Behavior Management

Proper oral health happens more between office visits than during office visits. Our goal is to set you up for success both at home and during dental visits. We know patients who have a dental home are more likely to receive appropriate and routine care and we want to be that dental home for you. Our goal is to work with the patient to provide the needed care in the individualized way that they respond to. We assess and manage behavior using the following techniques: 

• Desensitization
• Tell, Show, Do
• Incentives
• Positive reinforcement
• Distraction

We use words that are easy to understand. Instead of an explorer, we say “tooth counter.” Instead of saying X-rays, we just say we’re going to take pictures of your teeth. We use Mr. Bumpy and Mr. Thirsty. We help the patient be involved in the appointment by touching the instruments before we start working with them. Showing and allowing patients to touch the instruments first often helps ease their anxiety. 

All of this is designed to help patients cope with phobias and fears while creating a relaxing environment and minimizing stress. 

What is Desensitization? 

Desensitization is defined as the “gradual exposure to new stimuli or experiences of increasing intensity.” In the dental setting, desensitization is used to gradually expose the patient to the new dental experience. We do this by using varying methods including: 

• More frequent appointments – this allows the patient to be comfortable with our office and staff and builds trust with our providers 
• Collaborating with therapists – we will work alongside therapists to help the course of treatment 
• Smile kits – these are created to help patients become familiar with the instruments we commonly use in the office

We evaluate patients individually and determine a care plan for each patient at the appropriate level. 

Tell, Show, Do 

We first explain each step of what is going to happen, then we show a demonstration, finally we go forward with the intended procedure. As part of this process, we use a social story to walk the patient through the journey.

Incentives 

We always offer our patients a turn in the treasure box upon completion of the appointment. We stock our treasure box with sunglasses, balls, coloring books and many other fun prizes. Our patients anticipate the treasure box and are always happy to choose a treasure. 

Positive Reinforcement 

Our team cheers for each patient’s accomplishments—whether it’s seeing someone sit in the dental chair for the first time, getting an X-ray for the first time, or just coming in for their first appointment. We try to make moments happy, which then makes visits fun and exciting! 

Distraction 

All of our operatories have a television on the ceiling of the room. We use these to help calm and distract patients during treatment. We also use noise canceling earphones to help with the sounds common to dental offices. 

Other ways we set up your visit for success 

• Initial “Get To Know You” form telling us patient likes and dislikes 
• “Hang Out With Friends” Visits so the patient can see what a dental visit is all about. Patients may be ready to sit in the chair for an exam or just come in to check things out. These visits provide us with helpful information to understand the patient’s needs
• If at first you don’t succeed… try, try again! We want each patient to have a healthier, happier smile. If we don’t have success the first time, we’ll keep trying new techniques until the patient is comfortable
• Consistency is key. We work with parents and caregivers on step-by-step techniques to help with brushing and home care

Medical Mobilization and Protective Stabilization 

In addition to behavioral management techniques, protective stabilization is a method to immobilize or reduce the patient’s ability to move their arms, legs, body, or head freely. There are a variety of forms and levels. We use passive stabilization such as a wrap or blanket to stabilize the patient’s arms and legs, similar to the way a car seat stabilizes a child in a moving vehicle. When we calm the body, the mind becomes calmer as well, but our goal is to eventually get to a place where the patient is comfortable without stabilization in future treatment. 

Because every patient is different, a wide range of choices exists. Our dentists always choose the least restrictive method that is best for each patient. We discuss these techniques together prior to the appointment and move forward based on your comfort level and ultimately what is best for the patient.

Nitrous Oxide 

Sometimes the best course for treatment is Nitrous Oxide (aka “laughing gas”) during appointments where patients need dental work like fillings or crowns. We’ve found that this method works best to increase working time, help with pain management, decrease anxiety, and create a more pleasant experience overall. 

Nitrous Oxide is a sweet smelling gas administered through a “flavored” nasal hood or nose. It is always given along with oxygen to keep the patient safe. 

Nitrous does not put the patient to sleep and it is quickly metabolized in the body. That means that the patient recovers immediately. 

Occasional side effects consist of nausea, dizziness, and headaches. We will recommend that the patient does not come to the appointment on a full stomach for those reasons. If you’re concerned over safety, we understand. But we feel it’s perhaps the safest sedative in dentistry — mild, easily taken, and quickly and naturally removed from the body. 

Oral Conscious Sedation 

There are instances when even the strongest patient is unable to tolerate the extent of work needed during an appointment. In such cases, we may consider conscious sedation. This allows the patient to breathe on their own and easily respond to voice and touch. The sedation, however, will make them safely unaware of the treatment being rendered. With oral conscious sedation, we give medications orally on an individual, case-by-case basis, following review of the patient’s medical history and a physical exam.

Sedation

General anesthesia is an option for patients who are unable to tolerate conventional treatment. We use it as our last resort. We work with a licensed anesthesiology team who administers the anesthesia. Patients must first be evaluated by their pediatrician/doctor and usually the anesthesiology team in order to be cleared for anesthesia. There are times when this is necessary, and it is a safe alternative when treatment needs to be completed.