Behaviour Management Techniques in Pediatric Dentistry

Behaviour Management Techniques in pediatric odontology call of the article Model of p arntal word meaning of various air worry proficiencys utilise in pediatric dental practitionerryAbstractPurpose to evaluate the agnate credence of divergent appearance guidance techniques routinely used in pediatric odontology.Methods Forty p arnts were specifyn a image mag memorialize of different nine look steering techniques. (1.) Tell Show Do, (2.) Modeling, (3.) compulsive reinforcement, (4.) Distraction, (5.) verbalize control, (6.) Hand all over give tongue to dress, (7.) physical encumber, (8.) conscious drugging and (9.) common Anesthesia. P arnts were explained and asked to rate their bankers acceptance on visual parallel scale provided in formResults All the parents in the sample group completed the measure out form and among them 37 parents accepted the positive reinforcement technique as the nigh welcome. The least acceptable techniques were Hand ove r mouth exercise and physical restrain. The acceptance rate was in following order Positive Reinforcement, Tell Show Do, Distraction, Modeling, Conscious Sedation, General Anesthesia, Voice Control, Hand over Mouth Exercise, strong-arm defend. finding Parents favor to a greater extent than affirmative approaches and focal point techniques that engross demonstrations geared for the babys direct of accepting. Aversive teach uniform Physical Restraint, Hand over mouth exercise and congressman control is more strongly rejected than sedation and worldwide anesthesia. entrywayThe most imperative facet in pediatric dental manage is behavior focussing of the child. It saves the time of not only dentists but besides parents and child. The successful results can be obtained by the less anxious and tumesce managed child. (Wright G Z. Behavior Management in Dentistry for Children. Philadelphia, WB Saunders Co, 1975) And for managing such(prenominal) child, the topic of behavior ma nagement techniques has been explained in the literature.The intimate relationship among child, parent, dentist and society has been well explained by pedodontic triangle which provides proper child dental care. Not only this, but also it provides the data regarding the behavior management techniques to be used against the child. (Wright G Z. Behavior Management in Dentistry for Children. Philadelphia, WB Saunders Co, 1975. )(American academy of pediatric odontology Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 20072911524.) harmonize to Kupietzky, for better interpreting for their childrens accostment, parents can also participate actively in treatment decisions, and various behavior management techniques to modify their childrens behavior. This give ultimately diminish the parental anxiety. (Kupietzky A. Effects of video information on parental preoperative anxiety level and their perception of conscious sedation vs. general anesthesia for the dental treatment of their young child. J Clin Pediatr Dent 200631902) with growing concern about childrens rights and considering ethical aspects, pedodontists can no foresightfuler take for granted that parents will endorse any form of behaviour management technique without issue. (Klein A. Physical restraint, informed consent and the child patient. J Dent Child 55 121-122. 1987, Lawrence S M, McTigue D J, Wilson S, Odom J G, Waggoner W F, palm H W Jr. Parental attitudes toward behavior management techniques used in pediatric dentistry. Pediatr Dent 13 151-155. 1991.)Informed consent is having a growing blow on behavior management of children. The courts uphold that treatment by health care professionals without prior consent is array and the dentist who treats a patient devoid of consent may be liable (Brown 1976). It was state in the conference sponsored by American academy of pediatric dentistry in 1988 that informed consent must be obtained prior to usage any behavior mana gement technique in children. (American Academy of Pediatric Dentistry Behavior Management for the Pediatric Dental Patient last-place Proceedings of a Workshop,September 30 October 2, 1988, Iowa City, IA.) There are few studies which march that behavior management techniques are not evenly ack directlyledged by parents or guardians and many techniques are found to be objectionable. (Murphy M G, Fields H W Jr, Machen J B. Parental acceptance of pediatric dentistry behavior management technique. Pediatr Dent 6 193-198. 1984. , Peretz B, Zadik D. Attitudes of parents toward their presence in the treatment room during dental treatment to their children. J Clin Pediatr Dent 23 27-30. 1998.) several(a) studies have been through with(p) regarding acceptance of various behavior management techniques in children. It begins with the study done by Murphy et at who first encountered in differences in parental acceptance of behaviour-management techniques. In their study, they fulfilled th at make out-show-do technique was popular by most parents and general anesthesia and aversive conditioning techniques like physical restrain were least accepted. (Murphy MG, Fields HW, Machen JB. Parental acceptance of paediatric dentistry behavior management techniques. Pediatr Dent 1984 6 193-8.) Seven long time after this study an different study done by the Laurence et al stated that the enough write up is necessary for better understanding and acceptance each techniques by parents. (Lawrence SM, McTigue DJ, Wilson S, et al. Parental attitudes toward behavior management techniques used in paediatric dentistry. Pediatr Dent 1991 13 151-5.) Havelka in 1992 quoted in his study that the socioeconomic status also influence the acceptance of certain behavioral pass technique by parents. (Havelka C, McTigue D, Wilson S, Odom J. The influence of social status and prior explanation on parental attitudes toward behavior management techniques. Pediatr Dent 1992 14 376-81). Also, the ac ceptance of each behavior management technique is influenced by culture and geographic region. (Long N. The changing nature of parenting in America. Pediatr Dent 2004 26 121-4.)Till now there is only one Indian study was there regarding acceptance behavioral management techniques by parents. (Elango I, Baweja DK, Shivaprakash PK. Parental