behavioural science in pediatric dentistry

1. BEHAVIOURAL SCIENCE

2. DEFINITIONS
BEHAVIOUR:
It is defined as any change observed in the functioning of an organism
BEHAVIOURAL SCIENCE
It is the science, which deals with the observation of behavioral habits of man and lower
animals in various physical and social environments, including behavior pedodontics,
psychology, sociology and animal anthropology.
BEHAVIOURAL PEDODONTICS
It is a study of science, which helps to understand development of fear, anxiety and anger
as it applies to child in the dental situations.

3. CLASSIFICATIONS
Wilson (1933)
Lampshire
(1970)
Frankel (1962) Wright (1975)
Garcia-Godoy
(1986)

4. Wilson’s classification
Normal or bold
Tasteful or timid
Hysterical or rebellious
Nervous or fearful

5. FRANKEL’S CLASSIFICATION
RATING BEHAVIOUR WRIGHGT’S SYMBOLIC
REPRESENTATION
Definitely negative Refuses treatment, cries forcefully, extremely
negative behavior associated with fear
--
Negative Reluctant to accept treatment and displays evidence
of slight negativism, uncooperative behaviour
-
Positive Accepts treatment although cautious and willing to
comply with the dentist’s instructions with some
reservation
+
Definitely positive Unique behavior, having good rapport with the
dentist, looks forward to dental procedures and
understands the importance of good preventive care
++

6. LAMPSHIRE’S CLASSIFICATION
Co-operative
Tense co-operative
Outwardly apprehensive
Fearful
Stubborn/defiant
Hypermotive
Handicapped
Emotionally immature

7. WRIGHT’S CLASSIFICATION
Co-operative
Lacking co-operative ability (0-3 years)
Potentially co-operative
• Uncontrolled/hysterical/incorrigible
• Defiant/obstinate
• Tense co-operative
• Timid behavior/shy
• Whining

8. GARCIA-GODOY CLASSIFICATION
Fearful
Timid
Spoiled
Aggressive
Adopted
Handicapped
Co-operative

9. FACTORS AFFECTING A CHILD’S BEHAVIOUR IN
THE DENTAL OFFICE
Under the control of the
dentist
Out of control of the dentist
Under the control of the
parents
• Dental office
environment
• Dentist’s activities
and attitude
• Dentist’s attire
• Presence or absence
of parents
• Presence of an older
sibling
• Growth and
development
• Nutritional factors
• Past dental experiences
• Genetics
• School environment
• Socio-economic status
• Home environment
• Family development
and peer influence
• Maternal behaviour

10. UNDER THE CONTROL
OF DENTIST

11. DENTAL CLINIC
• Should be warm and simulate a homely
environment
• The operating environment should be made
colourful
• Separate exit and entry
• Dental auxillary should be kind and greet
the children with a smile
• Appointment should be short
• Preparation before the appointment

12. EFFECT OF DENTIST’S ACTIVITY AND
ATTITUDES
• Data gathering and observation
• Structuring
• Externaliization
• Empathy and support
• Flexible authority
• Education and training

13. EFFCET OF THE DENTIST’S ATTIRE
Based on previously experienced stressful situations with his physician

14. PRSENCE OR ABSENCE OF PARENTS IN
THE OPERATORY
• Separation anxiety
• Older children may not require mother’s
presence as they would have achieved
emotional independence

15. PRESENCE OF AN OLDER SIBLING
• Little effect on children below 3 years od age
• Most noticeable at 4 years and slightly above.

16. NOT UNDER THE CONTROL OF
THE DENTIST

17. GROWTH AND DEVELOPMENT
• Deficiency in physical growth
• Mental retardation
• Very young children may respond differently

18. NUTRITIONAL FACTORS
• Increased sugar intake can cause irritable behavior
• Hypoglycemia can cause criminal behavior
• Skipping breakfast leads to impaired performance

19. PAST MEDICALAND DENTAL
EXPERIENCES

20. GENETICS
• Plays an important role in psychological development
• It can be modified by the environment

21. SCHOOL ENVIRONMENT
• 50% of the child’s development is
affected by school
• Teachers and peers influence the
behavior of younger children
• Seniors become role models to juniors

22. SOCIO-ECONOMIC STATUS

23. THANK YOU

24. UNDER THE CONTROL OF THE
PARENTS

25. HOME ENVIRONMENT
• Home is the first school where a child learns
how to behave
• Post-natal behavior of the child depends on the
pre-natal emotional status of the mother

26. FAMILY DEVELOPMENT AND PEER
INFLUENCE
• Position of the child in the family
• Over-indulgence by the parents
• Disharmony in the family
• Sibling relationships

27. MATERNALANXIETY AND BEHAVIOUR
• Can have an influence on the child’s mental,
physical and emotional development that
begins even after birth
• Somatic development of the fetus depends on
the nutritional status of the mother
• Substance abuse during pregnancy can have
detrimental effects on the child
• An anxious mother is more likely to have a
child who is uncooperative for dental
treatment.

