Behavior Management for the Pediatric Dental Patient

Behavior Shaping

 Non-pharmacological methods

1.       Tell-Show-Do

2.       Modeling

3.       Using parents as leverage

4.       Restraints

5.       Aversive techniques – HOM

 Pharmacological methods

1.       Nitrous Oxide-Oxygen

2.       Sedation's : Oral, IV

3.       GA

“Tell-Show-Do”

·         Developed by Addelston in 1959.

·         Tell it !

·         Show it !

·         Do it !

·         Always be honest !

·         Never sneak things up on kids !

Parental LeverageParental Leverage

·         Sometimes, need to use parents as leverage to obtain appropriate behavior.

·         Get informed/implied consent from parents.

·         Explain procedure to the parents first.

·         Parents sent out immediately when child cries.

·         Bring parent back when child stops crying.

Modeling

·         Use an older sibling or child to model for an apprehensive patient.

·         Best to use someone they look up to.

·         Very effective in families that have 2 or more kids.

Restraints

·         Can be used for anesthesia administration.

·         Informed consent prior to use.

·         Human - parents, assistant.

·         Sensitive about the use of the word.

·         Can be called a “positioner”.

     e.g. : Papoose Board, Pedi-Wrap, Molt

              mouth props etc.

      Aversive Techniques

·         Hand over Mouth and Airway - not used anymore.

·         Hand over Mouth Exercise (HOME) only.

·         Informed consent must be obtained prior to use.

·         Never use on a frightened child.

·         Rarely used. Legal Issues.

Hand Over Mouth Technique

·         Used for an extremely uncooperative-defiant-hysterical child.

·         Hand placed over the mouth to muffle screaming.

·         Talk very softly close to the ears.

·         Place hand back if child starts screaming again. Keep repeating until cooperative.

·         Always be in control of your emotions.

Pharmacological Methods

1.       Nitrous Oxide-Oxygen

2.       Premedication

3.       Conscious Sedation

4.       General Anesthesia

Nitrous Oxide-OxygenNitrous Oxide-Oxygen

·         “Laughing gas”.

·         One of the safest pharmacologic methods of behavior management.

·         Very few adverse effects, easily removed from the lungs in <4 minutes.

·         Special equipment required.

·         Will not work for a defiant child.

·         Cannot replace local anesthesia.

Indications :

·         reduce fear in an anxious or apprehensive patient.

·         to raise the pain threshold.

·         w/ conscious sedations.

Contra-indications :

·         defiant child.

·         to replace poor behavior management local anesthesia.

·         upper respiratory infections.

·         psychiatric  disorders.

·         h/o motion sickness  and vomiting.

Premedication

·         Can give mild sedative night before or the morning of the appointment.

·         Rarely done for very young children.

·         Can be used to teenage children.

·         Common Drugs: Valium

Conscious SedationsConscious Sedations

·         Sedative drug (Oral/Nasal/IV/IM/ Rectal) + Nitrous.

·         Special training required in several states.

·         Patient is able to maintain their own airway. Can cry during procedure.

·         Advantages : retrograde amnesiac properties of the drugs commonly used.

General Anesthesia

·         Completely under, (Oral/Nasal) endotracheal tube to maintain respiration.

·         Usually done in a Hospital.

·         Anesthesiologist or anesthetic nurse required.

·         Special training and hospital privileges required.

Indications :

·         extremely young child with rampant caries.

·         handicapped children

·         extremely fearful children

·         any systematically complication condition e.g. congenital heart condition etc.

 Risks

Written consent

                         Medical clearance - Pediatrician, Anesthesia.


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