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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.
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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
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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.
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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 ...