visual imagery

• children have very powerful imaging and fantasying abilities.
• tell the story, or just ask the child to imagine about playing with a cheerful dog and it yelps louder and louder.
• children were asked to open their mouth wide, the clinician talks constantly through the visit.

How to applied?

• talk constantly throughout the visit
• tell the story throughout the visit (if you can)

humor

• Humor comes from the feeling of (1)Relief or (2)Incongruity
  • Relief = the relief of tension, stress.
  • Incongruity = the situation that doesn't cause harm but wrong of sense, violate accepted pattern.
• For children, humor sense is developing along with cognitive ability.
  • 6months : see people
  • 12months : peak a boo
  • 2-6 years :
    1. mistreat object - the first thing that the child cognitive function will develop, they will play by using stuff for another object("talk to a shoe, use bowl as hat")
    2. mistreat word - when the child has more vacabularies, they will play by misnaming thing("show me your nose, but point to ear and laugh", "Brush the ears")
    3. play with similar words sound(rhyming) - this require higher connection between similar sound words
  • 6-12 years : riddle and joke
    • Especially 7 years old, children start to realized that some word can has two meaning eg. "what are the kissing flower?" - Tulips.

How to applied?

• when the very young child doesn't talk back or pay attention to you: use little joke like "where is your teeth?", and find them at his/her hand.
• another joke - asking the child their age, when they hold up their finger, try miscounting it. - when their are two sibling ask who is older, then address to the younger child and ask 'are you the older? I thought you were older but just shorter' - asking the child, the character they can identify, but making mistake eg. "winnie's the pool is a horse, right? - breath from your nose not from your toe, oh not that, I mean not from your mouth - Humor is one of the great powerful tool to reduce emotional distance

What ever you do, it is important to use the style that are comfortable and natural for you!

parent present or absent

• parent present isn't inhibit treatment, instead parents can see the carefulness of the dentist.
• However, when the child behaves badly, it's usually because the child feels that the parent are their protector or supporter. So, dentist can ask the parent to leave the room, which will make the child understands that their parent and dentist are on the same team.

How to applied?

• when the young child doesn't respond and display bad behavior, assume that it's because parents are present as protector/supporter. The best way is to ask the parent to leave, and tell the child that if they behave well, the parent can come back.

Restrain

• Passive restraint ususally used with conscious sedation. Some parent prefer, general anesthesia.
• Prohibit in European country.
• Tell the child that you will place the blanket over their body which will help them not to move, keep them warm, and makes the tooth can be fixed very easily.
• Explain to the parent honestly about the method. Which the acceptance mostly depend on the dentist attiude by using it to protect the child from harming themself, not using as a punishment, or using with the sense of anger/frustration.

How to applied?

• tell the child that it is the blanket that keep them warm, and help them not to move, so that the dentist can fix their tooth easily and fast.
• Never use this method as a punishment or with anger/frustration.

Hand over mouth(HOM)

• create trauma in child, shouldn't never be used
• Just for study purpose
  • use to establish communication, when every other method isn't effective.
  • use monotone voice, place hand over the child mouth, tell them with the calmly voice tone beside their ear to be "quiet" and "we just want to talk and see your teeth"

Retraining

• When the child becomes misbehaviour again. It is needed to be retrained.
• First, tell the child "We don't do that here". Because the child might have heard from the other/ parent attitude, and develop anxiety and fear
• Then the retraining process will include any proper child behavior management techniques you comfortable with. eg. humor, start with easy treatment, give a choice, distraction(by telling story,counting, etc.), voice control(some times)

How to applied?

• It's normal for children to become anxiety again in recall visit. You can use any same technique to help the child more relax.

Hypnosis

• All patient management techniques are hypnosis!

• Trance hypnosis

  • The treatment problem is not the pain itself, but it is the fear of pain that the child focuses on that inhibit treatment.
  • Use the environment to distract the child from focusing on the fear of pain, eg.
    • tell them to imagine the spaceship launching off to the universe when hear the sound of high speed handpiece.
    • Tell them the stories, children has very immersive imagination.

• Non-Trance hypnosis

  • Many management techniques are in this category. The examples are..
    • using body language - the child can interpret body language better than spoken language, such as warm voice, warm touch
    • using causal or less aggressive language - such as using discomfort instead of pain, feel the pinch instead of injection, it's like tell the child to not think about elephant, they will think of elephant. If you tell them there will be no pain they will think about pain.
    • use "yet" - like: you haven't tried the strawberry vitamin flavour yet. This will prepare the child to be excited and enjoy with the treatment.
    • refer to the other children - such as many of your friends like tooth cleaning,