NON-PHARMACOLOGICAL BEHAVIOR MANAGEMENT

1. BEHAVIOURAL
MANAGEMENT
PRESENTATION BY
-SWALIHA ALTHAF

2. DEFINITION :
- BEHAVIOUR
-BEHAVIOUR MANAGEMENT
-BEHAVIOUR SHAPING
-BEHAVIOUR MODIFICATION

3. CLASSIFICATION
 NON-PHARMACOLOGICAL BEHAVIOUR MANAGEMENT
• COMMUNICATION
• USE OF SECOND LANGUAGE
• TELL-SHOW-DO
• DESENSETIZATION
• MODELING
• BEHAVIOUR SHAPING

4. • CONTINGENCY MANAGEMENT
• EXTERNALIZATION
• DISTRACTION
• ASSIMILATION AND COPING
• PARENTAL PRESENCE ORABSENCE
• RETRAINING
• VISUAL IMAGERY

5. • -FLOODING TECHNIQUE
• -VOICE CONTROL
• -USE OF POETRY ANDDRAWINGS
• -HYPNOSIS
• -HAND OVER MOUTH TECHNIQUE
• -PROTECTIVE STABILIZATION

6. BEHAVIOUR-
BEHAVIOUR is any activity that can be
observed , recorded and measured.
BEHAVIOUR MANAGEMENT-
BEHAVIOUR management is the means
by which dental health team effectively and
efficiently performs treatment for a child and
at the same time instills a positive dental
attitude.(WRIGHT,1975)

7. BEHAVIOUR SHAPING-
It is the procedure , which slowly develops
BEHAVIOUR by reinforcing a successive
approximation of desired BEHAVIOUR until desired
BEHAVIOUR comes into being.
BEHAVIOUR MODIFICATION-
It is definedas the attempt to alter human
BEHAVIOUR and emotion in a beneficial manner
according to laws of modern learning
theory.(EYSENCK,1964)

8. NON-
PHARMACOLOGICAL
(PSYCHOLOGICAL APPROACH)
• -COMMUNICATION
• -USE OF SECOND LANGUAGE
• -TELL-SHOW-DO
• - DESENSITIZATION
• -MODELING
• -BEHAVIOUR SHAPING

9. • CONTINGENCY MANAGEMENT
• -EXTERNALIZATION
• -DISTRACTION
• -ASSIMILATION AND COPING
• -PARENTAL PRESENCE OR ABSENCE
• -RETRANING
• -VISUAL IMAGERY

10. • VOICE CONTROL
• USE OF POETRY AND DRAWINGS
• HYPNOSIS
• HAND OVER MOUTH TECHNIQUE
• PROTECTIVE STABILISATION
-PHARMACOLOGICAL MANAGEMENT
• PRE-MEDICATION
• CONSCIOUS SEDATION
• GENERAL ANESTHESIA

11. COMMUNICATION
• Communicative management is universally used in
pediatric dentistry with both the cooperative and
uncooperative child (chambers,1976)
•By involving in conversation, the dentist not only
learns about the patient but may also relax the
patient

12. Types of communication
1. Verbal communication by speech
2.Nonverbal communication –
Expressions without words like hand shaking ,
eye contact , smiling.
-Both verbal and non verbal

13. • communication should be comfortable and
relaxed.
• Communication with children aged 3 to7 years
should be based on Piagetian
• Concept which involves life like name to dental
instruments like hand piece called whistling
Charlie.
• The most important aspect of communication is
getting the child to respond to dentist’s command.

14. • The three most important facets of communication
are source, medium and receiver . In reference to
dentistry , dentist is the source , dental clinic is the
medium and child is the receiver
• -If the dentist is good , sympathetic , confident and
honest; dental is neat ,quiet , familiar to children
,full of toys; the automatically child is
communicating and is well managed.

16. USE OF SECOND LANGUAGE
(EUPHEMISM)
• Euphemisms are substitute words, which can be
used in the presence of child .
• The dental staff as well as dentist should oriented to
the use of second language .

17. DENTALTERMINOLOGY
Air
Anesthetic
Bur
Impression material
Caries
Matrix
Rubber dam
stainless steel crown
X – ray
Radiograph
Hand piece
WORD SUSTITUTE
• Wind
• Sleepy medicine or sleepy water
• Brush or pencil
• Pudding or mashed potatoes
• Brown spot : sugar bugs
• Fence for filling
• Hat for tooth
• Raincoat
• Camera
• Picture
• Whistling train

18. TELL-SHOW- DO :
The cornerstone of behaviour management was given
by Addleston in 1959.
 Specifically , the dentist tells the child what is
going to be done in words the child can understand
.Second , the dentist demonstrates to child exactly
how the procedure will be conducted . Finally
,practitioner performs the procedure exactly as it
was described and demonstrated
Objectives :
- To teach the patient aspect of dental
visit and to familiarize him with the dental
settings.
- To shape the patients response to various
procedures.

