（P96-111）兒童口腔行為管理講稿-口腔專業(yè)課課件-兒童口腔

SpeechscriptLecturer:Jin-hua-wangviceprofessorTime:2013-10-24SectiononeOutlineDoctor-patientrelationshipCharacteristicsBehaviourmanagementContentandObjectivedefinitionTheconceptof“behaviormanagement’’hasevolvedovertheyearsfromthenotionof“dealingwith”thechildtobuildingarelationshipbetweenthechild，parent，anddentistthatisfocusedonmeetingthechild，soralhealthcareneeds。Theoptimaloutcomeforthechildisapositiveattitudetowardoralhealthandfuturedentalcare．2.goalTheoverallgoalisthatthedentistisabletoprovidehigh—quality,safedentalcarelnanenvironmentthatisaspleasantaspossibleforthechildDentaltreatmentmakesgreatdemandsofthechild，andthevneedthehelpofacaringpractitionertobeabletocopewiththesemonmisconcepttionsCommonmisconceptionsaboutchildbehaviorandbehaviormanagementcanmakedentistshesitantaboutprovidingcareforchildren．Theymaythinkthatsomepeoplearebornwiththatskillandmaysimplyletotherstakeonthoseresponsibilities.However,dentistsofeverypersonalitytypecanSuccessfullytreatchildren、andlikeallotheraspectsofdentistry,thisisaskillthatrequirespractice,self-reflection，andefforttoimprove.SectiontwoNon-pharmacologicalbehaviormanagementAdversepsychologicalreactionsDentalfeardentalanxietydentalantagonisticBehavioralfactorsAgeofchildrenparentalanxietytreatmenthistorylevelofcognitiveofdentaldiseaseMedicalenvironmentTreatmentprogramsPatientsindifferentagegroupsofchildren'soraladmissionstechnologyLessthanthreeyears3-6years6-12yearsNon-pharmacologicalbehaviormanagementtell-show-doThetechniqueknownastell—show—doisoneofthemostintuitiveyetessentialbehaviormanagementtechniques．Intell-show-do，thepatientisIntroducedtothedentalenvironmentinanonthreateningwaythattheycancomprehend．FirstthechildistoldabouttheprocedureorinstrumentInachildfriendlymanner.Nextthechildisshownwhatwillhappenorwhatwillbeused.Theymaybeallowedtosee,touch,orsmellthematerialorinstrumentortheymaywatchademonstrationoftheprocedure.Finallythechildexperiencestheprocedure，instrument，ormaterial．ThistechniqueworksbestwithchildrencapableofcommunicationbutisverySuccessfulinallbutveryyoungtoddlers．Thedentistwouldbeadvisedtonotoverlookthisusefultechniqueinolderchildrenandadolescentstohelpallayfears.Thistechniqueisalmostuniversallyacceptabletochildren，parents，anddentists．preappointmentexperiencereinforcementPositivereinforcementisawaytorecognizethecooperationofthechildpatientandrewardit.Positivereinforcementisenjoyableforthedentistandthepatientandcontributestothechild’soverallsenseofaccomplishmentwithSuccessfullycompletingadentalprocedure．Socialpositivereinforcementismosteffectiveandbestwhenitisspecifictothebehaviorthatiscooperative.Thepatientwillbepleasedbyacommentsuchas“youareabeingsuchagreatpatienttoday.However,childrenaremorelikelytocontinuethedesiredbehaviorifthepraiseismorespecific,suchas“Thankyouforsittingsostillandopeningyourmouthsowide”.Suchafocusedcommentoftenmotivatesachildtositalittlestillerandopenabitwider．Complimentingthechildinfrontoftheparentsandthedentalassistants，againbeingspecifictothepositivebehaviorsthechildexhibited，isagreatwaytoboosthisself-esteemandmemoriesofthevisit．distractionDistractionisanotherformofbehaviorguidancethatcanhelpshapechildren’spositivebehaviorandimprovetheirperceptionofthevisitGoingtoadentalvisitisachallengeforchildren，anddistractionisaneffectivemeansofhelpingthemcope.Properuseofdistractiontechniquescanhelptakethechild’smindoffoftheunpleasantaspectsoftreatmentandredirectittoabetter,morepleasantplace.Thenursingliteraturehasshownwithimmunizationthatparentalreassurancewasrelatedtoincreasedneedforrestraint，increasedverbalpain，andincreasedinformationseeking，whereaschildrenwithparentalassisteddistractionexhibitedbetterbehaviorandlessfear．modelingvoicecontrolVoicecontrolisaneffectivemeansofobtainingcompliancefromachildpatient．VoicecontroliSadifferenceinmodulation，tone，and／orvolumetogainthepatient’SattentionandcomplianceInvoicecontrol．instructionsshouldbefirm,definite，andconvincingPinkhamandPaterson”pointoutthattobemostSuccessful，thefacialexpressionmustmirrorthemessage．