MANAGING THE PATIENT, PRACTICE,

AND PARENT

Edited : Cahyo Nugroho

 CLASSIFYING BEHAVIOR
Cooperative
Lacking Cooperative Ability
Potentially Cooperative
Uncontrolled Behavior
Defiant Behavior
Timid Behavior
Tense-Cooperative Behavior
Whining Behavior
 Cooperative
Cooperative children are reasonably relaxed.
Minimal apprehensions
Following instructions
Permit dentist to function effectively and
efficiently.
75-80% of children seen in the dental office
will be cooperative.
 Lacking Cooperative Ability
Very young children with whom
communication cannot be established due to
lack of developed communication skills.
Typically children under 2 to 3 years of age.
Also includes special needs children of any
age.
 Potentially Cooperative Behavior
Use of the term potentially is a euphemism!
Classification for children who are a behavior
problem.
Have the ability to be cooperative, but are not.
Require the dentists skills to develop
cooperative behavior.
 Uncontrolled Behavior

Typically seen in young child between ages 3-6.

Can manifest kicking, flailing and fighting behavior.
Once children socialized by kindergarten and elementary
school, typically become cooperative.
Suggestive of a state of acute anxiety or fear. (We will
differentiate between the two later.)
Requires great patience from the dentist.
Also requires assuring that the child does not harm self or
other.
 Defiant
Typically associated with school aged children.
More characterized of boys.
I dont want to. I wont. I dont have to.
Sometimes passive resistance.
Requires strong assertive response from
dentist.
 Timid Behavior
Milder form of negativism.
Characteristic of pre-school child
Hide behind mother
Typically anxious child.
Require patience; empathy; and frequent
instructions.
 Tense Cooperative Behavior
Borderline between cooperative and
uncooperative.
Extremely tense, but attempting to cooperate.
Emotions controlled, but obvious they are
emotionally stressed.
Accept dentistry, but express dislike for not
consistent with experience.
 CRYING TYPES

Compensatory cry
Fearful cry
Obstinate cry
Painful cry
 Compensatory Cry

Whining

Droning on accompanied by few if any tears.

 Fearful Cry
Sobbing
Rasping
Tears
Result of fear, either objective or subjective
as we will discuss.
 Obstinate Cry
Siren like pitch.
Crying to be attempt to avoid cooperating
Physical flailing and fighting.
Associated with uncontrolled behavior
reaction.
Firm, assertive behavior required by dentist.
 Painful Cry
Moaning
Associated Grimacing
Authentic manifestation of a problem.
Lack of profound anesthesia typically the
issue.
FEAR AND ANXIETY
 ANXIETY
apprehension, tension or uneasiness which stems from the
anticipation of danger, the source of which is largely unknown
or unrecognized. Primarily of intrapsychic origin, in distinction
to fear, which is the emotional response to a consciously
recognized and usually external threat or danger. Anxiety and
fear are accompanied by similar physiologic changes. May be
regarded as pathologic when present to such an extent as to
interfere with effectiveness in living, achievement of desired
goals or satisfactions or reasonable emotional control.
 FEAR
Objective Fears

Direct stimulation of the sense organs; personal

experience based

Subjective Fears

Based on feeling and attitudes suggested to the

child by others, without the child having had an
experience personally.
 PRINCIPAL FEARS BY AGE
THREE YEARS - Visual fears (masks, policeman)
FOUR YEARS - Auditory fears (sirens)
FIVE YEARS - Bodily harm (falling, dogs, dentist)
SIX YEARS - Many fears; especially auditory and spatial
SEVEN YEARS - Deeper fears (not being liked/loved)
EIGHT YEARS - Fears reduced; continuation of failure, being liked
NINE YEARS - Few fears; but ability to compete successfully exists
TEN YEARS - School
ELEVEN YEARS - Major fears re-emerge; health and animals
TWELVE YEARS - Fears dissipate; fear is silly.
RELATING EMOTIONAL MATURATION
TO THE DENTAL SITUATION

Two Year Old

Three Year Old
Four Year Old
Five Year Old
Six to Twelve Year Olds
 Two Year Old
Variable in ability to communicate.
Language skills developed at highly variable months
in age to children.
Solitary play, or if with another child the play is
parallel play.
Fearful; avoid sudden movements, such a moving the
dental chair.
Children four and under tend to be more cooperative
with parent n the operatory with them.
 Three Year Old
Dentist can communicate with.
Frequently talkative; enjoys telling stories.
Dentist can engage with questions: pets,
brothers/sisters, cartoon characters.
Stranger anxiety/fear greatest between 2 and
4.
 Four Year Old
Good listeners
Typically follow instructions.
Lively minds and great talkers.
Peak of fearful period, with fears declining to age six.
Height of fear of bodily injury. An issue for dental
treatment.
Period of intense super-ego development.
 Five Year Old
Kindergarten age
Enjoys group activities; playmates
Fears generally reduced.
With appropriate parenting is able to accept
new experiences.
Responsive to comments about appearance.
 Six to Twelve Year Olds
Elementary school children.
Developing independence from parents.
Peers becoming increasingly important, and affect
behavior.
Able to resolve fears.
Desires acceptance, therefore more compliant.
Adjusts easily
Can tolerate unpleasant experiences.
 VARIABLES AFFECTING
CHILDRENS BEHAVIORS
Parental Behavior
Overprotection (extreme domination or
indulgence)
Rejection
Over anxiety
Over-Identification
Past Medical History
Other Variables: socioeconomic, cultural, sex,
ordinal position, sibling relationships, number of
children in the family
 ASSESSING AND RECORDING
CHILDRENS BEHAVIOR IN THE DENTAL
SITUATION
Definitely Negative (F1)
Refusal of treatment, crying forcefully, fearful, or any overt
evidence of extreme negativism
Negative (F2)
Reluctant to accept treatment; uncooperative; some evidence of
negative attitude, such as sullen or withdrawn, but not
pronounced.
Positive (F3)
Acceptance of treatment; at times cautious; willingness to comply,
at times with reservation, but follows directions
Definitely Positive (F4)
Good rapport with dentist; interested in procedures; enjoys the
situation.
 DYNAMICS OF BEHAVIOR
These codes should be entered in the patients
record, and will provide a cue for anticipated
behavior at a subsequent visit.
Childrens behavior will vary through an
appointment and the codes should be used to
indicate such: F1 initially and during anesthesia; F4
after rubber dam placement and during treatment.
Thank You