Speech script Lecturer:HongmeiZhang vice professor Time: 2015-10-22 Section one Outline .Doctor-patient relationship Characteristics Behaviour management Content and Objective 1 Pediatric dentistry treatment triangle A major difference between the treatment of children and the treatment of adults is the relationship.Treating adults generally involves a one-to-one relationship,that is a dentist -patient relationship.Treating a child usually rely on a one-to-two relationship among dentist ,pediatric patient,and parent or guardians,which illustrates this relationship is known as the pediatric dentistry treatn ent triangle In the relationships of the three side ,the child is the fo n of the both family and the dental team.That kind attitude,patiently explanation and excellent skills of the dentist is the precondition to get trust and harmonization Definition: The concept of behavior managementhas evolved over the years from the notion of"dealing with the child to building a relationship between the child, parent,and dentist that is focused on meeting the child's oral health care needs The optimal outcome for the child is a positive attitude toward oral health and future dental care. 2.goal The overall goal is that the dentist is able to provide high-quality,safe denta care In an environment that is as pleasant as possible for the child Dental treatment makes great demands of the child,and thev need the help of a caring practitioner to be able to cope with these demands 1.Adverse psychological reactions
Speech script Lecturer : Hongmei Zhang vice professor Time: 2015-10-22 Section one Outline ⚫ Doctor-patient relationship Characteristics ⚫ Behaviour management Content and Objective 1. Pediatric dentistry treatment triangle . A major difference between the treatment of children and the treatment of adults is the relationship . Treating adults generally involves a one –to-one relationship , that is a dentist –patient relationship . Treating a child usually rely on a one-to-two relationship among dentist ,pediatric patient , and parent or guardians , which illustrates this relationship is known as the pediatric dentistry treatment triangle . In the relationships of the three sides , the child is the focus of attention of the both family and the dental team . That kind attitude, patiently explanation and excellent skills of the dentist is the precondition to get trust and harmonization . Definition: The concept of“behavior management’’has evolved over the years from the notion of “dealing with”the child to building a relationship between the child， parent，and dentist that is focused on meeting the child， s oral health care needs 。The optimal outcome for the child is a positive attitude toward oral health and future dental care． 2.goal The overall goal is that the dentist is able to provide high—quality,safe dental care ln an environment that is as pleasant as possible for the child Dental treatment makes great demands of the child，and thev need the help of a caring practitioner to be able to cope with these demands. 1. Adverse psychological reactions
(1)Frightened mind Many ch hildren perceive a visit to the dentist as stressful,especially the infants and pre-school children.There are some reasons: (a)meet unfamiliar adult medical staffs and environment (b)some odd instrument and special equipment; (c)strange sounds and tastes: (d)dis omfort and even pain Though the reasons for frightened mind are various,the main one is the pain.It is natural for the children without being physically and mentally well developed.Only for this can the children be attended and cared by their guardian.It's proved that children patients by the means of behavior management,their fears maybe reduced or can be diagnosed for ora treatment thoroughly (a)For a short while The mood keeps on a short time.It's not good for the children to keep time too long for the treatment. (b)Fulminant 8 (3)Thinking methods (1)Concrete thinking (2)Put oneself as a center 3.Behavioral factors in pediatric dental treatment (1)Age of children (2)Parental anxiety (3)Treatment history (4)Level of cognitive for dental disease (5)Medical environment (6)Treatment programs 4.Quality demands for the medical workers. Besides generally qualifications possessed by other medical workers,the doctor and nurses in pediatric dentistry should have the following:Restraint'”,Replacement'”,“Quickness”,"For each other'”,“Kindness heat” 5.Patients in different age groups of children's oral admissions technology (1)Less than 3 years (2)3-6 years