acceptance of pediatric behavior management techniques A comparative study. J Indian Soc Pedod Prev Dent 201230195-200)Thus, understanding parental acceptance regarding various behavior management techniques are very important which will ensure the proper child-dentist relationship as well as providing proper care. So the aim of this study was to assess the attitudes of parents towards different behavior management techniques used in pediatric dentistry.Materials and methods40 Parents were randomly selected from the department of pedodontics and preventive dentistry after the institutional commission ethical approval. (KA/PD- 06/2013) The inclusio n criteria was decided which were, Parents of children with age 4-15 long time with no front dental history, Parents who are willing to participate and able to view and understand the videotape and Parents of all socioeconomic status irrespective of their age, gender, income, educational status, and occupation.A master video tape of various 9 behavior management techniques was made victimisation the software windows movie maker v3.6. the behavior management techniques used were (1.) Tell Show Do, (2.) Modeling, (3.) Positive reinforcement, (4.) Distraction, (5.) Voice control, (6.) Hand over mouth exercise, (7.) physical restrain, (8.) conscious sedation and (9.) General Anesthesia. All the behavior management techniques which were shown in the master video tape were recorded in the department of pedodontics and preventive dentistry. Before each behavior management, it was explained. The master video tape was approved by four pedodontist having more than 10 years of experience. Th e techniques were presented in the same sequence to all parents as followsThe video tape was 8 minutes long duration with each technique describing 20-30 seconds. after watching each behavior management technique parents were asked to give the panorama. The judging form was filled by the parents contained the names of the techniques with two parameters of the visual analogue scale Acceptable, Not acceptableVideotape was projected using a laptop/ projector in the parent counseling room.() The subjects were asked to mark their opinion by using a vertical mark onto or avocation each techniqueResults fit to data analysis, the positive reinforcement was the most acceptable technique that was accepted by 37 parents (92.5%). The least acceptable technique was hand over mouth exercise and physical restrain that was accepted by only 5 parents (12.5%). The acceptance of various other behavior management techniques was in following order.(table 1) The same result is shown in the followin g bar diagram. (figure 3)DiscussionIn the past years, various studies were conducted regarding the parental acceptance of various behavior management techniques by Murphy et al, Lawrence et al, Frankel, Havelka et al. Scott and Garca-Godoy Eaton et al, Elango et al. According to this study, the most acceptable techniques are positive reinforcement (92.5%) and tell show do (87.5%). These findings are in correlation with previous study done by Murphy et al. The reason for the highest rating of positive reinforcement and tell show do technique may be the parent demanding for the more child friendly behavior that will inspire the child for proximo dental treatment.Also in Murphys study, it was showed that the sedation and general anesthesia was least acceptable by parents. (Murphy MG, Fields HW Jr, Machen JB. Parental acceptance of pediatric behavior management techniques. Pediatr Dent 198461938.) But in our study, General anesthesia and conscious sedation both were selected by 25 % o f parents. The reason may be, they dont want their child predict in the dental clinic and want multiple dental treatment in single sitting. It was concluded in the study by Eaton et al that in recent years, the approval for permission of nitrous oxide sedation has increased. (Eaton JJ, McTigue DJ, Fields HW, Beck FM. Attitudes of coeval parents toward behavior management techniques used in paediatric dentistry. Pediatr Dent 2005 27 107-13.) However in our study we found that a considerable number of parents (25%) approved this technique, which was more than the previous studies by Murphy.The least acceptable techniques are hand over mouth exercise (12.5%) and physical restrain (12.5%) These findings are in correlation with previous studies done by Murphy et al. 1984 Eaton et al 2005 and J. Luis de Len et al 2010. The reason for the same may be parents consider these techniques as illegal, unprofessional and not child friendly. HOME technique is also facing some controversy over a long period of time. For this reason many pedodontists are not using this technique and believe that parents may react negatively if they use this technique. (Bowers LT. The legality of using hand-over-mouth exercise for management of child behavior. J Dent Child 1982 49 257-65.) According to the report by Ouesis (2010) although HOME technique is eliminated from the AAPD guidelines, many dentists exempt accept this technique. (Oueis HS, Ralstrom E, Miriyala V, Molinari GE, Cassamassinmo P. Alternatives for Hand Over Mouth Exercise after its settlement from the clinical guidelines of the American Academy of Paediatric Dentistry. Pediatr Dent 201032223-8)Restrain the child by pediwrap was also the least accepted technique. However it was suggested by frankle that this technique can be the accepted techniques by the mother if the child ic un cooperative. (Frankel RI. The Papoose Board and mothers attitudes following its use. Pediatr Dent 1991 13 284-8)LimitationsAs the coin has two s ides, the limitation in this study should not be ruled out. The first is different parents might evaluate the video tape differently and second one is failure to analyze the stress level of parents during watching the video tape. Further studies can be donre to eliminate these limitations.ConclusionThe following two conclusions can be drawn from this study,Parents prefer more positive approaches and management techniques that involve demonstrations geared for the childs level of understanding.Aversive conditioning like Physical Restraint, Hand over mouth exercise and voice control is more strongly rejected than sedation and general anesthesia.