Behaviour modification techniques aim to reduce dental anxiety in children. Dessensitization involves gradually exposing children to stimuli related to dental treatment, from telling to showing to doing. Modelling allows children to observe appropriate behaviours. Contingency management uses reinforcement to modify behaviour by presenting or withdrawing rewards. Aversive conditioning techniques like voice control, hand-over-mouth exercises, and physical restraint are used as a last resort to manage disruptive behaviour and allow treatment.

1. 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

2. MOLD
 MOLD STYLE

3. ⦿“The patient needs to wear the functional
appliance for a brief time only during day-time
to influence the muscles in such a way that
the neuromuscular masticatory pattern is
improved” (Sander, 2001).
⦿Furthermore, “three hours of continuous
stimulation is enough to move the tooth in the
periodontium and to produce alveolar bone
remodeling” (Roberts, 1997).

4. • Exercising jaw muscles
• Encouraging correct chewing
• Training correct nasal breathing
• Correcting tongue position
• Good replacement of pacifier / dummy

5. ⦿ Introduced in 1992 (most successful product of MRC)
⦿Tooth channels and labial bows guide the
erupting/developing dentition into correct alignment,
while the tongue tag and lip bumpers treat
myofunctional habits.
⦿Starting is a soft (Silicone) Phase 1 appliance

6. ⦿THIS IS MUCH STIFFER FINISHING OR PHASE 2 IS HARDER
(POLYURETHANE).(SAME PRINCIPLE AS ORTHODONTIC
ARCHWIRE). AS THE TEETH COME INTO PLACE, MORE
FORCE CAN BE USED TO ENCOURAGE THEIR ALIGNMENT.
⦿ The myofunctional characteristics are the same as the T4K
Phase 1.
⦿ Use the finishing T4K Phase 2 for a further 6 to 12 months.
⦿ NOTE : Use beyond this period is recommended depending on the outcome
and the next phase of orthodontic treatment.

9. BEHAVIOUR MODIFICATION
 It involves three techniques:
 DESENSITIZATION
 MODELLING
 CONTINGENCY MANAGEMENT

10. 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

11. 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

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13. 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

14. 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

15. BEHAVIOUR MODIFICATION
MODELLING:
 It is effective when :
 Observer is aroused
 Model has higher status and prestige
 Associated with positive consequences

16. 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

17. 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

18. 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.

19.  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

20.  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

21.  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

22.  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

23.  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

24.  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

25. 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

26. 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

27.  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

28.  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

29. 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

30.  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

31.  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.  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

33.  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

34.  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

35.  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