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Dentist's reassuring touch: effects on children's behavior

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Abstract

Physical contact with patients by health care providers has been found to benefit the patients by reducing their fearful or avoidant reactions. This study tested whether a reassuring touch could be used during a routine pediatric dental examination to reduce children's anxiety and improve their behavior. Thirty-eight children between 3.5 and 10 years of age were randomly assigned to one of two experimental conditions. Children assigned to the touch condition were patted on the upper arm or shoulder on two separate occasions by the dentist during the examination while simultaneously receiving verbal reassurance and descriptions of the upcoming procedures. Children in the no-touch control condition received only the reassuring verbal descriptions without contact. Results indicated that touched children between the ages of 7 and 10 years (but not children aged 3.5 to 7 years) displayed less fidgeting behavior than their no-touch counterparts (P < 0.05). Post-treatment, children who were touched tended to report greater pleasure (P < 0.06) but less dominance (P < 0.10) than children not touched.
SCIENTIFIC ARTICLE
Abstract
Physical contact with patients by health care providers has beenfound to benefit the patients by reducing their fearful or
avoidant reactions. This study tested whether a reassuring touch could be used during a routine pediatric dental examination
to reduce children's anxiety and improve their behavior. Thirty-eight children between
3.5
and 10 years of age were randomly
assigned to one of two experimental conditions. Children assigned to the touch condition were patted on the upper arm or
shoulder on two separate occasions by the dentist during the examination while simultaneously receiving verbal reassurance
and descriptions of the upcoming procedures. Children in the no-touch control condition received only the reassuring verbal
descriptions without contact. Results indicated that touched children between the ages of7 and
10
years (but not children aged
3.5 to
7
years) displayed lessfidgeting behavior than their no-touch counterparts
(P
<
0.05). Post-treatment, children who were
touched tended to report greater pleasure
(P
<
0.06) but less dominance
(P
<
0.10) than children not touched. (Pediatr
Dent:15:21-24, 1993)
Dentist's reassuring touch: effects on children's behavior
Paul E. Greenbaum, PhD Mark A. lumley, PhD Clara Turner, DMD
Barbara G. Melamed, PhD
Introduction
Anxiety-related behavior orreactions occur commonly
during the delivery of health care to children. Specific
procedures such as inoculations, venipuncture, or anes-
thesia induction; and general events such as separation
from parents and meeting strangers may induce fear and
subsequent clisruptive behavior.
In
the dental environ-
ment, children's fearful, resistant, and/ or clisruptive be-
havior has been considered an obstacle to adequate care,
resulting in management problems and/ or avoidance of
future treatment.': Fincling effective ways to reduce fear
and manage clisruptive behavior has been a common con-
cern among pecliatric dentists, and comprehensive dis-
cussions and lists of behavior management strategies have
been published>" One potentially effective strategy not
mentioned in these lists is the use of a reassuring touch.
Touch may be a simple and effective way to reduce the
fears that may accompany dental care.
Among adults, results from a number of meclical stud-
ies have supported the efficacy of touch for improving
patients' reactions. Patients who were touched either just
before or during treatment reported better rapport with
nurses and doctors,"
9
and less pain and anxiety.'? Outside
of medical settings and within the more controlled labora-
tory environment, adult responses to touch have indi-
cated a lowering of psychophysiological arousal as in-
dexed by heart rate.11.12Stuclies of hospitalized preschool
children also have found touch to be effective in reducing
distress.P" For example, Triplett and Arneson" found
that among very young children, ages3days to 44months,
clistressbehavior (i.e.,crying, verbal protests) terminated
more quickly when nurses patted, stroked, or hugged the
children while providing verbal reassurance, compared
20 Pediatric Dentistry: January/February, 1993 - Volume 15, Number 1
with using verbal reassurance alone.
The topography or type of touch as well as its environ-
mentalcontext can affect patients' responses to touch. This
study used gentle arm or shoulder patting - a type of
touch that is appropriate to the dental context and that
was expected to maximize fear reduction. Since touch
given without accompanying verbal statements can be
perceived as threatening or unfriendly," touches in this
study always were accompanied by a verbal description
of upcoming procedures and reassuring statements to
ensure that they would be perceived as supportive.
