Module 5: Behavior Guidance
Special Care- Behavior Guidance

Key Points

  • 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.
  • 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. Other factors my include lack of stability, muscle control, or impulse control, which can result in behavior that can endanger the safety of the child or the oral health professional providing care.
  • Behavior guidance decisions must involve a parents and, if appropriate, the child.
  • 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.
  • Informed consent is the process of getting permission before conducting a health care intervention on a person. An oral health professional will ask for consent by providing the patient or, in the case of a minor or incompetent adult, parents, with relevant information about diagnosis, treatment needs, and potential consequences of the prescribed treatment so that an educated decision about treatment can be made by the patient or parents.
  • Communicative management and appropriate use of commands are used universally in dentistry with both cooperative and uncooperative children. It is the most fundamental form of behavior guidance.
  • Nitrous oxide/oxygen-inhalation sedation is a safe and effective technique in most cases to reduce anxiety and enhance effective communication.
  • Advanced behavior guidance techniques include protective stabilization, deep sedation, and general anesthesia. Some techniques require special certification, which may vary by state.
  • Protective stabilization should be used only when absolutely necessary to protect the child and oral health staff during oral health procedures. There are no universal guidelines for this technique that apply to all settings.
  • Sedation can be used safely and effectively with children who are unable to cooperate with oral health care owing to lack of psychological or emotional maturity and/or mental, physical, or medical disability. The need to diagnose and treat, as well as the safety of the child, practitioner, and staff, should be considered for the use of sedation. The decision to use sedation must take into consideration alternative behavioral guidance modalities, the child’s oral health needs, the effect on the quality of oral health care provided, the child’s emotional development, and the child’s medical and physical considerations.
  • General anesthesia is a controlled state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command. The use of general anesthesia is sometimes necessary to provide quality oral health care for children.