1. BEHAVIOR MANAGEMENT

2. BEHAVIOUR MANAGEMENT
“It is the means by which the dental health team effectively & efficiently performs treatment for a child & at the same time instills a positive dental attitude” -WRIGHT (1975)
Classified as:
Non-pharmacological
Pharmacological

3. Non-pharmacological behaviour management
Communication
Behaviour modification(shaping)
Pre- appointment behavior modification
Behaviour management

4. Communication Universally applicable tool
It is the basis for establishing a strong relationship with the child patient.
Helps in completion of dental procedures and development of a positive attitude in children.
Should be initiated at the time of entry of the child into dental office and continued through the entire treatment time.

5. Communication TYPES: Verbal- by speech
Non-verbal- in the form of body language, eye contact, smile, expressions,
Touching, patting etc
Both verbal and non-verbal

6. Communication Words chosen should be pleasant and expressing concern
Patient should be addressed by his name
Use of euphemisms -euphemisms is substitute words which can be used in presence of children. Eg: raincoat for rubberdam.

7. Behaviour Modification
DEFINITION:
BEHAVIOR MODIFICATION IS DEFINED AS ” THE ATTEMPT TO ALTER HUMAN BEHAVIOR & EMOTION IN A BENEFICIAL MANNER ACCORDING TO THE LAWS OF MODERN LEARNING THEORY”

8. Behaviour Modification
It involves use of reinforcers that on being learned change child’s behavior to an appropriate form.
Based on stimulus-response theory.
It is a step by step technique to make the child involved in dental therapy

9. Behaviour Modification
It involves three techniques:
DESENSITIZATION
MODELLING
CONTINGENCY MANAGEMENT

10. Behaviour Modification
DESENSITIZATION
The concept comes from “systemic desensitization” used to reduce anxiety in patients by behavior therapists.
Patient learns to replace anxiety by relaxation

11. Behaviour Modification
DESENSITIZATION
Joseph Wolpe has suggested that in place of imaginery scenes, real life contacts can be effective in a dental situation.
The method employed is called TELL-SHOW-DO
Introduced by Addelston
Involves telling, showing of stimuli in increasing order of fear, followed by doing the procedures.
Language chosen should be simple
The situation is presented to the child slowly and repeatedly

12. Behaviour Modification
DESENSITIZATION
Indications:
Initial visit
Subsequent visits for every new interaction of the child
Apprehensive child due to previous information .
Effective in children above 3 yrs of age
Begins from initial entry till completion of the procedure
The heirarchy of events may be decided by the dentist for the individual patient

13. Behaviour Modification
MODELLING:
The basic procedure involves allowing the patient to observe one or more individuals who demonstrate appropriate behaviors in a particular situation
The model may be real or symbolic(posters)
Was introduced by BANDURA

14. Behaviour Modification
MODELLING:
Steps-
Gain attention of the patient
Desired behavior is modeled
Physical guidance may be needed
Reinforcement of guided behavior
Reinforcements for appropriate behaviors without modelling

15. Behaviour Modification
MODELLING:
It is effective when :
Observer is aroused
Model has higher status and prestige
Associated with positive consequences

16. Behaviour Modification
CONTINGENCY MANAGEMENT
It is a method of modifying the behavior of children by presentation or withdrawal of reinforcers
Reinforcers by definition increase the frequency of a behavior
Types of reinforcers:
Positive: presentation of which increases behavior
Negative: withdrawal of which increases behavior

17. Behaviour Modification
CONTINGENCY MANAGEMENT
Can also be classified as
Social reinforcers-praise, facial expressions, physical contact
Material reinforcers- toys, games. Sweets should not be given.
Activity reinforcers- seeing a movie, watching tv,outdoor games,etc

18. Preappointment preparation
It involves preparing the child as well as the parents for the forthcoming dental visit.
This can be done by:
Messages in the form of letters or s
by showing videotapes, audiovisual aids and live models.

19. Behaviour Management audioanalgesia Also called as WHITE NOISE
Involves providing a sound stimulus of such intensity that the patient finds it difficult to attend to anything else.

20. Behaviour Management Hypnosis
Also called as “suggestion therapy”
Technique of producing altered state of consciousness without the use of pharmacological agents.
Very rarely used in dentistry.