(1)Frightened mind Many children perceive a visit to the dentist as stressful , especially the infants and pre-school children . There are some reasons : (a) meet unfamiliar adult medical staffs and environment ; (b) some odd instrument and special equipment ; (c) strange sounds and tastes ; (d) discomfort and even pain . Though the reasons for frightened mind are various , the main one is the pain . It is natural for the children without being physically and mentally well developed . Only for this can the children be attended and cared by their guardian . It’s proved that children patients by the means of behavior management , their fears maybe reduced or disappeared , and they can be diagnosed for oral treatment thoroughly . (2)Forms of Mood (a) For a short while The mood keeps on a short time . It’s not good for the children to keep time too long for the treatment. (b) Fulminant (c) Interesting (d) Reality (3) Thinking methods (1) Concrete thinking (2) Put oneself as a center 3. Behavioral factors in pediatric dental treatment (1) Age of children (2) Parental anxiety (3) Treatment history (4) Level of cognitive for dental disease (5) Medical environment (6) Treatment programs 4. Quality demands for the medical workers. Besides generally qualifications possessed by other medical workers ,the doctor and nurses in pediatric dentistry should have the following :“Restraint” ,“Replacement” ,“Quickness” ,“For each other”, “Kindness heart”. 5. Patients in different age groups of children's oral admissions technology (1) Less than 3 years (2) 3-6 years
(3)6-12 years common misconcepttions Common misconceptions about child behavior and behavior management can make dentists hesitant about providing care for children.They may think that some people are born with that skill and may simply let others take on those responsibilities.However.dentists of every personality type can Successfully treat children and like all other aspects of dentistry,this is a skill that requires practice,self-reflection,and effortto improve Section two Non-pharmacological behavior management Non-pharmacological behavior management 1.tell-show-do The technique known as tell-show-do is one of the most intuitive yet essential behavior management techniques.In tell-show-do,the patient is Introduced to the dental environment in a nonthreatening way that they can comprehend.First the child is told about the procedure or instrument In a child friendly manner.Next the child is shown what will happen or what will be used. They may be allowed to see,touch,or smell the material or instrument or they may watch a demonstration of the procedure.Finally the child experiences the procedure.instrument.or material.This technique works best with children capable of communication but is very Successful in all but very young toddlers.The dentist would be advised to not overlook this useful technique in older children and adolescents to help allay fears.This technique is almost universally acceptable to children,parents.and dentists. 2.preappointmentexperience 3.reinforcement Positive reinforcement is a way to recognize the cooperation of the child patient and reward it.Positive reinforcement is enjoyable for the dentist and
(3) 6-12 years common misconcepttions Common misconceptions about child behavior and behavior management can make dentists hesitant about providing care for children．They may think that some people are born with that skill and may simply let others take on those responsibilities. However,dentists of every personality type can Successfully treat children、and like all other aspects of dentistry,this is a skill that requires practice,self-reflection，and effort to improve. Section two Non-pharmacological behavior management ⚫ Non-pharmacological behavior management 1. tell-show-do The technique known as tell—show—do is one of the most intuitive yet essential behavior management techniques．In tell-show-do，the patient is Introduced to the dental environment in a nonthreatening way that they can comprehend．First the child is told about the procedure or instrument In a child friendly manner. Next the child is shown what will happen or what will be used. They may be allowed to see,touch,or smell the material or instrument or they may watch a demonstration of the procedure. Finally the child experiences the procedure，instrument，or material．This technique works best with children capable of communication but is very Successful in all but very young toddlers．The dentist would be advised to not overlook this useful technique in older children and adolescents to help allay fears. This technique is almost universally acceptable to children，parents，and dentists． 2. preappointment experience 3. reinforcement Positive reinforcement is a way to recognize the cooperation of the child patient and reward it. Positive reinforcement is enjoyable for the dentist and
the patient and contributes to the child's overall sense of accomplishment with Successfully completing a dental procedure.Social positive reinforcement is most effective and best when it is specific to the behavior that is cooperative The patient will be pleased by a comment such as'you are a being such a great patient today.However,children are more likely to continue the desired behavior if the praise is more specific,such as"Thank you for sitting so still and opening your mouth so wide".Such a focused comment often motivates a child to sit a little stiller and open a bit wider.Complimenting the child in front of the parents and the dental assistants,again being specific to the positive behaviors the child exhibited,is a great way to boost his self-esteem and memories of the visit. 