Management of Children in

Paediatric Dentistry
OH 4001
 Behaviour Management

•To know the main Behaviour

Management techniques used in
Paediatric Dentistry
•To know the main methods of
communicating with child patients
 Aims

• Understand how children relate to the adult world

and consider development
• Structure of dental visits
• Strategies to help children cope
• Role of parents
• Anxious and uncooperative children
 Development
• A continuum

• Motor development

• Cognitive development
 Motor Development
• Paediatricians use motor milestones
• Age 2 most walk independently
• From age 2 most developments are refinements cf
new skills
• Hand to eye coordination improves
• Age 6-7 most are capable of effective tooth brushing
• Below that - need supervision
 PAEDIATRIC DENTISTRY

• First aim- manage the patient

• Then- manage the oral condition

 Communication

Verbal- must be adapted to age and maturity of the child

Initially it can focus on child’s interests, home,
school, leisure

Visual-
Relaxed, friendly, cheerful, confident
eye contact
 I have a name!

Know the child’s name and use it.

Know their age - its important to them

 Voice control

A controlled alteration of voice volume or tone or

pace to influence and direct a patients behaviour

Objectives
To gain a patients attention and compliance
To prevent negative or avoidance behaviour
To establish appropriate adult- child roles
 Non verbal communication
The reinforcement and guidance of behaviour through
appropriate contact, posture and facial expression

Objectives
• To enhance the effectiveness of other techniques
• To gain or maintain the patients attention and compliance

non-verbal communication is at least as important as spoken

words to anxious patients
 Tell show do
Is a technique of behaviour shaping used with both
verbal and non verbal communication

Objectives
• To teach the patients important aspects of the
dental visit and familiarise the patient with the
dental setting and instruments and procedures
 Tell-Show- Do (T.S.D)

1. Tell child what is to be done

2. Show child instrument

3. Do it

Be brief
Praise for reinforcement
 Positive reinforcement
The process of establishing desirable patient behaviour
through appropriate feedback and to reinforce
desirable behaviour

• Praising and rewarding desirable behaviour

immediately and often as required
• Avoiding support for undesirable behaviour
 Reinforcement

Based on social learning theory that the child develops

behaviour in response to rewards e.g love and approval
of parents

SHOWS APPROVAL :
•Verbally
•Visually
•frequently
Approval should be closely linked to action
 Parental Presence
• Negotiating with the parent whether or not they remain
in the surgery– in order to gain patient cooperation

Objectives
• To gain the patients attention and compliance
• To prevent negative or avoidance behaviours
• To establish appropriate adult- child roles
• To enhance the communication environment
 Behaviour Shaping

The process of influencing a patient towards

a desired ideal using a step by step approach
 Desensitisation

Construct a series of steps

Introduce steps one at a time

Start with least fear arousing

Use reinforcement at each stage

 Modelling

•A relaxed and cooperative patient is treated

and is watched by the child

•The aim is that this behaviour will be

imitated

•Can be used combined with reinforcement

and desensitisation
 The first stages

•Establish communication with child and

parent
•Obtain child’s and parents? past dental
history
•Examine child
•Draw up a realistic treatment plan
•Establish treatment objectives and explain
them to child and parent
 Treatment Planning- order of events

•e.g - Examination and prophylaxis

•Fissure sealants

•Infiltration and small restoration

•More extensive procedures

 Adverse Behaviour

•Avoid ridicule

•Avoid anger

•But avoid rewarding poor behaviour

 Inhalation sedation

• The only currently recommended technique for inhalation

sedation is the use of a titrated dose of nitrous oxide with
oxygen.

• It is absolutely essential that safeguards be in place to

ensure that a hypoxic mixture cannot be
administered.

CONSCIOUS SEDATION IN THE PROVISION OF DENTAL CARE 2003

 Safe technique
• Dedicated equipment with specific safety features
• Titrated dose of inhaled Nitrous oxide
• Predictable responses
• Rapidly reversible
• Eliminated quickly
Porter Relative Analgesia Machine