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Dr. GHADA MAHMOUD

Dr. Ghada Mahmoud

Factors affecting child behavior

Variables related to Cognitive age

Fear and anxiety
child patient
Physical /mental disability

Appearance of dental office

Variables related to
Personality of dentist and staff
Dental environment Time and length of appointment
Pain Free Dentistry

Variables related to Parenting attitude

Parenting attitude DFA of parents

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Variables related to
child patient

Cognitive age
Fear and anxiety
Physical /mental disability

Dr. Ghada Mahmoud 2023

Dental Fear & Anxiety DFA

What is the difference between FEAR and
ANXIETY?
Fear is a feeling that something terrible is going to
happen ; physiological changes including
tachycardia, profuse perspiration and
hyperventilation; and overt behavioral
movements such as becoming jetty or shaking.
Anxiety is a specific unpleasurable state of tension
which indicates the presence of some danger, it
arises from anticipation of an event, the outcome
of which is unknown.

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Causes of DFA
CONDITIONING
Subjective Fear

Dr. Ghada Mahmoud 2021

CLASSICAL CONDITIONING OF ANXIETY

PROVOKING STIMULI

❖The first theory published by the Russian

scientist Ivan Pavlov
❖It is learning by association
❖The general model:
stimulus (S) elicits response (R)

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Dr. Ghada M. Mahmoud

Conditioned stimulus?

Conditioned response?

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WHITE COAT

+
Injection
(vaccination)
Pain
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WHITE COAT

No
Injection

Fear

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Conditioned stimulus?

Conditioned response?

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DIRECT CONDITIONING to aversive

encounters in the dental office

Sights Needles,
white coat

Eugenol
Smells cut dentin

Turbine
Sounds suction

Sensations Vibrations
manipulation
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Subjective Fear learning through role

models, such as family, peers and society

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Variables related to
Dental environment

Appearance of dental office

Personality of dentist and staff
Time and length of appointment
Pain Free Dentistry

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1- The appearance of the dental office

Visual
Auditory

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1- The appearance of the dental office

❑ Make the waiting room comfortable, resembling the

child’s own environment
❑ More appealing operating room
❑ Try to avoid having the child see others in pain or
emotionally upset
❑ If possible, have the child leaving through another
door

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2- The personality of the dental team

❑Children are extremely sensitive to

hidden emotions, lack of enthusiasm
for the child will soon be recognized
❑Approach the child in natural,
friendly and casual manner
❑Whenever possible , all
conversation should be directed
toward the child
❑Use the nick name of the child
❑Dentist and assistants are better to
be in a good mode for more tolerance
of misbehaving patients
❑Flexibility in time frames

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3- time and length of appointment

❑ children shouldn’t be kept in dental chair for more

than 30 minutes
❑Preschoolers shouldn’t be given appointment
during regular nap time, they become sleepy, irritable
and cry easily
❑Elective dental treatment shouldn’t be scheduled
soon after a serious emotional experience, such as
birth of a sister or brother or death of someone close

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4- Pain Free Dentistry

PAINLESS ANESTHESIA

&
PAINLESS DRILL

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PAINLESS ANESTHESIA
• The needle must be out of sight
• Always use topical anesthesia
• Child can choose the flavor
• Dry the mucosa at the site of injection
▪ Apply the topical for at least 30sec
• Get supportive control of the patient’s head and hands
• Use short needle
• Use anesthetic pathway technique

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COMPUTER CONTROLLED DELIVERY SYSTEM

https://www.youtube.com/watch?v=EiXcCFwnoUE

Murat YENISEY. Appl Oral Sci. 2009;17(5):414-20

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ADJUNCTIVE VIBRATION

GATE CONTROLTHEORY
Sonya Jairaj Wexler and Allan E. Wulc. Pain Reduction Using Vibration
in Aesthetic Injections and in Eye and Facial Plastic SurgeryDOI 10.1007/978-1-4939-1544-6_12,

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Sonya Jairaj Wexler and Allan E. Wulc. Pain Reduction Using Vibration
in Aesthetic Injections and in Eye and Facial Plastic SurgeryDOI 10.1007/978-1-4939-1544-6_12,

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DENTAL VIBE

https://www.dentalvibe.com/for-dentists/

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PAINLESS ANESTHESIA

&
PAINLESS DRILL

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DRILL
HEAT
VIBRATION
ANESTHESIA

Vivek S Hegde and Roheet A Khatavkar A new dimension to conservative dentistry: Air
abrasionJ Conserv Dent. 2010 Jan-Mar; 13(1): 4–8.

