Behavior Management Techniques Research Articles

Influence of dentists' age, gender, working experience, and practitioner type on the use of behaviour management techniques in dental treatment of children.

Abstract.

Comparative evaluation of role play and group discussion as teaching-learning method for behavior management in pediatric dentistry

Communication, behavioral and attitudinal skills are an integral part of teaching behavior management to dental undergraduate students. Due to the complexity of these skills, clinical teaching through didactic method imparts minimal capacity for adopting deep approach to learning. The implication of role play and group discussion could be an opportunity to facilitate such learning outcome. The objectives of this study were to evaluate and compare the efficacy of role play and group discussion as teaching-learning methods for behavior management in pediatric dentistry. The study was carried out with ninety-two final BDS undergraduate students at Sharad Pawar Dental College & Hospital, INDIA. Tell-Show-Do, non-pharmacological behavior management technique was taught to intervention and control group by role play and group discussion method respectively. To assess knowledge gain, pre-test and post-test was conducted. To evaluate acquisition of communication, behavioral and attitudinal skills, students were made to perform a clinical procedure i.e. placement of pit and fissure sealant in primary molars. Each student was evaluated by direct observation using a check-list. Role play method was found to be highly effective as significant difference was observed in knowledge gain (p=0.020) and acquisition of behavioral and attitudinal skills (p= 0.027) among intervention and control group.

Live Modeling Versus Tell-Show-Do Technique Based on Children's Heart Rates, Oxygen Saturation and Facial Image Scale.

Tell-Show-Do is most popular and Live modeling is less frequently used behavior management techniques in pediatric dentistry. This study was conducted to compare the children's response to these two techniques by measuring the objective and subjective parameters of anxiety by using pulse rate, oxygen saturation and facial-image scale. A cross-sectional study was conducted among 138 children aged 5-10 years from December 2020 - August 2021. Children were randomly divided into three groups: Group A: Live modelling technique (mother as model), Group B: Live modelling technique (father as model), Group C: Tell-Show-Do technique. All were subjected to oral examination and rotary prophylaxis on first dental visit. Pulse oximeter was used to record heart rate, oxygen saturation along with facial-image scale scores before and after the treatment period. The average heart rate at the end of rotary prophylaxis session was significantly lower among children in group A than in group C (p=0.05). facial-image scale scores revealed high significance after the rotary prophylaxis treatment and it was lower in group A than group C and group B (p< 0.001). Average facial-image scale scores of fear perception by girls in group A was lower than group C and group B (p< 0.001). Oxygen saturation showed no significant differences between the three groups. Live modelling is equally worth practicing as Tell Show Do technique to decrease the anxiety level of children. Anxiety level increased during the procedural work than oral examination and facial image scale indicated anxiety.

Does the Efficacy of Behavior Management Techniques Differ Between Children From Single-Child and Multi-Child Families?: A Quasi-Experimental Study.

AimBehavior management techniques (BMTs) efficiently deliver dental treatment to children with dental anxiety. The objective of this quasi-experimental study was to examine whether the efficacy of BMTs applied for the improvement of compliance in pediatric patients differs between children 3–10-year-olds from single-child and multi-child families.Materials and MethodsIn this quasi-experimental, 197 caregiver-child couples were divided into two groups: single-child group (116 couples) and multi-child group (81 couples). Children's pre- and post-treatment anxiety levels were measured by facial mood scale (FMS) and Frankl Behavior Rating Scale (FBRS), respectively.Caregivers' dental anxiety was measured by the Chinese version of the Modified Dental Anxiety Scale (MDAS), which was included in the self-designed questionnaire. Data were analyzed by using the Mann-Whitney U-test, chi-square tests, and binary multivariate regression analysis.ResultsThere was no statistically significant difference in the demographic characteristics of the children between the two groups. BMTs were found to be capable of reducing children's dental anxiety (CDA): the compliance rate was 45.69–88.79% in the single-child group and 44.44–85.79% in the multi-child group pre- and post-BMTs, but there was no significant difference in the change of compliance between the two groups (p > 0.05). In the subgroup analysis, parenting style (odds ratio [OR] = 0.054, p < 0.05) and father's education (OR = 8.19, p < 0.05) affected the varies of children's compliance in the single-child group. In contrast, in the multi-child group, gender (OR = 8.004, p < 0.05) and mother's occupation (OR = 0.017, p < 0.05) were associated with these changes in compliance.ConclusionsIn this study, BMTs were proved to be beneficial in improving compliance in 3- to 10-year-olds children in dental treatment. Though there was no significant difference in the change of compliance between children from single-child and multi-child families, different associated factors may affect the two groups. Therefore, the related family factors should be taken into account when professionals manage each child's behavior in dental practice.

