Behavior Of Child In Dental Office Question And Answers

Behavior Of Child In Dental Office

Question 1. Write short note on child psychology.
Or
Write brief on Sigmund Freud Theory.
Or
Write brief psychological development from child to adolescent.
Answer. Psychology is the science dealing with human nature and behavior. It also includes understanding of the pattern of mental process characteristics of an individual.

Classical Psychoanalytical Theory

Sigmund Freud gives classical psychoanalytical theory for psychological development.

Freud proposed a structure called as psychic triad that essentially has three parts, i.e. id, ego, superego.

Id

• It is the most primitive part of personality.
• It is the basic structure of personality, which serves as a reservoir of instincts.
• The id is the source of all gratification and pleasure, it represents the unconscious, instructive urges that motivate behavior.
• Id can be defined as inherited reservoir of unorganized drives.
• It is governed by the pleasure pain principle, aims of immediate satisfaction of libidinal urges, is immoral, illogical and lacks unity of purpose.

Ego

• It is the ego that makes the necessary interaction with the social world possible and permits the needs of id to be satisfied.
• Ego can be defined as the integrating or mediating part of personality which develops out of interaction of id and environment.
• Ego is governed by the reality principle.
• Ego acts as a mediator between id and superego.
• Ego helps in channelizing id in social acceptable method.

Read And Learn More: Public Health Dentistry Question And Answers

Superego

• It is that part of personality that is internalized representation of the values and morals of society as taught to the child by parents and others.
• The superego acts as a conscience, it is the internal part of the individual that makes value judgments.
• Super ego stems from internalization of feeling love and hate, good and bad, praising and forbidding, reward and punishment.
• Superego is governed by the moral principle.
• Superego is linked to the social consciousness which is derived from familial cultural restrictions which are placed over the growing child.
  Freud believed that many personality disorders come because of a conflict between the ego and the superego.

Psychological Development of Child According to Sigmund Freud (Psychosexual Theory)

Freud postulated several major stages of development contributing to child’s behavior:

Oral Stage (Birth to 18 Months)

• It is characterized by the infant’s concern for his mouth and gratification, he feels from oral stimuli.
• Gratifying activities: Eating is the most obvious activity from which the child derives maximum pleasure. Sucking, biting, swallowing are also other gratifying activities.
• During this phase, the child’s personality is controlled by id.
• He demands immediate gratification of his desire.
• If child does not receive the sufficient gratification of pleasure at this age, fixation to this stage occurs as the individual becomes older, e.g. habit of digit sucking as the child gets older.
• If needs of the child are not adequately met he can develop pessimism, demandism, frustration and jealousy.
• If there is excessive oral gratification this leads to excessive optimism or narcissism.

Anal Stage

• This stage last from 18 months to 3 years of age.
• In this stage, bowel movements become a source of pleasure to the child.
• He may defecate often to achieve this pleasure which develop an ego. He comes to realize that he cannot always do what he wants, when he wants. He realizes his control over his needs and practices it with a fense of shame and doubt.
• In this stage, anal zone should be regarded as the principlezone of pleasure. Child derives gratification by expelling or by hoarding feces.
• Control over the sphincter leads to increased voluntary activity.
• During this stage there is development of personal autonomy and independence.
• Child realizes his control over his needs and practices with the sense of shame.
• When child is overemphasized by individuals on toilet training this leads to compulsive, obstinate and perfectionist behavior in later life known as anal personality while less toilet training leads to impulsive personality in later life.

Phallic Stage

• This stage lasts from 3 to 7 years.
• The child’s central interest shift to the genital region.
• Sexual gratification becomes more erotic during this time.
• He also recognizes the difference between boys and girls.
• According to Freud, the child’s feeling of attraction towards the parent of the opposite sex together with envy and fear of the same sex parent. So this stage is characterized by Oedipus complex and Electra complex.

Oedipus Complex

• Oedipus complex is seen in boys.
• Young boys are more attached to mothers and they consider father as their enemy.
• Oedipus complex originates from Greek mythology. Oedipus, the king of Thebes unwillingly slew his father and married his mother.
• Little boys adopt manner, attitude and interests of his father and they think that they become like their father, in this way they win their mother’s sexual love.

