behavior management

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ppt on behavior management by Dr Savitha Sathyaprasad

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behavior management

  1. 1. Behaviour management is important because a pediatric dentist is handling a cognitively, physically mentally and emotionally maturing child.
  2. 2. Is it necessary to let patient cry throughout the treatment…?
  3. 3. Or post the patient to general anesthesia….?!!
  4. 4. PEDODONTIC TREATMENT TRAINGLE CHILD DENTIST PARENTS SOCIETY The major difference in treating adults & children is in adults its 1 to 1 relationship. However treating a child is a pedodontic treatment triangle.
  5. 5. <ul><li>Tell the parents not to voice their own personal fears in front of the child. </li></ul><ul><li>Tell the parents never to use dentistry as a threat or punishment. </li></ul><ul><li>Not to Tell Anything About what Dentist Going to Do </li></ul>Parents counseling
  6. 6. CO-OPERATIVE TENSE CO-OPERATIVE OUTWARDLY APPREHENSIVE FEARFUL STUBBORN HYPERMOTIVE EMOTIONALLY IMMATURE HANDICAPPED LAMPSHIRE’S CLASSIFICATION
  7. 7. Under The Control of The Dentist <ul><li>Dental office </li></ul><ul><li>Dentist’s attitude </li></ul><ul><li>Dentist attire </li></ul><ul><li>Presence or absence of parents </li></ul><ul><li>Presence of older sibling </li></ul>FACTORS AFFECTING CHILD’S BEHAVIOR IN DENTAL CLINIC
  8. 8. Effect of Dentist’s Activity & Attitude
  9. 9. a) Data Gathering & Observation 2. JENK’s six categories of activities by a dentist
  10. 10. b) STRUCTURING Objective is to explain the child importance of dental treatment and its purpose in a manner the child understands
  11. 11. TOOTH BRUSHING WASHING THE MOUTH WITH VACCUM AND 3 WAY SYRINGE CLEANING THE TEETH WITH BRUSH IN HAND PIECE DRILLING A VITAL TOOTH WITH AIR TURBINE ANESTHETIC SOLUTION REFERRED AS WATER TO PUT TOOTH TO SLEEP MOTIVATING PATIENT TOWARDS ORAL HEALTH STRUCTURING
  12. 12. c)Externalization Attention, perception, sensation are on the site of injection, eyes closed, mouth open, body rigid and drawn from other stimuli. In such case externalization helps. c) Externalization
  13. 13. Distraction Attention is focused away
  14. 14. Involvement Involve the child so that child’s verbal or motor discharge do not interfere in treatment procedure
  15. 15. d) Dentist Attitude <ul><li>Empathy and support:- it’s the capacity to understand & experience the feelings of another without losing one’s objectivity </li></ul><ul><li>E.g. :- permit the child to express their feeling </li></ul><ul><ul><li>Comforting the child when it is appropriate by touching or reassuring pat </li></ul></ul><ul><ul><li>Providing a structuring situation which child can feel secure </li></ul></ul>
  16. 16. e) Flexible Authority <ul><li>The dentist authority must be tempered with a degree of flexibility or compromise in order to meet the needs of the particular patient or situation </li></ul>
  17. 17. f) Education & Training
  18. 18. 3.EFFECT OF DENTIST’S ATTIRE: <ul><li>--avoidance of the white coat. </li></ul>
  19. 19. <ul><li>Length of Appointment should be short </li></ul><ul><li>Appointment time should be early </li></ul><ul><li>avoid nap time . </li></ul>
  20. 20. Non-Pharmacological Methods <ul><li>Communication </li></ul><ul><li>Behavior Shaping (modification) </li></ul><ul><li>--Desensitization </li></ul><ul><li>--Modelling </li></ul><ul><li>--Contingency management </li></ul><ul><li>Behavior Management </li></ul><ul><li>-- Audio Analgesia </li></ul><ul><li>--Biofeed back </li></ul><ul><li>--Voice Control </li></ul><ul><li>--Hypnosis </li></ul><ul><li>--Humor </li></ul><ul><li>--Coping </li></ul><ul><li>--Relaxation </li></ul><ul><li>--Implosion Therapy </li></ul><ul><li>--Aversive Conditioning </li></ul>
  21. 21. <ul><li>TYPES OF COMMUNICATION </li></ul><ul><li>Verbal Communication </li></ul><ul><li>Non Verbal Communication </li></ul><ul><li>Both </li></ul>Universally used in pediatric dentistry with both co-operative and uncooperative child. Fundamental form of behavior management. 1.Communication by Chambers 1976
  22. 22. <ul><li>What to talk with the patient..? </li></ul><ul><li>Try to call by nick name, Give compliments about </li></ul><ul><li>Using animation Explain about the procedure briefly (tooth sleeping, worms in tooth) </li></ul><ul><li>Keep the patient occupied in your conversation through out the procedure </li></ul>
  23. 23. Systemic Desensitization <ul><li>It involves the step by step elimination of the fear, anxiety </li></ul><ul><li>Most Effective Methods for reducing maladaptive anxiety teaches the patient to substitute an appropriative or adaptive response – relaxation for maladaptive response anxiety its called as reciprocal inhibition its usually done by a behavior therapist </li></ul><ul><ul><li>Tell Show Do is a similar approach where telling, showing, doing is continues from the child entry to clinic where each person, instrument, procedure, is introduced to the patient to orient the child such that he will cope-up with the situation </li></ul></ul>