28. EFFECT OF PARENTING STYLES ON
CHILDREN’S BEHAVIOUR

29. • Parenting refers to the emotional climate in which parents raise their children
• It is dependent on parental responsiveness and demandingness
Baumrind’s Parental Matrix (1978)
Maccoby and Martin
(1983)

30. • Children follow the rules and
dentist’s instructions
• Parents are supportive of the
guidelines

31. • Parents may not respond much
to the choices offered by the
dentist
• They would often leave the
choice to their children

32. HELICOPTER PARENTING
A parent is over-protective, with excessive interest in the lives of their child, hovering
around the child all the time to rescue them from the consequences of poor decisons

33. Cultural differences in parenting

34. BEHAVIOUR MANAGEMENT(WRIGHT 1975)
It is defined as the means by which the dental health
team effectively and efficiently performs dental
treatment and thereby instills a positive dental
attitude.

35. 1)COMMUNICATION
2)BEHAVIOUR SHAPING
-DESENSITIZATION
-MODELLING
-CONTINGENCY MANAGEMENT
3)BEHAVIOR MANAGEMENT
-AUDIO ANALGESIA
-BIOFEEDBACK
NON-PHARMACOLOGICAL METHODS
OF BEHAVIOUR MANAGEMENT

36. -VOICE CONTROL
-HYPNOSIS
-HOMAR
-COPING
-RELAXATION
-AVERSIVE CONDITIONING

37. the means by which the dentist gets his point across
making himself understood by use of words or
expressions.
COMMUNICATION

38. TYPES OF
COMMUNICATION
verbal communication(speech)
non-verbal communication

39. FUNDAMENTALS OF
COMMUNICATION
• Positive approach
• Team attitude
• Organization
• Truthfulness
• Tolerance
• flexibility

40. Communication should be
comfortable and relaxed sitting and
speaking at the eye level allows a
friendlier atmosphere.address him
by his name compliment him about
his appearance.Ask questions about
his class his likes/dislikes.
HOW TO COMMUNICATE??

43. Use of euphemisms-euphemism are substitute
words which can be used in presence of
children
• Anesthetic solution is referred as water to put teeth to
sleep
• Rubberdam as rain coat
Radiograph as tooth picture

45. REFRAMING
• It is defined as taking a situation outside the frame that up to that
moment contained the individual in different conditions, and
visualize it in a way acceptable to the person involved so that
both the original threat and the threatened situation can be safely
abandoned. – Benjamin Peter, 1999
• A friendly atmosphere relaxes the patient; the child can be made
comfortable with the environment.

46. THANK YOU

47. DEFINITION:is the procedure which slowly develops behaviour by
reinforcing a successive approximation of desired beaviour untill the
desired behaviour comes into being.
BEHAVIOUR SHAPING
state the general goal or task to the child at the outset.
explain the necessity for the procedure.
divide explanation for the procedure.
give all explanation at child’s level of
understanding. Use euphemisms.
OUTLINE OF BEHAVIOUR SHAPING

48. it is defined as an attempt to alter human behavior and emotion in a
beneficial way and in accordance with the laws of learning.
DESENSITIZATION(tell-show-do)technique (Addleslon 1959)
Tell and show every step and instruments and explain what is
going to be done.
Continuosly and in grades from the level fear promoting objects or
procedure move to higher grades to more fearfull objects.
BEHAVIOUR MODIFICATION

49. TELL-SHOW-DO

50. TSD TECHNIQUE IS APPLIED AS FOLLOWS:
• The dentist uses the language that child can understand and tells
the patient what is to be done.
• the dentist demonstrates the procedure to the child using
model or himself.
• dentist proceeds to do the dental procedure exactly as
described.

