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This chapter discusses various behavioral treatment options for comprehensive dental treatment in infants, young children, adolescents, and individuals with special healthcare needs.


The task of the pediatric dentist has not changed in the last 60 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. 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 changes in parenting styles during their years of practice may have contributed to an increase in behavior management problems in the dental setting. 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.

Today’s pediatric dental environment is designed to be child friendly. Consumer electronics, 21st century aesthetic 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. Parents who call to request sedation or general anesthesia for appointments to clean their child’s teeth because the child “cried at the last visit” often do not understand the indications, risks, benefits, limitations, or costs of anesthesia or sedation. 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.

The American Academy of Pediatric Dentistry has a long history of developing guidelines for behavior management. The most recent guidelines state that behavior guidance techniques must be tailored to the individual patient and practitioner. Successful behavior guidance enables the oral health team to deliver treatment safely and efficiently and to nurture a positive dental attitude in the child. The goals of behavior guidance are to establish communication, alleviate fear and anxiety, deliver quality dental care, build a trusting relationship between the dentist and child, and promote the child’s positive attitude toward oral/dental health care. Communication between the child and pediatric dentist is developed through an ongoing process of dialogue, both verbal and nonverbal, that involves facial expressions, body language, and voice tone, always taking into consideration the cognitive level of the child. This is a comprehensive, continuous method that must be individualized for each child.

All behavior guidance techniques, other than communicative techniques, utilized by the practitioner ...

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