General strategies For very young children, scheduling should not interfere with nap times, and appointments should be made for times when the patient is likely to be most cooperative. It may be helpful to Dental office ambiance Children appreciate a bright, child-friendly reception room supplied with toys, puzzles, games, and children’s books and a corner equipped with child-sized furniture (AAPD, 2016a; Oliver & Manton, 2015). One study also reported that children in general prefer natural light, pictures on the walls, and an Communication Communication is the key to successful behavior guidance for children. Like adults, children respond to the tone of voice, facial expression, and body language of the dentist and the office staff. According to AAPD guidelines (2016a, p. 184), the objectives of nonverbal communication are to: ● Enhance the effectiveness of other communicative management techniques. ● Gain or maintain the patient’s attention and compliance. Because the dental hygienist is often the child’s first dental contact, the child’s experience with the hygienist can set the tone for the child’s entire dental experience. At the start of the appointment, a brief conversation between dentist or hygienist and the patient is appropriate to establish rapport. However, once treatment begins, the dentist or hygienist must clearly state what action is being requested of the child, for example, Children’s anxiety assessment scales Various assessment questionnaires have been designed specifically for use with pediatric patients (Riba et al., 2017). Parent questionnaires include those listed in Table 1. Two questionnaires designed to be answered by the child may also be useful in determining his or her feelings and degree Tell-show-do Tell-show-do, a popular form of behavior shaping previously discussed in the context of adult patients, was originally designed for use with children. According to the AAPD guidelines (2016a, p. 184), the objectives of tell-show-do are to teach the patient important aspects of the dental visit and familiarize the patient with the dental setting, and shape the patient’s response to procedures through desensitization and well-described expectations. Voice control Voice control, such as changing the volume, tone, or pace of one’s speech in order to deliver commands, is controversial because parents may find loud, sudden comments objectionable. Some authorities caution against using this technique, especially with certain cultures, which view this approach as a punishment (AAPD, 2015). In addition, although a commanding voice may result in less disruptive behavior, it can hurt the dentist-patient relationship by making the dental experience more unpleasant. Because of this, the AAPD (2016a) Distraction The AAPD guidelines (2016a, p. 185) list two objectives for the use of distraction: 1. Decrease the perception of unpleasantness. 2. Avert negative or avoidance behavior. Distraction can be passive or active. When successful, it decreases the child’s focus on the procedure and directs attention to something more pleasurable. Providing a TV, videos, and music is a commonly used strategy. Passive distractions, such as having a pet nearby, are not as effective as active participation in a pleasurable activity, such as playing a video game (Attar & Baghdadi, 2015).The use of visual or auditory stimuli, which are appropriate for the patient’s age, can be used in the waiting room and/or during dental treatment (Anthonappa
the parent and patient to be prepared and know what to expect on their first visit. One way to impart this information is via a customized web page.
aquarium or television to watch (Panda et al., 2015). It is recommended that the door between the waiting room and operatory be kept closed. As with adults, hearing sounds from the operatory, including the sound of a drill, may trigger children’s fear (Anthonappa et al, 2017). “Open wide for me so I can take a look at your teeth.” Cognitive rather than chronological age determines how much a child can understand. Bearing in mind that children vary widely in their cognitive development, practitioners should gear their communications to the developmental level of the child. Sentences should be short, and words should be simple. When the child responds appropriately to an instruction, positive feedback encourages the child to repeat the desired behavior. Feedback can take the form of praise, attention, touch, rewards, treats, or privileges (Oliver & Manton, 2015). Providing positive feedback at every stage of a procedure, immediately after the desired behavior, is more effective than a big reward such as a badge or small toy at the end of the session. If no reward is given, the desired behavior is less likely to be repeated.
of anxiety. The Facial Image Scale has pictures of faces and is designed for young children, and the Children’s Dental Fear Picture Test for children aged 5 or older assesses dental fear (Shetty et al., 2015).
This technique, which may be enhanced by showing pictures, drawings, or models, may be used with any patient and has no contraindications. It may provide the additional benefit of reassuring the parent, who can observe the attention their anxious child is receiving. As with adults, the effectiveness of this approach has not been particularly well studied. This technique is used in conjunction with verbal and nonverbal communication skills used by the dental staff and positive reinforcement (AAPD, 2015). It was less effective in children who had received dental care previously. recommends that practitioners explain this tactic to the parents beforehand to prevent any misunderstandings. According to the AAPD guidelines (2016a, p. 184), the objectives in using voice control are to: 1. Gain the patient’s attention and compliance. 2. Avert negative or avoidance behavior. 3. Establish appropriate adult-child roles. The technique may be used for all patients except the hearing impaired (AAPD, 2016a). et al., 2017). Allowing the child some active control can make a passive distraction more engaging. For example, the child wearing headphones may be given a remote control to change TV channels or change music tracks on a favorite CD. Short breaks requested by the patient are also a distraction. The child’s signal must not be ignored. However, children are apt to “test” the dentist even before the procedure begins. Such testing calls for an explanation that the signal must be reserved until necessary (Oliver & Manton, 2015). Various assessment questionnaires have been designed specifically for use with pediatric patients (AAPD, 2011). Parent questionnaires include those listed in Table 1.
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