Behavior Management Techniques in Pediatric Dentistry: How Well are they Accepted?
Al Daghamin S*, Balharith M, Alhazmi S, AlObaidi F and Kakti A
Riyadh Colleges of Dentistry and Pharmacy, Saudi Arabia
Submission: June 14, 2017; Published: August 09, 2017
*Corresponding author: Al Daghamin S, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia.
How to cite this article: A Daghamin S, Balharith M, Alhazmi S, AlObaidi F, Kakti A. Behavior Management Techniques in Pediatric Dentistry: How Well are they Accepted?. Acad J Ped Neonatol. 2017; 5(3): 555722. DOI: 10.19080/AJPN.2017.05.555722
Abstract
Introduction: Behavior management of child dental patients is essential and pediatric dentists use a variety of Behavioral and pharmacological techniques.
Aim and objective:To examine the acceptance by parents living in Saudi Arabia of nine Behavior-management techniques and its association with several possible confounding factors
Methodology:Following ethical approval, the parents were shown a video with nine behavior management techniques and their acceptance rate of each technique on a VAS (0-10).
Results:A total of 405 participants were recruited in this study from different cities in Kingdom of Saudi Arabia. 127 participants were male (31.4%) and 278 female (68.8%).
conclusion The most accepted technique was Tell-Show-Do, and the second preferred technique was Nitrous oxide inhalation sedation followed by GA and the least preferred was Passive restraint followed by HOM technique. Male parents preferred general anesthesia while the female parents preferred nitrous oxide inhalation sedation
Introduction
Behavior management of child dental patients is essential, and pediatric dentists use a variety of Behavioral and pharmacological techniques [1-3]. These techniques undergo re-assessment over time and some of them may have already been abandoned. One of the factors most frequently cited for these changes is parental acceptance [2-7]. This underlines the importance of pediatric dentists understanding which Behavior-management techniques are still acceptable to parents and identifying the factors influencing their acceptability.
Aim and Objective
To examine the acceptance by parents living in Saudi Arabia of nine Behavior-management techniques and its association with several possible confounding factors.
Review of Literature
Lawrence et al. [8] evaluated parents’ attitudes toward behavior management techniques used in pediatric dentistry by comparing the effect of prior explanation on parental acceptance of eight behavior management techniques. Videotaped segments made of children’s dental appointments containing examples of eight behavior management techniques were used. Parents viewing videotapes with explanations were significantly more accepting of behavior management techniques than those viewing videotapes without explanations; Mean visual analogue scores for both groups indicated generally positive attitudes toward the behavior management techniques studied. Parents reporting greater stress were less accepting of the behavior management techniques studied.
Murphy et al. [9] assessed the attitudes of parents toward behavior management techniques employed in pediatric dentistry. Sixty-seven parents viewed videotaped segments of actual treatment of three to five-year-old children. The majority of parents favored tell-show-do, positive reinforcement, voice control, and mouth props. Physical restraint by the dentist and assistant were viewed significantly more favorably than sedation and HOME. The least acceptable techniques were general anesthesia and Papoose Board.
Boka et al. [10] examined the acceptance by Greek parents of nine Behavior-management techniques and its association withm several possible confounding factors. After being shown a video with nine behavior management techniques, parents rated the acceptance of each technique on a 0–10 scale. The best accepted technique was tell–show–do, followed by parental presence/ absence (PPA) technique and nitrous oxide inhalation sedation. The least accepted techniques were passive restraint and general anesthesia.
Statistical Analysis
All data were subject to appropriate statistical analysis using SPSS data processing software.
Results
Demographic
A total of 405 participants were recruited in this study from different cities in Kingdom of Saudi Arabia. 127 participants were male (31.4%) and 278 female (68.8%). Nationality distribution was classified into Saudi (60%) and non-Saudi (40%). The participants’ age was found as following: 20-30 (32%), (31- 40) (40%), (41-50) (20%) and above 50 years olds (8%). The education level of participants was bachelor degrees (73%), high school graduate (16%), middle school (2.2%), post degree (2.2%) and elementary school (0.5%). The occupation distribution of our participants was as following: students (13%), housewife (30%), teachers (27%), engineers (7.2%), doctors (4.7%), workers (5.7%) and others (13.1%). Number of child per family was as following: one child (30%), two to three (35%), four to five (23.7%) and 6 or more (11.1%). All participants’ characteristics were summarized in Table 1.
In terms of the best techniques, with regards of gender no different on opinion was found with male and female in all technique except active restraint where male prefer more than female (t=2.33,P=0.02). Non-Saudi participants preferred parent presence/absence (P=0.003) and voice control (P=0.005) techniques more compared to Saudi participants.
No significant effect of age of the parent was seen on the choice of techniques. ANOVA revealed that there is significant correlation between education level and ‘HOM’ technique (P=0.005). As the educational level increased, “HOM” technique was less preferred. In terms of participants’ occupations, for the professionals ‘GA’ and ‘HOM’ techniques were less preferred which was statistically significant (P=0.03), (P=0.0001). As number of children per family increased, The preference of the following techniques increased with statistical significance; ‘Tell-show-Do’ (P=0.038), ‘Active restraint’ (P=0.014), ‘General anesthesia’ (P=0.03) and ‘Parental presence/absence’ (P=0.003) (Table 2-6).
Discussion
The most accepted technique was tell–show–do, as in most previous studies [5,10-13]. The very high rating found for tell– show–do was expected, as it is among the safest and least invasive behavior-management techniques and its acceptability appears relatively stable over time [2,3,5].
There was no significant differences for each behavior management technique between the different age groups which is similar to a study conducted by [9]. The least accepted techniques in the present study were HOM, and passive restraint by Papoose Board. These were also found as the least accepted techniques in other studies, although not in the same order [9]. Passive restraint using a Papoose Board, called also ‘‘protective stabilization’’[3], is a controversial technique among clinicians, since its use has been suggested to have the potential to produce serious consequences, such as physical or psychological harm, loss of dignity, and violation of a patient’s rights [2-3]. Hand-over-mouth is a controversial technique and it is no longer included in the AAP
A statistical significant difference is found between acceptance of the different techniques and the socioeconomic status and gender of the parent. While in our study, more the parents were professionally qualified and higher educated, less preferred was the HOM technique and passive restraint. (P=0.0001), (P=0.005). Further research is required where more subjects of the different representative regions of Saudi Arabia should be included.
Conclusion
The most accepted technique was Tell-Show-Do, and the second preferred technique was Nitrous oxide inhalation sedation, followed by the least preferred was Passive restraint followed by HOM technique. Male parents preferred general anesthesia while the female parents preferred nitrous oxide inhalation sedation.
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