Module 5: Behavior Guidance
Special Care- Behavior Guidance

5.1 An Overview of Behavior Guidance

Behavior guidance is a continuum of interaction with a child and parents directed toward communication and education, while also ensuring the safety of both oral health professionals and the child. The goal of behavior guidance is to ease a child’s fear and anxiety about the dental office and oral health procedures while promoting parents’ awareness of the need for good oral health and the process by which good oral health is achieved and to provide oral health care in the most comfortable, least restrictive, safest, and most effective manner. Some children have cognitive disabilities, communication or emotional disorders, or medical conditions that interfere with their ability to understand and cooperate with oral health procedures or communicate with oral health professionals. Advanced behavior guidance techniques should be used only with this goal in mind, not for the convenience of the oral health team and office staff.

Some behavior guidance techniques are intended to maintain communication, while others are intended to stop uncontrolled or unsafe behavior. Behavior guidance techniques must be selected based on the level of the child’s oral health needs as well as on the child’s ability to understand, cooperate, and communicate. All behavior guidance techniques used during a visit should be documented in the child’s record. The techniques can change as the child matures or becomes more familiar with the dental office setting. Each technique must be integrated into an overall behavior guidance “package” individualized for each child. Acquiring history about the child’s communication skills and special health care needs at the first appointment using a form (such as the Getting to Know Me tool in module 2) is crucial to making dental visits a success and making the best possible decisions about behavior guidance techniques.

Oral health professionals are encouraged to use behavior guidance techniques consistent with their level of education and training. An oral health professional who is not comfortable guiding a child’s behavior, in partnership with parents, should refer the child to another oral health professional with more knowledge, skill, and experience. Oral health professionals can also coordinate with other health professionals (e.g., behavioral specialist, psychologist, physician, social worker) involved in the child’s health care to prepare the child for oral health visits.

A variety of factors may make guiding the behavior of CSHCN challenging. CSHCN may be uncooperative for the same reasons as children without special health care needs (e.g., fear transmitted from parents, an earlier unpleasant dental visit, inadequate or inappropriate preparation for the first visit to the dental office, ineffective parenting practices) or because of immature or impaired development. Lack of stability, muscle control, or impulse control can also result in physical behavior that can endanger the child or the oral health professional. The oral health team’s attitude, body language, communication skills, confidence, and patience are critical to creating a positive dental visit and to gaining trust from the child and parents. Behavior may vary within an appointment, for different types of services, or as the child develops. Sometimes behavior is unpredictable. A technique that works in one situation may not be successful for another procedure or on a different day. A technique that works for one oral health professional may not work for another.

To manage these situations, oral health professionals need to assess the child’s developmental capabilities, comprehension, and communication skills and use the least restrictive behavior guidance techniques appropriate for that child. Assessing the child’s reaction to staff wearing infection control attire such as safety glasses and masks as well as aspects of the office environment such as dental lights, suction, handpieces, and other electronic devices, is important. For some CSHCN, advanced behavior guidance techniques may be needed. (See section 5.4 “Advanced Behavior Guidance Techniques.”)

Tips for Promoting Cooperation in the Dental Office  1

  • Set the stage for a successful visit by involving the entire oral health team—including the receptionist, dental assistant, dental hygienist, and dentist—as well as parents in collaborative decision-making.
  • Use desensitizing techniques to help the child become familiar with and accept the dental office, staff, and equipment before oral health procedures begin.
  • Allow children to bring comfort items such as a stuffed animal, a blanket, or headphones to listen to music.
  • Make appointments short whenever possible, providing only oral health procedures that the child can tolerate.
  • Praise and reinforce good behavior, and try to end each appointment on a positive note.