This document discusses various non-pharmacological behavior management techniques used for pediatric dental patients. It covers communication strategies, behavior modification techniques like desensitization and modeling, and contingency management using reinforcement. It also discusses aversive conditioning techniques like voice control, the hand-over-mouth exercise, and physical restraint. The goal of these techniques is to establish rapport, modify undesired behaviors, and facilitate dental treatment for children.

2. NON-PHARMACOLOGICAL BEHAVIOUR
MANAGEMENT
 Communication
 Behaviour modification(shaping)
 Pre- appointment behavior modification
 Behaviour management

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

31.  TYPES OF RESTRAINTS:
 FOR BODY:
 Pedi wrap
 Papoose board
 Sheets
 Beanbag with straps
 Towel & tapes
 FOR EXTREMITIES:
 Velcro straps
 Posey straps
 Towel & tapes
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