Behavior Management I Dr.

mariam jaljouli Introduction The foundation of practicing dentistry with children is built on the ability to guide them through their dental experience. The difference between treating children and adults is the relationship. Treating adults generally involves a one-to-one relationship (dentist-patient). Treating a child, however, usually relies on a one to two relationship (dentist-pediatric patient-and parents) Causes of Inappropriate Behavior: 1. evelopmental delay, !", acute and chronic disease, #ge.

$. %ears& either ac'uired (from parents, siblings, and peers) ( or learned fears (difficult previous medical or dental experience) ). #wareness of a dental problem

Classifying Childrens Cooperative Behavior: Wrights Clinical Classification: *ooperative +ac,ing cooperative ability -otentially cooperative

Fran l Behavioral !ating "cale: "ating 1& efinitely .egative ( / / ). "efusal of treatment, crying forcefully, fearful, or any overt evidence of extreme negativism. "ating $& .egative ( / ). "eluctant to accept treatment, uncooperative, some evidence of negative attitude but not pronounced (withdrawn) "ating )& -ositive ( 0 ). #cceptance of treatment( at times cautious( willingness to comply with the dentist, at times with reservation, but patient follows the dentist1s directions cooperatively. "ating 2& efinetly -ositive ( 0 0 ). 3ood rapport with the dentist, interested in the dental procedures, laughing and en4oying. 5se the shorthand form with the description of the clinical problem, e.g. 6 / , tearful 7

#he Functional In$uiry 8efore the dentist treats children ( medical and dental histories are ta,en. 9owever, functional in'uiry, from a behavioral point of view, also should be obtained. :t has $ goals& 1. +earn about the patient and the parent concern. $. 3ather information enabling a reliable estimate of the cooperative ability of the child. *onducted in $ ways& 1. $. ;ritten 'uestionnaire completed by parent. irect interview with the child and parent.

%arents of %ediatric %atients -arents shape their children1s behavior from birth. They have an important role in the pedodontic treatment triangle. The <=< affects acceptance of the management methods.

Some of the troublesome parental attitudes are : &verprotective %arents: This behavior often prevents the natural development of the child toward independence. T%or example, they insist on remaining with the child regardless of the office policy. !esults from a num'er of factors: 1. # threatening experience to the health of the child either during pregnancy or after birth. $. The parent was raised in a home that lac,ed warmth and love. ). !alad4ustment of the family. 2. <ome psychological disturbance of the parent. 9ow to deal with them> "easonable discussion is recommended( pointing the importance of establishing a one- to- one relationship between the dentist and the child satisfies most overprotective parents. *iting the office policy is .?T helpful.

Manipulative %arents =xcessively demanding attitudes, extend to directing diagnosis and treatment plan. =.g. parent who refuses radiographs. 9ow to deal with them> #s, them why they refuse radiographs> #c,nowledge their concern and their dialogue can be developed. #lso, conservative radiation hygiene practices can be identified.

(ostile %arents

They 'uestion the necessity for treatment in a disturbing manner. "esult from& 1. -oor personal experiences in the dental office, $. # general negativism toward health professionals, ). %eelings of insecurity on a foreign environment 2. !isconceptions about dentistry. 9ow to deal with them> =xperience patience and explain the treatment. %ran, discussion lead to smoother relationship. )eglectful %arents

5sually discovered by failure to maintain appointment, and missing recall visits. (5nappreciative of dental care, careless, busy) 9ow to deal with them> *ounseling and explaining the importance of dentistry Critical Moments on the Dental *ppointment: +. "eparation from the parent .ot recommended for patients younger than ) years of age. The dentist opinion should be ,nown before the treatment, and the parent agrees -etting into the chair ifficult( natural fears, needs assistance. This provides the first real opportunity to praise the child for his good behavior Dentist seated at chair. :ndicates that treatment is imminent #he injection

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The most universally feared procedure in dentistry for children. Techni'ue now is painless for most children (topical anesthesia) 0. #he dental procedure "estorative and extraction 2nd of appointment <ome children spend all their emotional reserves during the appointment and then become unglued afterward. !eturn to parent <ome children want their parents to feel guilty about ma,ing them go to the dentist.

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#he %rofile of a -ood Child Dental %atient: 1. $. ). 2. <eparates well from the parent 3ets right into the chair *an handle and respond to 'uestions and accepts praise. *ooperate at in4ection time, can even cry and may need momentarily restraint at the time of in4ection. *rying stops when the needle disappears. @. Tolerates restorative procedures and extractions. A. #t the end of the appointment, heBshe is eager to leave yet is patient enough and human enough to stay around to be congratulated. C. "eturn to the parent bearing pride. Mis'ehaving Child Dental %atient These are children who 4ust can not cope or, 4ust will not cope with the stimuli and behavioral demands of the dental experience. *ategory 1& #he emotionally compromised child :t is important to realiDe the problem may be undiagnosed. #nxiety. -oor dental patient !ay come from bro,en homes or other unfortunate parenting circumstances such as poverty, neglect or abuse *ategory $& #he shy introverted Child. The challenge is the communication between the child patient and the adult dentist #voidance behavior such as crying #ggressive behavior rare ?ur ob4ective is to establish rapport, trust, and communiDation

*ategory )& #he frightened Child "anges from fear of the needle to fear of bodily harm to general fear of the un,nown <ome of the causes for fear are :ntellectually unable because of age or slow development ?ther emotional upsets in hisB her life #c'uired fears +earned fears =motional illness =xperience and common sense help you diagnose !a,e sure not to increase anxiety (may mean postponing the dental wor,, sedation or even 3#) *ategory 2: #he Child 4ho is adverse to authority These children misbehavior is based on an aversion to compliance with adult directives The misdirected goals and the associated behavior is s follows& 1. 5ndue attention.& #nnoying, irritating, teasing, disruptive $. <truggle for power& #rgues and contradicts, does the opposite of instructions, ma,es people angry, throws temper tantrums ). "etaliation and revenge& angerous (bitesE), see,s revenge. 2. :nade'uacy& gives up easily, seems incapable, displays inade'uacy.