3. COMMUNICATION
Universally applicable tool
It is the basis for establishing a strong
relationship with the child patient.
Helps in completion of dental procedures and
development of a positive attitude in children.
Should be initiated at the time of entry of the
child into dental office and continued through the
entire treatment time.
4. COMMUNICATION
TYPES:
Verbal- by speech
Non-verbal- in the form of body language,
eye contact, smile, expressions,
Touching, patting etc
Both verbal and non-verbal
5. COMMUNICATION
Words chosen should be pleasant and
expressing concern
Patient should be addressed by his name
Use of euphemisms -euphemisms is substitute
words which can be used in presence of
children. Eg: raincoat for rubberdam.
6. DEFINITION:
BEHAVIOR MODIFICATION IS DEFINED AS
” THE ATTEMPT TO ALTER HUMAN BEHAVIOR &
EMOTION IN A BENEFICIAL MANNER ACCORDING
TO THE LAWS OF MODERN LEARNING THEORY”
BEHAVIOUR MODIFICATION
7. BEHAVIOUR MODIFICATION
It involves use of reinforcers that on being
learned change child’s behavior to an
appropriate form.
Based on stimulus-response theory.
It is a step by step technique to make the
child involved in dental therapy
8. BEHAVIOUR MODIFICATION
It involves three techniques:
DESENSITIZATION
MODELLING
CONTINGENCY MANAGEMENT
9. BEHAVIOUR MODIFICATION
DESENSITIZATION
The concept comes from “systemic
desensitization” used to reduce anxiety in
patients by behavior therapists.
Patient learns to replace anxiety by relaxation
10. BEHAVIOUR MODIFICATION
DESENSITIZATION
Joseph Wolpe has suggested that in place of
imaginery scenes, real life contacts can be effective
in a dental situation.
The method employed is called TELL-SHOW-DO
Introduced by Addelston
Involves telling, showing of stimuli in increasing order
of fear, followed by doing the procedures.
Language chosen should be simple
The situation is presented to the child slowly and
repeatedly
11. BEHAVIOUR MODIFICATION
DESENSITIZATION
Indications:
i. Initial visit
ii. Subsequent visits for every new interaction of the child
iii. Apprehensive child due to previous information .
Effective in children above 3 yrs of age
Begins from initial entry till completion of the procedure
The heirarchy of events may be decided by the dentist
for the individual patient
12. BEHAVIOUR MODIFICATION
MODELLING:
The basic procedure involves allowing the
patient to observe one or more individuals who
demonstrate appropriate behaviors in a
particular situation
The model may be real or symbolic(posters)
Was introduced by BANDURA
13. BEHAVIOUR MODIFICATION
MODELLING:
Steps-
Gain attention of the patient
Desired behavior is modeled
Physical guidance may be needed
Reinforcement of guided behavior
Reinforcements for appropriate behaviors without
modelling
14. BEHAVIOUR MODIFICATION
MODELLING:
It is effective when :
Observer is aroused
Model has higher status and prestige
Associated with positive consequences
15. BEHAVIOUR MODIFICATION
CONTINGENCY MANAGEMENT
It is a method of modifying the behavior of
children by presentation or withdrawal of
reinforcers
Reinforcers by definition increase the
frequency of a behavior
Types of reinforcers:
Positive: presentation of which increases
behavior
Negative: withdrawal of which increases
behavior
16. BEHAVIOUR MODIFICATION
CONTINGENCY MANAGEMENT
Can also be classified as
Social reinforcers-praise, facial expressions,
physical contact
Material reinforcers- toys, games. Sweets
should not be given.
Activity reinforcers- seeing a movie, watching
tv,outdoor games,etc
17. PREAPPOINTMENT PREPARATION
It involves preparing the child as well as
the parents for the forthcoming dental
visit.
This can be done by:
Messages in the form of letters or emails
by showing videotapes, audiovisual aids
and live models.
18. Also called as WHITE NOISE
Involves providing a sound stimulus of
such intensity that the patient finds it
difficult to attend to anything else.
BEHAVIOUR MANAGEMENT
AUDIOANALGESIA
19. Also called as “suggestion therapy”
Technique of producing altered state of
consciousness without the use of
pharmacological agents.
Very rarely used in dentistry.