Knowledge and attitudes of dental practitioners regarding the use of behaviour management techniques for paediatric dental patients.

Understanding children's behaviour and development is crucial in managing and treating paediatric dental patients. Dental practitioners are expected to be aware of the behaviour management techniques which will facilitate routine dental treatment of the child dental patient.

Generalization and maintenance of caregivers' effective instruction delivery following group behavioral skills training

AbstractBehavioral skills training (BST) is an effective modality to train parents in a variety of behavioral techniques for their children. However, extended wait times for behavioral health services can result in increased severity of children's problem behaviors. Furthermore, there is limited research demonstrating that behavior management techniques trained via BST generalizes beyond the setting in which they were trained. The purpose of this study was to evaluate the effectiveness of group‐based BST to improve three caregivers' use of effective instruction delivery (EID) for three children diagnosed with neurodevelopmental disorders and determine the extent to which effective instructions maintained and generalized to the home. Results indicated that all three caregivers' improved their EDI which resulted in children's improved response to instructions that maintained over time. Furthermore, caregivers' use of EID generalized to the home and maintained over time. Findings, implications, and areas for future research are discussed.

Does the Behavior of Pediatric Patients towards Dental Treatment Influence the Pattern of Adjacent (Sound, Decayed, and Filled) Proximal Surfaces in Primary Molars?

This retrospective study aimed to investigate the influence of patient behavior toward dental treatment on the presence of adjacent (sound, decayed, or filled) proximal surfaces in the primary molars. The study included a records review of 2226 pediatric patients. Records were eligible if the patients were in primary or mixed dentition, and if they included a complete set of bitewings and periapical intraoral radiographs of all their primary molars. Four calibrated reviewers used intraoral radiographs to record the sound, decayed, and filled proximal distal surfaces of the first primary molars and the mesial surfaces of the second primary molars. Demographical variables were reported from patients’ medical records including gender, age, medical history, nationality, and patient behavior. Patients’ behaviors were evaluated using Frankl’s Behavior Rating Scale. The Pearson correlation was used to test the association between the sound, decayed, and filled distal surfaces of the first primary molars and the mesial surface of the second primary molar. High correlations of ≥0.6 were further tested in simple and multiple linear regression models to test the influence of patients’ behaviors on these correlations after adjusting for demographical factors. All tests were performed at 5% significance level A. A total of 1194 records met the inclusion criteria and were analyzed. There was a high positive correlation between the sound, decayed, and filled distal surfaces of the first primary molar and similar surfaces on the mesial of the second primary molars (0.66, 0.61, and 0.60, respectively). Compared to cooperative patients, the adjusted estimate of the mean decayed mesial surface of the second primary molar increased significantly for non-cooperative patients by 0.1 (95% CI = 0.16–0.53). On the contrary, the adjusted estimate of the mean sound mesial surfaces of the second primary molars decreased significantly by 0.09 for non-cooperative patients, compared to those who were cooperative (95% CI = −0.52–−0.15). Patient cooperation did not significantly influence the mean of the filled mesial surfaces of the second primary molars (adjusted B = 0.01, 95% CI = −0.05–0.09). Educating parents and clinicians about the influence of children’s behaviors on oral health is highly encouraged to improve treatment outcomes and reduce the progression of dental caries. The implementation of specific behavior management techniques is also important to reduce dental fear and anxiety.

Acceptance of Parents for Behavior Management Technique with Reference to Previous Dental Expertise and Dental Anxiety.

