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TECHNIQUES
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Introduction - Definition
- Classification of behavior management modalities
Behavior management techniques:- Desensitization Introduction
- Definition
- Indications
- Technique
- Tell, Show, Do
- Verbal communication
- Conclusion
- Modeling Introduction
- Requirements
- Technique
- Contingency management Definition
- Reinforcers
- Types of reinforcers
Key points.
Conclusion.
References.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Non-pharmacological methods of
behavior management:1.
Communication
2.
Behavior modification (shaping)
a) Desensitization
b) Modeling
c) Contingency management
3.
Behavior management
a) Audio analgesia
b) Biofeedback
c) Voice control
d) Hypnosis
e) Coping
f) Humor
g) Relaxation
h) Aversive conditioning
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Pharmacological methods of
behavior management:1. Pre-medication
a) Sedatives and hypnotics
b) Anti-anxiety drugs
c) Antihistamines
2. Conscious sedation
3. General anesthesia
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
SYSTEMIC DESENSITISATION
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
SYSTEMIC DESENSITISATION
Introduced by Joseph
Wolpe.
Reciprocal Inhibition
Process by which a
person experiencing
anxiety in association
with a certain stimulus
is made to experience
a response that
inhibits anxiety to that
same stimulus.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Technique in its classical form: Teach the patient how to relax; to induce a state
of deep muscle relaxation.
Introduce imaginary scenes related to his fears,
presented in a graduated fashion so that the
scenes only provoking minimal anxiety are
described.
Gradually more stressful situations are
presented.
Anxiety is minimized through the use of
relaxation.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Basis of the childs fear: Childs fear General fear ( Fear of the
dental environment)
-- Specific fear ( Fear of the
drill or the needle)
When this information is known, a
hierarchy of fear producing stimuli can be
constructed.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
1.
2.
3.
4.
5.
Selected stimuli may be:Brushing the childs teeth with a prophylaxis brush held in hand.
Brushing with a prophylaxis brush in slow speed hand piece.
Using a fine finishing bur in a slow speed hand piece revolving in
the mouth but not in contact with teeth.
Applying the finishing bur gently to a tooth surface.
Desensitization from the needle fear is more difficult, especially
with young children, who cannot be expected to react favorably to
the sight of a needle, even less ,to its introduction into their
mouth.
Some dentist prefer to show the patient the cotton roll with topical
anesthetic and avoid sight of the needle, while others consider
some for of sedation.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Components of this technique: TELL:- Telling the child about the new
situation and what is going to be done.
SHOW:- Showing the child the new
environment; Demonstration for the
patient of the visual, auditory and tactile
aspect of the procedure.
DO:- Doing what the child was told would
be done.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
VERBAL COMMUNICATION
Communication should be
comfortable and relaxed.
Language which is preferred
by the child, containing words
that express pleasantness,
friendship and concern.
Voice that is used should be
constant and gentle. Tone of
voice can express empathy
and firmness.
Patient prefers being
addressed by his name.
Use of euphemisms.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dental Nomenclature
Euphemisms :
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
MODELLING
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
MODELLING
Introduced my Bandura in
1969.
He stated that learning occurs
only as a result of direct
experience which can be
vicarious- witnessing the
behavior and the outcome of
that behavior for other people.
He found earlier that children
exposed to an aggressive
model will imitate that type of
behavior both verbally and
nonverbally.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Types of models:
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
CONTINGENCY MANAGEMENT
The presentation or withdrawal of
reinforcers is termed contingency
management
Behavior therapists define dispensing a
reinforcer contingently as giving a
reinforcer after a desired behavior has
been performed.
(Do not confuse Contingent:- dependant
on chance)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Reinforcer:
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Social
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Activity
Material Reinforcers: They are perhaps the most effective for children.
Suitable items would be balloons, coloring sheets,
stickers, toothbrushes, games, etc. ( Try and keep the
item of dental significance)
Candy, sweets, chocolates, etc, are contraindicated as
they are baneful to oral health.
A present should be given at the end of a session as a
sign of approval of good behavior.
Items should not be offered as a bribe in hope of
encouraging good behavior, and certainly not be given if
the child has not been cooperative.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Praise:
Good
Thats right
Excellent
Exactly
Good job
Great
Thank you
2) Facial expressions:
Smiling
Winking
Laughing
3) Physical contact:
Patting head, shoulder, or
back.
Shaking/ holding hand
Hugging
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Activity Reinforcers:
Seeing a movie.
Having a friend stay
overnight.
Having a party.
Going shopping.
Going out to play.
Playing games with
friends.
Staying up late.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Little application of
activity reinforcers in the
dental office, but they
may be used with
significant success in the
home for programs such
as habits or plaque
control if the parents can
be trained to observe and
reinforce appropriate
behavior.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Some application of
activity reinforcement in
the dental operatory can
be used, and this is due
to childrens inherent
curiosity.
Following appropriate
behaviors children maybe
allowed to observe
treatment in a hand
mirror, or participate in
procedures by holding
instruments (not anything
sharp).
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
Dr.M.Ganesh,MDS(Pediatric
Dentistry)
THANK YOU.
Dr.M.Ganesh,MDS(Pediatric
Dentistry)