The document outlines key behavioral methods for managing dental anxiety in children during their first dental visit, including communication strategies, distraction techniques, positive reinforcement, and modeling behavior. It emphasizes the importance of preparing both the child and parents beforehand to establish good communication, conduct comprehensive histories, and introduce basic treatments. Additionally, the document discusses techniques for managing difficult children, such as physical restraint and the hand-over-mouth technique, while highlighting the need for a supportive and friendly environment.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. College of Dentistry
Pedodontic I
Psychological Management-2-
First Dental Visit
Dr. Hazem El Ajrami

3. • Behavioral methods for removing dental
anxiety:
The use of a particular method depends on the
patient's developmental age and personality.
1. Communication.
2. Tell-Show-Do (TSD).
3. Distraction.
4. Positive reinforcement.
5. Modeling.

4. 1. Communication:
 Physical: by patting the shoulder or striking
the hair.
 Visual: appearing relaxed and friendly.
 Verbal: words must be used at the child's
level of comprehension.

5. • Voice control, tone is very effective in altering
the behavior during communication. Use sudden
firm commands to get the child's attention. Loud
commands help reduce disruptive behavior.

6. 2. Tell-Show-Do (TSD):
It is a series of successive approximation based
on informing then demonstrating and finally
performing part of a procedure. The technique is
used routinely in introducing a child to
prophylaxis, the child is told that the teeth are to
be brushed using a special brush, and show him
how it revolves in the hand piece, and then brush
his teeth. The transition from the brush to bur
will be easier which can be introduced as a
special cleaner. The explanations should not be
detailed, as this would confuse the child and
arouse anxiety.

9. 3. Distraction:
Ignoring undesirable acts and then
directing attention away from a behavior,
thought or feeling to something else.

10. 4. Positive reinforcement:
Reinforcement may be defined as the
strengthening of a pattern of behavior, which
increases the probability of that behavior being
displayed in the future. Reinforce appropriate
behavior. Give immediate verbal approval.
Another form of a reward is a present e.g.
balloons, stickers, or coloring sheets. A present
should be given at the end of the session as a
sign of approval and should not be offered as a
bribe in the hope of encouraging good
behavior.

12. 5. Modeling:
A technique used for the treatment of fears.
Providing an example or demonstration with
the goal to let the child reproduce behavior
exhibited by the model. One of the parents or
another child undergoing dental treatment
would be a good example. The use of
videotapes can also be beneficial.

13. • Management of the difficult child:
Physical restraint:
It is a mean of behavior control to achieve an
adequate level of dental treatment. Parents must
be informed and give consent before using
restraints. Useful for extremely resistant patients
and those who need help controlling their
extremities e.g. patients with neuromuscular
disorders. Restraints, restrict the movement of
the child's head, hands, feet, and body, while the
child is kept in a fully reclined position. Parents
and assistant may be helpful aids.

15. • Types of restraints:
Wrap: a nylon mesh cover wrapped around
the child.
Mouth prop: to control jaw movement.

17. • Hand over mouth technique (exercise):
The purpose of this technique is to gain the
attention of a highly protesting child so that
communication could be established. It is
based on, maladaptive acts (screaming,
kicking) are linked to restraint, and
cooperative behavior is related to removal of
the restriction (hand over the mouth).

19. • Used to restrain a protesting child gently but
firmly by placing hand or towel over the child's
mouth to subdue protest and noise for few
seconds. Then speaking quietly but clearly into
the child's ear explaining that the hand will be
removed as soon as the crying stops. Restricted
only for a defiant child not recommended for
children under three years old or handicapped
children.

20. First Dental Visit
• The first appointment should be considered a
mutual assessment session. Preparation of the
child and the parents before the first visit will
result in a better behavior pattern in the dental
office.

21. • Preparation of the child (pre-appointment
experience):
The parents must be instructed to:
Inform the child about the dental visit casually.
Avoid conversation including unfavorable
references to dentistry.
Tell the child that the dentist will count your
teeth and look after them.
Inform the dentist about the child's first name,
nick name, name of the child's pets, toys,
friends and the child's interests and hobbies.

22. • Aim of the first visit:
1. Establish good communication with the
child.
2. Taking full history (social, dental and
medical).
3. Examine the child and take radiographs.
4. Introduce child to simple treatment.
5. Explain treatment aims to child and parent.

23. 1. Communication with the child:
 Objective: to allay anxiety.
 It starts with the receptionist (or assistant) who
must give a good impression about the clinic.
The assistant must be nicely dressed, smiling
and kindly guide the child to the waiting room.
 The waiting room must be attractive and
comfortable for both children and parents.
 The dentist must communicate with the child
visually: appear relaxed and friendly, and
physically: by patting the child kindly.

25. 2. History:
The history must be kept updated in recall
visits (4-6 months). It comprises the following
items:
 Personal (Social) history: name, date of birth,
address, school, brothers and sisters, pets,
hobbies, mother's occupation, father's
occupation.

26. Dental history: past dental history (type of any
previous treatment, regularity of visits, changing
dentist) all this gives an impression about the
attitudes of child and parents towards dental
treatment. Ask the child about his chief complaint
using simple words with no reference to pain.
Medical history: systemic diseases, mental
problems, any previous operations or serious
illness, also family history of serious illness.

27. 3. Examination:
 Approach: Start by asking the Child: How many
teeth do you have? Then: Let's count your teeth!
 Children less than five years or those who refuse
to sit on the dental chair can be examined on
their mother's lap. The dentist can then count the
teeth loudly and start examination using a
mirror. If the reason of the visit is just check up
and the child is uncooperative it is better to
postpone the examination.

28. A. Clinical examination:
I. Extra-oral examination:
What to be examined?
 The general appearance of the child,
weight, height, gait.
 The texture of the skin, lips, eyes.
 Check the lymph glands and facial
asymmetry.

29. II. Intra-oral examination:
This includes soft tissue examination
and hard tissue examination.
 Soft tissues: cheek, tongue, hard and soft
palate, gingiva.
 Hard tissue: teeth present, color, structure,
oral cleanliness, occlusion, presence of
spacing or crowding.

30. B. Radiographic examination:
The value of radiographs is to:
 Diagnose caries in areas inaccessible to
clinical examination.
 Detect abnormalities in developing
dentition.
 Investigate specific problems e.g. periapical
lesions.

31. C. Diagnosis:
Diagnosis is the statement of any
disease affecting patient's oral health, or any
abnormality affecting dental development; it
can be made after clinical and radiographic
examination.

32. 4. Introductory treatment:
Ideally, no treatment should be given in the
first dental visit, except when there is an
emergency to relieve pain.
In case of highly cooperative children the
following can be performed:
A. Prophylaxis of anterior teeth only.
B. Topical fluoride application.
C. Simple operative treatment.

33. 5. Explain aims of the treatment:
 Concluding the session explain aims of the
treatment to the parents.
 Emphasize on the need for preventive as
well as operative methods.
 Request the child's toothbrush on the
second appointment.
 Give an estimate of the munber of visits
required to complete treatment.

34. • Time and length of the appointment:
The dental appointment must be set early in
the morning or after the child's naptime. The
length should be about 15-20 minutes.
• Recall visits:
Usually they proceed smoothly if the child is
properly managed in the first visit.

35. Thank You