  24. 24. INDICATIONS : <ul><li>First Visit </li></ul><ul><li>Subsequent visits when introducing new dental procedure </li></ul><ul><li>Fearful Child </li></ul><ul><li>Apprehensive Child because of information received from parents. </li></ul>First visit
  25. 25. Desensitization by JosephWolpe1975 Behavior Shaping (modification)
  26. 26. TELL SHOW DO TECHNIQUE By ADDLESLON 1959
  27. 27. 2 . Modeling by Bandura 1969 <ul><li>Procedure involves allowing a patient to observe one or more individuals (models) who demonstrate a positive behavior in a particular situation. </li></ul><ul><li>Modeling can be done by </li></ul><ul><li>--Live Models </li></ul><ul><li>--Filmed Models </li></ul><ul><li>--Posters </li></ul><ul><li>--Audio-visual aids </li></ul><ul><li>Modeling should </li></ul><ul><li>not be of minor surgery, </li></ul><ul><li>blood </li></ul>
  28. 28. 3. Contingency Management <ul><li>Positive Reinforcer (Henry W Fields 1984) </li></ul>
  29. 29. <ul><li>Negative Re-inforcer by Stokes & Kenndy 1980 is one whose contingent withdrawal increases the frequency of behavior.It is usually the termination of an aversive stimulus.e.g.:withdrawal of the mother S E P (selective elimination of parent) </li></ul>
  30. 30. <ul><li>Audio Analgesia by Gardner, Licklider 1959 : Or `White Noise’ is a method of reducing pain. This technique consists of providing a sound stimulus of such intensity that the patient finds it difficult to attend to anything else . </li></ul>
  31. 31. Biofeed Back by Buonomono 1979 : involves the use of certain instruments to detect certain physiological processes associated with fear. Humor : helps to elevate the mood of the child
  32. 32. COPING by Lazaue 1980
  33. 33. <ul><li>Voice Control : It is modification of the intensity and pitch of one’s own voice in an attempt to dominate the interaction between the child and the dentist.It reminds the child that the dentist is an authority figure to be obeyed </li></ul>
  34. 34. <ul><li>Relaxation : This technique is used to reduce stress and is based on the principle of elimination of anxiety. </li></ul><ul><li>Hypnosis by Romanson 1981 : It is an altered state of consciousness characterized by a heightened suggestibility to produce desirable behavioral and physiological changes. </li></ul><ul><li>Implosion Therapy: Sudden flooding with a barrage of stimuli which have affected him adversely and the child have no other choice but to face the stimuli until a negative response disappears.It mainly comprises of Home,Voice Control and Physical Restraints. </li></ul>
  35. 35. <ul><li>Aversive Conditioning: It is a method of managing extremely negative behavior. </li></ul>
  36. 36. HOME(Hand over mouth exercise) <ul><li>It was introduced by Evangeline Jordan in the year 1920. </li></ul><ul><li>The purpose of the Home technique is to gain the attention of a child so that communication can be achieve . </li></ul><ul><li>INDICATIONS </li></ul>-- 3 TO 6 YRS OLD. --Healthy child who can understand but who exhibits defiance and hysterical behavior during treatment. --A child who can understand simple verbal communication. --Children displaying uncontrollable behavior.
  37. 37. CONTRAINDICATIONS <ul><li>Child under 3 years of age. </li></ul><ul><li>Handicapped/Immature Child. </li></ul><ul><li>Physical, mental and emotionally handicap. </li></ul>.
  38. 38. PHYSICAL RESTRAINTS <ul><li>Last resort for handling uncooperative/handicapped patients </li></ul><ul><li>Restraints are usually needed for children who are hyper motive,stubborn or defiant. </li></ul><ul><li>Physical Restraints involve restriction of movement of the child’s head,hands,feet or body. </li></ul><ul><li>It can be:-- Active :- restraints provided by the dentist,staff or parent without the aid of restraining device. </li></ul><ul><li>-- Passive:- with the aid of restraining device. </li></ul>
  39. 39. Assistance for I mmobilization (Parental aid during an examination)
  40. 40. Physical aids to keep patients mouth (Molt mouth prop)
  41. 41. Mouth props with suction tips
  42. 42. Pappose board in use
  43. 43. Immobilization for control of body & extremities (Patient in a pedi-wrap) Head positioner
  44. 44. Immobilization for the extremities (Posey strap on wrist) Immobilization aids for head stabilization ( Proper positioning of the dentist’s hands, forearm & body) Immobilization for control of body & extremities (Patient lying in a beanbag dental chair insert)
  45. 45. T H A N K Y O U

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