Behavior Management I

Dr. mariam jaljouli

Introduction

The foundation of practicing dentistry with children is built on the ability to

guide them through their dental experience.

The difference between treating children and adults is the relationship.

Treating adults generally involves a one-to-one relationship (dentist-patient). Treating
a child, however, usually relies on a one – to – two relationship (dentist-pediatric
patient-and parents)

Causes of Inappropriate Behavior:

1. Developmental delay, MR, acute and chronic disease, Age.

2. Fears: either acquired (from parents, siblings, and peers) ; or learned fears
(difficult previous medical or dental experience)

3. Awareness of a dental problem

Classifying Children’s Cooperative Behavior:

Wright’s Clinical Classification:

ㄱ Cooperative
ㄴ Lacking cooperative ability
ㄷ Potentially cooperative

Frankl Behavioral Rating Scale:

ㄱ Rating 1: Definitely Negative ( _ _ ). Refusal of treatment, crying forcefully,

fearful, or any overt evidence of extreme negativism.
ㄴ Rating 2: Negative ( _ ). Reluctant to accept treatment, uncooperative, some
evidence of negative attitude but not pronounced (withdrawn)

ㄷ Rating 3: Positive ( + ). Acceptance of treatment; at times cautious; willingness

to comply with the dentist, at times with reservation, but patient follows the
dentist’s directions cooperatively.

ㄹ Rating 4: Definetly Positive ( + + ). Good rapport with the dentist, interested in

the dental procedures, laughing and enjoying.

0 Use the shorthand form with the description of the clinical problem, e.g. “ _ ,
tearful ”
The Functional Inquiry

Before the dentist treats children ; medical and dental histories are taken. However,
functional inquiry, from a behavioral point of view, also should be obtained.

It has 2 goals:

1. Learn about the patient and the parent concern.

2. Gather information enabling a reliable estimate of the cooperative ability of the
child.

Conducted in 2 ways:

1. Written questionnaire completed by parent.

2. Direct interview with the child and parent.

Parents of Pediatric Patients

ㄱ Parents shape their children’s behavior from birth.

ㄴ They have an important role in the pedodontic treatment triangle.
ㄷ The SES affects acceptance of the management methods.

Some of the troublesome parental attitudes are :

ㄹ Overprotective Parents:

This behavior often prevents the natural development of the child toward
independence. TFor example, they insist on remaining with the child
regardless of the office policy.
Results from a number of factors:

1. A threatening experience to the health of the child either during pregnancy

or after birth.
2. The parent was raised in a home that lacked warmth and love.
3. Maladjustment of the family.
4. Some psychological disturbance of the parent.

How to deal with them?

Reasonable discussion is recommended; pointing the importance of
establishing a one- to- one relationship between the dentist and the child satisfies most
overprotective parents.

Citing the office policy is NOT helpful.

ㅁ Manipulative Parents

Excessively demanding attitudes, extend to directing diagnosis and treatment plan.

E.g. parent who refuses radiographs.

How to deal with them?

Ask them why they refuse radiographs? Acknowledge their concern and their
dialogue can be developed. Also, conservative radiation hygiene practices can be
identified.

ㅂ Hostile Parents

They question the necessity for treatment in a disturbing manner.

Result from:
1. Poor personal experiences in the dental office,
2. A general negativism toward health professionals,
3. Feelings of insecurity on a foreign environment
4. Misconceptions about dentistry.

How to deal with them?

Experience patience and explain the treatment. Frank discussion lead to
smoother relationship.

ㅅ Neglectful Parents

Usually discovered by failure to maintain appointment, and missing recall visits.

(Unappreciative of dental care, careless, busy)
How to deal with them?

Counseling and explaining the importance of dentistry

Critical Moments on the Dental Appointment:

1. Separation from the parent

Not recommended for patients younger than 3 years of age.
The dentist opinion should be known before the treatment, and the parent
agrees

2. Getting into the chair

Difficult; natural fears, needs assistance.
This provides the first real opportunity to praise the child for his good
behavior

3. Dentist seated at chair.

Indicates that treatment is imminent

4. The injection
The most universally feared procedure in dentistry for children.
 Technique now is painless for most children (topical anesthesia)

5. The dental procedure

Restorative and extraction

6. End of appointment
Some children spend all their emotional reserves during the appointment and
then become unglued afterward.

7. Return to parent
Some children want their parents to feel guilty about making them go to the
dentist.

The Profile of a Good Child Dental Patient:

1. Separates well from the parent

2. Gets right into the chair
3. Can handle and respond to questions and accepts praise.
4. Cooperate at injection time, can even cry and may need momentarily restraint at
the time of injection. Crying stops when the needle disappears.
5. Tolerates restorative procedures and extractions.
6. At the end of the appointment, he/she is eager to leave yet is patient enough and
human enough to stay around to be congratulated.
7. Return to the parent bearing pride.

Misbehaving Child Dental Patient

These are children who just can not cope or, just will not cope with the stimuli and
behavioral demands of the dental experience.

Category 1: The emotionally compromised child

ㄱ It is important to realize the problem may be undiagnosed.

ㄴ Anxiety.
ㄷ Poor dental patient
ㄹ May come from broken homes or other unfortunate parenting circumstances
such as poverty, neglect or abuse

Category 2: The shy introverted Child.

ㄱ The challenge is the communication between the child patient and the adult
dentist
ㄴ Avoidance behavior such as crying
ㄷ Aggressive behavior rare
ㄹ Our objective is to establish rapport, trust, and communization
Category 3: The frightened Child

ㄱ Ranges from fear of the needle to fear of bodily harm to general fear of the
unknown
ㄴ Some of the causes for fear are
ㄷ Intellectually unable because of age or slow development
ㄹ Other emotional upsets in his/ her life
ㅁ Acquired fears
ㅂ Learned fears
ㅅ Emotional illness

ㄱ Experience and common sense help you diagnose

ㄴ Make sure not to increase anxiety (may mean postponing the dental work,
sedation or even GA)

Category 4: The Child who is adverse to authority

ㄱ These children misbehavior is based on an aversion to compliance with adult

directives
ㄴ The misdirected goals and the associated behavior is s follows:
1. Undue attention.: Annoying, irritating, teasing, disruptive
2. Struggle for power: Argues and contradicts, does the opposite of instructions,
makes people angry, throws temper tantrums
3. Retaliation and revenge: Dangerous (bites!), seeks revenge.
4. Inadequacy: gives up easily, seems incapable, displays inadequacy.