BEHAVIOURAL MANAGEMENT IN PEDIATRIC DENTISTRY

BY :- MAHARISHI RATHORE

BEHAVIOURAL MANAGEMENT
Should go hand in hand with the hand piece skill and knowledge of Dental materials for the successful treatment of children. Disruptive behaviour can interfere significantly with providing quality dental care,resulting in increased delivery time and risk of injury to the child.

Surveys of clinicians have found that DENTISTS consider the uncooperative child to be among the most troulbesome problems in Clinical Practice.

 Behavioural management methods in pediatric dentistry are directed towards the goal of communication and education. The relationship between the dentist and the child is built through a dynamic process of dialouge,facial expression and voice tone ; all methods of delivering a message. The Goals of behaviour management are to achieve good dental health in the child and to help develop the childs positive attitude towards dental health.

 Behavioural management is a thus not an application of individual techniques created to deal with the child,but rather a comprehensive methodology means to develop a relationship between the patient & the doctor which ultimately builds trust and allays fears & anxieties.

 1. AUDIO ANALYSIS (or,White Noise):- is a method of producing pain.This technique consists of providing a sound stimulus to such intensity that the patient finds it difficult to attend to anything else.Auditory stimulus such as pleasant music has been used to reduce stress and also reduce the reaction to pain. 2. BIO FEEDBACK:- Bio feedback involves the use of the certain instruments to detect certain physiologic process associated with fear.

Child can be Managed by the following methods:-

 3. HUMOR :- Humor help to elevate the mood of the child which help the child to relax. Functions of humor are :- - Social - Emotion - Informative - Motivation - Cognitive

4. COPING :- It is the mechanism by which the

child copes up with dental treatment .It is defined as the cognitive and behavioural efforts made by an individual to master, tolerate or reduce stressful situations.

 5. VOICE CONTROL :- It is the modification of intensity and pitch of one own voice in an attempt to dominate the interaction between the dentist and the child.

6. RELAXATION :- This technique is used to reduce Stress & based on principles of elimination of anxiety. 7. HYPNOSIS :- It is an altered state of consciousness characterized by heightened suggestibility to produce desirable , behavioural & physiological changes .

 8. IMPLOSION THERAPY :- Sudden flooding with a barrage of stimuli which have affected him adversely & the child has no other choice . But to face the stimuli until negative response disappears. 9. ADVERSIVE CONDITIONING :- Child who displays a negative behaviour and does not respond to moderate behaviour modifications technique falls into the category of frankles , definitive negative behaviour .

HOME (Hand-Over-Mouth-Exersice)
The behavioural modifications method of aversive conditioning is also known as HOME. It was 1st introduced by Evangeline Jordan,1920. The purpose of HOME is to gain the attention of a child so that communication can be achieved.

INDICATIONS
A healthy child who can understand but who exhibits defiance & hysterical behavior during treatment. 3-6 years old. A child who can understand simple verbal commands. Children displaying uncontrollable behavior.

CONTRAINDICATIONS
Child under 3 years of age. Handicaped child/immature child, frightened child. Physical ,mental and Emotional Handicap.

Factors To Be Considered Before Applying HOME Technique

HOME technique should not be used as a routine procedure for the management of the child. Inform the parents about the procedure. Consent of the Parents is very important. Pediatric Dentists should be aware of the changing laws that govern informed consent.

TECHNIQUE
After determining the childs behavior ,the dentist firmly places his hand over the childs mouth and behavioral expectations are calmly explained close to the childs ear. When the childs verbal outburst is completely stopped and the child indicates his willingness to cooperate, he should be complimented for being quiet and praised for good behavior. It should be noted that the childs airway is not restricted while performing the technique and the whole procedure should not last for more than 20-30 seconds.

Several Variations of HOME

Hand over mouth with the airway unrestricted. Hand over mouth and the nose and the airway restricted. Towel held over the mouth only. Dry towel held over the nose and mouth. Wet towel held over the nose and mouth.

HOMAR (Airway Restricted)

The Advantage behind Airway Restriction is that the child will be quiet so as to breathe and the screaming will decrease so that the Doctor can proceed. Together with Hand Over Mouth, Nostrils are pinched for 15 seconds. Belanger,(1993) believed that Airway Restriction was the critical element and it should be avoided.