Original Article |
Corresponding author: Maria Shindova ( mariya.shindova@gmail.com ) © 2022 Maria Shindova.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Shindova M (2022) Knowledge and attitudes of dental practitioners regarding the use of behaviour management techniques for paediatric dental patients. Folia Medica 64(1): 128-133. https://doi.org/10.3897/folmed.64.e64416
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Introduction: Understanding children’s behaviour and development is crucial in managing and treating paediatric dental patients. Dental practitioners are expected to be aware of the behaviour management techniques which will facilitate routine dental treatment of the child dental patient.
Aim: The objective of the study was to investigate dental practitioners’ awareness and use of non-pharmacological behaviour management techniques in attending paediatric dental patients in Plovdiv, Bulgaria.
Materials and methods: An anonymous, self-completed mailed survey was sent to 200 dentists. The recorded information included items on awareness and frequency of using different non-pharmacological behaviour management techniques, socio-demographic questions, working experience, specialty status.
Results: Survey response was 59% and 118 dental practitioners participated in the study. Tell-show-do, positive reinforcement, and stop signals were considered the most used techniques by more than 50% of participants. Less than 7% of the respondents reported the use of desensitization, cognitive restructuring, and latent inhibition.
Conclusions: Most of the dental practitioners had a medium level of awareness of the non-pharmacological behaviour management techniques. The lack of training in using these techniques, however, is of concern. There is a need to build awareness among the dentists associated with the child psychology and its application during treatment.
behaviour management techniques, paediatric dentistry, survey
Children exhibit a broad range of physical, emotional, intellectual and social development and a wide diversity of attitudes and temperament. Thus, understanding children’s behaviour and development is crucial in managing and treating paediatric dental patients. Dental practitioners are expected to be aware of behaviour management techniques (BMT) which will facilitate the routine dental treatment of the child dental patient. Furthermore, they are encouraged to utilize BMT consistent with their level of professional education and clinical experience. Dentists must have a wide range of behaviour guidance techniques to meet the needs of the individual child and be tolerant and flexible in the implementation of these techniques.[
Different authors have reported the application of BMTs in different countries. In the USA, the southern dentists used less aversive techniques and there was a reduction in the use of hand over mouth exercise (HOME). Significant differences by sex and age were seen in the use of non-verbal communication and advanced techniques. The most favoured technique was parental presence in the dental operatory, though older males were significantly less likely to allow parental presence for some procedures.[
No publications reporting the awareness or the use of BMT in Bulgaria were retrieved despite its importance in creating a positive attitude towards dentistry which should best begin during early childhood, subsequently creating a child’s healthy oral environment and a future healthy adult.
Therefore, the objective of the study was to investigate dental practitioners’ awareness and use of the non-pharmacological BMTs in attending paediatric dental patients in Plovdiv, Bulgaria.
The cross-sectional study consisted of an anonymous, self-completed mailed survey. Potential subjects were sent an email describing the study and inviting their participation. Two hundred dentists were invited to participate in the study. The participants were randomly selected and only currently practicing dentists were included. The mail included a brief cover letter explaining the purpose of the survey. It stressed the anonymity of the survey and that the responses would be aggregated. The surveys were mailed within a three-week period. The study was conducted in September 2020 and consisted of two sections. Section I included demographic questions, including gender, age, work setting, experience, specialty status-general practitioner versus specialist. From section II, information concerning the awareness and frequency of using the different non-pharmacological BMT was collected. Ethical approval was obtained from the University of Plovdiv Research Ethics Committee before circulating the questionnaire (document No. P-1371/30.04.2018).
The obtained data were tabulated, processed and analyzed using a SPSS version 21.0 (IBM, USA). Descriptive statistics were generated to estimate demographic data and the frequency of using BMTs.
