The Functional Inquiry

1) Goals:
a) Learn pt and parent concerns
b) Estimate level of cooperative ability
2) Methods:
a) Written questionnaire
b) Direct interview
3) Sample questions:
a) Reaction to past medical experiences?
b) Parental anxiety level?
c) How ill the pt react to an exam?
4) Functional inquiry review of medical history:
a) ADHD
e) Is it 1st visit to dentist?
b) Learning disability
f) Childs hobbies
c) Mental health disorder g) Parent/guardian comments
d) Drug/alcohol abuse
h) Pts medications
Behavior Management Techniques
1) Goals:
a) perform quality dentistry for pt
b) promote positive pt attitude and confidence in themselves in dental environment
2) Pre-appointment strategies
a) brochure or discussion w/ parent
b) videotape presentation
c) modeling w/ siblings or parents
3) Techniques
a) Behavior shaping
b) Aversive conditioning
Behavior Shaping
-procedure that slowly develops behavior by reinforcing successive approximations to a desired goal
-reinforcement of desired behavior may be verbal or nonverbal (SMILE, WINK, ETC.) which are very effective
-reinforcement should be immediate and specific to the desired behavior
-nonspecific behavior (you are a good boy) is not helpful and bores pt after several uses
-good example of behavior shaping in the Tell-Show-Do technique (most impt behavior management tech.)
-dentist explains a procedure to child using age-appropriate terminology (Tell), familiarizes pt
w/instruments and procedures by gentle demonstration (Show), then performs the procedure (Do)
-is indicated for children of all types of behavior/cooperation levels
Aversive Conditioning
-psychological strategy that uses some form of negative stimulus w/ purpose of extinguishing or improving negative
behavior
-indicated for children over 3 yrs of age that are momentarily uncontrolled or defiant
-not indicated for children under 3 yrs, timid, tense-cooperative, or lack cooperative ability (mentally challenged)
-several variations of aversive conditioning exist:
a) voice control (use firm tones)
b) hand-over-mouth exercise (HOME)
-aversive conditioning should always be followed by positive reinforcement for improved behavior
-communication w/ parent before and after aversive conditioning is a necessity
-aversive conditioning exposes dentist to liability so parental informed consent should be obtained prior to use
Miscellaneous Techniques for Behavior Management
1) Appt length: studies conflicting regarding appt length on childs behavior
2) Appt time: some dentists believe morning is better b/c pt is rested while others think afternoon is better b/c pt is
less active and more manageable
-one study showed no real difference in appt time on behavior