No experimental stuclies of the effects of touch have
been conducted in the dental setting, and no stuclies of
touch have examined effects on preschool or elementary
school-aged children, From a practical perspective, it is
this age group that most often presents for dental treat-
ment and, therefore, may benefit from touch as a fear
reducer. Thus, this study of children undergoing a dental
examination and prophylaxis tested the effectsofadentist's
touch when provided in an appropriate verbal context,
compared with the effects of a control conclition (verbal
description alone) on children's self-reported and behav-
ioral anxiety.
Method
Forty-four children between 3.5 and 10 years of age
who were patients at the University of Florida Faculty
Pediatric Dental Clinieparticipated. Children were selected
as potential subjects from dentists' appointment calen-
dars
if
they were the appropriate age and were scheduled
for a dental examination, prophylaxis, and fluoride treat-
ment. To increase sample size yet maximize sample ho-
mogeneity, only children who had .had a prior dental
examination were included. Sixchildren (three from each
experimental condition) who were studied initially were
dropped from analyses because their data were incom-
plete (five cases) or the dentist failed to complete the ex-
perimental protocol (one case).Theremaining 38children
(20 males and 18 females) constituted the experimental
sample.
Two faculty dentists, one female and one male, con-
ducted the examinations and provided the experimental
manipulation. Experimental conditions were counterbal-
anced across dentists; each dentist saw an equal number
of patients in each condition (Dentist 1: 16 touch, 16 no-
touch; Dentist 2:three touch, three no-touch). The protocol
for the experimental manipulation and measures was re-
viewed and approved by the University ofFlorida Health
Center Institutional Review Board.
Before arriving at the clinic, children were randomly
assigned by coin toss to either the touch or no-touch con-
dition, after matching for gender and age (younger than or
older than 7 years); this resulted in 19patients per group.
Hence, the groups did not differ in age (touch M =83.3
months vs, no-touch M =84.7 months), and there were
approximately equal numbers of males and females in
each condition (touch: 11 males, eight females; no-touch:
nine males, 10females). Treatment groups were matched
for age and gender primarily as control variables as both
have been shown to covary with dependent variables
used in this study (subjective reports and overt behavioral
indices of emotion). Along with reducing error variance,
gender and age were included as factors in this study
because any differences moderated by these patient char-
acteristics would provide data useful for the practitioner
and for understanding the development of touch effects.
Upon arrival, informed consent was obtained from
parents and children. Children were separated from their
parents and were first administered the Dental Fear Scale
(DFS),16and then asked to report their feelings about "be-
ing at the dentist" using the Self-Assessment Manikin
(SAM)Y Immediately following the dental examination
and treatment, children again used the SAM to rate their
feelings about being at the dentist. Both theDFSand SAM
provide measures of children's dental fear; however, the
DFS represents a relatively stable, more trait-like index,
whereas SAM measures situational fluctuations in emo-
tion. In the current study, DFS ratings were taken before
treatment to ascertain that the randomization procedure
generated two experimental groups that were equivalent
in pretreatment levels of dental fear. The SAM ratings
were used to provide an index of the effects of the experi-
mental conditions on children's subjective reactions.
The DFS is a IS-item questionnaire derived from a
subsca1e of the SO-itemChildren's Fear Survey Schedule
(CFSS).18The 15 items include a range of dental stimuli
potentially evoking fear in children (e.g., having to open
your mouth, having instruments in your mouth, choking,
injections, the sight of a drill, the sound of the drill, etc.).
Children rated how afraid they were ofeach item on a 5-
point Likert-type scale, and a total score was obtained by
summing the ratings. The DFS has a test-retest reliability
coefficientof .86,19and its validityin predicting behavioral
and physiological indices of fear has been demonstrated
in several studies.