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Er:YAG, Er,Cr:YSGG
Analgesic effect
Sterilizing effect

Verma S K et al,Laser in dentistry: An innovative tool in modern dental

practiceNatl J Maxillofac Surg. 2012 Jul-Dec; 3(2): 124–132.

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❑ Direct application of ozone gas

to the caries lesion on the tooth
surface
❑ Remineralising solution
immediately after application
of ozone
Healozone
❑ Supply of a 'patient kit', which
consists of toothpaste, oral
rinse and oral spray all
containing fluoride.

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Maru VP et al. Caries Removal by Chemomechanical (Carisolv™) vs. Rotary Drill: A

https://www.youtube.com/watch?v=7rH0omvs4_4
Systematic ReviewThe Open Dentistry Journal, 2015, 9, 462-472

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Pain Assessment
Pain has a direct influence on behavior and should be assessed
and managed throughout treatment.

Pain Assessment
❑ Self-report
❑ Observing changes in patient
behavior (e.g., facial expressions,
crying)
❑ Body movement during
treatment
❑ Biologic measures (e.g., heart
rate, sweating)
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Variables related to
Parents

Parenting attitude
DFA of parents

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• There is a direct relationship between child’s

behavior in the dental office and maternal anxiety.
Parent who are used to talk about their fears of
dentistry in front of their kids, or those who always
threaten their kids with going to dentist as
punishment, tend to have very fearful child in the
dental environment.

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Parental Attitudes
1- Over protective Attitude

❑ interferes with the natural

development of the child toward
independence
❑Assistance is forced on the child in
every minute task completed
❑They don’t allow the child to
experience and learn to cope with
problems and anxieties
•encouraging safety and dependence
over autonomy and exploration
•always knowing what’s best for their
child and emphasizing this to them at
every occasion
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❑ The child lacks self confidence

❑ The child is fearful in new situations
❑ Low self esteem
❑ Prone to anxiety and depression
❑ Insecure
❑ Fearful in new situations

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MANAGEMENT
• These parents insist on accompanying the child in the
dental office. Although they may repeatedly interfere
with dental procedure, they should be allowed to stay so
as not to create barrier between parent and dental stuff
• Enhance trust
• Relieve parent anxiety
• Explain every procedure and its rationale
• Assure pain free dentistry

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2- Over indulgent Attitude overpermissive

❑Parent are luxury heaping

❑They insist to accompany the child into
dental office
❑Pointing to the lack of apprehension of the
child and to his/her young age
❑This may be due to a threatening experience
during early childhood or pregnancy,
maladjustment in the family or the parent was
raised in a home that lacks warmth and love

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CAUSES
▪ A threatening experience to the health of the
child either during pregnancy or after birth
▪ Single child after difficulties in pregnancy
▪ Parent was raised in a home that lacks warmth
and love
▪ Maladjustment in the family
▪ Some psychological disturbance of the parent

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❑Child is self centered and stubborn

❑child learns to manipulate his/her parents into satisfying all of
his/her desires
❑Child acts superior, bossy and dominating
❑Typically they presents the type of behavior as DEFIANT or
king child

Logical consequences

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MANAGEMENT
• Parents should be instructed not to interfere with
communication and treatment
• Dentist should set himself/herself as the only authority
figure in clinic
• Establish a one-to-one relationship with the child
• Voice control can be used ( over 3 years)

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3- Over authoritative Attitude ( dominating)

❑Parent expects behavior from their child
that is incompatible with his age
❑They are not supportive of their anxieties
but rather continuously criticize them
❑They may compare them with their older
siblings and demand the same behavior
❑The child will be often afraid of overtly
resisting the dentist but will commonly use
delaying tactics to avoid treatment

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4- Underaffectionate Attitude ( Rejecting)

❑It grade from mild

indifference because of
work to complete neglect
because of emotional
problem
❑Rejected child may be
treated with violence,
constantly criticized and
may be severely punished

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➢ Use pre appointment letter or telephone call

➢ Compliment parent for seeking child dental health
➢ Advise parent not to talk about his own dental
fears in front of the child
➢ Instruct the parent never to use dentistry as a
threat or punishment
➢ Assure the parent that modern dentistry is mainly
pain free
➢Don’t promise the child that dentist will not hurt
him/her
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INFORMED CONSENT

• Consenting has both ethical and legal

implications
• Communicative management
techniques do not require consent.
• Any other behavior guidance require a
prior informed consent .
Elements of the consent:
1- full description of the procedure
2- objectives and side effects if any
3- approval and signature of parent or legal
guardian
4- contact information of the clinician.

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