Amani . Bayan . Rahaf .

Dalia
1

ALFARABI MEDICAL COLLEGE
Introduction to behavioral
dentistry
Final exam

Wrote By :- amani najjar , rahaf radwan , dalia basher
Bayan abu - emarah













GOOD LUCK
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Chapter 1
Health Care Communication skills
1-Sender:
Sender is the person who starts the communication of information (sending the message). In health care
he may be doctor or nurse.
2-Encoding:
Putting the message into a form that the receiver will understand.
3- The message:
The information which communicator transmits to audience.

4-Channel:
Method used to transfer the message from sender to receiver.
5- Decoding:
The receivers process of translating the message into a meaningful form.
6-Receiver:
Person to whom we are sending the information.
7-Feedback:
A response by the receiver to the senders communication.
Feedback helps to ensure that the message received has been decoded correctly.
Can be: Verbal and Non-Verbal Reactions.
Positive and Negative feedback.
Communication barriers from receivers side:
Poor listener.
Inattention.
Lack of interest.
Lack of trust.

Types of communication:
1. Verbal Messages - the words we choose.
2. Paraverbal messagr how we say the words .
3. Nonverbal message our body languge .








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Chapter 2
The Dentist-Patient Relationship

Factors affecting dentist patient relationship:
Differences in:
Educational level.
Social class (rich doctor- poor patient).
Gender (male doctor- female patient).
Different languages.

3- Mutual-participation Model:

Best model for relationship between dentist and patient.

Suitable for chronic disease such as dental caries and periodontal disease.

Three Basic Models of the Dentist-Patient Interaction

Model Physicians Role Patients Role Clinical Application
of Model
Decision making
Activity passivity
model
Dose something to
patient .
Passive (unable to
respond or inert)
receive ttt
Anesthesia, acute
trauma, coma
Operative dental
treatment .
Doctor
Guidance-
cooperation
Tells patient what
to do .
cooperator (obeys) Dental chechup Doctor
Mutual
participation
Helps patient to
help himself .
Participant in
partnership(uses
expert help)
Most chronic
illnesses,
psychoanalysis,
etc.
Doctor and
patients
















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Chapter 3
Behavior Management In Pediatric Dentistry

Category 1= definitely negative child :

Child refuses treatment .
Cries with fear .
Combative .
Unable to accept treatment procedure .
Needs to end procedure .

Category 2= negative child :
Slightly Combative .
Able to accept treatment .
Procedure Safely completed .

Category 3= positive child :
Child accept treatment but with caution .
Quite .
Not combative .
Cooperative .

Category 4= Definitely positive child :
Good Child dentist relationship .
Interested in dental treatment .
Happy and helpful .

3- Over indulgence :
Parents give child whatever he needs , wish or desires .

Features :
Spoilt , selfish (S,S) .
In dental office : resistant , screams without tears . It is very difficult to make relationship with this child
.











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II. Behavior Management Techniques ( Non Pharmacological ) :

1- Systemic Desensitization :
Showing the child around dental office to get familiarized .

2- Tell Show Do ( TSD ) :
Effective in all age groupe especially after age 6 years most important technique .

3- Modiling :
Procedure involves allowing a patient to watch another child .

4- Distraction :
Diverting attention from what may be perceived as an unpleasant procedure .

5- Voice Control :
It is modification of voice and use of sudden , loud and firm commands as stimuli to suppress the
disruptive behavior .

Indications : uncooperative or inattentive .
It should not be used with : children disability , or are unable to understand and communicate .

6 positive Reinforcement :
Reward the cooperative behavior with praise and small presents .

7 protective Stabilization ( Immobilization ) :
Indication :
Mental or physical handicap .
Ineffectiveness of other techniques .

Pharmacological Manrgment :

1- Inhalation sedation : Nitrous oxide oxygen Analgesia Given by mask .
2- A topic anesthetic : can be applied with a cotton swab .
3- A local anesthetic : injected .














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Chapter 4
Dental care for people with Disabilities
Classification:
A) According to time of onset into: -
- Developmental disability : - 1
Present at birth or occurred during the developmental period (before age 22 years).
2) Acquired Disability :
Occur later on in life may be due to :
Trauma as head injury .
Chronic diseases as cancer.
B) According to response in dental clinic:
1- high functioning: patient able to dentist order.
2- Low functioning: dont respond to basic commands.
Austism :-
- Oral health problem in austim :
Damaging oral habits :- common and included
1- bruxism ( over clenching of teeth )
2- biting tongue and lips
3- pice ( eating abnormal substance as sand or pens )
Cerebral palsy
Result from damage to motor part of brain.
A) clinical picture:
* Uncontrolled body movement and convulsions.
* Mental retardation.
* Paralysis in limbs.
* Visual impairments, hearing loss and deafness.
Oral health problem in Cerebral palsy
and autism ) (Cerebral palsy Bruxism
Common in people with cerebral palsy can be severe and cause teeth fracture and
pulp exposure.
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Down Syndrome
A) Clinical Picture :
* Mental Retardation.
* Characteristic fact .
* Cardiovascular diseases.
*Decreased immunity.
*Early Alzheimer and memory.
Oral health problem Down Syndrome
Macroglssia :
Big protruded and fissured tongue( from forwards position of mandible and
opened mouth) leading to xerostomia.























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Chapter 5
Management of dental fear and anxiety
Dental phobia:
a severe form of this fear is called Dental phobia.

The effects of fear on the body include:










Pharmacological techniques
The main types of pharmacological anxiety control are :
Sedation : An induced state of decreased level of consciousness.
Advantages of Inhalation:
*) It is the safest and most controllable form of sedation available.
*) It has few complications, and the patient has no side effects.
Oral sedation benzodiazepine
C) Intravenous sedation:
The effects of the drug can last up eight hours after and the patient must be
accompanied by a responsible adult.
It can be used on most healthy adults but must be avoided in patients
With severe lung disease, some heart problems or in pregnancy. It is also not
suitable for children or the elderly.
d) General anesthesia:
A state of unconsciousness.

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Chapter 6
Dental management of geriatric patients

According to older ability to seek dental care :-
Functionally independent older : able to got to dental care
Frail older adult : persons with chronic disease contributing to major limitation in mobility
Functionally dependent older : present in nursing home
Gerontology of the oral cavity :- can be defined as effect of aging on oral tissue
It include :-
1- abrasion , attrition , and erosion of teeth
2- the tissue for older patients may be slower to heal
3- gingival recession increase
4- osteoporosis is a common problem in elderly changing alveolar bone also decrease in bone mass in
mandible leading to :-
a- fragility and risk of fracture
b- failure of Osseo integration of dental implants.
Common Oral Disease in the elderly :-
1- root caries is most common
2- periodontal disease next common
3- missing teeth
4- edentulism without teeth , complete loss of all natural teeth

Medical disease

Oral manifestation Control
Hypertension
Nor oral manifestation of hypertension but
antihypertensive drug can cause side
effects as:
- Xerostomia
- Gingival overgrowth
- Paresthesia
- Afternoon appointment are
recommended
- Salvia stimulants
- Use of sedative the night before a
procedure to decrease anxiety related
rise pressure
Diabetes
- Delayed healing wounds
- Xerostomia is common
- Tenderness, pain and burning
sensation of tongue
- Increase risk of infection candied
infection are more common
- Morning appt .( endogenous cortisol )
- Saliva stimulants
- Try to decrease symptoms with
sodium bicarbonates and water risen
- Antifungal
Arthritis ( if
tempromandibular
joint is involved )
- Difficallty for chew
- Difficult to do daily routine
- Care such as brushing teeth
- Many short appointments instead of
one long
- Oral appliances reduce stress on joint
Surgical considerations in geriatric patient :-
Minor oral surgery under local can be done in dental setting
Hospital setting in best for :-
1- multiple extractions or general anesthesia
2- surgery for patients on anticoagulants
3- patient who suffer from psychological problem

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Chapter 7
Understanding conflict management
Type of conflict :-
1- intrapersonal conflict within an individual
2- interpersonal conflict occurs between tow individuals
3- itragroup conflict occur within persons in a group
4- intergroup conflict is the disagreement between group





















Different style of communication

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- : Conflict management
conflict management means style used by one or both members to cope with a conflict to limit the
negative aspects of conflict and to increase the positive aspects of conflict .
- Style of conflict management :
- avoiding style : - 1
not baying attention to the conflict and not taking any action to solve it . very common style
- style : ommodation ( smoothing ) acc - 2
Allowing one person to satisfy his concerns while neglecting other person concerns .
- forcing ( copetition ) style : - 3
When some one uses his power and formal authority to win the situation on the other persons expense
- compromising ( sharing ) style : - 4
Trial to resolve a conflict by identifying a solution that is partial ( not completely 0 satisfactory to both
members .
- ) style : collaboration (problem solving - 5
Cooperating with each other to find completely satisfactory solution to both members ( win-win ) its the
best conflict management style .
- ion : The drawback is the collaborat
1- tack more time and effort
2- not successful when members have different values or goals .







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CHAPTER 8
PATIENT COMPLIANCE AND BEHAVIOR MODIFICATION
Definition : Patient compliance means the patient following instructions of the dentist.
Non-Compliance means the patient not following instructions of dentist e.g., not taking medicines, not
maintaining oral hygiene.
Non- compliance problems in Dentistry:
Implants :
The implants can fail if the patient doesnt follow the instructions of the dentist
1-Eg. After placing implant, the patient is told not to chew on the immediately placed tooth.
2-The patient is told to maintain a soft diet for two weeks.
Orthodontics:
The orthodontic treatment might fail if:
1-The patient does not use the retainer or head gear correctly.
2- The patient does not wear it for the required amount of time.
Periodontics:
Periodontal treatment will fail if :
1-The patient does not maintain good oral hygiene, after the treatment.
2- Does not come regularly for recall appointments.
Factors affecting patient compliance:
1- Poor communication by the dentist
2- Forgetfulness of the patient
3- Psychological factors as depression
4- Knowledge and belief about the disease.
5- Patient readiness for treatment.



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How to improve patient compliance:
1- Assess the patient.
By understanding the patients medical and dental history, a dentist can know the ways to ensure good
patient compliance.
2- Improve communication with the patient :
Explain the instructions clearly
Let him ask questions
3- Educate the patient:
Let him know the effects of non-compliance.
4- Motivate the patient:
To increase his motivation, tell him that he is going to be assessed in the next appointment.
Also use positive reinforcement to motivate him.














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Chapter 9 Handling the difficult patient
Reasons why a patient can be difficult patient:
a) Psychiatric disorders e.g. anxiety, depression, alcohol abuse
b) Functional impairments (e.g. physical disability)
c) Always unsatisfied nature.
Classification of difficult patients
1- Dependent Clingers 2- Demanders 3-Manipulative help rejecters 4-Self Destructive
1-Dependent Clingers:
Excessively dependent on the doctor, desperate for reassurance, but will return continually with a new
symptom every time
How to manage:
1- Give frequent appointment
2- Develop a good doctor patient relationship
2-Demanders:
1- inexhaustibly needy 2- not thankful 3- will use intimidation 4- threaten
litigation
How to manage:
1- Acknowledge that the patient needs good medical care and request that he stop misdirecting his
anger (maybe hes angry with something else, but takes out his anger on the doctor).
2- Assure him that he is in good hands
3-Manipulative help rejecters:
1- Continually return to clinic saying that the treatment failed.
2- Asks doctor to do unnecessary treatment.
3- Pessimistic and think that nothing will help.
How to manage:
1- Establish a good doctor patient relationship to avoid unnecessary treatments
2- Give frequent appointments
4-Self destructive: Patients who have suicidal tendency ,Will not make any effort to improve their
condition.
How to manage: Refer him to a psychiatric consultant
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SHORT ACCOUNT
1] list 4 types of non-verbal communication :-
1- appearance
2- gestures
3- facial expression
4- eye contact
5- proximity
2] 4 points of clinical features of cerebral palsy :-
* Uncontrolled body movement and convulsions.
* Mental retardation.
* Paralysis in limbs.
* Visual impairments, hearing loss and deafness.
3] 4 oral manifestations of uncontrolled diabetes :-
- Delayed healing wounds
- Xerostomia is common
- Tenderness, pain and burning sensation of tongue
- Increase risk of infection candied infection are more common
4] 4 types of conflict management strategies :-
1- avoiding style :-
2- accommodation ( smoothing ) style :-
3- forcing ( copetition ) style :-
4- compromising ( sharing ) style :-
5- collaboration (problem solving ) style :-
5] factors affecting patient compliance :-
1- Poor communication by the dentist
2- Forgetfulness of the patient
3- Psychological factors as depression
4- Knowledge and belief about the disease.
5- Patient readiness for treatment.

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6] 4 points of gerontology of oral cavity
1- abrasion , attrition , and erosion of teeth
2- the tissue for older patients may be slower to heal
3- gingival recession increase
4- osteoporosis is a common problem in elderly changing alveolar bone also decrease in bone mass in
mandible leading to :-
a- fragility and risk of fracture
b- failure of Osseo integration of dental implants.

7] 4 ways of improving patient compliance :-
1- Assess the patient.
2- Improve communication with the patient :
3- Educate the patient:
4- Motivate the patient:
8] Types of pharmacological management of patient :-
1- inhalation sedation
2- atopical anesthetic
3- local ansesthetic
9] factors affecting dentist patient relationship :-
Educational level.
Social class (rich doctor- poor patient).
Gender (male doctor- female patient).
Different languages.