Behaviour Management of Crying Toddler in Dentistry

Behaviour oversight of Crying Toddler in DentistryManagement of Sobbing Tot In A Pediatric Dental Office- A ReviewABSTRACTThe most everyday way by which electric razor expresses worry and solicitude is by let loose at dental theatrical role. Proper knowledge and understanding is required to portray effective dental treatment to a child by the application of unlike behavi literal way techniques. Treating a egregious child is one of the most demanding and tiring situation encountered in dental practitionerry. Behavior solicitude in a strident child is a comprehensive continuous methodology targeted to build relationship between child, leaven and doctor aimed at eliminating business and anxiety and ultimately mental synthesis trust. This article was aimed to review the various reasons for foreplay of cry of child in dental office and behavior techniques employed by the dentist for proper management of the child.Key Words-Anxiety, Behavior Management, FearINTRODUCTION Behavior management is a comprehensive continous methodology targeted to build relationship between child, parent and doctor aimed at eliminating fear and anxiety and ultimately building trust. As most of the young children do not cooperate during dental appendages, thus a dentist plays a crucial role to forestall a irresponsible dental attitude, to guide the child through their dental experience and to perform quality treatment safely. 1Children and young adults and indeed all patients, exhibit some form of anxiety or fear when about to receive dental care. Many factors book been proposed as contri preciselyory to childrens anxiety about dental maps which include the dental clinic environment, equipments, past dental treatment experience and the attitude of the dental staff. To address these inducive factors, various behavior management strategies are being practiced which including verbal and non- verbal communication, tell show do distraction , presence or absence seizure of parents in the surgery, modeling, audio visual aids , positive living , visual aids, physical restraints, HOME(Hand over Mouth) technique, sedation, general anesthesia etc. 2Dental anxietyand fear has been a constant dynamic of the child patient. 2 A child patient tends to be anxious and fearful during dental treatment due to antecedent traumatic experience in dental office or during hospitalization for other purposes. It is very difficult to carry out any dental procedure if a child is uncooperative in dental office. It is crucial that a dentist mustiness understand and share the feelings of a child and show disturbance before starting any treatment.3 Treating a crying child is one of the most taxing and difficult job for a dentist due to unanticipated attitude of a child during treatment. Delivery of effective dental treatment in a crying child requires incorporation of various behavior passing techniques.Thus acquisition of skills that allow a dentist to handle such un conc urlable situations in the best possible way is of utmost importance. A dentist should take a childs cry as an advantage instead than a drawback as crying is a mode of expression of the genius traits, hence should be used as a diagnostic tool.3Dental fear and anxiety is a dilemma concerning pediatric patients, their parents, and dental professionals. Its prevalence in children and adolescents ranges from five percent to twenty percent. Fearful pediatric patients often tend to be uncooperative during dental visits. This renders treatment difficult or even impossible, causes occupational stress among dental staff, and increase the chance of discord between dental professionals and patients or their parents. Dental fear and anxiety are the main cause of dental avoidance that leads to deterioration of ones oral health and whitethorn impair ones psychosocial functioning and quality of life. 4Dental Fear Dental fear is defined as an unpleasant emotion caused by the threat of danger, pain , or harm during dental treatment. 5 It is characterized by change in body physiological symptoms due to changes in cardiovascular and respiratory systems. The response of a child commonly occurs by a real or imagined threat to his own safety. The patient readies himself in a fight or flight stance to either escape the stimulus or stands and conquer it. Rachmans model of fear acquisitioning is one of the most accepted theor, which is supported by several studies. This theory has proposed that fear might develop through three pathways treat conditioning (classical conditioning), vicarious conditioning (modelling), and information/ instruction. The second base and third pathways are manifestations of indirect fear acquisition.3Dental Anxiety Anxiety is a feeling of worry, nervousness, or unease about something with an uncertain outcome. Dental anxiety is defined as an abnormal fear of visiting the dentist for any dental procedure and unjustified anxiety over dental procedures and may have psychological, cognitive and behavioral consequences. Dental anxiety may be a problem in childhood as it is associated with poor oral health outcomes and an change magnitude dependence on costly spareist dental services. Children who show more anxious behavior have a greater chance of having dental diseases as compared to children who are non-anxious in the dental office. Dentists need to understand the anxiety of the child and implement procedures that enhance a feeling of control which include giving childs choices, helping within treatment or otherwise manipulating dental objects and acknowledging the childs experience.4Due to less communication skills exhibited by children, they are not able to properly express their fears and anxieties. When children cannot manage, they attempt to escape the upcoming event. This ultimately leads to crying of a child which also is a way of a child to show their anxiety and discomfort. 