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.
1.Tell-show-do
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.
5. Distraction
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.
Parental presence/absence
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
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