1. PEDODONTICS 1-3 Dr. Abdullah Abumoamar

2. Behavior Management 2

3. Behavior Management Techniques There are different methods in which the behavior of the child can be modified. It is important to understand the theory behind each method and its effects in behavior modification of the child to accept dental treatment.

4. Behavior Management Techniques Objectives of behavior modifications: 1-To establish effective communication with the child and the parent. 2-To gain confidence of both the child and the parent and the acceptance of dental treatment.

5. Behavior Management Techniques Objectives of behavior modifications: 3-To teach the child and the parent, the positive aspects of preventive dental care. 4-To provide a relaxing and comfortable environment for the dental team to work in, while treating the child.

6. Behavior Management Techniques 1)Communication: Communicating with the child is the real key to behavior management and is indicated for every child seen in the dental office. It is verbal and non-verbal, in other words it can be both objective and subjective.

7. Behavior Management Techniques a-Verbal Communication: -It is best initiated for younger children with complementary comments about the appearance or dress. -The language used should consist of words that express pleasurness and friendship followed by questions that elicit an answer other than Yes or No.

8. Behavior Management Techniques b-Non-Verbal Communication: -Such Communication includes warm, friendly environment and happy smiling team. -Non-verbal messages can be received from eye or body contact, for example placing a hand on a child's shoulder while setting on a chair side, conveys a feeling of warms and friendship and may be useful with all patients.

9. Behavior Management Techniques -These methods give positive encouragement and convey the apprehension state without a spoken word and enhance other management techniques.

10. Behavior Management Techniques C -Message clarity: Communication is a complex, multi-sensory process. It includes a sender, a medium and a receiver. The dentist team is the sender, the spoken word is the medium and the pediatric patient is the receiver.

11. Behavior Management Techniques C -Message clarity: The message must be understood in the same way by both the sender and the receiver, the language used is appropriate to the child's age and the words must be used at the child's level of understanding.

12. Behavior Management Techniques C -Message clarity: For pediatric dentist, word substitutes are like a second language, the following are examples of word substitutes that can used to explain procedures to children. Water syringe → water gun. Alginate → pudding.

13. Behavior Management Techniques During communication avoid the following: 1- Fear 2-Asking approval 3-Delaying tactics.

14. Behavior Management Techniques 2)Behavior Shaping: -Shaping is used to establish a behavior that is not presently performed by the individual for development of a new behavior by the successive reinforcement. -For children behavior shaping consists of a series of steps towards ideal behavior. This is most easily achieved by explanation and learning of dental procedures and selective reinforcement.

15. Behavior Management Techniques Reinforcement defined as the strengthening of a pattern of behavior which increases the probability of that behavior being displayed in the future. The most powerful reinforces are facial expression, positive voice modulation and verbal praise

16. Behavior Management Techniques Do not reinforce many times at one step and avoid under-reinforcement at any step. The technique is useful for all patients who can communicate and there are no contraindications

17. Behavior Management Techniques 3)Voice Control: This technique uses a controlled alteration of voice, volume and tone to influence and direct child's behavior. ex. an abrupt change form soft to loud voice without any changes in face expression. Such technique aim to gain attention of the child, improve his compliance as well as to establish authority.

18. Behavior Management Techniques 3)Voice Control: Voice control is not appropriate for too young children who cannot understand or with intellectual or emotional impairment.

19. Behavior Management Techniques 4)Tell-Show-Do (TSD): It is a technique of behavior shaping used with both verbal and non-verbal communication. Tell → involves an age appropriate language and explanation of the procedure. Show → is used to demonstrate the procedure. Do → is performing part of a procedure. Trust → always be honest

20. Behavior Management Techniques 4)Tell-Show-Do (TSD): Objectives: 1-To teach the patient important aspects of the dental visit and familiarize the patient with the dental setting. 2-To shape the patient's response to the procedures through desensitization and well described expectations. Indications: with any patient.

21. Behavior Management Techniques 5) Modelling: It is a type of behavior modification in which young patient can learn about dental experience by looking at other children receiving treatment as live model or by video tape of a child undergoing treatment.

