Principles of Behavior Management Technique
Principles of Behavior Management Technique
Principles of Behavior Management Technique
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Lec. 5
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1. Non-pharmacological methods
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B. Communication
The hallmark of a successful dentist in managing child dental patient is
his ability to communicate with them and win their confidence. The fears
and the natural innate oddity of a child predict that explanations must be
given for new or different techniques and procedures.
Types of Communication:
A. Verbal.
B. Non-verbal.
Non-verbal communication may be in the form of patting, smile,
acknowledging good behavior and by showing concern.
C. Behavioral shaping
It is based on the stimulus-response theory and principles of social
learning. The child is taught how to behave. Different techniques used for
behavior shaping are:-
a) Tell-show-do technique
b) Desensitization
c) Modeling
d) Contingency
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a) Tell-show-do technique
In this technique, the child is told first about the treatment, showed the
instruments and then the treatment is actually performed. Thus a child
who requires a restoration is told that his teeth are to be brushed or
cleaned. He is shown the hand piece and how it revolves and is
introduced to the child as a special brush that cleans his teeth with water.
The child should be assured that it won’t hurt him but only goes near the
cheek.
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While taking radiographs, the x-ray machine is introduced as a camera
that takes the photo of the teeth. This technique should be practiced every
time a new instrument or object is brought near the child.
‘Praise’ should be added to the TSD sequence to reinforce good behavior.
Tell-show-do technique needs to be modified while treating a child who
is visually impaired. When the tell-touch-do, or tell-smell-do techniques
are to be used, the child is allowed to touch, feel and smell the materials
and instruments (except the sharp ones).
b) Desensitization
It is also called as reciprocal inhibition. It is a training procedure or steps
taken to reduce the sensitivity of the patient to a particular anxiety
producing situation or object. Each situation or object is then introduced
progressively starting from least fear producing to more threatening
stimuli.
c) Modeling
This procedure involves, allowing a patient to observe one or more
individuals (model) who demonstrate appropriate behavior in a particular
situation. Models can be – live (other children present in the operatory) -
filmed (symbolic or vicarious).
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d) Contingency management
The presentation or withdrawal of reinforcers to modify a child’s
behavior is termed contingency management. Reinforcers by definition
always increase the frequency of a behavior.
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Relaxation: Relaxation usually involves a series of basic exercise
that may take several months to learn and which require the
patients to practice at home for at least fifteen minutes each day.
This technique apparently works by reducing tension, well-known
potentiator of pain.
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Technique of HOME
The dentist gently but firmly places his hand over the child’s mouth. With
the verbal outburst completely stopped, the child is told that when he
cooperates the hand will be removed. When the patient indicates his
willingness to cooperate, usually by a nod of the head and cessation of
attempts to scream, the hand is removed and the patient is reevaluated. If
the disruptive behavior continues, the dentist again places his hand over
the child’s mouth and tells him that he must cooperate. Once the child
cooperates he must be complimented.
2) Physical restraining
Consent of the parent’s should be taken prior to the use of physical
restraints. They are useful and effective in facilitating the delivery of
dental care for patients who need help controlling their extremities and
for managing extremely resistant patients who need dental care but are
not candidates for general anesthesia. Some of the commonly used
physical restraints.
3) Voice control
Sudden and firm commands that are used to get the child's attention and
stop the child from his current activity. Soft, monotonous soothing
conversation can also be used as it is supposed to function like music to
set the mood. In both cases what is heard is more important because the
dentist is attempting to influence behavior directly and not through
understanding. The tone of voice and the facial expression of the dentist
are also important as they function like a mirror.
Voice control is most effective when used in conjunction with other
communications. A sudden command of “Stop crying and pay attention!”
may be a necessary preliminary measure for future communication. Voice
control is an effective behavior guidance tool when it is used properly in
a correct situation. However, because parents may find voice control to
be an aversive technique, discussing this technique with parents prior to
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its use may decrease the risk for misunderstanding. (It may not be
acceptable to all parents or clinicians, some parents might feel offended if
you raise your voice on their child.)
Objectives
To gain the patient attention and compliance.
To avoid negative or avoidance behavior.
To establish authority.
Indications
Uncooperative and inattentive patients.
Contraindications
Children who due to age, disability, mental or emotional immaturity are
unable to understand.