Electra Complex

• Electra complex is seen in girls.
• In this young girls develop an attraction towards the father and they resent the mother being close to the father.
• Electra complex was introduced after Agamemnon’s daughter, who arranged for her mother to be murdered in order to win her father’s love.

Latent Stage

• This stage lasts from 7 to 11 years.
• Freud believes that sexual impulses are suppressed in the service of learning.
• Maturation of ego take place during this stage andsuperego is firmly internalized.
• Degree of control is developed over the instinctual impulses.
• Better sense of initiative is developed by the child and he/she starts adapting to the adverse environment.
• Main aim of this phase is the growth of personality.
• If there is lack in the inner control or there is excessive inner control, this leads to immature behavior as well as decrease in the development of the skill.

Genital Stage

• The genital stage represents the resurgence of sex drive in adolescence and the more specific focusing of pleasure in sexual inter course.
• As this period progresses, the child makes contact and formrelationships with members of the opposite sex.
• Also at this time, the superego undergoes furtherdevelopment and becomes more flexible.
• Child has a material personality. Sense of identity develops and helps to separate from dependence of parents.
• Fluctuating extremities in emotional behavior andpreoccupation with philosophical and abstract thoughts predominate due to struggle to attain firm sense of self.
• Child is now more mature, able to make right decision andprepare to face the world.

Question 2. Explain the management of child in a dental clinic and parent counseling in respect of oral hygiene of the child.
Or
Write in brief on management of child in dental office.
Or
Write in brief on management of child in dental clinic.
Or
Write short note on management of child patient.
Answer.

Management of Child in a Dental Clinic

Communication

The hallmark of a successful dentist in managing child dental patient in his ability to communicate with them and win their confidence.

Objectives of Communication

They are as follows:

• Establishment of communication: This is done by involving a child in a conservation, the dentist not only learns about the patient but also may relax youngster.
• Establishment of communicator: Dental assistant talks with the child during transfer from reception room to operatory and during preparation of child on a dental chair.
• Message clarity: Message should be simple and easy to understand by a young child. Euphemisms can be used.
• Another important aspect of communication is ability of dentist to get the child respond to his commands.

Euphemisms

• Child should be addressed at his or her level of comprehension. The use of inoffensive or mild expressions may be substituted for those that suggest unpleasantness or are fear promoting. “Giving sleepy medicine on the tooth” is much less offensive and fear promoting than “I am going to give you an injection on your gum”.
• The dental staff as well as the dentist should be oriented to the use of a “second language.” It should be emphasized that word substitutes are most effectively used with preschool children.
  Tone of the voice can also be very effective in altering the child’s behavior. Change of tone or volume can be used to communicate a feeling or sense to the child. A kind, firm, or a soft or a loud voice says a lot to the child. It does not depend on what you say but it depends on how you say it.

Distraction

• In this, the patient is distracted from the sounds and/or sight of dental treatment thereby reducing the anxiety.
• Objective is to relax the patient and to reduce anxiety during treatment.
• Use stories and fairy tales.
• Use slow instrumental music.
• Relaxation effect of music and the sound of music will eliminate unpleasant dental sounds like the sound of handpiece.
• Choice of distraction is chosen by the patient; this will help child gain control over the unpleasant stimulus and give them a feeling of being in a familiar environment.
• Child seeing the audiovisual presentation will have multisensory distraction as he will tend to concentrate on the TV screen thereby, screening out the sight of dental treatment and the sound of the program will help eliminate the unpleasant dental sounds like the sound of handpiece.
• Types of distraction are:
  • Audio distraction: Patient listens to audio presentation through headphones throughout the course of the treatment.
  • Audiovisual distraction: Patient is shown audiovisual presentation through television during the entire treatment.

Behavioral Shaping

• It is based on the stimulus response theory and principles of social learning. The child is taught how to behave.
• The techniques for behavior shaping are:
  • Tell-show do technique: In this technique child is told about the treatment, showed the instruments and then treatment is actually carried out.
  • Desensitization: It is also known as reciprocal inhibition. It is helpful in reducing fear and tension.
  • Modeling: Modeling procedure allows a patient to observe one or more individuals (models) who demonstrate appropriate behavior in particular situation.