Out of the 200 surveys that were mailed, 118 subjects (59% response rate) were included in the statistical analysis for this study. The sample size was n=118 dentists. The demographic information about the responders and their practices is shown in Table
Table
Demographic and practice information of the investigated practitioners (n=118)
n | Percentage of responders | |
Sex | ||
Male | 47 | 39.8% |
Female | 71 | 60.2% |
Total years in practice | ||
<5 years | 23 | 19.5% |
5–10 years | 54 | 45.8% |
10–20 years | 26 | 22.0% |
>20 years | 15 | 12.7% |
Specialty status | ||
General practitioner | 69 | 58.5% |
Other specialty, not including paediatric dentistry | 40 | 33.9% |
Paediatric dentistry | 9 | 7.6% |
Paediatric dentistry + other specialty | 0 | 0 |
Location of facility | ||
Urban | 113 | 95.8% |
Rural | 5 | 4.2% |
Received formal training on BMT | ||
Yes | 22 | 18.6% |
No | 96 | 81.4% |
Techniques | Awareness of BMT by respondents | Usage of BMT by respondents | ||||
n | % | Mean | n | % | Mean | |
Nonverbal communication | 44 | 37.29% | 2.81 | 13 | 11.02% | 1.89 |
Tell-show-do | 77 | 65.25% | 2.36 | 62 | 54.54% | 3.12 |
Voice control | 68 | 57.63% | 0.82 | 36 | 30.51% | 3.02 |
Positive reinforcement | 97 | 82.20% | 3.63 | 78 | 66.10% | 2.89 |
Negative reinforcement | 31 | 26.27% | 0.67 | 7 | 5.93% | 0.68 |
Distraction | 64 | 54.24% | 3.22 | 39 | 33.05% | 3.05 |
Stop signals | 92 | 77.97% | 2.03 | 63 | 53.90% | 3.38 |
Modelling | 55 | 46.61% | 1.33 | 17 | 14.41% | 2.03 |
Desensitization | 38 | 32.20% | 0.58 | 9 | 7.63% | 0.97 |
Cognitive restructuring | 13 | 11.02% | 1.77 | 5 | 4.24% | 1.04 |
Parental presence/absence | 61 | 51.69% | 2.89 | 16 | 13.6% | 2.01 |
Latent inhibition | 7 | 5.93% | 0.43 | 2 | 1.69% | 0.93 |
Restraint | 20 | 16.95% | 1.92 | - | - | - |
The response rate to this survey (59%) is an indication of the interest that dental practitioners have in the topic of behaviour management of child dental patients. Generally, the results of the present study show that dental practitioners had a medium level of awareness of BMTs which is an encouraging finding. With these results, providers have evidence to support or change their BMTs according to their practice characteristics as they continue to gain experience throughout their careers. To improve the quality of oral health in children, more training courses on BMT are needed. In the present study, practitioners’ awareness of BMT varied, the highest being for positive reinforcement (82.20%), a technique which is simple and easy to be remembered and applied, and the lowest for latent inhibition (5.93%) which is not universally applied and time-consuming.
The great majority of respondents in our investigation employed communicative BMTs. TSD and positive reinforcement are two of the most successful yet simple basic BMTs which can be used with all paediatric patients regardless of their cooperation level.[
Although stop signals was reported as the most accepted BMT by children in an exploratory study investigating children’s perceptions of dental BMTs in 2013, there is a dearth of literature reporting its use among dental practitioners.[
Distraction is also a simple and effective BMT that could be used with any child regardless of their cooperation level.[
Desensitization, cognitive restructuring and latent inhibition are useful techniques in the management of anxious children and those with specific dental phobias.[
Voice control is classified as a basic BMT and appropriate training and application are crucial for the success of such technique and avoidance of unnecessary patient’s distress. Although some authors in the USA and Arabian region reported high frequency use of voice control (92%), in the present study, only one third of the respondents selected it for anxiety reduction during treatment of paediatric dental patients.[
In past studies, the use of physical restraint was reported by more than 80% of respondents.[
The results of the present study highlighted the use of a variety of non-pharmacological BMT among dental specialists. Most participants were aware of BMTs, although few acknowledged having adequate skills to apply the techniques. Almost all respondents have rated the TSD, positive reinforcement, and stop signals as the most commonly used non-pharmacological BMTs. There is a need to build awareness among the dentists associated with child psychology and its application during treatment. The future exploration of BMT trends will be interesting as the profession begins adopting alternative caries management strategies that may decrease their use.