Non Pharmacological Behavioural Management PDF

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Summary

Psychological Intervention in Medicine...

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Behavioural Management: Non-Pharmacological Definition Wright, 1975:  

The means by which the dental health team effectively and efficiently performs treatment for a child. The aim is to instill a positive dental attitude.

Other aim:  

To create a long-term interest on the patient’s part for ongoing prevention and improved dental health About communication and education

Factors influencing child behavior Medical/Dental history Children who have had negative medical/dental experiences may be more anxious about dental treatment Parental anxiety A parent who is unable to contain their own dental anxieties, may increase the child’s own anxiety Awareness of a dental problem Children who know they have a dental problem are more likely to exhibit negative behaviour at the first dental appointment

The role of the parent   

Many parents prefer to be present during treatment, especially if their child is young or at first visit Children’s behaviour is unaffected by parental presence or absence Exception is young children (< 4y.o) who behave better with their mothers present

Techniques of Non-pharmacological BM Preparatory information   

Pre-appointment letters Welcoming the new patient and family to the clinic Informing them about what will happen, give advice on preparing the child

Non-verbal communication   

Having a child-friendly environment Happy, smiling team Gentle pats and squeezes minimise distress

Voice control    

Young children often respond to the tone of voice rather than the actual words Use a controlled alteration of voice, volume, tone or pace to direct a patients behaviour May not be acceptable to all parents Not appropriate for children too young or with intellectual/emotional impairment

Tell-show-do   

Use language appropriate to the child’s age Useful for all patients who can communicate Avoid negative words

Enhancing control (stop signal)   

A stop signal, usually raising an arm, should be rehearsed The dentist should respond quickly when it is used Useful for all patients who can communicate

Behaviour shaping & positive reinforcement 

Reinforcement = the strengthening of a pattern of behaviour, increasing the probability of that behaviour being displayed again in the future

 

Positive reinforcer = stickers, badges Most powerful reinforcers are social stimuli eg; facial expression, positive voice tone, verbal praise, hugging

Modelling  

People learn about their environment by observing other’s behaviour, using a model, either live or by video to exhibit appropriate behaviour in the dental environment For best effects, models should be the same age as the target child

Distraction  

Aims to shift the patient’s attention from the dental setting to some other situation. Eg; cartoons combined with reinforcement, audio tapes, distraction with words while giving LA

Negative reinforcement  

Strengthening of a pattern of behaviour by removal of a stimulus which the individual perceives as unpleasant (a negative reinforcer) as soon as the required behaviour is exhibited Eg; hand-over-mouth (HOM) technique, selective exclusion of the parent (SEP)

Systematic desensitization  

exposing a child to a series of dental experiences, progressing only when he can accept the previous one in a relaxed state May start with mirror and probe, followed by radiography, rubber cup prophylaxis, fissure sealing, LA, rubber dam, restorations..

Controversial techniques not universally accepted Restraint  

The act of physically limiting the body movements of the child in order to facilitate dental procedures and to decrease possible injuries to the child/dentist Eg; keeping a child‘s head still with one hand while the other hand is giving injection; wrapping a child’s whole body with a custom-made body restraint (papoose board) or bed sheet

Whole body restraint/wrapping   

Least accepted management technique to parents (Fields, 1988) Majority of mothers who involved in its use for their own children were very positive about it (Frankel, 1991) Used in conjunction with sedation – patients with physical/mental disabilities

Hands-over-mouth (HOM)     

The purpose is to gain attention of a child to allow communication (Craig, 1971) Children don’t remember nor be affected by HOM/restraint experiences (Barton et al., 1993) 51% paediatric dentists in UK thought that the child would come to fear dental treatment if HOM were used (Newton et al., 2004) 50% respondents believed HOM was still an acceptable technique (Oueis et al., 2010) The techniques:  When confronted with temper-tantrum, the dentist places his hand over the child’s mouth only sufficiently to stop the noise the child is making, to allow effective communication  At the same time the DSA restraints any flailing limbs...