Steps in Modeling

• Patients attention is obtained.
• Desired behavior is modeled.
• Physical guidance of desired behavior may be necessary when patient is initially expected to mimic modeled behavior.
• Reinforcement of required behavior.
• Contingency management: It is the method of modifying the behavior of children by presentation and withdrawal of reinforcers. These reinforcers can be:
  • Positive reinforcer: It is one whose contingent presentation increases the frequency of behavior.
  • Negative reinforcer: It is one whose contingent with drawl increases the frequency of behavior.
    Reinforcements are:
    • Social: For example praise, positive facial expression, physical contact by shaking hand, holding hand, patting shoulder.
    • Material: Given in form of toys and games. Sweets should not be given as rewards.
    • Activity reinforcers: Involve child in watching TV show/ special program for him/her.

Behavior Management Techniques

• Audioanalgesia
  • It is also called as white noise.
  • This consists of providing a sound stimulus of such intensity that the patient finds it difficult to attend to anything else.
  • The effect is due to distraction, displacement of attention and a positive feeling on the part of dentist that it can keep.
• Biofeedback
  • In this method certain physiologic reactions of body are detected that may indicate fear, e.g. checking heart rate that may increase when patient is in stress.

Voice Control

• When normal communication tones and expression fails, voice control can act as positive reinforce.
• Voice control is most effective when used in conjunction with other communication.
• A sudden command to “Stop crying and pay attention” may be necessary measure for future communication.

Multisensory Communication

• Nonverbal message also can be used to send message.
• The clinician’s simple act of placing a hand on the child’s shoulder conveys a feeling of warmth and friendship.
• Eye contact is equally important.

Hypnodontics

• Use of hypnosis in dentistry is known as hypnodontics.
• Hypnosis is a state of mind in which suggestions are not only more readily accepted than in walking state, but are also accepted upon more powerfully than would be possible under normal conditions.

Coping

Patients differ not only in their perception and response to pain but also in their ways of dealing or coping with the stress associated with painful experience. The different coping mechanisms are:

• One coping mechanism is distraction or displacement of attention away from the threat.
• Frequently, the patient spontaneously endeavors to utilize this coping behavior by thinking of something pleasant or diverting.
• Verbalizing fears to others is another well-known way of copying.
• Another used by persons facing the threat of stress or pain employs affiliative behavior when people feel threatened, they prefer to be with others.

Relaxation

It involves a series of basic exercise which may take several months to learn and which require the patient to practice at home within 15 minutes each day.

Aversive Conditioning

• This method is used as a last resort for a very young, immature, physically handicapped or those who are mentally or emotionally afflicted.
• The two techniques are:
  • Home technique or hand over mouth exercise: Dentist gently but firmly places his hand over the child’s mouth. When the verbal outburst is completely stopped, the child is told that when he cooperates the hand will be removed. When the patient indicates his willingness to cooperate, usually by a nod of a head and cessation of attempts to stream, the hand is removed and patient is re-evaluated.
  • Physical restrain: They are useful and effective in facilitating the delivering of dental care for patients who need help for controlling their extremities and for managing resistant patients who need dental care but who are not candidates for general anesthesia.

Implosion Therapy

In this technique, patient is flooded with many stimuli which have affected him adversely. The child has no other choice but to face it until negative behavior disappear.

Retraining

It is required for children displaying considerable apprehensive or negative behavior.

• During retraining, the objective is to build new series of association in child’s mind.

Parent Counseling in Respect of Oral Hygiene of Child

• In infants and toddlers avoid frequent use of bottle with sugared milk or drinks as this will lead to nursing bottle caries. After feeding clean the gums of child and later on teeth with a cloth or soft brush after every meal or before sleep.
• In 3 to 6-year-old child, parents should be instructed to brush for the child for at least once a day, and to clean between any teeth that are in contact with each other with dental floss. Bedtime is ideal time to establish this routine.
• Parents need to remain active in supervising the home care practices of 6 to 12-year-old child. At this age, span a transition can be made from care provided by the parent to supervised self-care.
• At age of 10 years most children are capable of fine motor co-ordination necessary for adequate toothbrushing. Parents should continue to monitor brushing and flossing frequency and adequacy.

Question 3. Write short note on role of HOME in child management.
Answer. HOME refers to the Hand Over Mouth Exercise.

• It was first described by Dr Evangeline Jordan in year 1920.
• Lampshire named this technique as emotional surprisewhile Kramer called it as aversive conditioning.

