Behavior Guidance
Behavior guidance techniques are used to promote a positive dental attitude, safety, and quality dental care. Through communication, the dental team can assist your child to overcome fear and anxiety; teach coping mechanisms; and guide your child to be cooperative, relaxed, and self-confident in the dental setting.
Basic and advanced behavior guidance techniques have a proven track record of success and are a large portion of the training program for pediatric dentists.
Basic Behavior Guidance
- Tell-show-do
- Positive reinforcement
- Distraction
- Nitrous oxide/oxygen
- Skill building
Advanced Behavior Guidance
- Conscious sedation
- General anesthesia (in-office, in-hospital)
Basic Behavior Guidance
Tell-show-do includes:
- Verbal explanation of the procedure in phrases appropriate to the developmental level of your child (“Tell”)
- Demonstration for your child (“Show”)
- Completion of the procedure (“Do”).
Positive reinforcement includes:
- Rewarding desired behavior with praise, stickers or prizes, and toys.
Distraction includes:
- Diverting your child’s attention away from the actual dental procedure by using video games, movies, and television programs.
Nitrous oxide/oxygen
Nitrous oxide/oxygen, also known as laughing gas, is used to help relax children with mild anxiety or a gag reflex. This gas is most successful for the understanding child who is anxious about dental care. Laughing gas is a safe drug that has an onset time of about 5 minutes and loses its effect in about the same amount of time when your child returns to breathing room air. The recovery is rapid and complete, and your child may return to normal activities after the appointment. With most basic behavior guidance techniques, we use local anesthesia, a numbing agent to “make the teeth sleepy.” Often this is all that is required to complete treatment in a successful manner for cooperative children.
Skill Building
The Skill Building appointment is recommended for children who are very young and/or extremely anxious, and our basic behavior guidance techniques haven’t proven quite successful in accomplishing treatment.
This is a 15-minute appointment that allows your child one-on-one time with a member of our team to become more familiar with the dental environment. We will show your child how to be helpful in the dental chair by learning about the different tools we have to complete the treatment and experiencing the sounds and sights that he/she will encounter during their visit. This is accomplished in a fun and non-threatening manner so your child is able to build the skills needed to complete a dental appointment and trust us in the process. The next appointment type will be recommended based on the outcome achieved from the Skill Building appointment.
Advanced Behavior Guidance
These procedures are indicated for:
- Fearful, anxious children who are unable to cooperate with nitrous oxide alone.
- Children who are unable to cooperate due to lack of emotional maturity or mental, physical, or medical disability.
- Children for whom sedation or general anesthesia may protect the developing psyche and/or reduce medical risk.
For advanced behavior guidance, we use local anesthesia along with one of the following:
Conscious Sedation
Uses nitrous oxide plus a short-acting drug (Versed) that produces additional sedation and memory loss (in about 75% of children) for the duration of the dental treatment. The drug is given by mouth approximately 15 minutes before dental work begins. This technique is used for short procedures (less than 30 minutes). A recent, normal physical examination from your family physician or pediatrician is usually required.
Important notes about sedation:
Most of the time, your child will not be asleep during sedation with Versed. Children less than 25 pounds are not typically good candidates for this type of sedation. Also, there is no drug that works well for all children, since each individual child varies significantly in their metabolic rate and in their response to drug therapy. Sedation works successfully in about half of children. According to the pediatric dental literature, some children can have a paradoxical reaction to sedation medications, meaning your child may become agitated instead of sedated. Unfortunately, we cannot predict which children will have this response.
General Anesthesia
General anesthesia is a safe method to deliver needed dental care when sedation has been attempted and treatment is not able to be completed. All of your child’s treatment is completed in a single visit while he or she is asleep, safe, and comfortable. It is often the treatment of choice for:
- Emergency surgical procedures
- Children who require special medical care or have physical or emotional disabilities
- Children who require extensive treatment
- Children who are extremely fearful of the medical/dental environment and are unable to cooperate with sedation alone
- Children who live long distances from our clinic and have extensive treatment needs that would require multiple sedation appointments.
General anesthesia is the use of anesthetic gases and drugs that “put the child to sleep” and is administered only by an anesthesiologist or nurse anesthetist. Your child is unaware of dental treatment while under the influence of a general anesthetic. We perform general anesthesia in two different settings:
In Our Office:
Two certified registered nurse anesthetists, each with several years of pediatric experience, provide this service in our office. As a parent herself, Dr. Stacey trusts implicitly the level of care given by these providers and would trust them to put her own child to sleep for any procedure.
In the Hospital:
Dr. Stacey is on the medical staff at Providence St. Mary’s Medical Center. Often children with special healthcare needs require their dental treatment in a hospital environment. We are fortunate to work with our community hospital to be able to provide this service to our patients.
