MOBILE

Behaviour Guidance in Paediatric Dental Patients

Recommendations

Foundational Articles

Al Zoubi L, Schmoeckel J, Mustafa Ali M, Alkilzy M, Splieth CH. Parental acceptance of advanced behaviour management techniques in normal treatment and in emergency situations used in paediatric dentistry. Eur Arch Paediatr Dent 2019;20:319-23.

American Academy of Pediatric Dentistry. Best practices: Behavior guidance for the pediatric dental patient. 2015. Available at: https://www.aapd.org/research/oral-health-policies–recommendations/behaviorguidance-for-the-pediatric-dental-patient/. Accessed Feb. 23, 2020.

Davies C, Harrison M, Roberts G. UK national clinical guidelines in paediatric dentistry: guideline for the use of general anaesthesia (GA) in paediatric dentistry. Available at: https://scholar.google.com/scholar?hl=en&as_ sdt=0%2C21&q=Davies+C%2C+Harrison+M%2C+Roberts+G&btnG=. Accessed May 10, 2020. Hallonsten AL, Jensen B, Raadal M, Veerkamp J, et al. EAPD guidelines on sedation in paediatric dentistry 2005. Available at: https://www.eapd.eu/index.php/policies-and-guidelines. Accessed April 18, 2020.

Riba H, Al-Zahrani S, Al-Buqmi N, Al-Jundi A. A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl Scale. EC Dental Science 2017:16;269-75.

Prado IM, Carcavalli L, Abreu LG, et al. Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials. Int J Paediatr Dent 2019;29:650–68.

Scottish Dental Clinical Effectiveness Programme (SDCEP). Conscious sedation in dentistry: Dental clinical guidance, Third Ed.,2012, pp 1-48.

Background

There have been numerous behavioural guidance methods mentioned in the dental literature including: desensitization methods (tell-show-do, distraction, using child’s imagination, humour, and using euphemisms); positive reinforcement and praise; communicative techniques (ask-tell-ask); Background aversive techniques (voice control, hand-over mouth, protective stabilization); and pharmacological techniques (e.g., nitrous oxide-oxygen inhalation, sedation, general anaesthesia). Behaviour guidance techniques will differ in acceptability among countries, patient groups and dentists.

IAPD Recommendations

  1. When choosing the behaviour guidance techniques, the medical, dental and social history and cognitive level need to be considered. Consensus-based statement > Global agreement 100%

  2. To monitor and document child behaviour or anxiety over time, it is advisable to use a scale (e.g., the Frankl, Houpt or Venham behaviour scales) Consensus-based statement > Global agreement 91%

  3. Additional informed consent may be necessary for behaviour management techniques that may be considered aversive. Consensus-based statement > Global agreement 88%

  4. Behaviour management must be performed by adequately qualified dental providers with each country’s or state’s regulations followed. Consensus-based statement > Global agreement 88%

  5. In some cases, and if the dental needs allow, delaying the treatment or minimally invasive approaches can be an alternative to immediate treatment requiring aversive techniques, sedation and/ or general anaesthesia. Consensus-based statement > Global agreement 92%

  6. The most acceptable behaviour management techniques for parents include: tell-show-do, positive reinforcement, distraction, and nitrous oxide/oxygen inhalation. Consensus-based statement > Global agreement 84%

  7. Patient protective stabilization may be indicated for a patient who: requires immediate diagnosis/ urgent care; requires limited treatment and cannot cooperate; has uncontrolled movements due to age, has emotional or cognitive-developmental issues; or is necessary for the safety of the patient, staff, dentist, or parent. Consensus-based statement > Global agreement 79%

  8. Indications for sedation or general anaesthesia include: pre-cooperative and fearful patients for whom non-pharmacological behaviour guidance techniques are likely to be unsuccessful; patients who cannot cooperate due to physical, medical or special needs; and patients with extensive dental treatment needs or treatment of dental trauma. Consensus-based statement > Global agreement 96%

Other Recommendations