Behavioural Management

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BEHAVIOURAL MANAGEMENT

IN PEDIATRIC DENTISTRY

BY :- MAHARISHI RATHORE


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BEHAVIOURAL MANAGEMENT

Should go hand in hand with the hand piece skill andknowledge of Dental materials for the successfultreatment of children.

Disruptive behaviour can interfere significantly withproviding quality dental care,resulting in increaseddelivery time and risk of injury to the child.

Surveys of clinicians have found thatDENTISTSconsider the uncooperative child to be among the mosttroulbesome problems in Clinical Practice.


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Behavioural management methods in pediatric

dentistry are directed towards the goal of

communication and education.

The relationship between the dentist and the

child is built through a dynamic process of

dialouge,facial expression and voice tone ; allmethods of delivering a message.

The Goals of behaviour management are to

achieve good dental health in the child and tohelp develop the childs positive attitude

towards dental health.


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Behavioural management is a thus not an

application of individual techniques created to

deal with the child,but rather a comprehensivemethodology means to develop a relationship

between the patient & the doctor which ultimately

builds trust and allays fears & anxieties.


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Child can be Managed by the

following methods:- 1. AUDIO ANALYSIS (or,White Noise):- is amethod of producing pain.This techniqueconsists of providing a sound stimulus to such

intensity that the patient finds it difficult toattend to anything else.Auditory stimulus suchas pleasant music has been used to reducestress and also reduce the reaction to pain.

2. BIO FEEDBACK:- Bio feedback involvesthe use of the certain instruments to detectcertain physiologic process associated with

fear.


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3. HUMOR :- Humor help to elevate the mood of

the child which help the child to relax.

Functions of humor are :- - Social

- Emotion

- Informative

- Motivation- Cognitive

4. COPING :- It is the mechanism by which the

child copes up with dental treatment .It is definedas the cognitive and behavioural efforts made by

an individual to master, tolerate or reduce

stressful situations.


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5. VOICE CONTROL :- It is the modification of

intensity and pitch of one own voice in an attempt

to dominate the interaction between the dentistand the child.

6. RELAXATION :- This technique is used

to reduce Stress & based onprinciples ofelimination of anxiety.

7. HYPNOSIS :- It is an altered state of

consciousness characterized by heightenedsuggestibility to produce desirable ,

behavioural &physiological changes .


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8. IMPLOSION THERAPY :- Sudden flooding

with a barrage of stimuli which have affectedhim adversely & the child has no other choice .

But to face the stimuli until negative response

disappears.

9. ADVERSIVE CONDITIONING :- Child who

displays a negative behaviour and does not

respond to moderate behaviour modifications

technique falls into the category of frankles ,

definitive negative behaviour .


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HOME

(Hand-Over-Mouth-Exersice) The behavioural modifications method of

aversive conditioning is also known as

HOME. It was 1st introduced by Evangeline

Jordan,1920.

The purpose of HOME is to gain theattention of a child so that communicationcan be achieved.


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INDICATIONS

A healthy child who can understandbut who exhibits defiance &hysterical behavior duringtreatment.

3-6 years old.

A child who can understand simple

verbal commands. Children displaying uncontrollable

behavior.


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CONTRAINDICATIONS

Child under 3 years of age.

Handicaped child/immature child,

frightened child.

Physical ,mental and Emotional

Handicap.


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Factors To Be Considered Before

Applying HOME Technique

HOME technique should not be used as a

routine procedure for the management of thechild.

Inform the parents about the procedure.

Consent of the Parents is very important. Pediatric Dentists should be aware of the

changing laws that govern informed consent.


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TECHNIQUE

After determining the childs behavior ,the dentistfirmly places his hand over the childs mouth andbehavioral expectations are calmly explained closeto the childs ear. When the childs verbal outburstis completely stopped and the child indicates hiswillingness to cooperate, he should becomplimented for being quiet and praised for good

behavior. It should be noted that the childs airwayis not restricted while performing the techniqueand the whole procedure should not last formore than 20-30 seconds.


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Several Variations of HOME

Hand over mouth with the airway

unrestricted.

Hand over mouth and the nose and the

airway restricted.

Towel held over the mouth only.

Dry towel held over the nose and mouth.

Wet towel held over the nose and mouth.


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HOMAR (Airway Restricted)

TheAdvantage behindAirway Restriction is that

the child will be quiet so as to breathe and the

screaming will decrease so that the Doctor canproceed.

Together with Hand Over Mouth,Nostrils are

pinched for 15 seconds.

Belanger,(1993) believed that Airway Restriction

was the critical element and it should be avoided.


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Behavioural Management

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