Behaviour Management

• What is the Tx triangle?

  Child pt, parent, dental team
• 2 yr old qualities?

  • +++ attached to parent
  • short attention span
  • limited language
  • can follow simple instructions
  • fear of loud noise
  • exhibit negative behaviour
• 4 yr old


  • inquisitive
  • v legalistic
  • good imagination
  • developing and asserting independence
• late childhood


  • Less dependent on parents
  • IDs with members of same sex
  • More sophisticated use of language
  • 7 years ‘age of reasoning’
  • Sense of duty and accomplishment
• adolescent ?


  • identity formation
  • independent
  • emotional turmoil
  • moody
  • oversensitive to criticism
  • miserable for no reason
• Factors affecting anxiety

  • PMH
  • PDH
  • SH
  • awareness of dental issue
  • general temperament
  • parents
• Child behaviour categories?

  1. Pre cooperative
  2. potentially cooperative
  3. cooperative
  4. lacking cooperative ability
• internal factors affecting behaviour

  • tiredness
  • hungry
  • toothache
  • uncomfy
  • unwell
• External factors affecting behaviour


  • time of day
  • weather
  • company
  • noise
• Parental anxiety?

  Relationship between maternal anxiety and difficulties in child patient management at all ages. Consider presence, anxiety and attitude
• Parental attitudes?

  • overprotective
  • Manipulative
  • hostile
  • neglectful
• Presence of Parents


  • clinicians choice, state policy at first visit
  • generally behaviour unaffected unless younger than 4
• Parent in pros

  • silent support
  • emotional support
  • consent
  • involve in advice
• Parent out pros

  • reduce communication interference
  • no transfer of anxiety
  • dentist more relaxed
• Dental team considerations ?

  • Pre-appointment information
  • Waiting times
  • Dental environment
  • Communication
  • Manner
  • Structure of appointment
  • Appointment scheduling
• Pre apt letter?

  • Useful for parental and child anxiety
  • Welcome to practice
  • Photos of staff
  • Information about what will happen at first visit
  • Advice on preparing the child
  • Simple language
• waiting times?


  • long wait = worse behaviour
  • Activities in waiting room
• Aim of behaviour management?

  1. undertake Tx of child
  2. positive dental attitude
  3. reduce anxiety
  4. long term interest
• Behaviour management...


  improves communication

  reduces anxiety

  reinforces or eliminates patterns of behaviour
• Non verbal communication

  • continuous
  • can reinforce AND contradict verbal signs
  • inc. child friendly env, happy team
  • reinforces childs feelings to minimise stress
• Language

  • age appropriate
  • no jargon
  • no threatening explanations
• voice control ?


  • Controlled alteration of voice, volume, tone, pace
  • Used to direct patients behaviour
  • Especially useful in young children
  • Aims to improve attention and compliance
  • Establishes authority
  • Shown to decrease disruptive behaviours without producing long-term negative effects
• empathy


  +++ likely to complete Tx
• Stop signal ?


  • +++ control
  • raise alarm and rehearse
  • respond quickly to build trust
• Modelling?

  • either live or video
  • similar age
  • must show right behaviour
  • positive outcome for correct behaviour
• Distraction?


  • audio
  • short term
  • verbal
  • shifts pts attention
• Systemic desensitisation ?


  • Helps patients by repeated contacts
  • Hierarchy of fear producing stimuli constructed WITH patient
  • Exposure in ordered manner
  • Used in conjunction with relaxation
  • Only progress when patient feels comfortable
• Coping strategies?

  • efficacious in older children
  • coping promoting statements
  • relaxation or rationalisation
• Behaviour shaping?

  • Small, clear steps towards desired behaviour
  • Used in conjunction with positive and negative reinforcement 
• Positive reinforcement ?


  • Strengthening of behaviour pattern
  • Increases probability of that behaviour being demonstrated again
  • Positive reinforcers e.g. stickers
  • Social/emotional stimuli most powerful
  • Do not reinforce inappropriate behaviour
• Negative reinforcement ?

  • remove pleasant stimulus
  • applied consistently to all actions apart from the desired one
  • selective exclusion of parent