21. Behaviour Management coping
Children respond to stressful situations by coping.
It includes an individual’s internal and emotional processes and his external behavioral responses.
The way the patient copes with his fears determines the type of patient he is.

22. Behaviour Management coping
Mechanisms:
By thinking of something else- “Distraction”
Verbalizing fears to others
Preferring to be with others, say, mother- this is called “employing affiliative behavior”
“Mental rehearsal”- going over in one’s mind in advance the sequence of anticipated events and reappraising the threats involved.

23. Behaviour Management relaxation
It involves a series of basic exercises which the patient practices at home and may require several weeks to months to learn.
Therefore seldom used by clinicians.

24. Behaviour Management Aversive conditioning
Aversive conditioning is the extension of overall behaviour guidance designed to facilitate the goals of communication, cooperation & delivery of quality oral health care in difficult children.
It includes three practices:
Voice control
Hand-over-mouth exercise (HOME)
Physical restraint/Treatment immobilization

25. Behaviour Management Aversive conditioning
Voice control
Voice control
Voice control is a controlled alteration of voice,volume, tone,or pace to influence & direct the patients behaviour .
Parents unfamiliar with this technique may benefit from a prior explanation to prevent misunderstanding
OBJECTIVES:
To gain patient’s attention & compliance.
To avert negative or avoidance behaviour.
To establish authority

26. Behaviour Management Aversive conditioning
Hand over mouth exercise
2. Hand-over-mouth exercise (HOME)
popularized by : EVANGELINE JORDAN
OBJECTIVES:
To redirect child's attention enabling communication
To extinguish excessive avoidance behavior
To reduce the need for sedation or G.A .
INDICATIONS:
For uncooperative child
A healthy child who is able to understand verbal commands & cooperate , but exhibits negative behaviour

27. Behaviour Management Aversive conditioning
Hand over mouth exercise
CONTRAINDICATIONS:
Child under yrs of age
Special child (physically, emotionally & mentally compromised)
Child with airway obstruction or mouth breather.

28. Behaviour Management Aversive conditioning
Hand over mouth exercise
MODIFICATIONS:
HOM with airway unrestricted
HOM with airway restricted (HOMAR)
Towel held over nose & mouth
Dry towel held over nose & mouth
Wet towel held over nose & mouth

29. Behaviour Management Aversive conditioning
Physical restraint
3. Physical restraint/Treatment immobilization
It is the direct application of physical force to a patient with or without the patient’s permission to restrict his or her freedom of movement.
It may be:
Active: Performed with restraining device
Passive: Performed without restraining device

30. Behaviour Management Aversive conditioning
Physical restraint
OBJECTIVES:
To eliminate unwanted movement.
To protect patient, staff or dentist from injury
To facilitate quality dental treatment.
INDICATIONS:
A patient who requires immediate diagnosis treatment & can’t cooperate
When the safety is at risk
Child who is becoming tired from long appointments
A sedated pt who requires limited stabilization
Stubborn child

31. Behaviour Management Aversive conditioning
Physical restraint
PRECAUTIONS:
Tightness & duration of the stabilization must be monitored
The stabilization must not restrict circulation
Stabilization should be terminated as soon as possible in a patient who is experiencing severe stress

32. Behaviour Management Aversive conditioning
Physical restraint
TYPES OF RESTRAINTS:
FOR BODY:
Pedi wrap
Papoose board
Sheets
Beanbag with straps
Towel & tapes
FOR EXTREMITIES:
Velcro straps
Posey straps

33. Behaviour Management Aversive conditioning
Physical restraint
FOR HEAD:
Head positioner
Forearm body support
Extra assistant
FOR MOUTH:
Mouth blocks
Banded tongue blades
Mouth props
Finger guard or interocclusal thimble

34. Behaviour Management Implosion Therapy
Child patient is flooded with so many stimuli that he has no other option than to face it, until the negative behavior disappears.
It may include HOME, voice control, physical restraints.

35. Behaviour Management Retraining
employed in case of children presenting negative behavior, with bad experience in previous dental visits, or improper peer or parental orientation.
The child presents such behavior due to STIMULUS GENERALISATION, where similarities in stimuli generate similar responses.
In retraining, we make the child DISCRIMINATE between old and new stimuli,
The older response gradually diminishes - this is known as RESPONSE EXTINCTION.

36. Thank You