Six Techniques for Managing Behaviour in Pediatric Dentistry

Voice control

Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patient's behaviour.

Objectives:
(i) To gain the patient's attention and compliance.
(ii) To avert negative or avoidance behaviour.
(iii) To establish appropriate adult-child roles.

Indications: May be used with any patient.

Contraindications: None.

Non-verbal communication

Non-verbal communication is the reinforcement and guidance of behaviour through appropriate contact, posture, and facial expression.

Objectives:
(i) To enhance the effectiveness of other communicative management techniques.
(ii) To gain or maintain the patient's attention and compliance.

Indications: May be used with any patient.

Contraindications: None.

Tell-show-do

Tell-show-do is a technique of behaviour shaping used with both verbal and non-verbal communication.

Objectives:
(i) To teach the patient important aspects of the dental visit and familiarize the patient with the dental setting.
(ii) To shape the patient's response to procedures through desensitization and well-described expectations.

Indications: May be used with any patient.

Contraindications: None.

Positive reinforcement

Positive reinforcement is the process of establishing desirable patient behaviour through appropriate feedback.

Objectives:
(i) To reinforce desired behaviour.

Contraindications: None.
 
Indications: May be useful for any patient.

Parental presence/absence

Parental presence/absence involves either allowing or removing the parent(s) from the dental surgery in order to gain cooperation.

Objectives:
(i) To gain the patient's attention and compliance.
(ii) To avert negative or avoidance behaviours.
(iii) To establish appropriate adult-child roles.
(iv) To enhance the communication environment.

Indications: May be used with any patient.

Contraindications: None.

Hand over mouth exercise

Hand over mouth exercise is a technique for managing unsuitable behaviour that cannot be modified by the more straightforward techniques. It is often used with inhalation sedation (conscious sedation).

Objectives:
(i) To redirect the child's attention, enable communication with the dentist so that appropriate behavioural expectations can be explained.
(ii) To extinguish excessive avoidance behaviour and help the child regain self-control.
(iii) To ensure the child's safety in the delivery of quality dental treatment.
(iv) To reduce the need for sedation or general anaesthesia.

Indications:
(i) A healthy child who is able to understand and co-operate, but who exhibits obstreperous or hysterical avoidance behaviours.

Contraindications:
(i) In children who, due to age, disability, medication, or emotional immaturity are unable to verbally communicate, understand, and co-operate.
 (ii) Any child with an airway obstruction.

Other techniques such as sedation in all its forms and general anaesthesia are described elsewhere.