19
,zo
The SAM assesses a respondent's current subjective
state on three, independent dimensions of emotion. The
version of the SAM used in this study was designed spe-
cifically to measure these dimensions in children. The
SAM consists of three sets of drawings of a schematized
human figure." Each set depicts one of the three emo-
tional dimensions with five drawings of the figure vary-
ingfrom one extreme of the dimension to the other. For the
"displeasure-pleasure" dimension, SAM's facial expres-
sion changes from a frown to a smile. For the "arousal-
calmness" dimension, SAM changes from being "jumpy"
and" agitated" with eyes wide open tobeing amotionless,
relaxed figure with eyes closed. In the "submission-domi-
nance" dimension, SAM changes in size from very small
to very large. The displeasure, arousal, and submission
poles of the dimensions are descriptive of negative emo-
tional states such as fear and anxiety. Each dimension of
the SAMispresented tothe children, who point tothe one
figure in each series of five that represents their current
emotional state, and a value from 1 to 5 is recorded for
each dimension. The validity of this measure has been
shown in several studles.F-"
Upon completion of the pretreatment self-report mea-
sures, the children were escorted into the dental operatory,
and seated in a dental chair. A wall-mounted video cam-
era recorded children's behavior during the examination.
Videotapes were scored later for overt behavior by a rater
who was blind to the hypothesis of the study. A second
independent rater served to determine interobserver reli-
ability. The Behavior Profile Rating Scale (BPRS),"an in-
strument designed specifically to measure fear-related
behavior of children undergoing dental procedures, pro-
vided operational definitions of the two behaviors ob-
served in this study: fidgeting (defined as repetitive hand,
leg, or foot movement), and inappropriate mouth closing
(preventing the dentist from continuing treatment and
operationally defined as the dentist asking the child to
"open your mouth," "open wider," etc.). Interobserver
reliability was adequate for each behavior; r =.92 and .88,
respectively.
Dentists in the touch condition were instructed to pat
children on the upper arm or shoulder for approximately
10seconds on two occasions during the examination. The
firsttouch occurred when the dentist entered the operatory
and greeted the child. The second touch occurred during
the dental examination, just before the dental explorer
was used to check for carious lesions. During each touch,
dentists described the upcoming procedure in a calm and
friendly voice along with reassuring statements such as
"This
will
be easy," or "This won't hurt." In the no-touch
condition, children also received the verbal description
Pediatric Dentistry: January/February, 1993 - Volume 15, Number 1 21
and reassurance during the greeting and before the dental
explorer; however, touching did not accompany these
verbal messages. Dentists were not restricted from talking
during the examination, but they did avoid any other
touching of the child, except for contact around the oral
cavity as required by the examination.
Results
Statistical analyses and pretreatment differences
Data for each dependent variable were analyzed using
a 2 x 2 x 2cross-classified hierarchical analysis of variance
(ANOV A).
In
each ANOV A, the three independent fac-
tors were gender (male/female), age (3.5-<i.9 years/7.a-
10 years), and touch condition (touch/no-touch). The hi-
erarchical order of entry removed age and gender effects
before testing the focal variable of touch.
Pretreatment DFS and pre- and post-treatment SAM
scores for both experimental conditions are presented in
Table 1. Among pretreatment measures, DFS and SAM
displeasure and arousal did not differ significantly be-
tween touch and no-touch groups, F (1, 30) <1.0, NS.
However, younger children (ages 3.5 to 7 years) in the no-
touch condition had higher submission self-ratings than
children in either the older no-touch, or the younger or
older touch groups, Touch
X
Age interaction, F (1, 30) =
4.25,
P
<0.05. Thus, in analyzing post-treatment SAM
scores, pretreatment SAM scores were entered as
covariates, thereby removing variance associated with
pretreatment differences prior to testing for post-treat-
ment differences." None of the subjective or behavioral
dependent measures differed significantly between the
two dentists, and no consistent differential effects of den-
tist for each Touch condition were noted.
Effects of touch
Overt behavior. Fidgeting
behavior, scored as the per-
centage of total examination
time, was log transformed
prior to analysis to increase
variance homogeneity. The
ANOV A indicated a signifi-
cant main effect for touch, F (1,
30) =4.63, P <0.05. Children
who were touched showed
less fidgeting time than those
who were not touched (touch
M=12.5% vs. no-touch M =
22.2%). The touch main effect
was qualified by a significant
Touch X Age interaction, F (1,
30) =7.52, P <0.01. Tests for
simple effects indicated that
only older children in thetouch
condition showed less fidget-
ing than their no-touch coun-
terparts (older touch M
=
7.4% vs. older no-touch M =
27.5%), F (1, 30) =16.60, P
<
0.001; (younger touch M
=
18.2% vs. younger no-touch M =16.3%),
F
(1, 30) =1.58,
P
>0.10. The analysis of inappropriate mouth closings re-
vealed no significant main effects or interactions.