IntroductionBehavior management of pediatric patients may be done by behavioral and pharmacological techniques. Parents play a vital role when making a decision for treatment for the kid.AimTo evaluate parental acceptance towards behavior management techniques (BMT) at the side of its reference to previous dental expertise and dental anxiety.Materials and methodsA descriptive cross-sectional survey was conducted among forty parents of children between three to twelve years before dental treatment. The statistical analysis was done using the Chi-square test, Student's paired and unpaired t -test. p < 0.05 was considered statistically significant. Data analysis was performed using software package of statistical analysis (SPSS 22.0 version and GraphPad Prism 6.0 version).ResultsThe most accepted technique was audiovisual technique followed by tell-show-do and anesthesia. The least accepted technique was oral sedation. Parents whose children were treated at the Postgraduate Clinic of Department of Pediatric Dentistry had lower incomes than those from the private practice. 24% preferred general anesthesia compared to active restraint.ConclusionAudiovisual technique is the most accepted behavior management technique by parents and is an efficient distraction technique for behavior management for anxious pediatric patients. Postgraduate clinic parents had lower incomes than those at the private practice. Parental dental experience and dental anxiety didn't have an effect on the acceptance of any specific behavior management technique.How to cite this articleShukla H, Kulkarni S, Wasnik MB, et al. Acceptance of Parents for Behavior Management Technique with Reference to Previous Dental Expertise and Dental Anxiety. Int J Clin Pediatr Dent 2021;14(S-2):S193-S198.

Using non-pharmacological behaviour management techniques to manage the young patient's dental visit

Using non-pharmacological behaviour management techniques to manage the young patient's dental visit

Short Term Outcome in Sleep Disturbance Intervention in Children with ASD in a Tertiary Care Hospital in Bangladesh

Aim: The aim of this study was to identify the relationship between sleep patterns and behavioral difficulties in children with ASD using sleep disturbance treatments. Methods: We selected a total 41 children with sleep disorders as study population. The sleep services (behavioral sleep management techniques) were given by the child development center team of Dhaka Shishu Hospital comprising of physician , developmental therapist and psychologist. Children were split into eight groups and two gender divisions based on their age, and they were then studied over a period of 6 months . Sleep disorders were investigated both before and after intervention. Results: The results revealed that the children’s sleep dysfunction improved from before, with the lowest improvement percentage decreasing from 62.9 percent to 51.8 percent and the greatest improvement percentage increasing from 100 percent to 59.2 percent, whereas a sleep problem showed no change at all (sleepwalking). Conclusion: The study has tried and succeeded to an extent to intervene in the sleep dysfunction process of children with ASD in a tertiary care hospital. However, there is still much to learn about the clinical efficacy of these types of behavioral interventions in children with ASD who have sleep disruption.

Modifications of behavior management strategies pre- and post-covid-19 scenario: A survey among pediatric dentists.

COVID-19 presented a unique scenario among children, specifically all over the world. The children had decrease outdoors activities and learning times, increased use of electronic gadgets and changes in sleep patterns. These altered behavior patterns of children directly influenced their behavior in the dental operatory. This coupled with the stringent protocols of COVID-19, made the behavior management of children a tedious task. However, as they say that necessity is the mother of all inventions, the pediatric dentist took this time to evaluate newer methods of behavior management and modified old strategies with newer modifications. The main aim of this study was to observe the modifications in behavior management strategies among pediatric dentists in the post-COVID-19 era while managing the child in dental operatory. Four hundred pediatric dentists were mailed a questionnaire consisting of 24 open and closed-ended questions consisting of personal data, professional information, and questions regarding various behavior management techniques used by them in pre- and post-COVID-19 era. Data obtained were subjected to statistical analysis using SPSS version 26.0, IBM, and a comparison of frequencies of categories of variables with groups was made using Chi-Square test and McNemar test. The results showed that there were statistically highly significant changes in behavior management strategies pre- and post-COVID-19 scenario with P < 0.01. Conventional techniques like Tell-Show-Do were popular in both pre- and post-COVID-19 times with minor modifications in approach, but conscious sedation and distraction techniques were evaluated to have gained more popularity in the post-COVID-19 times along with exploration of new novel techniques.

