Behavior management of children in the dental office.

One of the first conclusions offered by this article was that behavior management has been a pertinent theme in literature addressing clinical pediatric dentistry. This has been true for much of the twentieth century. Another conclusion stated that this literature generally focuses on the preschool child after the child has acquired sufficient development and maturity that he or she can be communicated to in conversation. It was also pointed out that most general approaches to the subject of behavior management deal with the normal child, which for the purposes of this article can be construed as a cognitively, sociologically, and psychologically developed child with no unusual circumstances. The usual age of a child being approachable in language was determined to be approximately around the third birthday. An analysis of patient management in two previous issues of Dental Clinics of North America written almost 35 years apart revealed that there were many more similarities than differences. One conclusion derived from the present article was that all North American dental practitioners have lived in a culture that assumed that the behavior management of normal children 3 years of age and older can generally be regarded as achievable through linguistic techniques. This comparison of the two issues showed that the topics of informed consent and risk management in behavioral pediatric dentistry grew considerably in the last decades of the twentieth century, pharmacologic techniques became more sophisticated, and the linguistic domain remained important to most dentists who sought to treat preschool children. Regarding this last point, it was offered that a lot of the success of a clinician within the linguistic domain may be determined as much by the thoughts, feelings, and nonverbal acts of communication of the clinician as by any other factor. These include the many factors that describe a child's possibilities of success during the dental experience, such as fear status, allegiance to a misdirected goal of childhood, and learned helplessness. Because of the importance of the linguistic domain to most practitioners treating children, this domain was focused on, including how further mastery might be obtained for the clinician seeking more competence here. A method of the clinician examining his or her own effectiveness to refine a strategy for addressing the potential for more powerful linguistic interactions with children was briefly outlined. For the practitioner wishing more specific information, the reference list should provide a didactic base for further intellectual distinctions and assessments.

Prediction of sports-related dental traumatic injuries.

Predicting sports-related traumatic injuries is an important concern for dental health professionals. A predictive index has been developed that determines the likelihood of a sports-related traumatic dental injury in children and adolescents. This index can be used to aid in the prevention of injury by understanding who is most likely to be injured and what factors influence the chance of injury. The index has been designed for ease of use by dental health professionals, and has incorporated data collection and tracking features.

Comparison of undergraduate pediatric dentistry clinical procedures from 1982-83 through 1996-97.

Using the information obtained from the Collegiate Patient Management System a comparison of average numbers of procedures performed by third year dental students from 1983/84 to 1996/97 was made. The data were grouped in order to compare Group I (1983/1989) to Group II (1990/1997). Student's t-tests were performed to determine significant differences between the groups for the various procedures. The number of new patients in Group I was only 8.2 compared to Group II--7.9 and the total number of new and recall patients seen by students was Group I--33.5 compared to Group II--29.9. Students in Group I performed 19.3 one-surface restorations compared to 11.8 (p = .0001) in the later group and 9.5 two-surface restorations compared to 6.0 (p = .0003) for the 1990's group. Stainless steel crowns, pulpotomies, extractions and sealants were also compared. The total numbers of patients visits was 66.8 in GRP I compared to 49.6 (p;eq.0001) in GRP II. There has been a decrease in most student experiences in the undergraduate pediatric dental clinic in the past 15 years.

Linguistic maturity as a determinant of child patient behavior in the dental office.

Progressively during the 20th century dentistry for children has become more efficient, less painful, and more prevention oriented. In the last quarter of the 20th century there was a dramatic decrease in dental decay for many American children. These two facts paired with the fact that stories about dentistry being painful are gone in many American communities and have been replaced with stories about how pleasant the dental appointment can be would seem to predict that child patient management and the interception of inappropriate behavior would not be a critical skill for the dental clinician that treats children today. This finding however is not the case. It is submitted that misbehavior now stems from the fact that today's parents are not encouraged to raise their children as urgently as in the earlier part of the century. It is offered that the child's incompetence in working with other people in the constituent speech acts of requests and promises causes the child confusion, frustration, and perhaps anxiety. The child's dental experience is a complex conversation between the dentists as requester and the child patient as the promisor of effective actions to the dentists' reasonable requests.

The effectiveness of preventive resin restorations in pediatric patients.

In a six-year, eight-month period, 5,185 preventive resin composite sealants (preventive resin restorations) were placed in permanent molars and premolars in children, five through eighteen years of age in the University of Iowa Pediatric Dentistry Clinic. The purpose of this investigation was to determine the frequency of failure or retreatment of these teeth. The median observation time was for 18.5 months (the longest was for 79.2 months); 88.3 percent required no additional restorative procedures. The median time for resealing was one year after placement, in 6.2 percent of the cases. Three hundred and sixty-four (8 percent) of these teeth required retreatment consisting of one-surface amalgam or additional composite material. In conclusion it would appear that the composite/sealant/restoration in the permanent dentition may require further evaluation in an attempt to reduce the incidence of repair or replacement of these restorations.

Personality development. Managing behavior of the cooperative preschool child.

Because communication is so important to the management of child behavior by the dentist, it must be remembered that the development of the child mentally, emotionally, socially, and cognitively is very important. The importance of the dentist's behavior management skills cannot be overemphasized as a determinant to the successful dental experience for the preschool child. This article provides an overview of behavior management domains for the preschool child, discusses the origin of misbehavior for seemingly "normal" children, and reviews the parental dimension of contemporary pediatric dentistry, and the dentist's role as an ontological coach.

The roles of requests and promises in child patient management.

It is typical for some to assess the misbehavior of children in the dental appointment to be exclusively for reasons of fear. Such an assessment is offered in this paper to be naive. Fear certainly can be a predictor of avoidance behavior, but avoidance behaviors are often found in child dental patients who are remarkably well acquainted with dentistry and who know that the procedures that lay ahead for them are in no way painful or fearful at all. In the case of a recalcitrant child patient, the mechanism by which human beings get things done with other human beings, requests and promises, does not work because of the child's aversion to adult authority. It is submitted that there are children who are poor promisers, because of a background discourse that they have with themselves that makes it difficult for them to interface effectively, i.e. by making effective promises, with other people. Since the dentist is a requester and the dental appointment works by requests, these children are reliably problem patients. They cannot make commitments to cooperate. Four types of children have been described who by a misdirected goal of their childhood, which they have absorbed early, are reliable predictors of misbehavior and avoidance behavior during dental appointments. The internalized goal makes cooperation with a requesting adult difficult. This fact is often seen perhaps in the dental office first, because in our society today very few requests are made of our preschool children.(ABSTRACT TRUNCATED AT 250 WORDS)

Ontological coaching and the "rules of the game".

For most misbehaving pediatric patients, their fear is linguistic (established and reinforced through internal dialogue anticipating the event) rather than biological (triggered involuntarily by a specific stimulus). This paper discusses ontological coaching, a means of addressing and reversing this negative perception. Setting appointment ground rules with the parents in advance also is addressed.

An analysis of the phenomenon of increased parental participation during the child's dental experience.

The role of the parent during their child's dental experience, in contemporary society, has changed during the past decade and should be addressed by pediatric dentists. Included in this matter are issues regarding risk management and practice management. Behavioral pediatric dentistry is in flux, much like the world that it serves; there appear to be schisms within the profession regarding one aspect of this: the presence of parents in the dental operatory. Presented here is an analysis of the paradigm-shifts in society since World War II, when a postfigurative parenting strategy was in vogue. An explication of noted anthropologist Margaret Mead's descriptions of this and two subsequent parenting styles, including configurative (or transitional) and prefigurative (contemporary) are presented. They are analyzed in terms of parental attitudes concerning trusting their child to authority figures, including the dental clinician. This emerging protective instinct is termed "social hypertrophy", based on social biologist Edward O. Wilson's work. Dentists are encouraged to understand parental attitudes and avoid unnecessary conflict.

Epidemiology and prediction of sports-related traumatic injuries.

All sports injuries, and this is certainly true of dentally related sports injuries, occur for predictable reasons. In some instances, these predictors have been well studied and are recognized by participants as well as coaches, dentists, and other responsible parties. In other instances, there is much to be learned about these predictors. There is no question that predictors have direct influence upon the incidence and prevalence data for dental injuries related to each sport. Because of the variability of these predictors from one sport to another, from one sports participant to another, from one age group to another, and even from on playground, field, or court to another, the importance and validity and usefulness of much of the data available currently is debatable. The importance of sports dentistry is not based solely on the urgency afforded by a given number of injuries among a specified number of participants over a certain amount of time. It is the predictable nature of these injuries and the need for the profession to take responsible action in their prevention and treatment that provides the strongest imperative for a sports dentistry movement.

A clinical review of preventive resin restorations.

Since the 1981-1982 academic year, the University of Iowa Department of Pediatric Dentistry had placed approximately 2000 composite/sealants or preventive resin restorations in children's molars. When these children appeared again for examination or treatment, their restorations were evaluated for retention, maintenance, and quality. Results were encouraging: more than 80 percent of the sealant material was "all present"; and more than 98 percent of the composite restorative material was rated quite satisfactory (the "Alfa" category).