Behavior Management for Children With Special Healthcare Needs in Pediatric Dentistry

The American Academy of Pediatric Dentistry (AAPD, 2015) defines children with special health care needs as those with “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment.” Managing these patients may require modifications to conventional behavior guidance techniques to accommodate their individual needs and abilities (AAPD, 2015).

For some children with special needs, general anesthesia may be considered a last resort after appropriate behavioral guidance and protective stabilization techniques have been attempted when appropriate (AAPD, 2015). In children with intellectual disabilities, protective stabilization may be considered when a simple dental procedure needs to be completed and cooperation cannot otherwise be achieved (AAPD, 2015).

Aversive Behavior Management Techniques

Aversive behavior management techniques include approaches such as protective stabilization and the historically used hand-over-mouth technique (HOME).

Protective Stabilization in Special Needs Dentistry

Protective stabilization includes a range of techniques that may involve the parent, dental team, specialized devices, or a combination of these approaches (AAPD, 2015).

One approach is knee-to-knee stabilization, where the parent assists in holding and stabilizing the child to allow basic procedures such as oral examination or fluoride application to be completed safely (AAPD, 2015).

Protective stabilization can also involve specialized devices such as a mouth prop or Kiddie Wrap. These approaches may be considered when the child is extremely uncooperative, has a significant intellectual disability, or requires urgent treatment when sedation or general anesthesia is not available (AAPD, 2015).

Before protective stabilization or another aversive technique is used, informed consent must be obtained from the parent or caregiver (Connick et al., 2000).

Hand-Over-Mouth Technique (HOME)

The hand-over-mouth technique was historically used as a behavior management approach and was reported to be effective when applied appropriately. However, it is no longer recommended by the American Academy of Pediatric Dentistry’s guidelines (AAPD, 2008).

Following its removal from the clinical guidelines, alternative behavior guidance approaches have become more widely supported. Techniques such as voice control, positive reinforcement, and tell-show-do are among the approaches endorsed and encouraged for managing children’s behavior in the dental setting (Oueis et al., 2010).

Creating a Positive Dental Experience for Every Child

Pediatric dental behavior management involves a wide range of techniques, each designed to achieve the same fundamental goals: reducing fear and anxiety, improving cooperation, and developing a positive attitude toward dental care.

No single technique is appropriate for every child. The pediatric dentist should assess the child’s developmental level, personality, anxiety, medical and dental history, and individual needs before selecting an appropriate approach. Combining different behavior guidance techniques and tailoring them to the individual child can help create a safer, more comfortable, and more positive dental experience.

References

• Oueis HS, Ralstrom E, Miriyala V, Molinari GE, Casamassimo P. Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry. Pediatr Dent 2010;32(3):223-228.