Psychological behavior management techniques to alleviate dental fear and anxiety in 4–14-year-old children in pediatric dentistry: A systematic review and meta-analysis

Child's uncooperative behavior can impede the efficient delivery of dental care. Therefore, in spite of exceeding availability of behavior management techniques there is a need to search for a psychological behavior management technique that effectively reduces fear and anxiety during dental treatment and instill a change in child's attitude toward the treatment and is also acceptable by the parents. The aim of our systematic review is to determine the efficacy of various psychological behavior management techniques in managing a child's behavior in pediatric dentistry by assessing the fear and anxiety levels, ease of use by the clinician, application in various operative procedures, and parental acceptance. A systematic search was conducted by two reviewers in databases PubMed, Google Scholar, Scopus, Web of Science, and Cochrane for the studies published from January 1, 2011, to December 31, 2020. Studies included were clinical studies which evaluated the efficacy of various psychological behavior management techniques by evaluating the fear and anxiety levels and the changes in behavior during dental treatment in children aged between 4 and 14 years. The studies selected were then assessed for quality with the help of predetermined criteria which categorized the studies into high, medium, and low. Through search strategy, 7147 articles were yielded. After screening through titles and abstracts, 60 nonduplicated articles were selected which were further screened for full text. At the end, 15 articles were included in systematic review and 3 articles for meta-analysis. It was concluded that all the psychological behavior management techniques aided in reduction of fear and anxiety. In noninvasive procedures, conventional psychological behavior management techniques can be effective but in invasive procedures other newer psychological behavior management techniques showed better results. The aspect of parental acceptance regarding various techniques was not discussed in any of the included studies.

Use of universal behavior management techniques for child dental patients by final year dental therapy students in Enugu, Nigeria

Background: Behavior management techniques are employed to allay fears and to ensure maximum cooperation during the course of treatment of children. Objectives: This study assessed the knowledge and use of universal behavior management techniques (UBMT) for children by final year dental therapy students in Enugu, Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 167 final year dental therapy students attending Federal College of Dental Technology and Therapy (FCDTT), Enugu, Nigeria. Data on sociodemographic profile, knowledge, and use of the UBMT were collected using questionnaires. Reasons for choice of techniques were also collected. Data analysis was performed using SPSS version 21.0 (IBM, Chicago, IL, USA), and the effect of all significant factors was inferred at P < 0.05. Results: Students aged 19 to 29 years participated in the study, and the mean age was 22.65 ±2.47years. More females (111 [66.5%]) than males (57 [33.5%]) participated in the study. Many (110 [65.9%]) of the final year students were aware of the “tell-show-do” technique, whereas a few (26 [15.6%]) were aware of the “desensitization” technique. Many (110 [56.9%]) also used the “tell-show-do” technique, whereas seven (4.2%) used the desensitization technique. There was significant association between age, use of the “positive reinforcement” technique (P = 0.02), and “ease of use” as a reason affecting the choice of UBMT (P = 0.03). Conclusion: Most final year dental therapy students were aware of UBMT, but there was a varied level of knowledge of the different techniques among them. “Tell-show-do” was the most common technique known and it was used by the study participants. Age was associated with use of the “positive reinforcement” technique, whereas “ease of use” affected the choice of UBMT.

Child behavior management technology in pediatric dentistry. Review of non-pharmacological techniques

The dental treatment can easily lead to strong reactions of fear and acute anxiety in adults and children alike. It is one of the most common reasons for avoiding the dental office and for neglecting orodental problems. Dental anxiety has been shown to increase the incidence of dental pathology (decayed and/or extracted teeth), increase the frequency and intensity of episodes of dental pain, and reduce the overall quality of oral health. Dental disorders can not only have significant physical consequences for the child, such as disturbed sleep, reduced food intake, digestive disorders, delayed growth and development, but can also affect their mental concentration, which leads to decreased school performance; social interactions can also be adversely affected. Pain, previous unpleasant experiences with dentists or less trained dentists can be serious reasons why the child is afraid, developing phobias that can follow him for a lifetime. To gain their trust and help them escape the fear of the dental office, children always need to be treated by a calm, warm, patient doctor who can understand their fears and explain, step by step, what is going on. Behavior management is widely accepted as a key factor in providing oral and dental care to children. It is imperative that any behavioral approach of the pediatric patient be based on empathy and concern for the physical and mental well-being of each child. A wide variety of behavioral management techniques (pharmacological and non-pharmacological) are available to pediatric dentists. It is important to choose the right one for the benefit of each child patient, depending on the individual’s physical and mental characteristics in each case.

