non pharmacological methods of behaviour management

2.  BEHAVIOUR
MANAGEMENT(WR
IGHT 1975)-IS
DEFINED AS THE
MEANS BY WHICH
THE DENTAL
HEALTH TEAM
EFFECTIVELY AND
EFFICIENTLY
PERFORMS DENTAL
TREATMENT AND
THEREBY INSTILLS
A POSITIVE
DENTAL ATTITUDE.

3.  PARENTAL ANXIETY-maternal anxiety and child’s co
operative behaviour at the first dental visit has significant
corelation.it is because of child parent symbiosis that begins in
infancy and gradually diminishes.
 The effect is greatest with those younger than 4yr of age.
 MEDICAL EXPERIENCES-
 children who view medical experiences positively are more
likely to be co-operative.
 Surgical experiences adversely influence behaviour at the first
dental visit.

4.  RATING1:DEFINITELY NEGATIVE-complete refusal
of treatment,forceful crying,fearfulness
 RATING2:NEGATIVE-uncooperativeness,some
evidance of negative attitude but not pronounced
 RATING3:POSITIVE-acceptance of
treatment,cautious behaviour,is cooperative but
may become uncooperative once treatment
starts.
 RATING4:DEFINITELY POSITIVE-good rapport with
dentist,interested in dental procedure

6.  1)COMMUNICATION
 2)BEHAVIOUR SHAPING
 -DESENSITIZATION
 -MODELLING
 -CONTINGENCY MANAGEMENT
 3)BEHAVIOR MANAGEMENT
 -AUDIO ANALGESIA
 -BIOFEEDBACK

7.  -VOICE CONTROL
 -HYPNOSIS
 -HUMOR
 -COPING
 -RELAXATION
 -AVERSIVE CONDITIONING

8.  The means by which the dentist gets his point
across,making himself understood by use of
words or expressions.

9.  TYPES OF COMMUNICATION--
 1)VERBAL
COMMUNICATION(SPEECH)
 2)NON-VERBAL COMMUNICATION
which includes-body
language,eye contact,showing
concern,smiling,giving a hug or a
pat

10.  Communication should be comfortable and
relaxed sitting and speaking at the eye level
allows a friendlier atmosphere.address him
by his name compliment him about his
appearance.Ask questions about his class
his likes/dislikes.

11.  Use of euphemisms-euphemism are
substitute words which can be used in
presence of children
1)Anesthetic solution is referred as water to put
teeth to sleep
2)Rubberdam as rain coat
3)Radiograph as tooth picture
Reframing-by this both original threat and the
threatened situation can be handled

13. DEFINITION:is the procedure
which slowly develops
behaviour by reinforcing a
successive approximation of
desired beaviour untill the
desired behaviour comes into
being.

14.  1)state the general goal or task to the child at
the outset.
 2)explain the necessity for the procedure.
 3)divide explanation for the procedure.
 4)give all explanation at childs level of
understanding. Use euphemisms.

15.  DESENSITIZATION(tell-show-do)technique
 A)Tell and show every step and instruments
and explain what is going to be done.
 Continuosly and in grades from the level fear
promoting objects or procedure move to
higher grades to more fearfull objects.

17.  INDICATION-
 1)first visit
 2)subsequent visits when introducing new
dental procedure
 3)fearful child
 4)apprehensive child because of information
received from peers/parents

18.  TSD TECHNIQUE IS APPLIED AS FOLLOWS:
 A)The dentist uses the language that child
can understand and tells the patient what is
to be done.
 B)the dentist demonstrates the procedure to
the child using model or himself.
 C)dentist proceeds to do the dental
procedure exactly as described.

19.  Procedure involves allowing a patient to
observe one or more individual (models) who
demonstrate a positive behavior in a
particular situation therefore, the patient will
frequently inact the models behavior.
 IT CAN BE DONE BY
 A) live model – siblings.
 B) Filmed models
 C) Posters
 D) Audiovisual aids

20.  It is a method of modifying the behavior of child by
presentation or withdrawal of reinforces. Reinforces
can be:
 Positive reinforcer is one whose contingent
presentation increases the frequency of behavior
 Negative reinforcer is one whose contingent
withdrawal increases frequency of behaviour.
 Negative reinforcer is usually a termination of an
aversive stimulus Eg. withdrawal of mother

22.  Social : Example:
Praise, Positive facial
expression, shaking
hands, holding hands
and patting shoulder.
 Material: may be given
in form of toy and
game.
 Activity Reinforces:
Involving child in some
activity, like watching
tv show fixed on
ceiling at eye level.

