The Behavior managementin the Pediatric dentistry Department of preventive and pediatric dentistry Zhang Hong-me 2010.11.4 Pediatric dentistry aims at prevention and treatment of oral diseases in childhood and adolescence as the basis for good oral health throughout life.So we need know how to help (1)the definition of behavior management (2)the children's psychology (3)the pediatric dentistry treatment triangle (4)the motivate methods of behavior managemen Section One The definition of behavior management The definition is:Children patients fear or even refuse to be treated of oral treatment more or less due to the personalitics of their own The method to remove the disadvantage actions of dthe l ofmec the vor mangemnt in the Section Two The children's psychology 1.Frightened mind Many children perceive a visit to the dentistas stressfu especially the infants and children.The (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 children without being physically and mentally well developed.Only for thiscan the children be attended and cared by their guardian.It's proved that children patients by the means of behavion management,their fears maybe reduced or disappeared,and they can be diagnosed for oral treatment thoroughly 2 Rely on mind Children (even infant)have strong feelings on their families (especially on ther mothers).They are shy with strangers,they would listen to their mothers,and they are unwilling to be separate from their parents.If the mother accompanies her baby.standing behind the chair.touching the child on the hand,the baby may cooperate to finish the whole process of treatment.If the dentist chats friendly with the mother just like acquaintance.he (she)may have more confidence with the dentist soas to reduce his(her)own frightened feelings 3.Formsof 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
The Behavior management in the Pediatric dentistry Department of preventive and pediatric dentistry Zhang Hong-mei 2010.11.4 Pediatric dentistry aims at prevention and treatment of oral diseases in childhood and adolescence as the basis for good oral health throughout life. So we need know how to help children to cope with dental treatment. This chapter include four sections: (1) the definition of behavior management (2) the children’s psychology (3) the pediatric dentistry treatment triangle (4) the motivate methods of behavior management Section One The definition of behavior management The definition is: Children patients fear or even refuse to be treated of oral treatment more or less due to the personalities of their own. The method to remove the disadvantage actions of diagnosis so as to reach the goal of treatment is called the behavior management in the pediatric dentistry Section Two The children’s psychology 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. Rely on mind Children (even infant) have strong feelings on their families (especially on their mothers) . They are shy with strangers, they would listen to their mothers, and they are unwilling to be separated from their parents. If the mother accompanies her baby, standing behind the chair, touching the child on the hand, the baby may cooperate to finish the whole process of treatment. If the dentist chats friendly with the mother just like acquaintance, he (she) may have more confidence with the dentist so as to reduce his (her) own frightened feelings. 3. 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 (e)Interesting (d)Reality 4.Thinking methods (1)Image thinking Children mainly put the image thinking into commander.They are weak of the abstract thinking (2)Put oneselfasa center Section Three The characters between doctor and patient in the Pediatric dentistry 1.Pediatric dentistry A major difference between the treatment of children and the treatment of adults is th 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 triangle In the fthe three sides,the child is the focus of attentio of the both family and the dental tem.That kind attitude.patiently skills of the dentist is the precondition to get trust and harmonization. 2.The weakness of cooperation for the children Numerous systems have been developed for classifving the behavior of children in the dental I).cooperation oWright's nc).potentially cooperative.The knowledge of these systems 2).lacking in can be an asset to the dentist in several ways 1)It can assist in directing the management method. 2)It can provide a means for systematically recording behaviors 3)Itcan assist in evaluating the validity of current research 3.Qualitydem dical worker Besides generally qualifications possessed by other medical workers,the octors and the pediatric dentistry should have the following character:"Restraint","Replacement", "Quickness",For each other","Kindness heart". Section four:Fundamentals of atractive guide management mmunicating with children The first in the successful management of the young child is to establish communication .Communication is a complex and multi-sensory process.The basic principle is that the message must be understood by the children.Generally.communication with younger children is bes t started with complim entary comments.Then the dentist should notice these. age clarity,voice contro,body contract,active listening and appropriate responses 2.Tell-show-do technique (TSD) Tell-show-do is a series of successive approximations .Dentists should demonstrate various instrument step by step before their application by telling.showing and doing 3.Painless