Alzheimer’s Disease: Criteria for Dental Treatments

Among manifestations of neurodegenerative diseases, Alzheimer Disease (AD) contributes for 60-70% to elderly dementia. AD patients suffer from impaired cognitive function and from a compromised capacity to perform activities of daily living. Neurodegenerative diseases are characterized by neuronal loss, dystrophic neurites, and cerebrovascular amyloid. AD occurs more often in woman (2/3 of AD cases) compared with men. The presence of extracellular β-amyloid peptide and hyper phosphorylated tau protein are typical of the physiopathology of the AD brain. Developed under the age of 65 years, the PSEN1 gene is located on chromosome 14q24.3. In the elderly over 65 years, the late-onset of AD, the gene coding for PSEN2 is located on chromosome 1q31-q42. For the late onset AD, the apolipoprotein E was associated to the main risk factors of developing the disease (including molecules such as clusterin, complement receptor, phosphatidylinositol binding clathrin assembly protein and sortilin). Four genes have been identified on chromosome 11. The Amyloid P Protein precursor (APP) encoded by the gene (APP) is located on chromosome 21q. Altered APP processing and Aβ accumulation shed light on the AD pathogenesis. TNFα may act as a diagnostic marker with high sensitivity and specificity in patients with AD. Studies have identified altered oral health conditions (periodontitis, caries, gingival bleeding, probing depth &gt;4 mm). Poor gingival health and oral hygiene increase with the severity of dementia. Dental professionals should use behaviour management techniques for developing preventive strategies in order to stabilize the lesions.

Enhancing special care dentistry with sensory-adapted dental environment: A comparative study.

To compare and evaluate the effect of sensory-adapted dental environment (SADE) and regular dental environment in reducing anxiety levels in children with intellectual disabilities. This study was carried out in children with mild intellectual disabilities aged 8-13 years. The developmental screening test was utilized in screening and including these children with IQ scores between 52 and 67, and after random allocation, children were subjected to oral prophylaxis in the SADE and regular dental environment. Anxiety levels were assessed at baseline, 5 min, and at the end of the procedure using Venham's anxiety rating scale, pulse rate, and blood pressure values. The data were coded and analyzed using software SPSS (IBM version 22.0) for statistical analysis. Comparison between the groups was done using independent t-test and repeated measured ANOVA for objective assessment of intergroup and intragroup anxiety levels, respectively, and using Mann-Whitney U-test and Friedman's test for subjective assessment of intergroup and intragroup anxiety levels, respectively. These findings suggest that SADE significantly decreased anxiety levels and cooperative behavior in children with mild intellectual disability and can be used as an alternative behavior management technique in effectively handling children with intellectual disability.

Effect of Various Distraction Techniques on Pain and Anxiety of Pediatric Dental Patients: A Systematic Review

Among the many behavior management techniques suggested to reduce dental pain and anxiety during treatment in children, distraction appears to be a safe and cost-effective strategy that has been proven to deliver a practical and comfortable experience throughout a quick, unpleasant dental procedure. Distraction treatment is thought to work because &quot;the feeling of pain has a large psychological component.&quot; Using the PubMed, Medline, and ScienceDirect databases, a thorough evaluation of

Prevalence and Parental Attitude Toward Nitrous-Oxide and Papoose-Board Use in Two Dental Referral Centers in Saudi Arabia: A Cross-Sectional Study.

BackgroundParental preferences and attitudes strongly influence dentists’ choices for managing children’s behavior in clinics. This study aimed to assess parental attitudes toward two behavior management technique (BMTs)—nitrous oxide (N2O) sedation and/or protective passive stabilization by papoose board (PB)—before and after their children received dental treatment at two referral centers in Jeddah, Saudi Arabia.MethodsParticipants were parents of healthy children who required dental treatment under N2O and/or PB over an 18-month period. Before and after dental treatment, parents answered a questionnaire on their attitudes toward BMTs used on their children. Parents were divided into three groups: Group 1 (parents of children who received N2O), Group 2 (parents of children who received PB), and Group 3 (parents of children who received both N2O and PB).ResultsOut of the 132 parents who answered the questionnaire, 106 (80.3%) were in Group 1, 10 (7.6%) in Group 2, and 16 (12.1%) in Group 3. More children of parents with low monthly family incomes were in Group 3 than Group 1 compared to other family-incomes.ConclusionParental attitudes toward N2O and/or PB improved after their children experienced BMTs. The future use of PB alone with their child’s sibling was parents’ least preferred BMT (p = 0.001).

