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Behavioral Management in Pediatric Dentistry

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Paula Cohen

on 7 November 2013

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Transcript of Behavioral Management in Pediatric Dentistry

"A person's a person,
no matter how small!"
~Dr. Seuss
Meet Our Doctors!
Behavioral Management
Techniques
1. The Good

Paula Cohen
Walmir Da Costa
Parker Duke
Adrienne Fetner
Kristyn Healey
Susanna Hernandez


Distraction = Positive Reinforcement > Voice Control >>> Restraint
"we explain a situation in terms appropriate to the person's age and cognitive level"
Empirical Evidence
for T-S-D?
Works because...
you're educating your patient and involving them in the procedure, no matter how young they are.
they feel they have some control over the situation. (informed assent?)
you are removing the fear of the unknown as a factor of anxiety.
Which to use???
"it all boils down to reading the child"

Tell-Show-Do!
Three Categories of Behavior
Behavioral Management
Using tell-show-do and other techniques
Special Needs Children
Down-syndrome: T-S-D is great!
Autism: no T-S-D!

Children < 6 Years Old
Nitrous oxide/oxygen for injections
Dr. Gooch--Yup! AAPD states that TSD is common and supported by dental literature.

Dr. Dragstedt--Probably! But I couldn't quote any specific body of literature.

Dr. Johnson--Absolutely! But it can be used to your advantage or disadvantage, so know how to use it!
Don't be afraid!
Non-maleficence
Efficiency
"Tell-show-do"
"Tell-show-do"
“TELL”
-”Sleepy juice”
- “Mr. Whistle”
“SHOW”
Modeling
“DO”
Hypnosis
Distraction Techniques
Positive Reinforcement
Increasing sense of Control
Building a Relationship
References
Carson P, Freeman R. Tell-show-do: reducing anticipatory anxiety in emergency paediatric dental patients. International Journal of Health Promotion and Education 1998; 36 (3): 87–90.
Murray JJ, Niven N. The child as a dental patient. Current Opinion in Dentistry 1992; 2 (4): 59–65.
Wright FAC, McMurray NE, Giebartowski J. Strategies used by dentists in Victoria, Australia, to manage children with anxiety or behaviour problems. Journal of Dentistry for Children 1991; 58: 223–228.
Andlaw RJ, Rock WP. A Manual of Pedodontics, 3rd edn. Edinburgh: Churchill, 1995.
Find out MORE!
University of Florida D.M.D c/o 2012
Senior Pediatric Resident
Dr. Dragstedt
Dr. Gooch
University of Florida D.M.D c/o 1983
Pediatric Resident from UNC c/o 1985
Dr. Johnson
University of Florida D.M.D c/o 2005 Pediatric Resident c/o 2009
Distraction
Positive Reinforcement
Voice Control
Restraint
Managing the Parents
2. The Bad
3. The Ugly
Example: Prophy Cleaning
Tell-special toothbrush to make your teeth clean!
Show-allow them to feel the prophy cup on their fingers
Do-start on one tooth so they see it just tickles
Unique Situations
Self report treatment techniques used by dentists to treat dentally anxious children : a preliminary investigation
Background
Performed in the British society of pediatric dentistry conference.
Investigates the extent to which dentists employ monitoring technique vs blunting strategies when treating dentally anxious children.

Results
Mean blunting score was 2.5 , mean monitoring score 4.1.
All participants except one chose the item “I would explain step by step what I was going to do..
94 % claimed that they would talk about what they were doing with the child.
77% chose the blunting item “ talk with the child about a lot of things not to do with the treatment”.
Only 28 % claimed that they would point out distracters when performing an invasive procedure.

Conclusions
Treatment strategies relating to explaining procedures (TSD) were preferred.
Less than a third chose distracting techniques.
Practitioners believe that distracting techniques involve more effort than ( TSD).
Most interviewees preferred TSD techniques, because it build trust and decrease anxiety.
Downside of TSD, this may have implications in anxious children with “blunting coping style”

Methods
102 delegates completed a (MBTC) Monitor Blunter treatment checklist questionnaire.
Participants were asked to tick all of 10 statements (five monitoring and five blunting) that reflected how in general they would treat a dentally anxious child.
H. Buchanan & N. Niven
QUESTIONS?
What Do You Think?
Do you think there's a place for the use of restraints in pediatric dentistry? If so, when?

Is sedation dentistry the 'new' behavioral management technique? Is it appropriate for children?

What's your opinion on how all three topics presented relate to each other?
Full transcript