Guideline on Behavior Guidance

by Dr. Nadia Abazarnia

The American Academy of Pediatric Dentistry offers this guideline to educate health care providers, parents, and other interested parties about influences on the behavior of pediatric dental patients.

Basic behavior guidance

Communication and communicative guidance at the beginning of a dental appointment, asking questions and active/reflective listening can help establish rapport and trust. Once a procedure begins, the dentist’s tells the child exactly what is required to be cooperative.

For example, “I need you to open your mouth so I can check your teeth”, “I need you to sit still so we can take an X-ray”

Positive pre-visit imagery

Patients are shown positive photographs or images of dentistry and dental treatment before the dental appointment.

  • provide children and parents with visual information on what to expect during the dental visit, and
  • provide children with context to be able to ask providers relevant questions before dental procedures are initiated.

Direct observation

Patients are shown a video or are permitted to directly observe a young cooperative patient undergoing dental treatment

  •   familiarize the patient with the dental setting and specific steps involved in a dental procedure.
  •   give the patient and parent an opportunity to ask questions about the dental procedure in a safe environment.

Tell-show-do

  • teaches the patient important aspects of the dental visit and familiarizes the patient with the dental setting,
  •   shape the patient’s response to procedures through desensitization and well described expectations.

Ask-tell-ask

  • assess anxiety that may lead to noncompliant behavior during treatment
  •   teach the patient about the procedures and how they are going to be accomplished
  •   confirm the patient is comfortable with the treatment before proceeding.

Voice control

  •   gain the patient’s attention and compliance
  •   avert negative or avoidance behavior
  •   establish appropriate adult-child roles.

Nonverbal communication

  • enhance the effectiveness of other communicative management techniques
  •  gain or maintain the patient’s attention and compliance

Positive reinforcement and descriptive praise
In the process of establishing desirable patient behavior, it is essential to give appropriate feedback.
Positive reinforcement rewards desired behaviors thereby strengthening the likelihood of recurrence of those behaviors.

Distraction

  • decrease the perception of unpleasantness
  •  avert negative or avoidance behavior.

Memory restructuring

Memory restructuring is a behavioral approach in which memories associated with a negative or difficult event ( first dental visit, local anesthesia, restorative procedure, extraction) are restructured into positive memories using information suggested after the event has taken place. Restructuring involves four components: (1) visual reminders; (2) positive reinforcement through verbalization; (3) concrete examples to encode sensory details; and (4) sense of accomplishment.

The objectives of memory restructuring are to:

  •  Restructure difficult or negative past dental experiences
  •   Improve patient behaviors at subsequent dental visits.

Parental presence/absence

For parents to:

  • participate in infant examinations and/or treatment
  • offer very young children physical and psychological support
  • observe the reality of their child’s treatment.

For practitioners to:

  •   gain the patient’s attention and improve compliance;
  •   avert negative or avoidance behaviors
  •   establish appropriate dentist-child roles
  •   enhance effective communication among the dentist, child, and parent
  •   minimize anxiety and achieve a positive dental experience
  •   facilitate rapid informed consent for changes in treatment or behavior guidance

Extend effective support
Communication techniques for parents (and age appropriate patients) Because parents are the legal guardians of minors, successful bidirectional communication between the dentist/staff and the parent is essential to assure effective guidance of the child’s behavior.

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