4.distraction Distraction is another form of behavior guidance that can help shape children's positive behavior and improve their perception of the visit Going to a dental visit is a challenge for children,and distraction is an effective means of helping them cope.Proper use of distraction techniques can help take the child's mind off of the unpleasant aspects of treatment and redirect it to a better,more pleasant place.The nursing literature has shown with immunization that parental reassurance was related to increased need for restraint,increased verbal pain,and increased information seeking,whereas children with parental assisted distraction exhibited better behavior and less fear. 5.modeling 6.voice control Voice control is an effective means of obtaining compliance from a child patient.Voice control iS a difference in modulation,tone,and/or volume to gain the patient's attention and compliance In voice control.instructions should be firm,definite,and convincing Pinkham and Paterson"point out that to be most Successful,the facial expression must mirror the message. 7.protective stabilization
the patient and contributes to the child’s overall sense of accomplishment with Successfully completing a dental procedure．Social positive reinforcement is most effective and best when it is specific to the behavior that is cooperative. The patient will be pleased by a comment such as“you are a being such a great patient today.However,children are more likely to continue the desired behavior if the praise is more specific,such as “Thank you for sitting so still and opening your mouth so wide”.Such a focused comment often motivates a child to sit a little stiller and open a bit wider．Complimenting the child in front of the parents and the dental assistants，again being specific to the positive behaviors the child exhibited，is a great way to boost his self-esteem and memories of the visit． 4. distraction Distraction is another form of behavior guidance that can help shape children’s positive behavior and improve their perception of the visit Going to a dental visit is a challenge for children，and distraction is an effective means of helping them cope. Proper use of distraction techniques can help take the child’s mind off of the unpleasant aspects of treatment and redirect it to a better,more pleasant place.The nursing literature has shown with immunization that parental reassurance was related to increased need for restraint，increased verbal pain，and increased information seeking，whereas children with parental assisted distraction exhibited better behavior and less fear． 5. modeling 6. voice control Voice control is an effective means of obtaining compliance from a child patient．Voice control iS a difference in modulation，tone，and／or volume to gain the patient’S attention and compliance In voice control．instructions should be firm,definite，and convincing Pinkham and Paterson”point out that to be most Successful，the facial expression must mirror the message． 7. protective stabilization
Description:The use of any type of protective stabilization in the treatment of infants,children,adolescents,or patients with special health care needs is a topic that concems health care providers.care givers,and the public.The broad defi-nition of protective stabilization is the restriction of patient's freedom of movement,with or without the patient's permission,to decrease risk of injury while allowing safe completion of treatment.The restriction may involve another human(s).a patient stabilization device,or a combination thereof.The use of protective stabilization has the potential to produce serious consequences,such as physical or psychological harm,loss of dignity,and violation of a patient's rights.Stabilization devices placed around the chest may restrict respirations;they must be used with caution,especially for patients with respiratory compromise (eg,asthma)and/or who will receive medications (ie,local anesthetics,sedatives)that can depress respirations. Because of the associated risks and possible consequences of use,the dentist is encouraged to evaluate thoroughly its use on each patient and possible altematives.Careful,continuous monitoring of the patient is mandatory during protective stabilization. 8.other methods section three pharmacological behavior management 1.nitrous oxide combined Oxygen sedation techniques The use of nitrous oxide/oxygen(N2O/2)is a form of pharmacologic behavior management.It has been found to have a significant effect on reducing mild to moderately anxious and uncooperative child behavior and does facilitate coping at subsequent visits,even If it is not used.It is important to understand that the use of(N2O/O2)is only effective if accompanied by communicative behavior management techniques.N2O/O2 is used to improve the child's ability to cope so that he or she is more receptive to
