Finals L2 - Desensitization and therapeutic behavioral approaches

Behavior guidance

Other term for

Behavior management

Behavior management

• facilitate cooperation for dental care

Behavior modification

• behavior is learned

• Focused on changing behavior to facilitate dental treatment → adapting the patient’s environment

Desensitization

• Avoidance can increase anxiety but controlled exposure to stimuli can reduce anxiety

• A gradual approach to learning that increases tolerance of dental or other medical procedures

• Gradual exposure to new stimuli or experiences of increasing intensity

• Tell, show, do

Reinforcement

• Is the addition of a positive outcome to strengthen behavior

Praise, gifts, positive non verbal cues

Reinforcement

Shaping

• A conditioning technique that involves working toward a target behavior by breaking it down into gradual, successive steps and rewarding each step on the path toward the desired outcome

desensitization,

tell-show-do,

modelling,

contingency,

distraction

Shaping may include:

CUEING AND PROMPTING

• Clear physical and verbal indications that signal the patient to perform the behavior

Refers to decreasing the level of assistance needed to complete a task or activity

FADING

FADING

A cue or prompt is gradually withdrawn until the need for it gradually fades away.

When the child learns how to tolerate the procedure without escape behavior, aggression or protes

ESCAPE EXTINCTION

MODELING

• Child learns a certain behavior by observing the behavior of other children

• observe one or more models

Audio-visual &

Live modeling by sibling or parent

Types of modeling:

• Stealing the attention of the child

DISTRACTION

DISTRACTION

The aim is to decrease the perception of unpleasantness experienced by the target patient

1. Dental disease

2. Age

3. Intellectual disability

4. Cooperating in other settings

5. Communication

6. Caregiver desires

7. Self-care

enumeration for

Patient Selection

• first impression

• Information gathering

• Initial visit

Enumerate

Clinical Strategy

First impression

• Inform the family that the office is accustomed to caring for CSHCN

• Set expectations for the first visit

Information Gathering

1. Child's educational support system

2. Communication

3. Ability to perform specific self-care

4. Child's strengths and abilities

Non clinical area/ consultation room

Scheduled appointment

Discuss caregiver expectations and set goals.

Family provide input on the treatment approach

Under CLINICAL VISIT:

• Initial Visit

DENTAL STORIES

• My Visit to the dentist social history

PRACTICE EXAM KIT

1. Touch the patient's lips with the mirror (count to 5).

2. Touch the right cheek mucosa (count to 5).

3. Touch the left cheek mucosa (count to 5).

4. Touch the tongue (count to 5).

5. Have the patient open wide with the mirror above the tongue (count to 5 four times, once for each quadrant)

COMMUNICATION

• Use speech that is calm, clear, concrete, simple, slow, and repetitive

• Provide one instruction at a time

• Use terminology consistently

• Address the patient directly, not through the caregiver

• Use the caregiver to interpret patient communication

Under COMMUNICATION

1. Avoid bright lights and stimulating office design in areas intended

2. Avoid using strong flavors and odors in fluoride, prophy paste, and other dental products

3. Keep instruments covered

OFFICE SET UP

• Schedule short appointments (15-20 min)

• Divide procedures into discrete parts

• Attempt to schedule patient with the same provider, assistant, room

• Establish a routine, document it, and adhere to it

APPOINTMENT DESIGN

1. Have parent demonstrate a skill they practiced at home

2. Proceed slowly when moving the dental chair

EXAM TECHNIQUE