Guideline on Behavior Guidance for the Pediatric Dental Patient

Resident: Roberts

Date: 3/24/11

Article: Guideline on Behavior Guidance for the Pediatric Dental Patient

Author: Clinical Affairs Committee - Behavior Mangement Subcommittee

Journal: American Academy of Pediatric Dentistry

Year: 2008 Revision

Behavior guidance is based on scientific principles but requires skills such as communication, empathy, coaching, and listening. It is an art form built upon a foundation of science. The goals of behavior guidance are to establish communication, alleviate fear and anxiety, deliver quality dental care, and build a trusting relationship between dentist and child. All decisions regarding use of behavior guidance techniques must be based upon a benefit vs. risk evaluation.

Various techniques include:

Tell - show - do: This technique involves demonstrations and verbal explanations of the procedure in phrases appropriate to the developmental level of the patient.

Voice control: This involves altering the voice by volume, tone, and pace in order to direct patient behavior.

Nonverbal communication: This is guidance through appropriate contact, posture, facial expression, and body language.

Positive reinforcement: Positive reinforcement is rewarding desired behavior and thus strengthening the recurrence of those behaviors. May include voice modulation, facial expression, verbal praise, appropriate physical contact, tokens and toys.

Distraction: This is the technique of diverting the patients attention away from what may be perceived as an unpleasant procedure. May include, verbal language, contact, inanimate objects such as a t.v.

Parental presence: The presence or absence of the parent sometimes can be used to gain cooperation for treatment

Nitrous oxide: Nitrous Oxide can be used to reduce anxiety and increase effective communication. It is an inhalation anxiolytic/ analgesic agent.

Protective stabilization: can be used for special needs patients or situations where the benefit of completing a procedure outweighs the risk of damage to the developing psyche of the individual. Protective stabilization can decrease risk of injury while allowing safe completion of treatment. It should not be used with patients with a compromised airway or and a practitioner should be cautious when using medications that can cause depressed respirations.

Sedation: can be used on patients who are unable to receive care due to age, mental, physical or medical limitations. Various forms and methods exist depending on desired level of sedation: mild, moderate, deep sedation and General Anesthesia.

Conclusion/Assessment: Without extreme detail this article is a reminder that as pediatric dentist are goals to treat a patient should align with our duty to develop the psyche of the individual so that our patients become conditioned to a positive and appropriate experience. This article briefly outlines the various methods by which we can accomplish this task and was a good review.