Safe and effective treatment of dental diseases often requires modifying the child’s behaviour. Behaviour guidance is a continuum of interaction involving the dentist and the dental team, the patient, and the parent directed toward communication and education.
Recommendations for Basic behavior guidance
Communication and communicative guidance
Communicative management and appropriate use of commands are used universally in paediatric dentistry. Communicative management comprises a host of techniques which include, tell-show-do, voice control, nonverbal communication, positive reinforcement, and distraction. The dentist should consider the cognitive development of the patient, as well as the presence of other communication deficits (eg, hearing disorder), when choosing specific communicative management techniques.
A technique of behaviour shaping used by many paediatric professionals. The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient (tell); demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, nonthreatening setting (show); and then, without deviating from the explanation and demonstration, completion of the procedure (do).
2. Voice control
Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient’s behaviour. Parents unfamiliar with this possibly aversive technique may benefit from an explanation prior to its use to prevent misunderstanding.
3. Nonverbal communication
Reinforcement and guidance of behaviour through appropriate contact, posture, facial expression, and body language.
4. Positive reinforcement
In the process of establishing desirable patient behaviour, it is essential to give appropriate feedback. Positive reinforcement is an effective technique to reward desired behaviours and, thus, strengthen the recurrence of those behaviours. Social reinforces include positive voice modulation, facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team. Non-social reinforces include tokens and toys.
It is the technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure. Giving the patient a short break during a stressful procedure can be an effective use of distraction prior to considering more advanced behaviour guidance techniques.
The presence or absence of the parent sometimes can be used to gain cooperation for treatment. Parents’ desire to be present during their child’s treatment does not mean they intellectually distrust the dentist. It might mean they are uncomfortable if they visually cannot verify their child’s safety. It is important to understand the changing emotional needs of parents because of the growth of a latent but natural sense to be protective of their children. Practitioners should become receptive to the involvement of parents and welcome the questions and concerns for their children.
Nitrous oxide/oxygen inhalation
Safe and effective technique to reduce anxiety and enhance effective communication. Its onset of action is rapid, the effects easily are titrated and reversible, and recovery is rapid and complete. Additionally, nitrous oxide/oxygen inhalation mediates a variable degree of analgesia, amnesia, and gag reflex reduction.
Adopted from the guidelines of AMERICAN ACADEMY OF PEDIATRIC DENTISTRY