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INTRODUCTION : it is a non-pharmacological

behaviour management technique.

WHAT IS BEHAVIOUR ?

The term behaviour is broadly used to


include the entire complex of observable
& potentially measurable activities
including motor , cognitive & physiological
classes of responses.
WHAT IS BEHAVIOUR MANAGEMENT ?

It is the means by which the dental health


team effectively & efficiently performs
treatment for a child & at the same time
instills a positive dental attitude.

-WRIGHT (1975)
WHAT IS AVERSIVE CONDITIONING
TECHNIQUE ?
 Aversive conditioning is the extension of
overall behaviour guidance designed to
facilitate the goals of communication,
cooperation & delivery of quality oral health
care in difficult children.

 It is a safe & effective method of managing


extremely negative behaviour by a child
while receiving dental treatment.

 Dentist using it should obtain parental


consent prior to its use.
IT INCLUDES 3 PRACTICES:

Voice control

Hand-over-mouth exercise (HOME)

Physical restraint/Treatment immobilization


VOICE CONTROL
o Voice control is a controlled alteration of
voice ,volume, tone,or pace to influence &
direct the patients behaviour .

o Parents unfamiliar with this technique may


benefit from an prior explanation to prevent
misunderstanding.
OBJECTIVES:

1) To gain patient’s attention & compliance.

2) To avert negative or avoidance


behaviour.

3) To establish authority.
HAND-OVER-MOUTH EXERCISE
popularized by : EVANGELINE JORDAN
(1920)
OBJECTIVES:
1) To redirect child's attention enabling
communication with the dentist so appropriate
behavioural expectations can be explained.
2) To extinguish excessive avoidance behaviour
& help the child to regain self control.
3) To ensure the child’s safety in delivery of
quality dental treatment.
4) To reduce the need for sedation or G.A .
INDICATIONS:

1) For potentially uncooperative child who tries


to avoid dental treatment
2) A healthy child who is able to understand
& cooperate , but who exhibits
obstreperous or hysterical avoidance
behaviour
3) 3 to 6 yr-old child

CONTRAINDICATIONS:

1) Child under 3 yrs of age


2) Special child (physically, emotionally
& mentally compromised)
3) Child with airway obstruction
4) If dentist is emotionally involved
with the patient
METHOD:

 The dental assistant is asked to hold the


flaring arms & limbs of the child.

 The dentist places his hand over the child's


mouth ,so as not to block breathing.

 Then the behavioural expectations are


calmly explained close to the child’s ear.
 The hand is removed as soon as the child's
behaviour improves.

 It is important to realize that this is not a


punishment, it actually rewards good behaviour
by removing the hand when the child calms
down.

 The whole procedure should not last for


more than 20 seconds.
MODIFICATIONS:

1) HOM with airway unrestricted

2) HOM with airway restricted (HOMAR)

3) Towel held over nose & mouth

4) Dry towel held over nose & mouth

5) Wet towel held over nose & mouth


HOM with airway unrestricted

HOM with airway restricted


PHYSICAL RESTRAINT

•NEEDED FOR CHILDREN WHO ARE :


Hyper motive
Stubborn
Defiant
- Kelly (1976)

•A broad definition of physical restraint is the


direct application of physical force to a
patient with or without the patient’s
permission to restrict his or her freedom of
movement.
IT MAY BE

ACTIVE PASSIVE
Performed without Performed with
restraining device restraining device

OBJECTIVES:

 To reduce or eliminate unwanted movement.


 To protect patient, staff or dentist from
injury
 To facilitate delivery of quality dental
treatment.
INDICATIONS:

1) A patient who requires immediate diagnosis &


/ or limited treatment & can’t cooperate due
to lack of maturity & / or mental or
physical disability

2) When the safety of the patient , staff,


dentist or parents would be at risk without
the protective use of stabilization

3) Child who is becoming tired from long


appointments
4) A sedated pt who requires limited
stabilization to be helped in reducing
unwanted movement
5) Stubborn child who constantly closes his
mouth in order to avoid treatment

CONTRAINDICATIONS:
1) A cooperative non-sedated patient
2) A patient who cannot be immobilized
safely due to associated medical or
physical condition
3) A patient who has experienced previous
physical or psychological trauma from
protective stabilization (unless no
alternatives are available)

4) A non-sedated patient with non-emergency


treatment requiring lengthy appointments

PRECAUTIONS:
1) Tightness & duration of the stabilization
must be monitored & reassessed at regular
intervals

2) The stabilization around extremities or the


chest must not actively restrict circulation
3) Stabilization should be terminated as soon
as possible in a patient who is experiencing
severe stress or hysterics to prevent
possible physical psychological trauma.

TYPES OF RESTRAINTS:
FOR BODY:
•Pedi wrap
•Papoose board
•Sheets
•Beanbag with straps
•Towel & tapes
FOR EXTREMITIES:
•Velcro straps
•Posey straps
•Towel & tapes
FOR HEAD:

•Head positioner
•Forearm body support

FOR MOUTH:

•Mouth blocks
•Banded tongue blades
•Mouth props
PEDI WRAP

SHEET
PAPOOSE BOARD
BEANBAG

TOWEL WITH TAPES


HEAD POSITIONER

SHEETS

FOREARM BODY
SUPPORT

FourthMolar.com
VELCRO STRAPS
POSEY STRAPS
MOUTH BLOCKS
BANDED TONGUE BLADE
HEAD POSITIONING DONE BY EXTRA ASSISTANT
PARENTAL AID IN BODY SUPPORT
EXTRA ASSISTANT IMMOBILIZING
THE CHILD
SUMMARY:

It is a non-pharmacological behaviour
modification technique for the children
showing excessive avoidance behaviour.
3 tools are:
voice control
hand-over-mouth exercise
physical restraint
Main objectives:
-to avert excessive avoidance behaviour
-to gain patient’s attention & compliance