Table 1: Children's Anxiety Assessment Scales To help the practitioner evaluate the child’s developmental level as well as the impact of parental attitudes, behavior, and dental anxiety on the child, parents may fill out questionnaires such as those listed below: • Frankl Behavioral Rating Scale (assesses child’s behavior on a scale from positive to negative). • Toddler Temperament Scale (assesses child’s behavior at 12 to 36 months). • Behavioral Style Questionnaire (evaluates child’s temperament at 3 to 7 years). • Eyberg Child Behavior Inventory (assesses frequency and intensity of 36 common childhood behavioral problems). • Child Fear Survey Schedule – Dental Subscale (assesses child’s dental fear). • Parent-Child Relationship Inventory (evaluates parental attitudes and behavior that may cause childhood behavioral problems). • Corah’s Dental Anxiety Scale (assesses parental dental anxiety). Note . Adapted from: American Academy of Pediatric Dentistry. (2011). Guideline on behavior guidance for the pediatric dental patient. Pediatric Dentistry, 33 (6), 161-173. https://secure.advantagedental.com/images/files/Behavioral%20Guidance-AAPD%202011.pdf; Riba, H., Al-Zahrani, S., Al-Buqmi, N., & Al-Jundi, A. (2017). A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl Scale. EC Dental Science, 1 6(6). http://www.eccronicon. com>ecde>pdf>ECDE-16-00574; Shetty, R. M., Khandelwel, M., & Rath, S. (2015). RMS Pictorial Scale (RMS-PS): An innovative scale for the assessment of child’s dental anxiety. Journal of the Indiana Society of Pedodontics and Preventive Dentistry, 33 (1), 48-52. https://www.researchgate.net/publication/270657611_RMS_Pictorial_Scale_ RMS-PS_An_innovative_scale_for_the_assessment_of_child%27s_dental_anxiety; Pocket Dentistry. (2016). Special needs of anxious and phobic dental patients . https:// pocketdentistry.com/special-needs-of-anxious-and-phobic-dental-patients/. Modeling behavior
Modeling is often effective with children. Anxious children are shown a video of other children successfully undergoing a procedure similar to the one they are facing. Participant modeling involves the child imitating the skills demonstrated by the model (Appukuttan, 2016). This technique is reported to be more helpful in younger children such as those in the 4-to 9-year- Parental presence in the operatory The question of allowing parents into the operatory has been controversial for years, and responses range from very beneficial to very detrimental. The AAPD (2016a) notes that this type of parental involvement is becoming increasingly common and advises practitioners to adapt accordingly. This can entail a significant shift in thinking on the part of the dental professional. AAPD guidelines (2016a, p. 185) note the following objectives in allowing parents to stay: 1. Gaining the patient’s attention and improving cooperation. 2. Averting negative or avoidance behaviors. 3. Establishing appropriate dentist-child roles. 4. Enhancing effective communication among the dentist, child, and parent.
old age range (Oliver & Manton, 2015). Live modeling of peers or siblings is best used for pre-appointment teaching and is considered more effective in the reduction of pediatric anxiety compared to film modeling (Patil et al., 2017). This technique is most effective when the model and the patient are of similar age (Appukuttan, 2016). 5. Minimizing anxiety and achieving a positive dental experience. 6. Facilitating rapid informed consent for changes in treatment or behavior guidance. The question of whether to allow parental presence does not arise with some parents who may be unable or unwilling to extend effective support. A parent’s presence may be distracting to some dentists or make them uncomfortable. If this is the case, one option is to allow parents in the operatory for the initial visit but subsequently ask them to remain in the waiting room. Conversely, the dentist may actually find it helpful to have the parent in the room to distract the child by reading or talking about some pleasant subject during the procedure. might present with repetitive behaviors, psychiatric symptoms, or aggression that could result in injury to both patient and staff. Many dentists who lack experience in caring for patients with special needs or who are unfamiliar with appropriate behavioral guidance techniques may feel unqualified to provide necessary treatment and therefore refer patients with special needs to other practitioners (Moore, 2016). Appropriate facilities for these patients may be far from home or nonexistent. Dental teams experienced in the use of nonpharmacological behavioral techniques can be of great assistance to both patients with special needs and their caregivers. Patients with dental anxiety or severe dental phobia are considered an underserved special needs population as these issues usually preclude their ability to obtain routine preventive care (Pocket Dentistry, 2016). The Diagnostic and Statistical Manual of Mental Disorders has included dental phobia among its list of specific phobias (Singh et al., 2015). However, in addition to their phobia, these patients may have several other serious medical conditions. Often, dental personnel focus on the more obvious medical conditions and overlook the patient’s dental phobia. These patients may be labeled as uncooperative and, if they are treated at all, may be treated with the appropriate dental
Summary of nonpharmacological behavior guidance for fearful pediatric patients When used successfully, nonpharmacological behavior guidance techniques teach many children how to cope with their fears. However, there may be children who, like some very anxious adults, are unable to accomplish this goal with these techniques alone. These children may not be able to cooperate because of lack of psychological or emotional maturity; the presence of a mental, physical, or medical disability; or a combination of these impairments. These children may require protective stabilization, sedation, or general anesthesia (AAPD, 2016a). NONPHARMACOLOGICAL STRATEGIES FOR USE WITH FEARFUL OLDER ADULT PATIENTS AND PATIENTS WITH SPECIAL NEEDS According to the Special Care Dentistry Association (2016), Special Care Dentistry is that branch of dentistry that
provides oral care services for people with physical, medical, developmental, or cognitive conditions which limit their ability to receive routine dental care . Patients with special needs may include older adults or individuals with varied cognitive, physical, and functional impairments. People with special needs may have a higher level of dental fear and anxiety than that of the general population. For example, one study examined the anxiety levels of patients with hearing impairments (Suhani et al., 2016). The authors reported that compared with other studies, they saw higher levels of anxiety in those with hearing impairments. Although many patients with special needs are able to receive routine dental care in a dental office without difficulty, others may require special intervention. Patients with intellectual and developmental disabilities are vulnerable to poor oral health and can have unique challenges in maintaining oral hygiene as well as behavioral and communication challenges during dental treatment (Wilson et al., 2019) In all cases, patience and empathy are required when treating individuals who have physical or cognitive problems that complicate communication. Practitioners should also consider that a few of these patients
EliteLearning.com/Dental
Page 189
Powered by FlippingBook