#DEN4001
#D4/S1/W8
#SND

Behavioural Management

Prevention

• avoiding stress of first visit being precipitated by pain and fear
• acclimitising and desensitising people to dental in home or other location
• positive speak about the dentist, reading material, audio visual
• some type of exposure therapy before the appointment

Location

• introducing dental team in another setting they are familiar with
• comfort in familiarity once they arrive to clinic

Access

• size of rooms, lift access, ramps, stairs
• size of doorways, handrails, AV material
• public transport, disability access car parking, protection from weather, ramps into facility, ample parking

Timing

• some people more comfortable and compliant at certain times of day
  • behavioural changes and rhythms
  • medications
  • interruption to routine

Clinic environment

• sensory triggers
• aural pitch, cadence, volume, language
• body language, clothing, gender
• presence of family members/ carers

Treatment planning

• timing and sequencing, simple to complex?
• hand then rotary?
• treatments without LA first and progress to introducing it
• prevetion to perio to resto to surgical
• need to treat under restraint?

Specific behavioural techniques

• shaping
  • reward successive approximations to a target behaviour
• modelling
  • correct behaviour is demonstrated for the learner
  • learner observes the model, then imitates behaviour of the model
  • undesirable behaviours can be modelled as easy as positive ones can
• suggestion
  • guide the thoughts and behaviours through proposals

Pain and anxiety control

• fear
  • emotional response to perceived threat
  • basic survival mechanism occurring in response to specific stimulus, such as pain or threat of danger
• anxiety disorder
  • blanket term for several different forms of abnormal and pathological fear and anxiety
• phobia
  • irrational, intense and persistent fear or certain situations, activities, things, animals or people
  • main symptoms is excessive and unreasonable desire to avoid the feared stimulus
  • generally cause by event recorded in the brain and labelled as deadly or dangerous
• Measuring anxiety
  • Corahs dental anxiety scale
  • 

Management of anxiety

• optimal communication
• empathetic approach
• prepared to take alternative pathways
• establish preventitve strategy immediately
• address acute pain as soon as possible
• do follow up and review at short intervals
  Behavioural techniques
• distraction
• suggestion
• relaxation/hypnosis
• cognitive and behavioural therapy
• systematic desensitisation
  Pharmacological techniques
• GP prescribed or dentist prescribed
• illict: beware consent and compliance issues
• herbal calmatives
• conscious sedation (oral, inhalation, intranasal, intravenous)
• general anaesthesia
  Management of pain
• may need to consider treatment adjuncts used in order to perform dental procedures
  Diagnosis of pain
• need to be able to understand their pain experience in order to treat them appropriately

• gauge pain off presentation, abbey pain scale
• 

Restraints

• physical restraints not used anymore

Chemical restraints

• drug used for discipline or convenience and not require to treat medical symptoms
  • oral sedfation
  • nasal/inhalation sedation
  • intravenous sedation
  • intramuscular sedation
  • intranasal
  • per rectum
  • general anaesthetic
• may be needed based on compliance, anxiety and access for treatment
• used if other methods have not worked, and it is deemed safe for patient to undergo treatment under chemical restraint
• must consider
  • patient age
  • patient overall health
  • weight/body mass index
  • money
  • risk vs reward