4. INTRODUCTION
• Pediatric dentist- avoidance behaviors
• Frustrates ; guilt & anxiety, discomfort
• Management skills refined with time &
dedication
• Ways to manage-”embarrassment of riches” by
Dr. David Chambers in 1977
5. MISBEHAVING CHILD DENTAL PATIENTS
Can‟t or won‟t cope with the stimuli & behavioral
demands of the dental experience
Category I: The emotionally compromised
child
Category II: The shy, introverted child
Category III: The frightened child
Category IV: The child who is aversive to
authority
6. THE FRIGHTENED CHILD
• Formidable challenge to everyone who
encounters – dentist
• Intense, enormous cooperation
• Problem of fear is contended more
7. THE FRIGHTENED CHILD
• Study in the US by Agras et al(1969):
snakes>heights>storms>dental visit
• Fear of needles, handpiece, rubber dam
placement
• Fear of bodily harm
• Fear of the uncertain & strangers- infants &
toddlers
• Fear of separation- 3 year old
8. THE FRIGHTENED CHILD
• Misbehaviour is attributed to fear or other
cause- difficult
• Information, experience & common sense
9. DEFINITION
• Fear is an unpleasant emotion or effect
consisting of psychophysiological changes in
response to realistic threat or danger to one’s
own experience
• Fear & anxiety interchangeably used
• Anxiety is a vague unpleasant feeling
accompanied by a premonition that something
undesirable is going to happen
- Kent
10. CAUSES OF FEAR OF DENTISTRY
Intellectually unable
Not relieved even when educated
Chronologic age <36-40 months
Slow development
11. CAUSES OF FEAR OF DENTISTRY
Emotional upsets in life
Acute chaos at home
Abused children
Grieving close one‟s death
Other health problems
Self limiting
Resolve in time
Rigorous procedures- difficult to endure
12. CAUSES OF FEAR OF DENTISTRY
Acquired fears
„sold‟ to the child by peers, siblings or parents
Subjective Fears
Based on feelings & attitudes that have been
suggested by others
Not experienced personally
13. CAUSES OF FEAR OF DENTISTRY
Learned fears
Previous painful or difficult experience at
physician‟s or dentist‟s office
Objective Fears
Direct physical stimulation
of the sense organs
Not of parental origin
14. CAUSES OF FEAR OF DENTISTRY
Emotionally ill
Undiagnosed
Not noticed by the parents
Broken homes
Daily observing teacher
may notice
15. MANAGEMENT
• Easily identified except the emotionally ill
• Make certain-misbehavior is out of dread of
dentistry
• Parent & dentist obliged to avoid increasing the
anxieties
- postponing dental work
- using drugs
- perform under G/A
16. MANAGEMENT
• The most appropriate measures to be taken
regardless of :
-cost
-inconvenience
-loss of efficiency
17. MANAGEMENT
• Emotional illness:
-Refer to psychiatrist,
psychologist, counselor
-establish whether the child
is emotionally healthy to go
through dental appointment
18. CONCLUSION
• Misbehaving children encountered in pediatric
dental practice on a day to day basis
• A careful and intelligent identification of the
actual cause behind the behavior
• The management techniques to be adopted
• Reveal any unidentified psychological condition
suffered by the child.