FACTORS AFFECTING CHILD’S BEHAVIOUR IN DENTAL OFFICE

FACTORS UNDER CONTROL OF DENTIST Dental Office environment. Dentist’s activity and attitude Dentist’s attire Presence or absence of parents in operatory Presence of an older sibling. Length and time of appointment. Pre-appointment Preparation

Dental Office environment. It should be warm and simulate a homely environment Dental auxillary should be polite with the children and greet them warmly. A separate entry and exit. The operatory can be made colorful and lively with posters, television, toys for children. A separate waiting room for children with comics, books, toys etc.

Dentist’s activity and attitude Jenks gives 6 categories of activities by which dentists can enhance cooperative behaviour in children: Data gathering and observation Structuring Externalization Empathy and support Flexible authority Education and training

DATA GATHERING AND OBSERVATION Data gathering includes collecting information by a formal /informal interview or a written questionnaire from parent/child Observation is a continuous activity.Begins as soon as child enters the office and continues through waiting room area, interaction with the auxillary, reactions to different stimuli and objects in the dental office. This gives clues to the dentist as how to approach the child.

STRUCTURING Refers to guidelines of behaviour which are communicated by the dentist and his staff to the child. With this children know what to expect and how to react.

EXTERNALIZATION It is a process by which the child’s attention is focused away from the sensations associated with the treatment. Has two components: distraction, involvement. Objective : To interest and involve the child into the procedure, and simultaneously not letting him into verbal or motor discharges which may interfere in treatment. Example- a) during local anesthesia, involve him in verbal activity like counting numbers; or asking him questions on his likes n dislikes. b) during treatment, involve him in dental activity like giving him your dental mirror

EMPATHY AND SUPPORT It is the capacity to understand and to experience the feelings of another without losing one’s objectivity. This can be achieved by: -Letting the child express his feelings of anxiety and fear, but not allowing temper-tantrums. -Telling them that you understand their reactions to this new environment. -Comforting by words, touching or patting. -Encouraging on good behaviour

FLEXIBLE AUTHORITY This involves compromises made by the dentist to meet the demands of a particular patient or situation.

EDUCATION AND TRAINING This involves educating both child and parent regarding good dental health and stimulating them to make necessary behavioural changes to achieve these goals.

Dentist’s attire Previous bad experience with a dentist wearing a white attire may evoke fear in future situations with people wearing similar outfit.

Presence or absence of parents in operatory Good for preschoolers, handicapped Dentist feels relaxed in their absence. Older child may not need.

Presence of an older sibling. Serve as role model , depending on age of patient. Most effective in 4 yr olds.

Length and time of appointment short- less than 30 min. Long - upto 45 min Should be in early morning, not in their nap time.

Pre-appointment Preparation A letter or a phone call informing about the appointment. Helps reduce anxiety especially of the mother.

FACTORS OUT OF CONTROL OF DENTIST Growth and development of child. Nutritional factors. Past Dental & Medical Experience. Genetics. School environment Socioeconomic status

GROWTH AND DEVELOPMENT Any abnormality in normal growth and development may have led to feeling of rejection and inferiority. Mentally handicapping conditions. Very young child- under 3 yrs- lacks intellectual maturity to accept treatment.

NUTRITIONAL FACTORS Affects milestones of biological and cognitive development Studies have found irritable behaviour associated with increased intake of sugar.

PAST DENTAL AND MEDICAL EXPERIENCES Number of past visits to dentist/doctor not important. Quality of visits is important.

GENETICS Important for psychological development. Is further modified by environment.

SCHOOL ENVIRONMENT 50% of child’s development in school. Teachers and seniors serve role models.

SOCIOECONOMIC STATUS HIGH: Child may be spoiled. Psychological development normal. LOW: Child is often neglected May not value dental health.

FACTORS UNDER CONTROL OF PARENTS Home environment Family and peer influence Maternal attitude and behavior

HOME ENVIRONMENT Home is the first school where a child learns to behave.

FAMILY AND PEER INFLUENCE Family conflicts Influence of elderly and older siblings. Status of child in family.

MATERNAL ATTITUDE AND CHILD BEHAVIOUR IN A DENTAL SITUATION Mother Father

WHY? Mother-child relationship is more intimate Children usually have more contact with mothers

Parent –child relationship “One tailed” theory by Bell PARENT CHILD According to this one-tailed theory most of the child’s characteristics like his personality, behavior, etc are influenced by parental characteristics especially maternal.

Types of maternal attitudes Over Protective and dominant Over Indulgent Under affectionate Rejecting Authoritarian

Over Protective and dominant The usual feeling of love by mothers for children, when exaggerated leads to overprotection,which is harmful for normal psychological development of the child Causes may be- A history of delayed conception A history of miscarriage A history of no other sibling A history of handicapping or diseased condition in the child A history of paternal absence through death or divorce.  

Over Protective and dominant Signs: Excessive care to child continuing past the usual age Excessive concern in child’s routine problems. Mother is constantly involved in child’s daily activities. Child behaviour : Submissive Shy Anxious Lacks self confidence Lacks coping abilities Are cooperative Polite , obedient and disciplined

Over Protective and dominant Management: Create self confidence Familiarize with dental office

Over Indulgent This behavior may be associated with overprotection Or may be the dominant trait Management difficult in dental office Child behavior- Usually a spoiled child Aggressive and obstinate Demanding On denial of wishes throws temper tantrums Are difficult to make friends Demands attention

Under affectionate This behavior may vary from mild detachment to indifference to neglect. Causes : Unwanted child Mother’s career problems Father’s absence

Under affectionate Child behavior Usually well behaved Lacks decision making Cry easily Shy Unable to cooperate  

Rejecting It is an extreme behavior where child is totally neglected Causes: Any circumstance when child is unwanted Child behavior Lacks feeling of worthiness Aggressive Overactive Disobedient Tries to gain attention by any means Very difficult dental patients

Rejecting Manifests in form of Neglect Severe punishment Refusal to spend time and money on child

Authoritarian The mother controls the child with discipline varying from physical punishment to verbal ridicule She would impose her norms on the child Child behavior: Usual response may be submission Coupled with resentment and evasion Difficult dental patient

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