51. INDICATION-
1)first visit
2)subsequent visits when introducing new dental
procedure
3)fearful child
4)apprehensive child because of information received
from peers/parents

52. MODELING
• By Bandura in 1960
• Developed from the social learning principle
• It involves allowing the patient to observe
one or more individuals who demonstrate a
positive behavior in a particular situation.

53. Live models
Filmed model
Audio-visual aids
posters

54. CONTINGENCY MANAGEMENT
It is done by presentation or withdrawal of reinforcers.
Types:
• Positive reinforcer (Henry W Fields, 1984)
• Negative reinforcer (stokes and Kennedy, 1980)

55. Social reinforcement Activity
reinforcement
Material reinforcement

56. BEHAVIOUR MANAGEMENT

57. DISTRACTION
It is a technique that is used to divert the patient’s attention from what may be perceived
as an unpleasant procedure to decrease negative perceptions of treatment and negative
behavior.

58. BIOFEEDBACK
• By Buonomo in 1979
• Use of instruments to detect certain physiological processes associated with fear.

59. HUMOR
• Helps to elevate the child’s moods
• Laughter is a psychophysiological response to humor
that involves both characteristic physiological
reactions and positive psychological shifts.
• Functions of humor:
 Social
 Emotional
 Informative
 Motivational
 cognitive

60. COPING
• Given by Lazaue in 1980
• It is defined as the cognitive and behavioral efforts
made by an individual to master, tolerate or reduce
stressful situations.
• Types:
 Behavioral
 Cognitive
Temporary escape/changing control (Musslemann 1991)

61. VOICE CONTROL
• It is the modification of volume, tone and pace of
one’s own voice in an attempt to dominate the
interaction between the dentist and the patient.
• Used to avert negative or avoidance behavior
• Change in tone from gentle to firm is effective in
gaining child’s attention
• Used to remind the child that the adult is in control
• Used in conjunction with some form of physical
restraints and hand -over- mouth technique.

62. RELAXATION
This technique is used to reduce stress and is based on the principle of elimination of
anxiety.

63. HYPNOSIS
• It is an altered state of consciousness characterized by a heightened suggestibility
to produce desirable behavioral and physiological changes
• It reduces pain and anxiety

64. IMPLOSION THERAPY
Sudden flooding with a barrage of stimuli, which have affected him adversely and the
child has no other choice, but to face the stimuli until the negative response disappears.

65. AVERSIVE CONDITIONING
• Indicated in a child who displays a negative behavior and does not respond to
moderate behavior modification techniques.
• Two common techniques are:
 HOME
 Physical restraints

66. HOME
Given by Evangeline Jordan in 1920.
Indications:
• A healthy child who can understand, but exhibits hysterical behavior during
treatment.
• 3-6 years old
• A child who is capable of following verbal commands
• Children displaying uncontrolled behavior.
Contraindications:
• Child under 3 years of age
• Handicapped or emotionally immature child

67. Factors to be considered while using
HOME:
• Should not be used as a routine
procedure
• Inform the parents about this option
• Obtain consent
• Treating doctor should be aware of
changing laws.
• The whole procedure should not last for
more than 20-30 seconds.
Fig. A case by filed against Dr.
Howard Schneider

68. 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

69. PHYSICAL RESTRAINTS
• Restraint is the act of physically limiting the movements of a child to facilitate dental
procedures and decrease possible injuries to the child or dentist.
• Types of restraints:
 Active
 passive

71. RECENT BEHAVIOUR
MANAGEMENT TECHNIQUES
TELL-PLAY-DO
• Modified by Vishwakarma AP in 2017.
• Indicated for children between 5-7 years.
• As per the social learning theory by Bandura.
• Allows the child to play with the dental equipment.
MOBILE DENTAL APP
• VH Patil in 2017.
• The patient is virtually made dentist and carries out the dental
procedures on mobile applications.

72. VIRTUAL REALITY BASED DISTRACTION
• A computer based software that can be used to immerse children in the virtual
environment which completely obstructs the present situation.
• The VR equipment contains head mounted display and a tracking device. The head
mounted device contains the display screen which provides the view of virtual reality
environment in a 360 degree view.
• The tracking device monitors the head movements.
• The equipment provide an attachment for mouse, joystick or data glove for playing
games.
Contraindications
• Medically compromised children especially children with epilepsy, migraine and
vestibular disturbances
• Children with previous history of nausea or dizziness following the use of VR
device

73. THANK YOU