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This chapter discusses various behavior treatment options for comprehensive dental treatment in infants, young children, adolescents, and persons with special health care needs.


The task of the pediatric dentist has not changed in the last 50 years: to perform precise surgical procedures, measured in millimeters, on children whose behavior may range from cooperative to apprehensive to defiant. Additionally, these very precise surgical procedures require the child’s full attention and commitment for varying lengths of time. This need for full attention for varying lengths of time comes at an age when children appear to be more easily frustrated, focus on more egocentric thinking, and have more difficulty with impulsivity and inattentive behavior than ever before. Many parents today attempt to “become a friend” (perhaps a “Woodstock” effect of the baby boomer generation) to their child and lose the ability to set boundaries. In a survey of the American Academy of Pediatric Dentistry members on the use of behavior management techniques, the great majority of pediatric dental specialists (88%) believe that parenting styles have changed during their years of practice and that these changes may have contributed to an increase in behavior management problems in the dental setting.2 In a recent survey, 50% of parents bringing their children to a Children’s Hospital emergency department for after-hours emergency care expected that their child would be sedated for dental treatment.3


As American families in the 21st century become increasingly culturally diverse and better educated, and as they develop in new, perhaps more remote, family and social contexts, the US health care delivery system is experiencing parallel changes and is becoming more complex than ever before. Good evidence shows that parenting styles, parental attitudes toward and expectations of the delivery of pediatric dental care, the legal system, the insurance industry, and digital electronic advances are driving the available options for behavior management of children who require dental care.


Today’s pediatric dental environment is designed to be child friendly. Consumer electronics, 21st-century esthetic dental materials, leading-edge digital dental technology, and well-trained dental auxiliaries add to the child-friendly environment of today’s pediatric dental office. Decisions regarding behavior management of the pediatric dental patient must be made in concert with the parent and the dentist. Neither the dentist nor the parent can totally dictate the approach. Parents who call to request sedation or general anesthesia for appointments to clean the child’s teeth because the child “cried at the last visit” clearly do not understand the indications, risks, benefits, limitations, or costs of anesthesia or sedation.4 Similarly, the pediatric dentist must evaluate as part of the overall treatment plan the child’s potential for cooperation in light of age, individual growth and development, prior overall health and dental experiences, and the family’s attitude toward dental health. The pediatric dentist must then provide safe, competent, comprehensive, and relatively pain-free care in an affordable manner without creating fear. There is a considerable amount of literature on childhood ...

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