(b) Fulminant (c) Interesting (d) Reality 4. Thinking methods (1) Image thinking Children mainly put the image thinking into commander. They are weak of the abstract thinking . (2) Put oneself as a center Section Three The characters between doctor and patient in the Pediatric dentistry 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 . 2 . The weakness of cooperation for the children Numerous systems have been developed for classifying the behavior of children in the dental environment. Wright’s clinical classification places children in three categories : 1) . cooperation 2) . lacking in cooperative ability 3 ). potentially cooperative .The knowledge of these systems can be an asset to the dentist in several ways : 1) It can assist in directing the management method, 2) It can provide a means for systematically recording behaviors, 3) It can assist in evaluating the validity of current research. 3. Quality demands for the medical workers. Besides generally qualifications possessed by other medical workers, the doctors and nurses in the pediatric dentistry should have the following character: “Restraint”, “Replacement”, “Quickness”, For each other”, “Kindness heart”. Section four: Fundamentals of attractive guide management 1. communicating with children The first in the successful management of the young child is to establish communication .Communication is a complex and multi-sensory process. The basic principle is that the message must be understood by the children. Generally, communication with younger children is best started with complimentary comments. Then the dentist should notice these: message clarity, voice control, body contract, active listening and appropriate responses. 2. Tell –show-do technique (TSD) Tell-show-do is a series of successive approximations .Dentists should demonstrate various instrument step by step before their application by telling, showing and doing. 3. Painless
There are some methods,such as local anesthesia,removing dental carries with painless technique. 4.Han -0 mouth exercise(HOME) The HOME's purpose is to gain attention of a highly oppositional child,so that communication should be established and cooperation should be obtained for a safe course of treatment.The technique fits the rules of learning theory:maladaptive acts (screaming.kicking )are linked to restraint (hand over mouth)and cooperative behavior is reated to removal of the restrictionand the use of p tive reinforcement()The HOMEis ally used with children at the ageo who have had appropriate communicative abilities 5.Parent-child separation (1)Excluding the parent from the operating room can contribute toward development of positive behavior on the part of the child. (2) parent can be amj often providing important information and interpretation.Another important exception relates to age.Very young children (those who have not reached the age of understanding and full verbal communication )have a close symbiotic relationship with parents.Consequently.they usually are accompanied by them.It should be noted that children 3.5 to 4 years of age red to benefit most from the pa ent's presence.Those older than 4 years dem parental presence.Establishment of the policy therefore should be based on a rationale that takes into account the benefits and drawbacks resulting from separation as well as the dentist's personal views. 6.Behavior modification children.Many dentist allow young children into the parents to preview the denta experience.On these occasions many young children climb into the dental chair by themselves. The merits of modeling procedures are as follows: (a)Stimulation of new behaviors (b)Facilitation of behavior ina more appropriate manne (c)Extinction of fears (d)Disinhibition of inappropriate behavior due to fear. 7.Creating a safe enviroment for the child Film and videotapes have been developed to provide a model for the young patient Section five:Aversive therapy for negative children There are mainly three motivate methods of making diagnosis and making treatment to the negative children.They are the use of immobilization.the use of sedatives and general anesthesia 1.The use of immobilization (1Definition:Immobilization is a way to use mechanical to make the mouth open and control the patient's baby protect the and treat thedis 1).A patient requires diagnosis or treatment and does not cooperate after other behavior management techniques have failed. 2).The safety of the patient would be at risk without the use of protective immobilization
There are some methods, such as local anesthesia, removing dental carries with painless technique. 4. Hand-over-mouth exercise (HOME) The HOME’s purpose is to gain attention of a highly oppositional child, so that communication should be established and cooperation should be obtained for a safe course of treatment. The technique fits the rules of learning theory: maladaptive acts (screaming, kicking )are linked to restraint (hand over mouth ) , and cooperative behavior is related to removal of the restriction and the use of positive reinforcement ( praise ) . The HOME is usually used with children at the age of 3 to 6 years old who have had appropriate communicative abilities. 