23.  Child can be managed by following methods:
 Audio Analgesia: Also called as white noise. It is method of
reducing pain. This technique, consists of providing sound
stimulus of such intensity that patient finds difficult to attend
anything else. Auditory stimulus such as music reduces stress
and reaction to pain.
 Biofeedback :Involves use of certain instruments to detect
certain physiological process. Example: If blood pressure is
high instruments give stimulation, useful in anxiety and
echocardiogram can also be used.

25.  Humor: Helps to elevate mood of child. Few
functions are:
 -Social: forming and maintaining relationship
 -Emotional: Anxiety release
 -Informative: Transmits essential information.
 -Motivation: It increases interest.
 -Cognitive : Distracts from fearful stimulus.

26.  Coping: It is defined as the cognitive and behavioral
effort made by individual to master, tolerate or reduce
stressful situation.
 Coping effect is of two types:
 Behavioral: Physical and verbal activities ,in which
child engages to overcome stressful situation.
 Cognitive: The child may be silent and thinking in his
mind to keep calm.
 Signal System: when it hurts, we ask child to raise his
hand.

28.  It is modification of intensity and pitch of
ones own voice in attempt to dominant
interaction between dentist and child
 Use of conjunction with some form of
physical restrainer and hand over mouth
exercise.
 Change in tone from gentle to firm is
effective in gaining child’s attention and
reminding him that dentist is authoritive
figure to be obeyed.

29.  It is altered state of consciousness, when
used in dentistry ,it is termed hypodontics.
 Implosion Therapy: Sudden flooding with
barrage of stimuli which has affected him
adversely, and child has no option but to face
stimuli, until negative response disappears.
 Relaxation: It is technique to reduce stress
and is based on principle of elimination of
anxiety.

30. It can be safe and effective method of
managing extremely negative behavior.
2 important method used in clinical
practice are:
1) HOME
2) PHYSICAL RESTRAINT

31.  HOME(hand-over-mouth exercise):behavior
modification method of aversive
conditioning is called HOME introduced by
Evangeline jordan 1920
 The purpose of home is to gain the attention
of a child so that communication can be
achieved
 INDICATION:
 A healthy child who can understand but who
exhibits hysterical behavior during treatment
 3 to 6yr old child
 Children displaying uncontrollable behavior

33.  CONTRAINDICATION:
 Child under 3yrs of age
 Frightened child
 physical,mental and emotional handicap
 It should not be set as routine
procedure,inform the parent about the
procedure

34.  THE TECHNIQUE:
 After determining the child’s behaviour,the
dentist firmly places his hand over the child’s
mouth and behavioral expectation are calmly
explained close to child’s ear.when the childs
verbal outburst is stopped and child indicates
his willingness to co-operate,the dentist
removes his hand.once the child co operates he
should be complimented for being quite and
praised for good behaviour.The whole
procedure should not last for more than 20-
30sec

35.  SEVERAL VARIATIONS OF HOME
 a)hand over mouth with airway unrestricted
 b)hand over mouth and nose with airway
restricted
 c)towel held over mouth and nose
 d)wet towel held over mouth and nose

36.  The advantage behind airway
restriction is that child will be quite
so as to breath and sreaming will
decrease.
 Together with home,nostrils are
pinched for 15secs only.
 BELANGER believed that airway
restriction was critical element and it
should be avoided.

38.  It is the last resort for handling uncooperative
patient
 physiological restraints involves restriction of
head,hand,feet or body it can be
 ACTIVE:restraints performed by the dentist
staff or parent without the aid of restraining
device
 PASSIVE:with aid of restraining device

39.  FOR BODY:
pediwrap,papooseboard,sheets,beanbag with
straps,towel tapes
 For EXTREMITIES-velcro straps,posey
straps,towel and tape
 FOR HEAD-head positioner,forearm body
support
 FOR MOUTH-mouth blocks,banded tongue
blades,mouth props