BEHAVIOUR MANAGEMENT: the means by whih the dental health team effectively and

efficiently performs dental treatment and thereby instills a positive dental

attitude.
there are tw approaches to this: 1. non pharmacological
2. pharmacological
BEHAVIOUR SHAPING: it is the procedure which slowly develops behaviour by
reinforcing a successive approximation of the desired behaviour untill the desired
behaviuor comes into being.
BEHAVIOUR MODIFICATION: attepmt to alter the human behaviour and emotion in a
beneficial way and in accordnce with the laws of learning.
NON PHARMACOLOGICAL METHHODS OF BEHAVIOUR MANAGEMENT[2]:
1. COMMUNICATION
it is the means by which the dentist makes himself understood by the use of words
and expressions. this should be established from the first entry of the patient to
the clinic.
it is the basis to establish a relationship with the child which may lead to
succesful completion of dental procedures and help the child develop positive
attitude towards dental care.
TYPES OF COMMUNICATION:
verbal communication - by speach
non-verbal communication(multisensory commincation) by
body language, smiling ,eye contact, expression of feeling without speaking
showing concern, touching the child, patting him and giving him a hug
both using verbal and non verbal communiction
communication should be in a freindly, relaxed and comfortable manner
verbal communication is best for children below age of 3, in a gentle and
empathatic voice. conversation should include child's name, age, class etc. Also,
compliment him about his appearance, asking about his likes and dislikes.
communication should not be confusing, and sitting and speaking at the eye level
creates friendly atmosphere.
EUPHEMISMS [3]: these are the substitute words used by the dentist or the
assistant to make dental procedure more acceptable.
-air/water syringe- squirt gun -anesthetic- sleepy juice
-alloy- silver star -highspeed- water whistle
-flouride- tooth vitamins -sealant- nail paint for tooth
-rubberdam and clamps- rain coat and tooth ring -caries- tooth bug
-radiographic equipment- tooth camera
REFRAMING : defined as taking the situation outside the frame that up to that
moment contained the individual in different conditions and visualise it in a way
acceptable to the person. {benjamin peretz, 1999}

2.BEHAVIOUR SHAPING(MODIFICATION)
involves the use of selective reinforcers, these change a child's behaviour from an
inappropriate to an appropriate form. this is based on "stimulus response" theory.
example: a child with an unpleasant previous dental experience, would associate the
new dental visit with it and his/her response would be fear and crying.
it is a step by step process, during whichthe dentist is teaching the child to
behave and make the child co-operative and communicative to absorb complex
information.
it is important to lead the child slowly through procedure's explanation, making
them at chil's level of understanding nad using appropriate eupheisms
a. Desensitisation
joseph wolpe(1975) used this technique for removing fears and tension in children
with negative behaviour or unpleasant dental experiences.
SYSTEMIC DESENSITISATION[4]: The therapist creates a list of steps arranged as a
hierarchy from the least to the most stressful. The patient while in a state of
deep relaxation exposed one step at a time each step presented repeatedly until
there is no evidence of stress on the patient’s part. Thus the patient is
desensitised to the predominant fear.
 TELL SHOW DO
introduced by Addleslon in 1959 , tell and show every step, instrument and explain
what is going to be done.
has both verbal(tell) and non verbal(show and do) interactions
indicated for first visites, fearful child ,above 3 years of age and on subsequent
visits when new dental procedure is to be introduced.
TELL- in language the child undertands and done slowly and repeatedly
SHOW- demonstration on himself/herself or using a model
DO- procedure done as described

a hand held mirror is recommended, so that the child could see the procedure that's
being done, fpr example placement of the rubber dam could be shown.
[5]modifications are: tell touch do, tell touch smell, show touch do, show touch
smell.

b. modelling
introduced by Bandura in 1969, devdeloped from social learning principle.
patient observes one or more individuals(models) who demostrate a positive
behaviour and the patient will imitate the model's behaviour.
modelling can be done by: live models (parents, sibling or friend)
filmed models
posters
audio-visual aids
c. contingency management
done by either presenting or removing reinforcers.
Reinforcers: these are the sitmuli that increase the likelihood of desired
behaviour during conditioning.
Positive reinforcers: one whose presentation increases the frequency of behaviour
these are 1.Society- praisinf,patting shoulder,shaking hand for good behaviour.
2.Material-toys and games.{should not be used as a bribe}
3.Activity reinforcer-watching favorite cartoon during treatment for
good behaviour but withdrawn when become unco-operative
Negative reinforcers: one whose contingent withdrawl increases the frequency of
behaviour
3. BEHAVIOUR MANAGEMENT/GUIDANCE
a. distarction
to divert patient's attention using verbal distraction, favorite tv
programs,cartoons, magic tricks music and audio visual glasses,smartphones and
tabltes etc. these techniques increase the pain tolerance and reduce discomfort.
AUDIO ANALGESIA- listening to music or white noise.
b. biofeedback
using electroencephalogram and electromyography etc
c. voice control
modification of volume tone and pace of the voice in order to dominate the
interaction between the dentist and the patient. employed with un-cooperative and
unattentive children
used along with some restraints and hand over mouth exercise
d. hypnosis
to alter the state of consciousness and reduce the anxiety and reduce pain
perception. when used in dentistry it's called HYPNODONTICS.
also called, psychosomatic or suggestion therapy.
e.humor
elevate the mood of the child and helps the child relax. it also interests the
patient and urges them to get involved in the procedure.
f.coping
ways by which a child tolerates a stressful situation
two types:
1.behavioural- physical and verbal activities, in whichthe child engages to come
over stressful situation.
2. cognitive- child remains silent and thinks about being calm

TEMPORARY ESCAPE or CHANGING CONTROL:

asking the child to raise the hand ,and giving him some athourity and control to
stop the treatment, called temporary escape.

g.relaxation
technique to reduce stress and removal of anxiety. involves exercises which should
bepreacticed at home too.
h.implosion therapy
a sudden stimuli to the patient that affects him adversely and the child has no
other choice but to face the negative stimuli until their negative response
disappears.
involves: 1.VOICE CONTROL
2.PHYSICAL RESTRAINTS
pedi wrap, papoose board,sheets, bean bag with straps, velcro
straps mouth blocks
3. HOME
hand over mouth exercise
when the patient is not cooperative, hand is gently placed over
the child's mouth and is expected to remain calm and when the patient displays
suitable behaviour, the hand is removed and the child could be given positive
reinforcement.
proper airway should be maintained , should not be used on handicapped or immature
child.
i.aversive conditioning
for children with negative behaviour(--) , this method is safe and effective.
parental consent should be taken prior to it's use
2 common methods are: HOME and physical restraints.

[6]parental attitude and maternal role also affects a child's behaviour, he could
be a pampered child child who'll throw tantrums and could be neglected by his
parents.

REFERENCES
1. Behaviour science and it's application in pediatric dentistry Textbook of
pediatric dentistry, shobha tondon 5th edition [1][2]
2. http//tumblreuphemisms.com/ [3]
3. behaviour management of child in dental office, textbook of public health
dentistry, peter soben, 6th edition[4]