22. Behavior Management Techniques This technique seen to improve the apprehensive behavior of the child in the dental environment and decrease anxiety by showing a positive outcome of the required procedure to child illustrate the rewards. For best effects: 1-Models should be the same age. 2-Models should exhibit appropriate behavior and be praised.

23. Behavior Management Techniques 6) Desensitization: -This technique helps individuals with specific fears or phobias to overcome them by repeated contacts. -It is a training or steps taken to reduce the sensitivity of the patient to a particular anxiety producing situation or object. -Each situation or object is then introduced progressively starting from least fear producing to more threatening stimuli.

24. Behavior Management Techniques Stages of this technique: 1-Training the patient to relax. 2-A hierarchy of fear-producing stimuli is constructed. 3-Introducing each stimulus in the hierarchy in turn to the relaxed patient, starting with the stimulus that comes least fear and progressing to the next only when the patient no longer fear that stimulus.

25. Behavior Management Techniques 7) Distraction: -This approach aims to shift the patient's attention from the dental setting to some other situation, or from a potentially unpleasant procedure to some other action. -Distraction with words such as talking while administering local anesthesia or directing the attention through audio stories, music or cartoon. -This technique is useful for all patients who can verbally communicate, there are no contraindication.

26. Behavior Management Techniques 8) Retraining: It is a behavior control to previously poor dental experience, it is designed to replace the negative behavior that has developed but the causes of the child's negative behavior should be established first.

27. Behavior Management Techniques A-Avoidance: Avoidance of repeating the same procedure to the child who has suffered from bad dental experience. The treatment is performed in two visits, first entering different technique then performing a relatively painless procedure.

28. Behavior Management Techniques B- Substitution: Avoiding the instrument that produce anxiety, if the substitution is impossible, the child should be told that the instrument will be used as little as possible and with great care.

29. Behavior Management Techniques 9) Re-inforcement : At the end of a successful appointment, reward such as stickers or badges are often given to the child as a pleasant reminder of the appointment. There should be no punishment for the child and the dentist must ignore the inappropriate behavior.

30. Behavior Management Techniques 10) Aversive Conditioning (flooding technique): -It is a behavior modifications that eliminates a child attempt to avoid dental treatment. -This method is used as a last resort with the very young, immature or physically handicapped child or those who are mentally or emotionally afflicted.

31. Behavior Management Techniques 10) Aversive Conditioning (flooding technique): A-Hand Over Mouth (HOM) -It is a technique for managing unsuitable behavior that cannot be modified by straight forward technique. -It is not a punishment measure and the dentist should not express anger when using this method.

32. Behavior Management Techniques Objectives: 1-To redirect the child attention and enable communication with the dentist so that appropriate behavior expectations can be explained. 2-To extinguish excessive avoidance behavior and help the child regain self control. 3-To ensure the child's safety during dental treatment. 4-To reduce the need for sedation or general anaesthesia.

33. Behavior Management Techniques Indications: 1-Healthy child who is able to understand and cooperate, but he exhibits hysterical avoidance behaviors by kicking or temper tantrum. 2-Children over the age of 3 years who have normal intelligence to understand the dental instruments.

34. Behavior Management Techniques Contra-indications: 1-The technique should not be used with frightened children. 2-Also, not to be used in very young age or with children who have physical or mental disabilities that prevent them from understanding.

35. Behavior Management Techniques Technique: The dentist gently but firmly places his hand over the child's mouth with verbal outburst completely stopped, the child is told that when he cooperate the hand will be removed, when the patient indicates his willingness to cooperate the hand is removed and the patient is reevaluated. The airway should never be closed.

36. Behavior Management Techniques B-Physical Restraints: It can range from gently holding the child's hands during the injection procedure to full body restraint. The parents must be informed that the technique is safe and effective and their consent must be obtained.

37. Behavior Management Techniques Objective: 1-To control patient movements and prevent self-injury. 2-To teach child that resistance is unnecessary and he is willing to cooperate. 3-They should cause no injury to the patient and used only when necessary.

