ability of caregiver or person accompanying child to give consent
Decisions involving behavior management techniques must involve the parents and, if appropriate, the assent of the patient. Successful completion of dental services must be viewed as a partnership of dentist, parent, and child. When consent is required for any technique it must be informed consent prior to treatment. Documentation of consent may be by the use of specific forms or progress note entries.
The presence of parents in the dental operatory during treatment has been a concern historically. There may be limitations based on infection control, patient flow, or confidentiality. Some studies have shown children less than three years of age respond better if their parents are present. At a minimum, parents should be encouraged to participate in examination appointments if possible.
Parental presence should be addressed in the clinic policy and procedure manual, and possibly in the infection control manual.
Parental presence is inappropriate for conscious sedation and general anesthesia.
The IHS Technical Quality Assurance document calls for documentation in the patient record for children less than 6 years of age on:
the behavior management techniques used and the child’s response
Documentation of Behavior
The Frankl Scale is recommended as a way to meet this criterion without having to make extensive notes in the chart.
A system of pluses and minus can be used to approximate the Frankl Scale.
Category #1: (- -)
Definitely negative. Child refuses treatment, cries forcefully, fearfully, or displays any agitated, overt evidence of extreme negativism.
Combative, thrashing, verbal, unable to be restrained, need to terminate procedure.
Category #2: (-)
Negative. Reluctant to accept treatment and some evidence of negative attitude (not pronounced).
Slightly combative, verbal, slightly agitated, able to be restrained and procedure safely completed
Category #3: (+)
Positive. The child accepts treatment but may be cautious. The child is willing to comply with the dentist, but may have some reservations.
Quiet, not combative, cooperative, nonverbal.
Category #4: (+ +)
Definitely positive. This child has a good rapport with the dentist and is interested in the dental procedures.
Documentation in the clinical progress notes provides the practitioner with a record of success or failure with behavior management techniques. An entry such as "2 --> 3; VC,TSD" indicates that the patient went from a Frankl category 2 to a Frankl category 3 with voice control and tell-show-do techniques. This notation will facilitate treatment in successive appointments, and is important in multi-practitioner facilities.
Facility policy and procedure guidelines may restrict behavior management options. It is the responsibility of the dental practitioner to participate in the development of local policy, and to be aware of their content. Specific privileging for some procedures (e.g., nitrous oxide-oxygen sedation, conscious sedation, or general anesthesia) may be required.
Communicative management is an ongoing process used to:
gain attention and compliance
avert negative behavior
The following are specific communicative management techniques: