Behavior Management Facts

Misconceptions of Dental 20-

20-25% of all children
who have dental tx
Fear and Behavior display negative
behavior during tx
Management in Children (Baier ‘04; Brill ‘00; Raadal et al ‘95).
Behavior of pediatric
Department of Pediatric Dentistry patients reflects lowered
behavioral expectations
Joe Rawlins, DDS by parents and
Martha Harden, DMD contemporary culture
(Sheller ’04)

Misconception: By age 7, a child Dental Anxiety

should be more cooperative
Behavior management
In general, ++ behavior increases with age. However, problems are observed
the decline in anxiety is not consistent among older more frequently in children
children, and several studies have reported increased with dental anxiety
anxiety with age. Children with high dental
12% of children are dentally anxious by age 10 as anxiety are more likely to
measured by Children’s Fear Survey Schedule Dental have missed appointments
Subscale: CFSS-
CFSS-DS (Wogelius et al ’03) (Klingberg et al ’03)

Older children have often heard their parents or Dentally anxious

siblings/friends talk of dental treatment, and this can adolescents have an
result in increased anxiety prior to an appointment. increased risk of having
dental anxiety as an adult
(Locker et al ’01)

Misconception: Repeated exposures to the dental

Misconception: Parental presence setting will lead to more positive behavior
negatively affects behavior
As children progress beyond
Literature is contradictory on this point. the first visit and experience
Marzo ‘03: Parental presence affects a child’s behavior negatively.
„
more aversive procedures, they
„ Fenlon ‘93: Parental presence does not lead to a greater incidence of
negative behavior. will demonstrate less positive
Parental Presence/Absence (PPA) intervention behaviors. (Winer
(Winer ‘82)
can be a useful behavior modification technique Indication for treatment
Surveys: Dentists prefer not to have parents planning considerations: may
back. Parents prefer to be present or to have decide to complete most
access to viewing the treatment session. invasive procedures early in the
treatment process

1
Misconception: A bad visit will scar
Misconception: Scarring for life continued ...
a child for life
Increases in negative behavior or anxiety during
threatening visits (invasive procedures) subside
on later ones (easy recalls). (Howitt & Stricker ‘70, Venham
et al ’77, ’81)
Prior history of a “bad” experience has little
impact on the current visit unless the experience
was severely traumatizing. (Johnson & Baldwin ’69,
Lenchner ’66, Venham ’79)
„ No relation between the number of fillings a child
received and his/her dental fear (Ten Berge ’02).
Maternal anxiety is highly linked to child’s dental
anxiety and cooperation (Bankole ‘02).
Parental anxiety seems to be “passed down” to
children. The procedures themselves bear little
relation to the development of dental anxiety.
Aversive conditioning experiences appear to be
unrelated to the adult onset of dental anxiety,
and it may be that particular temperamental or
psychological traits are associated with the
condition. (Thompson ’00)

Behavioral Methods for Removing

Anxiety The Child’s View
Tell-
Tell-Show-
Show-Do
Playful Humor
Distraction
Positive
Reinforcement
Modeling

Behavior Guidance Techniques Behavior Guidance:

Knee to Knee Exam
Voice control
Nitrous Oxide
Restraint
Sedation
General Anesthesia

2
 Behavior Guidance:
Behavior Passive Immobilization
Guidance:
Nitrous Oxide

Used in Emergencies
and Sedations

Oral Sedation Behavior

Guidance:
Midazolam (Versed) General
Triple Combo Anesthesia
„ Chloral Hydrate
„ Meperdine (Demerol)
„ Hydroxyzine (Atarax)
Atarax)
Halcion

General Anesthesia at Children’s

OPENING DATE:
April 1, 2006
3 Dental Anesthesiologists
There are 25 Dentists
6 Faculty Doctors
6 Residents
17 Private Doctors
2 Oral Surgeons
From May 2006 to May 2007
there were 1,328 cases.
Average Case Length: 70
Minutes
Average Age: 4 Years

3
 Case Presentation Case Presentation
23 month old male with significant
maxillary decay
Medical History: NSF, NKDA
Dental History: Parents brushed teeth
every couple of days, put to bed with juice
until 15 months old
Behavior History: Knee to knee exam with
parental restraint

Case Presentation
Case Presentation

4
 Preventive Plan References
Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children’s fear and behavior in private pediatric dentistry practices. Pediatr Dent 2004;

1 week follow up: 26(4):316-

26(4):316-21.
Bankole OO, Aderinokun GA, Denloye OO, Jeboda SO. Maternal and child’s anxiety—
and treatment. Afr J Med Med Sci.Sci. 2002; 31:349-
31:349-52.
anxiety—effect on child’s behaviour at dental appointments

Brill WA, Child behavior in a private pediatric dental practice associated with types of visits and economic factors. Journal of Clinical
Pediatric Dentistry. 200; 25(1):1-
25(1):1-7.
„ Oral Hygiene Fenlon WL, Dabbs AR, Curzon ME. Parental presence during treatment of the child patient: a study with British patients. Br Dent J 1993;
174:23-
174:23-8.
Howitt JW, Stricker G. Sequential changes in response to dental procedures. J Dent Res 1970;49:1074-
1970;49:1074-1077.
Instructions Johnson R, Baldwin DC. Maternal anxiety and child behavior. J Dent Dent for Children 1969;36:87-
1969;36:87-92.
Locker D, Thomson WM, Poulton R. Onsent of and patterns of change in dental anxiety in adolescence and early adulthood: a birth cohort
study. Communtiy Dent Health 2001;18:99-
2001;18:99-104.

„ Use fluoridated Klingberg G, Beggren U, Carlsson SG, Noren JG. Child dental fear: cause-
1995;103:405-
1995;103:405-12.
cause-related factors and clinical effects. Eur J Oral Sci

Kotsanos N, Arhakis A, Coolidge T. Parental presence versus absence in the dental operatory:
operatory: a technique to manage the uncooperative
child dental patient. Eur J Paediatr Dent 2005; 6:144-
6:144-8.
toothpaste Lenchner V. The effect of appointment length on behavior of the pedodontic patient and his attitude toward dentistry. J of Dent for
Children 1966;33:61-
1966;33:61-74.
Marzo G, Campanella V, Albani F, Gallusi G. Psychological aspects in paediatric dentistry: parental presence. Eur J Paediatr Dent 2003;

„ Diet Counseling 4:177-

4:177-80.
Raadal M, Milgrom P, Weinstein P. The prevalence of dental anxiety in children from
personality traits. J Dent Res 1995;74:1439-
1995;74:1439-1443.
from low income families and its relationship to

Sheller B, Challenges of managing child behavior in the 21st century

century dental setting. Pediatr Dent 2004; 26:111-
26:111-3.
„ Regular recalls Ten Berge M, Veerkamp JS, Hoogstraten J, Prins PJ. The etiology of childhood dental fear: the role of dental and conditioning
experiences. J Anxiety Disord 2002; 16.321-
16.321-9.
Thomson W, Locker D, Poulton R. Incidence of dental anxiety in young adults in relation to dental
dental treatment experience. Comm Dent and
(consider 3 month Oral Epidem 2000; 28:289-
28:289-94.
Venham LL, Bengston D, Cipes M. Children’s response to sequential dental visits. J Dent Res 1997;56:454-
1997;56:454-59.
Venham LL, Goldstein M, Gaulin-
Gaulin-Kremer E, Petros K, Cohan J, Fairbanks J. Effectiveness of a distraction technique
technique in managing young
intervals) dental patients. Pediatr Dent 1981;3:7-
1981;3:7-11.
Venham LL, Quatrocelli S. The preschool child’s response to specific repeated dental procedures.
procedures. J Dent Res 1977;56:734-
1977;56:734-738.
Winer G. Child Development. 1982; 53(5):1111-
53(5):1111-1133.