5. Parent-child separation (1) Excluding the parent from the operating room can contribute toward development of positive behavior on the part of the child. (2) Parent accompany: the parent can be a major asset in supporting and communicating with a disabled child, often providing important information and interpretation. Another important exception relates to age. Very young children (those who have not reached the age of understanding and full verbal communication ) have a close symbiotic relationship with parents. Consequently, they usually are accompanied by them . It should be noted that children 3.5 to 4 years of age appeared to benefit most from the parent’s presence. Those older than 4 years demonstrated similar levels of response to dental care regardless of parental presence. Establishment of the policy therefore should be based on a rationale that takes into account the benefits and drawbacks resulting from separation as well as the dentist’s personal views. 6. Behavior modification Behavior modification can also be performed with live patient models such as siblings, other children. Many dentist allow young children into the operation with parents to preview the dental experience. On these occasions many young children climb into the dental chair by themselves. The merits of modeling procedures are as follows: (a) Stimulation of new behaviors (b) Facilitation of behavior in a more appropriate manner (c) Extinction of fears (d) Disinhibition of inappropriate behavior due to fear. 7. Creating a safe enviroment for the child Film and videotapes have been developed to provide a model for the young patient. Section five: Aversive therapy for negative children There are mainly three motivate methods of making diagnosis and making treatment to the negative children. They are the use of immobilization, the use of sedatives and general anesthesia. 1. The use of immobilization ①Definition : Immobilization is a way to use mechanical to make the mouth open and control the patient’s baby , protect the patient ,so as to diagnose and treat the disease . ②Indication for use 1).A patient requires diagnosis or treatment and does not cooperate after other behavior management techniques have failed. 2).The safety of the patient would be at risk without the use of protective immobilization
3).A patient requires diagnosis or treatment and can't cooperate because of mental or 3Methods 1).The use of open wide mouth prop. Common mechanical aids maintaining the mouth in an open position.It allows reach accessibility to the opposite side of the mouth.and operates on a reverse action.It can use with body verely retarded or very young.parents and enta assisants can assist in the conr of movements during dental procedures ④Cautions An explanation of the benefits of this management should be presented by the dentist before use if communication with the patient is possible.The parents should be given a careful explanation about how immobilization allows the needed dental work to be done while 2.General anesthesia If a child requires extensive dental treatment and cooperation can't be achieved by routine psychologic,physical or pharmacologic measures,the use of general anesthesia is recommended. General anesthesia describes a controlled status of accompanied by partial or totl los of pro ective reflexes including the inability to independently m tain an airway or ond to verbal commands 3.The use of sedatives The use of sedatives,such as nitrous oxide and oxygen is to provide a light sedation,which makes the child more easily influenced by the behavioral techniques.The children are able to keep their mouth and eyes as well as communicate and cooperate.usually increase the Indication (1)Emergency cases (2)Small children with complicated treatment need (3)Children with general owcoping ability(ghandicapped children)
3).A patient requires diagnosis or treatment and can’t cooperate because of mental or physical disabilities. ③Methods 1). The use of open wide mouth prop. Common mechanical aids maintaining the mouth in an open position. It allows reach accessibility to the opposite side of the mouth, and operates on a reverse action. It can use with body control. For children who are severely retarded or very young, parents and dental assistants can assist in the control of movements during dental procedures. ④Cautions An explanation of the benefits of this management should be presented by the dentist before use if communication with the patient is possible. The parents should be given a careful explanation about how immobilization allows the needed dental work to be done while minimizing the possibility of accidental injury to the patient. 2. General anesthesia If a child requires extensive dental treatment and cooperation can’t be achieved by routine psychologic, physical or pharmacologic measures, the use of general anesthesia is recommended. General anesthesia describes a controlled status of unconsciousness accompanied by partial or total loss of protective reflexes including the inability to independently maintain an airway or respond appropriately to verbal commands. 3. The use of sedatives The use of sedatives, such as nitrous oxide and oxygen is to provide a light sedation, which makes the child more easily influenced by the behavioral techniques. The children are able to keep their mouth and eyes open as well as communicate and cooperate, usually increase the effectiveness of the behavioral techniques previously described. Indication: (1) Emergency cases (2) Small children with complicated treatment need (3) Children with general low coping ability (e.g handicapped children )