Description: The use of any type of protective stabilization in the treatment of infants, children, adolescents, or patients with special health care needs is a topic that concerns health care providers, care givers, and the public.The broad defi-nition of protective stabilization is the restriction of patient’s freedom of movement, with or without the patient’s permission,to decrease risk of injury while allowing safe completion of treatment. The restriction may involve another human(s), a patient stabilization device, or a combination thereof. The use of protective stabilization has the potential to produce serious consequences, such as physical or psychological harm, loss of dignity, and violation of a patient’s rights. Stabilization devices placed around the chest may restrict respirations; they must be used with caution, especially for patients with respiratory compromise (eg, asthma) and/or who will receive medications (ie, local anesthetics, sedatives) that can depress respirations. Because of the associated risks and possible consequences of use, the dentist is encouraged to evaluate thoroughly its use on each patient and possible alternatives. Careful, continuous monitoring of the patient is mandatory during protective stabilization. 8. other methods section three pharmacological behavior management 1. nitrous oxide combined Oxygen sedation techniques The use of nitrous oxide/oxygen(N2O/O2) is a form of pharmacologic behavior management.It has been found to have a significant effect on reducing mild to moderately anxious and uncooperative child behavior and does facilitate coping at subsequent visits，even lf it iS not used.It is important to understand that the use of (N2O/O2) is only effective if accompanied by communicative behavior management techniques. N2O/O2 is used to improve the child's ability to cope so that he or she is more receptive to
techniques such as tell-show-do,positive reinforcement,and distraction.The dentist that relies upon N2O/O2 as a substitute for behavior guidance will be disappointed in its effects.Generally N2O/O2 is accepted well.by parents. Description:Nitrous oxide/oxygen inhalation is a 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.The need to diagnose and treat,as well as the safety of the patient and practitioner should be considered before the use of nitrous oxide/oxygen analgesia/anxiolysis.Detailed information concerning the indications. contraindications,and additional dinical considerations may be found in the Guideline on Use of Nitrous Oxide for Pediatric Dental Patients 2.Oral medications sedation techniques 3.Intravenous injection sedation techniques 4.Children's dental treatmentunder general anesthesia techniques Description:General anesthesia is a controlled state of un-consciousness accompanied by a loss of protective reflexes,including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal com-mand.The use of general anesthesia sometimes is necessary to provide quality dental care for the child.Depending on the patient,this can be done in a hospital or an ambulatory setting,including the dental office. Additional background information may be found in the Guideline on Use of Anesthesia Care Personnel in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient.3 The need to diagnose and treat,as well as the safety of the patient, practitioner,and staff,should be considered for the use of general anesthesia The decision to use general anesthesia must take into consideration:
techniques such as tell—show—do ， positive reinforcement ， and distraction．The dentist that relies upon N2O/O2 as a substitute for behavior guidance will be disappointed in its effects．Generally N2O/O2 is accepted well.by parents． Description: Nitrous oxide/oxygen inhalation is a 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.The need to diagnose and treat, as well as the safety of the patient and practitioner, should be considered before the use of nitrous oxide/oxygen analgesia/anxiolysis. Detailed information concerning the indications, contraindications, and additional clinical considerations may be found in the Guideline on Use of Nitrous Oxide for Pediatric Dental Patients 2. Oral medications sedation techniques 3. Intravenous injection sedation techniques 4. Children's dental treatment under general anesthesia techniques Description: General anesthesia is a controlled state of un-consciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal com-mand. The use of general anesthesia sometimes is necessary to provide quality dental care for the child. Depending on the patient, this can be done in a hospital or an ambulatory setting, including the dental office. Additional background information may be found in the Guideline on Use of Anesthesia Care Personnel in the Administration of Office-based Deep Sedation/General Anesthesia to the Pediatric Dental Patient.3 The need to diagnose and treat, as well as the safety of the patient, practitioner, and staff, should be considered for the use of general anesthesia. The decision to use general anesthesia must take into consideration:
(1).altemative behavioral guidance modalities: (2).dental needs of the patient; (3).the effecton the quality of dental care (4).the patient's emotional development (5).the patient's medical status. Prior to the delivery of general anesthesia,appropriate documentation shall address the rationale for use of general anesthesia,informed consent instructions provided to the parent,dietary precautions,and preoperative health evaluation.Because laws and codes vary from state to state,minimal re-quirements for a time-based anesthesia record should include: (1).the patient's heart rate,blood pressure,respiratory rate,and oxygen saturation at specific intervals throughout the procedure and until predetermined discharge criteria have been attained; (2).the name,route,site,time,dosage,and patient effect of administered drugs,including local anesthesia; (3).adverse events(if any)and their treatment; (4).that discharge criteria have been met,the time and condi-tion of the patient at discharge,and into whose care the discharge occurred Objectives:The goals of general anesthesia are to: (1).provide safe,efficient,and effective dental care; (2).eliminate anxiety: (3).reduce untoward movement and reaction to dental treatment (4).aid in treatment of the mentally,physically,or medically compromised patient; (5).eliminate the patient's pain response. Indications:General anesthesia is indicated for: (1).patients who cannot cooperate due to a lack of psycho-logical or emotional maturity and/or mental,physical,or medical disability: (2).patients for whom local anesthesia is ineffective because of acute infection,anatomic variations,or allergy;
（1）. alternative behavioral guidance modalities; （2）. dental needs of the patient; （3）. the effect on the quality of dental care; （4）. the patient’s emotional development; （5）. the patient’s medical status. Prior to the delivery of general anesthesia, appropriate documentation shall address the rationale for use of general anesthesia, informed consent, instructions provided to the parent, dietary precautions, and preoperative health evaluation. Because laws and codes vary from state to state, minimal re-quirements for a time-based anesthesia record should include: （1）. the patient’s heart rate, blood pressure, respiratory rate, and oxygen saturation at specific intervals throughout the procedure and until predetermined discharge criteria have been attained; （ 2 ） . the name, route, site, time, dosage, and patient effect of administered drugs, including local anesthesia; （3）. adverse events (if any) and their treatment; （4）. that discharge criteria have been met, the time and condi-tion of the patient at discharge, and into whose care the discharge occurred. • Objectives: The goals of general anesthesia are to: （1）. provide safe, efficient, and effective dental care; （2）. eliminate anxiety; （3）. reduce untoward movement and reaction to dental treatment; （ 4 ） . aid in treatment of the mentally, physically, or medically compromised patient; （5）. eliminate the patient’s pain response. • Indications: General anesthesia is indicated for: （1）. patients who cannot cooperate due to a lack of psycho-logical or emotional maturity and/or mental, physical, or medical disability; （2）. patients for whom local anesthesia is ineffective because of acute infection, anatomic variations, or allergy;
(3).the extremely uncooperative,fearful,anxious,or uncommunicative child or adolescent; (4).patients requiring significant surgical procedures: (5).patients for whom the use of general anesthesia may pro-tect the developing psyche and/or reduce medical risk; (6).patients requiring immediate,comprehensive oral/dental care Contraindications:The use of general anesthesia is contraindicated for (1).a healthy,cooperative patientwith minimal dental needs; (2).predisposing medical conditions which would make general anesthesia inadvisable. Section four local anesthesia for Children 1.local anesthesia Instructions 2.local anesthesia Operating essentials 3.Anesthesia maxillary molars 4.Anesthesia maxillary anteriorteeth 5.anesthesia Mandibularteeth 6.local anesthesia Complication Vocabulary Tel-show-do(告知-演示-操作) preappointment experience(治疗前的体验) reinforcement(正强化) distraction(分散注意力) modeling(模范作用 voice control(语音控制) protective stabilization(保护性固定)
（3）. the extremely uncooperative, fearful, anxious, or uncommunicative child or adolescent; （4）. patients requiring significant surgical procedures; （5）. patients for whom the use of general anesthesia may pro-tect the developing psyche and/or reduce medical risk; （6）. patients requiring immediate, comprehensive oral/dental care. • Contraindications: The use of general anesthesia is contraindicated for: （1）. a healthy, cooperative patient with minimal dental needs; （ 2 ） . predisposing medical conditions which would make general anesthesia inadvisable. Section four local anesthesia for Children 1. local anesthesia Instructions 2. local anesthesia Operating essentials 3. Anesthesia maxillary molars 4. Anesthesia maxillary anterior teeth 5. anesthesia Mandibular teeth 6. local anesthesia Complication Vocabulary Tell-show-do（告知-演示-操作） preappointment experience (治疗前的体验) reinforcement（正强化） distraction（分散注意力） modeling（模范作用 voice control（语音控制） protective stabilization（保护性固定）
dental general anesthesia(DGA,牙科全麻技术) sedative medication(镇静药物) medicatio allergy(药物过敏) allergic test for skin(皮肤过敏试验)
dental general anesthesia（DGA，牙科全麻技术） sedative medication（镇静药物） medicatio allergy（药物过敏） allergic test for skin（皮肤过敏试验）