Behavior guidance techniques in pediatric dentistry
Answers
Behavior guidance techniques ,both nonpharmalogical and pharmalogical, are used to alleviate anxiety, nurture a positive dental attitude, and perform quality oral health care safely and efficiently for infants, children, adolescents, and persons with special health care needs.
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Answer:
The American Academy of Pediatric Dentistry (AAPD) recognizes that dental care is medically necessary for the purpose of preventing and eliminating orofacial disease, infection, and pain, restoring the form and function of the dentition, and correcting facial disfiguration or dysfunction.1 Behavior guidance techniques, both nonpharmalogical and pharmalogical, are used to alleviate anxiety, nurture a positive dental attitude, and perform quality oral health care safely and efficiently for infants, children, adolescents, and persons with special health care needs. Selection of techniques must be tailored to the needs of the individual patient and the skills of the practitioner. The AAPD offers these recommendations to educate health care providers, parents, and other interested parties about influences on the behavior of pediatric dental patients and the many behavior guidance techniques used in contemporary pediatric dentistry. Information regarding protective stabilization and pharmacological behavior management for pediatric dental patients is provided in greater detail in additional AAPD clinical practice guidelines.2-4
Methods
Recommendations on behavior guidance were developed by the Clinical Affairs Committe, Behavior Management Subcommittee and adopted in 1990. This document is a revision of the previous version, last revised in 2011. This document was developed subsequent to the AAPD’s 1988 conference on behavior management and modified following the AAPD’s symposia on behavior guidance in 2003 and 2013.5,6 This update reflects a review of the most recent proceedings, other dental and medical literature related to behavior guidance of the pediatric patient, and sources of recognized professional expertise and stature including both the academic and practicing pediatric dental communities and the standards of the Commission on Dental Accreditation.7 In addition, a search of the PubMed® electronic database was performed using the terms: behavior management in children, behavior management in dentistry, child behavior and dentistry, child and dental anxiety, child preschool and dental anxiety, child personality and test, child preschool personality and test, patient cooperation, dentists and personality, dentist-patient relations, dentist-parent relations, attitudes of parents to behavior management in dentistry, patient assessment in dentistry, pain in dentistry, treatment deferral in dentistry, toxic stress, cultural factors affecting behavior in dentistry, culture of poverty, cultural factors affecting family compliance in dentistry, poverty and stress and effects on dental care, social risks and determinants of health in dentistry, gender shifts in dentistry, protective stabilization and dentistry, medical immobilization, restraint and dentistry, and patient restraint for treatment; fields: all; limits: within the last 10 years, humans, English, birth through age 18. There were 5,843 articles matching these criteria. Papers for review were chosen from this list and from references within selected articles. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians.
Background
Dental practitioners are expected to recognize and effectively treat childhood dental diseases that are within the knowledge and skills acquired during their professional education. Safe and effective treatment of these diseases requires an understanding of and, at times, modifying the child’s and family’s response to care. Behavior guidance is the process by which practitioners help patients identify appropriate and inappropriate behavior, learn problem solving strategies, and develop impulse control, empathy, and self-esteem. This process is a continuum of interaction involving the dentist and dental team, the patient, and the parent; its goals are to establish communication, alleviate fear and anxiety, deliver quality dental care, build a