3,4 Different anxieties and fears that children ha ve about visiting the dentist areMostly children are anxious during a new experience. There is incredulity about what is going to happen which increases the childs restlessness.Past negative experiences associated with medical treatment may be co-related with more anxiousness in dental treatment as well.Previous fearful dental visits have also been related to poor behaviour at subsequent visits.The parents who are unable to hold up their own dental anxieties, make the child more conscious.Mass mediaandcartoonsalso contribute to the negative image of dentist which may lead to development of dental fear.Management of Crying child during Dental TreatmentSuccessful treatment of a disruptive child depends partially upon selection of an appropriate behavior management technique. to each one child possess different behavior pattern on visiting the dentist. For managing a child in dental office various factors have to be seen like -the type of behavior, the childs anxiety, age of the chi ld, child rearing techniques, personality variables, parental attitudes toward behavior management techniques, dental treatment to be rendered and the jural implications.6Behavior management is of children in clinics is an integral part of pediatric dentistry. It is not just the application of individual technique formulated to deal with individuals but rather a comprehensive methodology meant to build a relationship between patient and dental professional. Behavior counsellor is based on scientific principles but also requires skills in communication, coaching, tolerance, and active listening.The aim of the behavior management is to instill a positive dental attitude on patient, alleviate fear and anxiety, deliver quality dental care, build a trusting relationship between dentist, child, and parent and create long term interest on patients part so as to facilitate ongoing prevention and improved dental health in the future. Since the child may enter the dental office with some fe ar and anxiety, the first objective of the dentist should be to put the child at his ease and make him realize that this experience is not unusual. It is make better to have morning appointments for patients and dentist should be realistic and reasonable to the child. This may help in developing a positive attitude of the child towards the dentist. Parents keep a significant influence on the behavior of their children. Most of the characteristics of the child like behavior, personality, anxiety and reaction to stress are directly influenced by parents characteristics. Parents should be educated before their childs visit as it may be helpful in promoting a positive dental experience.Behavior Guidance is a continuum of interaction involving the dentist, the dental team, the patient and the parent directed towards communication and education which ultimately builds trust and allays fear and anxiety. Both non pharmacologic and pharmacological behavior guidance techniques may be used by dental health care providers in providing oral health care for infants, children, adolescents, and persons with special health care needs.Some of the behavior modifications techniques include-Communication and communicative guidanceFirst objective in successful management of a crying child is to establish communication. By involving the child in communication, the dentist not only learns about the patient but also helps in relaxing the patient. The fear and anxiety of the child demands that each step should be explained. Appropriate use of commands may help the child develop a positive attitude toward oral healthDistractionDistraction is a newer method of behavior management of diverting the childs attention from sounds or sight of dental treatment, thereby reducing anxiety. Audio or Audiovisual distraction volition help in eliminating dental sounds and sight of the dental treatment, hence helping in gaining control of the child.Voice controlAnother modification of behavior modi fication in crying child is controlled alteration of voice volume, tone, or pace to influence and direct the crying childs behavior. It helps the dentist to gain the patients attention and compliance and to avert negative behavior.Positive reinforcementPositive reinforcement is an effective technique to reward desired behaviors and, thus, strengthen the recurrence of those behaviors. If a child stops crying or show good behavior he should be rewarded with tokens or toys.Tell-show-doTell-show-do technique can help in modifying the behavior of a crying child. It is the cornerstone of behavior management given by Addleston in 1959. The technique involves the dentist telling the child what is going to be done in words the child can understand. Second, the dentist demonstrates the child exactly how the procedure will be conducted and then, without deviating from the explanation and demonstration, completion of the procedure.Conscious SedationNitrous oxide/oxygen inhalation helps in provi ding a minimally depressed level of soul which helps in reducing anxiety and enhancing effective communication in a crying child. Its onset of action is rapid and the child responds appropriately to physical stimulation and verbal commands. The effects are reversible and recovery is rapid and complete. But before giving conscious sedation, proper diagnosis and treatment planning must be done. 6Other techniques include hand-over-mouth exercise (HOME) and medical immobilization. The behaviors of the dentist and dental staff members play an important role in behavior guidance of the pediatric patient. Successful behavior management enables the oral health team to perform quality treatment safely and efficiently and to nurture a positive dental attitude in the child. 6Knowing that pain is not the only reason for a child to cry during dental treatment will help parents and dentists to understand why a childs behavior is managed a certain way. As the children learn to cope with the denta l situation, the crying usually eases up. The learning process varies in every child. The role of the pediatric dentist is to help the child to get through his dental experiences so that the child may develop a positive attitude towards dentistry.CONCLUSIONThe most common emotional upsets exhibited during dental treatment are anxiety and fear and the most common way a child expresses fear is by crying at the dental ofce. The pediatric dentist can use an appropriate behavior management technique to make the child cooperative throughout the dental procedure and can help the child to develop a positive attitude towards dentistry.1