Shining new light on dementia treatment: ADAS‐Cog and quantitative EEG evidence of cognitive improvement in early and mid‐stage dementia using self‐administered 1070 nm transcranial near‐infrared photobiomodulation

AbstractBackgroundThe current evidence supporting nonpharmacologic treatment of dementia has focused mainly on environmental or interactive interventions, e.g., music, sensory stimulation, simulated presence, and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation, exercise and reminiscence improved cognition. The strongest evidence for reducing emotional disorders so far has employed music, psychological interventions and reminiscence. PubMed lists 918 citations related to non‐pharmacological treatments for dementia with music therapy and behavioral management techniques being the most efficacious showing modest improvements at best. Non‐pharmacologic treatment interventions directed at reversing both cognitive and behavioral symptom of dementia are small, few in number and with wide variation in defining outcome measures, and little comparative data across approaches to guide further research efforts or systematic clinical applicability. Photobiomodulation using brief, daily, pulsed LED‐driven transcranial infrared light stimulation, has been shown to markedly alter both cognitive and behavioral symptoms in people with mild to moderate dementia. Improved functioning has been documented by both standard neuropsychological testing and noninvasive Quantitative electroencephalographic (QEEG) measures of functional connectivity. This presentation describes a multi‐site, randomized, placebo controlled, at‐home, self‐administered treatment protocol employing pulsed transcranial and intraocular 1068nm near‐infrared light to achieve reversal of cognitive decline, and improve dementia patient’s physical and interpersonal behavior. Study subjects (n=100) were evaluated at two locations at baseline, midpoint (30 days) and termination (60 days) using both Quantitative EEG and ADAS‐Cog and caregiver evaluation of subject’s change in ADLs. This trial was a replication of an earlier pilot trial and a recent safety/feasibility trial with no adverse events reported in any study. MMSE improved 21.0%, 4.8 points in the active treatment group and 1.6 points in the placebo group. Sleep duration increased in the active treatment group by an hour after 8 days of treatment and caregivers noted improved mood, energy, and positive engagement in daily activities. None of these functional changes were noted in the placebo arm subjects. Active group’s clock drawing improved 20% and no change in the control group. Logical memory recall improved 3.3 points (p&lt; .03) and time to completion of Trails A&amp;B decreased 23.7% (p&lt;.03).

Comparison between dexmedetomidine and esketamine in pediatric dentistry surgery.

BackgroundDexmedetomidine (D) and esketamine (K) are used for the sedation of pediatric dental surgery. This study was designed to compare the effect of intranasal D and K in producing moderate sedation for uncooperative pediatric dental patients.MethodsThis prospective single-center cohort study was conducted at the Maternal and Child Health Hospital of Hubei Province after approval of the Medical Ethics Committee. One hundred and fifty American Society of Anesthesiologists (ASA) grade I and II patients aged 3–10 years who were uncooperative and could not be managed by conventional behavior management techniques were included in this study. Patients were classified into four groups. Group K was administered with esketamine (0.5 mg/kg), and group D was given D1 (1 µg/kg), D2 (1.5 µg/kg), or D3 (2.0 µg/kg) intranasally. The outcome measurements included the sedation level, changes in vital signs, sedation onset and recovery times, analgesia, behavior, and overall success.ResultsThe sedation onset time was significantly shorter for K and D3 compared with D1 and D2. The recovery time was fastest in group D1. The overall success rate was highest in group D3, followed by the D2, D1, and K groups; however, the difference between them was not significant. The intra-and postoperative pain scores in the D3 and K groups were significantly lower than those in the D1 group.ConclusionsIntranasal D and K are effective in producing moderate sedation for uncooperative pediatric dental patients.