Dr Hidayathulla Shaikh, Lecturer, College of Dentistry, Majmaah University.

To explain what is Behavior Management. To define Behavior Management. To discuss specific techniques associated with Behavior management.

It is the art and science which is not a mere application of individual technique formulated to deal with individuals but rather a comprehensive methodology to built a relationship between patient and healthcare provider. This builds trust and relieves fear and anxiety. Since childhood experience has important role in building adult behavior, proper behavior management right from an early age will help in the development of a proper oral health attitude.

Wright in 1975 defined Behavior management as – “The means by which the dental health team effectively and efficiently performs treatment for a child and at the same time instills a positive dental attitude”.

1) Voice Control 2) Nonverbal communication 3) Tell Show Do 4) Modelling 5) Reinforcement 6) Systematic desensitization 7) Distraction 8) Parental presence/absence 9) Hand Over Mouth Exercise (HOME)

It is a controlled alteration of voice volume, tone and pace to influence and direct patients behavior. Objectives To gain patients attention To avert negative behavior.

It is the reinforcement and guidance of behavior through appropriate contact, posture and facial expression.

Addleston in 1959 introduced this concept to explain children, the dental procedures and equipments. This technique involves the explanation of the procedure in 3 phrases Phrase 1 Developmental level (providing knowledge) to the patient (TELL).

Phrase 2 Demonstrations for the patient for visual, auditory, olfactory and tactile aspects of procedures in carefully define non threatening settings (SHOW). Phrase 3 And then without deviating from the explanation and demonstration, completion of the procedure (DO).

Bandura in 1969 developed this technique called ‘Modelling’ or ‘Imitation’. According to this technique learning occurs as a result of direct experience, which can be brought about by witnessing the behavior and the outcome. Modelling could be used to alleviate anxiety and encourage preventive care at home.

This is done by observing a model undergo an examination or treatment. The patient would gain information about the kinds of equipments that he or she will encounter and it will help reduce uncertainty. Modelling can be done using films or live models.

Reinforcement means any consequences which increases the likelihood of a behavior being shown. There are two types of reinforcement 1) Positive reinforcement – consequences which is pleasant and increases the likelihood of behavior. Ex- voice modulation, facial expression, verbal praise and physical demonstration.

2) Negative reinforcement An unpleasant event that can be avoided through some kind of action Ex – asking student to remain absent for the class.

Wolpe in 1952, developed this technique. This technique consists of two elements, gradual exposure of child to his/her fear and induced state of incompatibility with his/her fear. Here the therapist prepares the list of stressful events from least to most stressful. The patient while in a state of relaxation is exposed to the stressful event from the least stressful and repeated till there are no signs of stress.

It is the technique of diverting the patients attention from what may be perceived as an unpleasant procedure. Since the patients attention is drawn away there is less chance of anxiety.

This technique involves the presence or absence of the parent to gain cooperation for treatment. A wide diversity exists in practitioners philosophy and parental attitude regarding parents presence or absence during pediatric treatment. Children's response to their parents presence or absence can range from beneficial to detrimental. It is the responsibility of the practitioner to determine communication methods, use his own skill, optimize treatment settings for individual child.

HOME is accepted technique for intercepting and managing unsuitable behavior that cannot be modified by basic behavior management. Method The dentist firmly but gently places his hand on the Childs mouth and whispers in his ear that when he cooperates, the hand will be removed. The patient if indicates the willingness to cooperate either by nodding his head or by stopping screaming, the hand is removed.

Maintenance of the airway is mandatory. Written informed consent from a legal guardian must be obtained and documented in the patients record prior to the use of HOME. Indication 1) A healthy child who is able to understand and cooperate, but who exhibits unsuitable avoidance behavior.

Contraindications 1) In child who, due to age, disability, medication or emotional immaturity are unable to communicate verbally, understand and cooperate. 2) Any child with an airway obstruction.