SAY IT

• CHANGE IN TIMBRE, INTENSITY & PITCH OF VOICE
• TO GAIN CHILD’S ATTENTION, TO STARTLE HIM FROM DISRUPTIVE BEHAVIOR, USED IN
CONJUNCTION WITH PHYSICAL RESTRAINTS
 AUDIO ANALGESIA

• METHOD OF REDUCING PAIN

• PROVIDING SOUND STIMULUS OF HIGH INTENSITY
• BASED ON STIMULUS DISTRACTION
• MUSIC PROMOTE RELAXATION NOISE SUPPRESS PAIN (GARDNER ET AL)
• AUDIOTAPED STORIES, CARTOON TAPES MORE EFFECTIVE
 BEHAVIOUR MODIFICATION TECHNIQUES

• DESENSITIZATION

• TELL-SHOW-DO
• MODELLING
• CONTINGENCY MANAGEMENT
 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.
 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
 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
 REINFORCEMENT

• SOCIAL REINFORCES:- INCLUDE POSITIVE VOICE MODULATION ,FACIAL EXPRESSION,

VERBAL PRAISE, AND APPROPRIATE PHYSICAL DEMONSTRATIONS OF AFFECTION BY ALL
MEMBERS OF THE DENTAL TEAM.
1. PRAISE ( GOOD, EXCELLENT, THANK YOU )
2. FACIAL EXPRESSION ( SMILING , LAUGHING )
3. PHYSICAL CONTACT ( PATTING ON SHOULDER OR SHOULDER , HUGGING , SHAKING /
HOLDING HANDS )
• NONSOCIAL REINFORCES:- INCLUDE TOKENS AND TOYS
 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
 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
 MANAGEMENT OF SPECIAL GROUPS

• SPEECH IMPAIRMENT : BE PATIENT AND GIVE UNHURRIED ATTENTION.

• HARD OF HEARING : MAINTAIN EYE CONTACT AND SPEAK DIRECTLY TO THE CHILD. IF
VERBAL COMMUNICATIONS ARE NOT WORKING, USE PEN AND PAPER AND WRITE
LEGIBLY. BE PATIENT.
• VISUALLY IMPAIRED : SPEAK IN A NORMAL TONE AND SPEED OF VOICE. LET THE
CHILD KNOW IF YOU'RE LEAVING THE VICINITY, TO AVOID THE UNNECESSARY
EMBARRASSMENT
 MENTALLY RETARDED

• MORE TIME MUST BE SET ASIDE FOR ANY PRETREATMENT EXPLANATIONS OR

INSTRUCTIONS
• INSTRUCTIONS SHOULD BE SIMPLE, CONCRETE & REPEATED
• VISUAL INSTRUCTIONS BEFORE TREATMENT FACILITATE MANAGEMENT COMPARED
WITH VERBAL INFORMATION ALONE
• PLACE IN A RELATIVELY NON-STIMULATING ENVIRONMENT
• RESTRAINTS, SEDATION & GENERAL ANAESTHESIA