38. Behavior Management Techniques Indications: 1-For patients who are not capable of understanding the dental procedure. 2-Some mentally or physically handicapped patients because they have difficulty to control movement of their arms and legs.

39. Behavior Management Techniques Types: a)To control head movement. 1-Forearm-body support: the dentist should hold the child's head between his chest and arm to prevent sudden head movement.

40. Behavior Management Techniques 2-Papoose broad head positioner. 3-Plastic bowl

41. Behavior Management Techniques B) To control body movements: 1 -Safety belt.

42. Behavior Management Techniques B) To control body movements: 2-Triangular sheet.

43. Behavior Management Techniques B) To control body movements: 3 -Pedi-wrap.

44. Behavior Management Techniques B) To control body movements: 4-Papoose board

45. Behavior Management Techniques B) To control the oral cavity. 1-Intra-oral mouth prop: a-Wraped tongue blades.

46. Behavior Management Techniques B) To control the oral cavity. 2-Extra-oral mouth prop: Molt mouth prop which is constructed of metal and covered with rubber tubing.

47. Behavior Management Techniques Parent-Child Separation: Excluding the parent form the operating room can contribute toward developing a child's positive behavior. Exceptions in case of very young (<4 years) or disabled child, parent must be prevent during treatment helping in supporting, communication and often providing important information and interpretation.

48. Behavior Management Techniques Reasons for parents separation: 1-The parent often repeat orders, creating an annoyance for both dentist and child. 2-The dentist is unable to use voice control in the presence of parent because the parent may be offended.

49. Behavior Management Techniques 3-The child's attention is divided between parent and the dentist. 4-The parent injects orders which become a barrier to development of rapport between the dentist and child.

50. Behavior Management Techniques Practical Considerations: 1-Early morning appointments are reserved for young children based on the facts that the child is alert and the dental team is fresher. 2-Short appointment not more than 30 minutes specially for the young and fearfull child. 3-A long appointment was considered as 45 minutes or more after the child becomes fully introduced to the procedures and gains confidence in himself and in the dentist.

51. Behavior Management Techniques 4-Avoid sudden movement of the child, the child is told first. 5-Children cannot sit in one position for long time demanding a change in operating position thus the dental team has to be flexible as situations demand. 6-Avoid setting the instruments that provoke fear in front of the child's sight.

52. Behavior Management Techniques 7-The child should not be kept waiting in the reception area as many children become restless and tired when faced with long delays.

53. Behavior Management Techniques The first dental appointment: -The first appointment should be used to establish a sound basis for achieving cooperation and stimulating positive attitudes of the child. -Preparation of the child and parents before the first visit will result in a better behavior pattern in the dental office by providing them with information and instructions.

54. Behavior Management Techniques Pre-appointment preparation of the child: Parents must be instructed to prepare their children before the first appointment through pre-appointment mailings or phone. Parents’ instructions include: 1-Inform the child about the dental visit casually. 2-Avoid conversation including unfavorable references to dentistry.

55. Behavior Management Techniques 3-Tell the child that the dentist will count your teeth and look after them. 4-Inform the dentist about the child's first name, nick name, name of the child's pets, toys, friends and his interests.

56. Behavior Management Techniques 5-Explain your policy about the presence of parents in the operatory room. 6-Assure the parents of your interest and concern for their child.

57. Behavior Management Techniques Aim of the first visit: 1-Establish good communication with the child. 2-Taking full history (social, dental and medical). 3-Examine the child and take radiographs. 4-Introduce child to simple treatment only (prophylaxis and topical fluoride). 5-Explaine treatment aims to child and parent.

58. Behavior Management Techniques Preparation the child for local anesthetic injection: 1-The child should be positioned in comfortable position for both dentist and child. 2-Application of better testing topical anaesthesia.

59. Behavior Management Techniques Preparation the child for local anesthetic injection: 3-A simple explanation of the procedure should be given ''sleepy water'' with little pinch without hurt. 4-Momentary restraint of the arm and body by assistant or parent may be used