Objectives

• To gain the attention of child which enable him/her communication with the dentist so the appropriate behavioral expectation should be explained.
• To eliminate inappropriate avoidance behavior to dental treatment.
• To increase the confidence of child in coping with anxiety and provoking dental stimuli.
• For assuring the safety of child in delivery of quality dental care.

Indication

In a healthy child who is able to understand and cooperate but who exhibit defiant, obstreperous or hysterical behavior to dental treatment.

Contraindications

• In an immature child.
• When it prevent child from breathing.
• When dentist is emotionally involved with the child.

Technique

In this technique dentist gently but firmly place his hand over the child’s mouth. With the verbal outburst completely stopped, the child is told that when he cooperates the hand will be removed. When the patient indicates his willingness to cooperate, usually by a nod of a head and cessation of attempts to stream, the hand is removed and patient is revaluated.

Question 4. Write in brief on parent counseling.
Answer. Parent counseling can be defined as educating the parents regarding the child oral health status, optimal health care and informing them about the prevention of potential dental disease.

Purpose

• Discussion of emotional problem of child.
• Knowing about the attitude of parents towards behavior management.
• Educating the parents about
  • Various dental diseases.
  • Their harms.
  • How to prevent.

Instructions to the Parents

• Not to voice their own personal fear.
• Never to use dentistry as a thrill.
• To familiarize their child to dentistry.
• Never to shame or scold regarding dental treatment.
• Not to promise the child regarding the treatment.

Parent’s Education Guidelines

• For infants
  • Dental development should be take care of
  • Dental disease should be told about
  • Appropriate feeding methods
  • Oral hygiene methods
  • Importance of primary teeth
  • Supplements fluoride 0.25 mg tab.
• For 3 to 6 year of age:
  • Diet counselling
  • Oral hygiene methods
  • Fluorides (once daily toothpaste)
  • Professional dental care (0.50 mg tab).
• For 6 to 12 year of age
  • Sealants
  • Diet counseling
  • Fluoride (Twice daily tooth paste or 1 mg tab)
  • Oral hygiene method
  • Habits.
• For adolescents
  • Oral hygiene methods
  • Diet counseling
  • Fluoride (No benefit of systemic fluorides)
  • In tobacco users: Parent should counseled, not to punish.

Question 5. Write short note on parent counseling in dental health of a child.
Answer. In infants and toddlers avoid frequent use of bottle with sugared milk or drinks as this will lead to nursing bottle caries. After feeding clean the gums of child and later on teeth with a cloth or soft brush after every meal or before sleep.

• In 3 to 6-year-old child, parents should be instructed to brush for the child for at least once a day, and to clean between any teeth that are in contact with each other with dental floss. Bedtime is ideal time to establish this routine.
• Parents need to remain active in supervising the home care practices of 6 to 12-year-old child. At this age span a transition can be made from care provided by the parent to supervised self-care.
• At age of 10 years most children are capable of fine motor co-ordination necessary for adequate toothbrushing. Parents should continue to monitor brushing and flossing frequency and adequacy.

Question 6. Write short note on growth chart.
Answer. It is also known as road-to-health chart.

• It was first designed by David Morley and later on modified by WHO.
• It is a visible display of child’s physical growth and development.
• It is designed primarily for the longitudinal follow up of a child so that changes over the time can be interrupted.
• Growth chart offers simple and inexpensive way of monitoring weight gain and in fact child health over a time.
• Growth charts can also be used to predict the expected adult height and weight of a child because, in general, children maintain a fairly constant growth curve.
• When a child deviates from his or her previously established growth curve, investigation into the cause is generally warranted.
• Growth charts are different for boys and girls, due in part to pubertal differences and disparity in final adult height.
• In addition, children with diseases such as Down syndrome and Turner syndrome follow distinct growth curves which deviate significantly from children without these diseases.
• As such, growth charts have been created to describe the expected growth patterns of several genetic diseases.

Uses of Growth Chart

• For growth monitoring.
• As a diagnostic tool for identifying high risk children.
• For planning and policy making by grading malnutrition.
• As an educational tool due to its visual character.
• It helps the health worker on type of intervention which is required.
• Good method for evaluating effectiveness of corrective measures.
• Used as a tool for teaching.