Behavior Guidance for the Pediatric Dental Patient

Abstract

This best practice provides health care personnel, parents, and others with information for predicting and guiding behavior in children during dental procedures. Successful treatment of pediatric dental patients depends on effective communication and developing customized behavior guidance plans dependent on the patient’s treatment needs and the skills of the dentist. Behavior guidance is a continual process from basic to advanced techniques, using non-pharmacological and pharmacological options.When considering behavior guidance options, the following factor should be included and documented: medical history, temperament, informed consent (including risks, benefits, and alternatives), pain assessment, acuity of treatment needs, previous behavior during treatment, previous behavior guidance techniques used, and any alternative treatment options including no treatment or deferred care. Basic behavior guidance includes communication guidance, positive pre-visit imagery, direct observation, tell-show-do, ask-tell-ask, voice control, non-verbal communication, positive reinforcement and descriptive praise, distraction, and desensitization. For anxious patients and those with special health care needs, additional behavior guidance options include sensory-adapted dental environments, animal assisted therapy, picture exchange communication systems, mind-body therapies such as biofeedback and breathing exercises, and nitrous oxide-oxygen inhalation. Advanced behavior guidance includes protective stabilization, sedation, and general anesthesia. Each option requires an evaluation of objectives, indications, contraindications, and precautions. Knowledge of these options will aid healthcare professionals in providing patient-specific and family-centered behavior guidance for infants, children, adolescents, and persons with special health care needs.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry
Councils on Clinical Affairs and Scientific Affairs to offer updated information and recommendations to inform
health care providers, parents and others about the behavior guidance techniques used and behavioral influences impacting contemporary pediatric dental care.

^{KEYWORDS: ANESTHESIA, GENERAL; SEDATION; BEHAVIOR THERAPY, NITROUS OXIDE; DENTAL ANXIETY; PEDIATRIC DENTISTRY}