Behavioral Management

Techniques for the

Pediatric Dental Patient
Jacey Sheckler, RDH, MS
Fall 2017
Behavior Management
 Behavior Management

• Goals of communication and education

• Process of dialogue, facial expression, and voice
tone

• Build a relationship between dentist and patient

 To maintain compliance

• Skills of verbal guidance

• Expectation setting
• Extinction of inappropriate behavior
• Reinforcement of appropriate behavior
 Objectives

• To effectively and
efficiently perform
treatment for the child
• To instill a positive
attitude
 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
 Pediatric Dental Triangle

Child

• Patient should always be

your highest concern

• Continuum of interactions
between all three persons
Parent Dentist
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
 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.
 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
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
 Dental Profession

• Society is more litigious

• Parents are not consenting
to physical and
mechanical restraints
• Dentist may be portrayed
as the abuser
 Physical Restraint

• An example of protective
stabilization
• Will be discussed in depth
at a future lecture
Now is the time to reacquaint
ourselves to behavior
management skills
 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
Cooperative vs. Uncooperative
 Communicative Management
• Voice Control
• Nonverbal communication
• Tell-Show-Do
• Positive Reinforcement
• Distraction
• Parental Presence/Absence
 Voice Control

• Controlled alteration of voice volume, tone or

pace to influence and direct the patient’s
behavior
Voice Control

• Note the proximity of

the dentist to the
patient
 Voice Control

• To gain the patient’s attention and compliance

• To avert negative or avoidance behavior
• To establish appropriate adult-child roles
 Nonverbal Communication

• The reinforcement and guidance of behavior

through appropriate contact, posture, and
facial expression
 Nonverbal Communication

• To enhance the effectiveness of other

communicative management techniques
• To gain or maintain the patient’s attention
and compliance
 Tell-Show-Do

• Tell:
involves verbal explanations of
procedure in phrases appropriate to the
developmental level of the child
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
 Tell-Show-Do

• “Showing” the procedure on

the child’s baby doll
 Tell-Show-Do

• Do: Then, without

deviating from the
explanation and
demonstration,
completion of the
procedure
 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
 Positive Reinforcement

• To establish desirable patient behavior it is essential to

give appropriate feedback
• Effective method to strengthen the occurrence of
desirable behavior
 Positive Reinforcement
• Social reinforces include:
• Verbal praise
• Voice modulation
• Facial expression
• Appropriate physical demonstration of affection
 Positive Reinforcement

• Non-social reinforces include:

• Tokens such as stickers
• Small toys
 Positive Reinforcement

• The primary goal is to reinforce desired

behavior
 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
Distraction

Sunglasses to block
out the intensity of
the light as well as
being protective
 Distraction
• To decrease the perception of unpleasantness
• To avert negative or avoidance behavior
 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
Parental Presence/Absence

Would you want this parent

watching over you while
you treated his son?????
 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
 Pediatric Dental Triangle

Child

Presence could be beneficial or

detrimental

Parent Dentist
Parental Presence/Absence

Language may be a
barrier to
communication with
the dentist so
parental presence is
needed.
Parental Presence/Absence

“I told him you were an ice cream

vendor. You take it from there.”
 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
Parental Presence/Absence

• Gain the patient’s

attention and compliance
• Avert negative or
avoidance behaviors
• Establish appropriate
child-adult roles
 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
 Parental Presence/Absence
• For parental absence:
• Tend to repeat requests
• Become upset if child misbehaves
• Attempt to draw you in conversation
• May “test” you
 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
Parental Presence/Absence

• For presence:
• Can become a “silent”
helper

• Good educational tool

 Parental Presence/Absence
• Let the parent know:
• The child is the focus of your attention
• Questions will be answered either pre- or post-
treatment
 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
 Effective Dentists

• Establish rules for patients to follow

• Teach their patients
• Demonstrate kindness