19. TELL:
• Tell the child before you do it, while you are
doing it and after you have done it . You voice
should be soft , yet firm.
• Confident , and continuous .You should be
truthful with the child and if the procedure is
going to be painful or uncomfortable , say so.
SHOW ;
• Demonstration of the visual,auditory,
olfactory and tactile aspect of the procedure in
a carefully defined, nonthreatening setting
• The dentist can either demonstrate on
himself or an inanimate object.

20. • The noise of running hand piece shows the child
through the hearing medium . A pinch on the arm
before anesthesia administration demonstrate to the
child how the pinch of the injection in the mouth might
feel.
• Bring equipment from behind the child or the visual
level is preferred.
DO :
• Without deviating from explanation and
demonstration dentist perform the previewed
operation .
* In doing, do what you said you would do.
* Do not do until the child has clear awareness
of what it is you are going to do.

22. - This technique was demonstrated by James and
popularize by Wolpe.
- It means take away ones sensitivity to a type of
behavior.
-This is used in children having pre-established fears
and uncooperative behavior .
• Desensitization accomplished by teaching
the child a competing response such as relaxation
and then introducing progressively more
threatening stimuli.
Is an effective method for reducing maladaptive
behaviour

23. • Introduced by Bandura ( 1969).
-It is based on one’s learning or behaviour acquisition
occurs through observation of suitable model
performing specific behaviour.
-Synonyms : imitation , observational learning ,
identification, internalization , coping .
-Modeling seems to improve of the apprehensive child
who have had no previous dental experience .
-Types of modeling:
1. Audiovisual
2. Live modeling by parents , sibling etc.

24. OBJECTIVES OF MODELING:
 Stimulates acquisition of new behavior .
 facilitating the behavior already in the patients
in more appropriate manner.
 Elimination of avoidance behaviour .
 Extinction of fear.
ADVANTAGES OF MODELING:
 Patient’s attention is obtained.
 Designed behavior is modeled.
 Physical guidance of the desired behaviour.
 Reinforcement of the desired behaviour

25. MODELING

26. • It is defined as a process which slowly develops a
behavior by reinforcing successive approximation of the
desired behavior
until the desired behavior is expressed(Lenchner and
wright ,1975)
- It is based on stimulus- response theory.
-when shaping the behavior the dentist is teaching to a child
to behave .

28. - The presentation of positive reinforcers or
withdrawal of negative reinforcers is termed
contingency management.
- It include :
- Positive reinforcement
- Negative reinforcement
- Omisssion or time out
- Punishment
a) Positive reinforcement – is one whose
contingent presentation increases the
frequency of behavior ( Henry W Fields ,1984)
a) Negative reinforcement – is one whose
contingent withdrawal increases the
frequency of behavior ( Stokes and
Kenndy,1980).

29. Types of reinforcers
 Social – e.g. , praise , positive facial
expression , physical contact by shaking hand
, hug ,pat on shoulder.
 Material - may be given in the form of games
,toys.
 Activity reinforcers – Involving child in some
activity like watching TV shows , visit to park.

31. • It Is the process by which child’s attention is
focus away from the sensation associated with
dental treatment by involving in verbal or
dental activity.
Objectives:
- To decrease perception of unpleasantness
- to interest and involve children .

32. • The patient is distracted from the sound and/or
sight of dental treatment thus reducing anxiety.
- Objective is to relax the patient and to reduce
anxiety during treatment.
- Use stories and fairy tales.
- Use slow instrumental music .
• - Types of distraction:
a. Audio distraction
b. Audiovisual distraction .

34. - Stress can act to increase pain perception
while coping decrease it by process called
assimilation .
• Coping is defines as the cognitive and behavioral
efforts made by an individual to master, tolerate
or reduce stressful situations (Lazaue ,1980) .
-Coping effect may be of two types :
1.Behavioral –
are physical and verbal activity in which the
child engages to overcome a stressful situation
2.cognitive –
Efforts which involves manipulation of
emotions .

35. OBJECTIVES –
To avert avoidance behavior
• -To establish authority
• -To gain patient’s attention and compliance
Advantages of parental absence
a) Overcoming parental conditioning
b) Avoiding communication interference
c) Avoiding parental interference
• Advantagesof parental presence
a) Supporting and communicating with the
child
b) Very young patients.