Art and science of behavior

managment
Pediatric dentistry is an age defined
speciality and is an age defined speciality
and is distinguished by the art of
behavior guidance.

Behavior guidance is essential to deliver

quality dental care while building a
trusting and positive relationship.
Thruogh the years the terminology of
Behavior Management which means
“dealing with child” is changed to be
Behaivor Guidance which means
“building a relationship with the child” is
more preferred.
Behavior Guidance according to
(AAPD) is:
“the process by which practitionar helps patients identify appropriate and in
appropriate behavior , learning problem solving, strategies and develop impulse
”.control , self esteem
GOAL of behavior guidance is delivery
of quality , safe dental care in an
environment that is as pleasant as
.possible

B.G like all other aspects of dentistry,

is a skill that require practice and
.efforts to improve
Factors influencing child
behavior
Demographics
Demographics
ve more in young-
ve as child grows older+
ve in females more than males-
Environment
Environment
depend on socioeconomic status and household
characteristics
Status
Pressure + stress
Negative behavior
Dental fear
Dental fear
Its etiology is multifactorial and its product
of previous experience ,generilized fear
.and familial anxiety

exhibit fear 9-20%

Pain
Child in pain will always show negative
behavior
Parental anxiety
Dental anxiety of children is influenced
by their family especially from from
the mother
How to set successful Behavior
guidance
Dental office .1
.Décor should be child friendly
Scheduling .2
Early visits is preferred to avoid
tiredness and stress and negative
behavior
The dentist and his team .3 •
 The dentist and his team .3
Their ability to communicate with child

: Dentist should be
Emotive , energic

For kids personality who need to be felt special

 Quite ,gentle

For quite silent children

Overall the dentist should be kind ,friendly*

neat and positive
Patient assessment .4
:Ask the parents

how the child cope usually with medical visits*

how they feel the child will cooperate today*

Parents in the operatory .5

Studies show that parents is better to

stay in the operatory so the dentist can
inform them if any change occur in the
treatment plan
:BUT they should
a/ be a silent observer so the child focus on the
.dentist voice
b/avoid reassure the child since this may distress
the child
c/sibling should avoid watching during invasive
.dental procedure
Technique of B.G
 Tell-show-do

Explain the procedure

Show example
Do the procedure
Tell-show-do
Positive reinforcement
Reward the child cooperation with compliment,
.or prize

Voice control
Change in tone and volume attract child
attention
 Mouth prop
It’s a device is placed in the child mouth to
.prevent closure of teeth on the equipment
Hand or head holding
It done by adult to avoid child movement to
ensure safety

Oral sedation and G.A

Require parents approval
Nitrous oxide sedation
It’s a medication breathed through nose mask to
relax a nervous child and enable him/her to
. better tolerate dental treatment
 Management sequence
• Smile to the child
• Be welcoming
• Call them by their own name
• Put them in the center of attention
• Avoid the word “hurt” , “sharp”,
“needle”, “syringe”.
• Avoid crowding around the child (one
parent is enough)
Smily and welcomig
Fear of unknown
Dentist appearance
Avoid verbal reassurance like:
• This will not hurt
• There is nothing to worry about
 childrenese
• The dentist should develop a special
language to communicate with the child
in non threatening manner.
• Examples
L.A = put the tooth to sleep
Turbine = whizzy brush
Fissure sealant = tooth paint
Suction = hoover
 Empathy is the key
• Studies shows that the most effective
action a dentist can show to gain
child cooperation is EMPATHY
• It can be demonstrated by:
Why are you afraid?
Are you ok?
Do you feel fine?
Behavior guidance for different
age groups
Infants and toddler (less than30 month)
 Infants and toddler

Let them see and touch

Knee to knee position
Avoid caries removal because poor behavior at
this age
Use mostly fluoride
Pre schooler child(3-5)
 Pre schooler child(3-5)
Avoid moving the chair back because
the child maybe startled
Short,efficient visits
Encourage the child to assist you as
holding mirror or sucker can bring
+ve behavior and cooperation
School age child
 School age child
Listening to child.
Self disclosing assertiveness
(example: I cannot see your teeth
when your mouth is closed)
Give praise and compliment
Child with previous negative
dental experience
 Child with previous negative dental
experience
 Avoid hearing the child to prevent reviving past
memories.
 Prevent the parents from reminding the child of
the past experience.
 Make introducary visit without doing any
procedure just to show the child that you will do
something new and not harmful for him.
 Use nitrous oxide if necessary.
Child with special needs
 Child with special needs
Medical history is very important.
Interview with the caretaker is the
best way to predict cooperation.
If possible the child should be asked
about any concern.
Communicate with child at level
appropriate for his/her cognitive
level.
Reference
Pediatric dentistry (6th edition)
by Arthur J. Nowak

Child taming (1st edition)

By Barbara L Chadwick
Marie Therese Hosey