Expanding child behavior management technology in pediatric dentistry: a behavioral science perspective.

Resident: Adam J. Bottrill
Date: 11SEP09 Region: Providence
Article title: Expanding child behavior management technology in pediatric dentistry: a behavioral science perspective.
Author(s): Kuhn, Brett
Journal: Pediatric Dentistry
Volume #; Number; Page #s: Volume 16 pp: 13-17
Year: 1994
Major topic: Behavior management
Minor topic(s): Technology
Type of Article: Discussion

Main Purpose: Discuss issues relevant to incorporating new behavior management technology into the dental school curriculum and disseminating it to practicing dentists.
Overview of method of research: Discussion
Findings: More research needed.

Key points in the article discussion:
A. General: Behavior management is as fundamental to the successful treatment of children as are hand piece skills and knowledge of dental materials.
1. Disruptive behavior leads to increased delivery time, risk of injury to the child.
2. AAPD’s 10 endorsed behavior management methods in 1991:
a. voice control
b. TSD
c. positive reinforcement
d. distraction
e. nonverbal communication
f. hand-over-mouth
g. phsycal restraint
h. conscious sedation
i. nitrous oxide
j. GA
3. A lot has changed over the years WRT appropriate behavior management practices.
a. traditional behavioral techniques don’t always work
b. changes in community standards have resulted in objection to HOM, restraints and pharmacological intervention.
c. changes in legal and ethical standards have made some dentists hesitant to use some techniques.
4. The result is a lot more dentists currently open to new, non-invasive behavioral management techniques.
5. The answer may lie in a collaborative effort between dentists and behavioral psychologists.
6. The 3 discussed techniques were chosen based on initial research efficacy with pediatric patients.
a. non-intrusive
b. non-cumbersome
c. conceptually fit well along-side current techniques
B. Contingent Distraction:
1. Diverting a child’s attention and engaging them in alternative activities like watching TV, playing video games or listening to audio tapes (music or stories).
2. Making this distracter’s availability contingent upon cooperative behavior. Immediate termination of distracter at first sign of uncooperative behavior.
3. Initial studies reveal that this may be an effective, yet practical means of reducing problem behavior.
C. Live Modeling:
1. Permitting children to observe other children adaptively undergoing dental treatment is an effective way of preparing them to accept treatment and demonstrate what’s expected of them.
2. Decreases in disruptive behavior can also be produced by simply having a child observed by peers (peer pressure).
3. One other option is to show I video of a cooperative patient.
4. This wil need to be analyzed across a wide range of patient-types… cooperative to uncooperative.
D. Contingent Escape:
1. Instilling a sense of trust and control is important.
2. In the past, the “raised hand” technique could give the child this sense of control.
3. Often, disruptive behavior results in halting of the procedure… which reinforces the behavior.
4. In this procedure, brief periods of “escape” from the ingoing dental treatment are provided contingent upon good behavior. Disruptive behavior delays escape from the treatment.
5. I can actually see this form of contingent reward as a problem… especially if the child simply won’t allow the procedure to proceed.
6. Preliminary studies show great success with this procedure when implemented early and consistently in the treatment.
7. Further research needed to figure out how to train dental students on this method.
E. Conclusions:
1. Collaboration between dental and behavioral scientists has been encouraged by the AAPD and viable alternatives have begun to be developed.
2. More research is needed on all fronts to more firmly establish treatment parameters, curriculum changes etc…
3. It is important to note that these techniques serve to SUPPLIMENT, not replace existing behavioral management techniques.

Assessment of article: Seemed more like loose opinions rather than science. But I’ll let it slide because the topic interests me. "Need more IIIIIINPUT" (Johnny Five style)