BEHAVIOUR MANAGEMENT
HYPNOSIS
20. Children respond to stressful situations by coping.
It includes an individual’s internal and emotional
processes and his external behavioral responses.
The way the patient copes with his fears
determines the type of patient he is.
BEHAVIOUR MANAGEMENT
COPING
21. Mechanisms:
By thinking of something else- “Distraction”
Verbalizing fears to others
Preferring to be with others, say, mother- this is
called “employing affiliative behavior”
“Mental rehearsal”- going over in one’s mind in
advance the sequence of anticipated events and
reappraising the threats involved.
BEHAVIOUR MANAGEMENT
COPING
22. It involves a series of basic exercises which the
patient practices at home and may require
several weeks to months to learn.
Therefore seldom used by clinicians.
BEHAVIOUR MANAGEMENT
RELAXATION
23. Aversive conditioning
Aversive conditioning is the extension of overall
behaviour guidance designed to facilitate the
goals of communication, cooperation & delivery
of quality oral health care in difficult children.
It includes three practices:
1. Voice control
2. Hand-over-mouth exercise (HOME)
3. Physical restraint/Treatment immobilization
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING
24. BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING
1. Voice control
Voice control is a controlled alteration of voice,volume,
tone,or pace to influence & direct the patients behaviour .
Parents unfamiliar with this technique may benefit from a
prior explanation to prevent misunderstanding
OBJECTIVES:
I. To gain patient’s attention & compliance.
II. To avert negative or avoidance behaviour.
III. To establish authority
Voice control
25. 2. Hand-over-mouth exercise (HOME)
popularized by : EVANGELINE JORDAN
OBJECTIVES:
To redirect child's attention enabling communication
To extinguish excessive avoidance behavior
To reduce the need for sedation or G.A .
INDICATIONS:
For uncooperative child
A healthy child who is able to understand verbal
commands & cooperate , but exhibits negative behaviour
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING Hand over mouth exercise
26. CONTRAINDICATIONS:
Child under 3 yrs of age
Special child (physically, emotionally & mentally
compromised)
Child with airway obstruction or mouth
breather.
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING Hand over mouth exercise
27. MODIFICATIONS:
HOM with airway unrestricted
HOM with airway restricted (HOMAR)
Towel held over nose & mouth
Dry towel held over nose & mouth
Wet towel held over nose & mouth
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING Hand over mouth exercise
28. 3. Physical restraint/Treatment immobilization
It is the direct application of physical force to a
patient with or without the patient’s permission to
restrict his or her freedom of movement.
It may be:
Active: Performed with restraining
device
Passive: Performed without
restraining device
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING Physical restraint
29. OBJECTIVES:
To eliminate unwanted movement.
To protect patient, staff or dentist from injury
To facilitate quality dental treatment.
INDICATIONS:
A patient who requires immediate diagnosis treatment
& can’t cooperate
When the safety is at risk
Child who is becoming tired from long appointments
A sedated pt who requires limited stabilization
Stubborn child
Physical restraint
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING
30. PRECAUTIONS:
Tightness & duration of the stabilization must
be monitored
The stabilization must not restrict circulation
Stabilization should be terminated as soon as
possible in a patient who is experiencing severe
stress
Physical restraint
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING
32. FOR HEAD:
Head positioner
Forearm body support
Extra assistant
FOR MOUTH:
Mouth blocks
Banded tongue blades
Mouth props
Finger guard or interocclusal thimble
Physical restraint
BEHAVIOUR MANAGEMENT
AVERSIVE CONDITIONING
33. Implosion Therapy
Child patient is flooded with so many stimuli that
he has no other option than to face it, until the
negative behavior disappears.
It may include HOME, voice control, physical
restraints.
BEHAVIOUR MANAGEMENT
Implosion Therapy
34. Retraining
employed in case of children presenting negative
behavior, with bad experience in previous dental visits,
or improper peer or parental orientation.
The child presents such behavior due to STIMULUS
GENERALISATION, where similarities in stimuli
generate similar responses.
In retraining, we make the child DISCRIMINATE
between old and new stimuli,
The older response gradually diminishes - this is known
as RESPONSE EXTINCTION.
BEHAVIOUR MANAGEMENT
Retraining