protectivestabilizationDescription:Theuseofanytypeofprotectivestabilizationinthetreatmentofinfants,children,adolescents,orpatientswithspecialhealthcareneedsisatopicthatconcernshealthcareproviders,caregivers,andthepublic.Thebroaddefi-nitionofprotectivestabilizationistherestrictionofpatient’sfreedomofmovement,withorwithoutthepatient’spermission,todecreaseriskofinjurywhileallowingsafecompletionoftreatment.Therestrictionmayinvolveanotherhuman(s),apatientstabilizationdevice,oracombinationthereof.Theuseofprotectivestabilizationhasthepotentialtoproduceseriousconsequences,suchasphysicalorpsychologicalharm,lossofdignity,andviolationofapatient’srights.Stabilizationdevicesplacedaroundthechestmayrestrictrespirations;theymustbeusedwithcaution,especiallyforpatientswithrespiratorycompromise(eg,asthma)and/orwhowillreceivemedications(ie,localanesthetics,sedatives)thatcandepressrespirations.Becauseoftheassociatedrisksandpossibleconsequencesofuse,thedentistisencouragedtoevaluatethoroughlyitsuseoneachpatientandpossiblealternatives.Careful,continuousmonitoringofthepatientismandatoryduringprotectivestabilization.othermethodssectionthreepharmacologicalbehaviormanagementnitrousoxidecombinedOxygensedationtechniquesTheuseofnitrousoxide/oxygen(N2O/O2)isaformofpharmacologicbehaviormanagement.Ithasbeenfoundtohaveasignificanteffectonreducingmildtomoderatelyanxiousanduncooperativechildbehavioranddoesfacilitatecopingatsubsequentvisits，evenlfitiSnotused.Itisimportanttounderstandthattheuseof(N2O/O2)isonlyeffectiveifaccompaniedbycommunicativebehaviormanagementtechniques.N2O/O2isusedtoimprovethechild'sabilitytocopesothatheorsheismorereceptivetotechniquessuchastell—show—do，positivereinforcement，anddistraction．ThedentistthatreliesuponN2O/O2asasubstituteforbehaviorguidancewillbedisappointedinitseffects．GenerallyN2O/O2isacceptedwell.byparents．Description:Nitrousoxide/oxygeninhalationisasafeandeffectivetechniquetoreduceanxietyandenhanceeffectivecommunication.Itsonsetofactionisrapid,theeffectseasilyaretitratedandreversible,andrecoveryisrapidandcomplete.Additionally,nitrousoxide/oxygeninhalationmediatesavariabledegreeofanalgesia,amnesia,andgagreflexreduction.Theneedtodiagnoseandtreat,aswellasthesafetyofthepatientandpractitioner,shouldbeconsideredbeforetheuseofnitrousoxide/oxygenanalgesia/anxiolysis.Detailedinformationconcerningtheindications,contraindications,andadditionalclinicalconsiderationsmaybefoundintheGuidelineonUseofNitrousOxideforPediatricDentalPatientsOralmedicationssedationtechniquesIntravenousinjectionsedationtechniquesChildren'sdentaltreatmentundergeneralanesthesiatechniquesDescription:Generalanesthesiaisacontrolledstateofun-consciousnessaccompaniedbyalossofprotectivereflexes,includingtheabilitytomaintainanairwayindependentlyandrespondpurposefullytophysicalstimulationorverbalcom-mand.Theuseofgeneralanesthesiasometimesisnecessarytoprovidequalitydentalcareforthechild.Dependingonthepatient,thiscanbedoneinahospitaloranambulatorysetting,includingthedentaloffice.AdditionalbackgroundinformationmaybefoundintheGuidelineonUseofAnesthesiaCarePersonnelintheAdministrationofOffice-basedDeepSedation/GeneralAnesthesiatothePediatricDentalPatient.3Theneedtodiagnoseandtreat,aswellasthesafetyofthepatient,practitioner,andstaff,shouldbeconsideredfortheuseofgeneralanesthesia.Thedecisiontousegeneralanesthesiamusttakeintoconsideration:（1）.alternativebehavioralguidancemodalities;（2）.dentalneedsofthepatient;（3）.theeffectonthequalityofdentalcare;（4）.thepatient’semotionaldevelopment;（5）.thepatient’smedicalstatus.Priortothedeliveryofgeneralanesthesia,appropriatedocumentationshalladdresstherationaleforuseofgeneralanesthesia,informedconsent,instructionsprovidedtotheparent,dietaryprecautions,andpreoperativehealthevaluation.Becauselawsandcodesvaryfromstatetostate,minimalre-quirementsforatime-basedanesthesiarecordshouldinclude:（1）.thepatient’sheartrate,bloodpressure,respiratoryrate,andoxygensaturationatspecificintervalsthroughouttheprocedureanduntilpredetermineddischargecriteriahavebeenattained;（2）.thename,route,site,time,dosage,andpatienteffectofadministereddrugs,includinglocalanesthesia;（3）.adverseevents(ifany)andtheirtreatment;（4）.thatdischargecriteriahavebeenmet,thetimeandcondi-tionofthepatientatdischarge,andintowhosecarethedischargeoccurred.?Objectives:Thegoalsofgeneralanesthesiaareto:（1）.providesafe,efficient,andeffectivedentalcare;（2）.eliminateanxiety;（3）.reduceuntowardmovementandreactiontodentaltreatment;（4）.aidintreatmentofthementally,physically,ormedicallycompromisedpatient;（5）.eliminatethepatient’spainresponse.?Indications:Generalanesthesiaisindicatedfor:（1）.patientswhocannotcooperateduetoalackofpsycho-logicaloremotionalmaturityand/ormental,physical,ormedicaldisability;（2）.patientsforwhomlocalanesthesiaisineffecti