combating dental anxiety.
Another approach that could be considered a cognitive approach is distraction. This
technique attempts to shift attention from the dental setting towards some other kind
of situation. Distracters such as videotaped cartoons and stories have been used to
help children cope with dental treatment. The results have been somewhat equivocal
and the threat to switch off the video was needed to maintain co-operation.
2.6.4 Relaxation
Relaxation training is of value where patients report high levels of tension, and
consists of bringing about deep muscular relaxation. It has also been used in
conjunction with biofeedback training. As the techniques require the presence of a
trained therapist, the potential value in general paediatric dentistry has still to be
assessed.
2.6.5 Systematic desensitization
The basic principle of this treatment consists of allowing the patient gradually to
come to terms with a particular fear or set of fears by working through various levels
of the feared situation, from the 'mildest' to the 'most anxiety' programme.
This technique relies on the use of a trained therapist and in most instances a simple
dentally based acclimatization programme should be tried first.
2.6.6 Hand over mouth exercise (HOME)
The physical restraint of children in order to undertake clinical dental care has
prompted much debate. Hosey (2002) and Manley (2004) note that in the United
Kingdom the use of physical restraint is presently unacceptable. However, some
authors are suggesting (Connick et al., 2000; Kupietsky, 2004) that restraint in
combination with inhalation sedation may be a helpful procedure if general
anaesthesia is not readily available.
In this section other options to restraint have been suggested and, although time
consuming, are likely to provoke less of a nervous reaction and avoid associating
dental care with an unpleasant experience. For those readers who wish to study the
topic in more detail, comprehensive clinical guidelines collated by The American
Academy of Paediatric Dentistry have been published in the Journal of Paediatric
Dentistry (2002).
2.7 SYNOPSIS OF THE GUIDELINES BY THE AMERICAN ACADEMY OF
PAEDIATRIC DENTISTRY ON BEHAVIOUR MANAGEMENT
2.7.0 Introduction
To help those readers who wish to have an overview of the key elements in the
guidelines, a brief summary of the objectives and indications/contraindications for a
number of behaviour management techniques, available to dental practitioners, are
listed.