1. FACTORS AFFECTING CHILD’S BEHAVIOUR IN DENTAL OFFICE

2. 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

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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

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

10. 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.

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

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

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

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

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

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

17. 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.

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

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

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

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

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

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

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

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

26. MATERNAL ATTITUDE AND CHILD BEHAVIOUR IN A DENTAL SITUATION
Mother
Father

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

28. 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.

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

30. 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.

31. 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

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

33. 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

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

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

36. 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

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

38. 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

39. Thank You