Self-report. As indicated in the Table, at post-treat-
ment, children who were touched tended to rate "being at
the dentist" as more pleasurable than their no-touch
coun-
terparts, F (1, 30)
=
3.85, P<0.06. The touch group also
reported a tendency for higher submission ratings
(less
dominance) than the no-touch group, F (1, 30)
=
2.95,P <
0.10. No significant effects were associated with the
SAM
arousal scale.
Discussion
Results from this study support the view that a dentist's
reassuring touch affects children's emotional and behav-
ioralreactions during a dental examination. Children who
were randomly assigned to receive touch rated their feel-
ings about being at the dentist as more pleasant (or less
unpleasant), compared to those not touched. During the
examination, children who were touched by the dentist
exhibited less fidgeting behavior than those not touched.
The latter effect, however, was limited to older children,
ages 7 to
10
years; children ages 3.5 to 7 years who were
touched did not differ in their fidgeting behavior from
those not touched. Fidgeting is considered by lay people
as a "nervous" behavior, and by psychologists and etholo-
gists as a behavioral mechanism to displace or adapt to
high arousal and conflict." Research on psychiatric pa-
tients and normals has found that such repetitive move-
ments increase as a person's psychological discomfort and
anxiety increase." Thus, although the true meaning of a
child's fidgeting behavior is unknown, there is some evi-
dence that it is a behavioral manifestation or sign of fear or
Table. Mean (standard deviation) self-reported dental fear (DFS)and pre- and post-
treatment emotion
(SAM)
scores for the touch and no-touch conditions
Experimental Condition
Self-Report Variable Touch No-Touch
Dental fear (DF5) 38.68 (9.42) 36.21 (13.97)
Displeasure/pleasure (SAM)
Pretreatment 3.32 (1.34) 3.32 (1.34)
Post-treatment 3.68 (0.58 3.05 (1.51)
Arousal/ calmness (SAM)
Pretreatment 2.79 (1.81) 2.68 (1.86)
Post-treatment 2.37 (1.74) 2.10 (1.63)
Submission/ dominance (SAM)
Pretreatment 3.00 (1.15) 2.58 (1.39)
Post-treatment 2.90 (1.29) 2.95 (1.39)
Note: The SAM variables were rated on 1- to 5-point scales, with higher values indicating greater
pleasure, calmness, and dominance. The SAMmeans are unadjusted although analyses used
pretreatment scores as covariates.
22 Pediatric Dentistry: January/February! 1993 - Volume 15, Number 1
anxiety. In summary, this study indicates that, for some
children, touch accompanied by reassuring explanations
can reduce anxiety as measured in both subjective and
behavioral domains.
Yet touch, as provided in this study, appears to have
limited effects,in that only two anxiety-related variables
- subjective displeasure and fidgeting - were influ-
enced. Other variables thought to be measures of a child's
anxiety - subjective arousal and noncompliance (inap-
propriate mouth closings) - were not affected.
It
should
be recognized, however, that the brief dental examination
was minimally stressful for many children. Further, the
study of only recall patients potentially reduced the de-
gree of anxiety observed by eliminating fear associated
with novelty. As a result, a "floor effect" may have oc-
curred in which the base rate of arousal and noncompli-
ance was so low that even a powerful intervention would
have had difficulty showing an effect.
It
is possible that
touch during a more distressing procedure such as a res-
toration would have greater anxiolytic properties. Alter-
natively, certain dental procedures may be so anxiety-
inducing (or certain children so anxiety-prone) that touch
proves to be too weak an intervention, and stronger mea-
sures are indicated. For example, a dentist's use of a loud
voice to control highly distressed children was found to
reduce disruptive behavior and self-reported arousal dur-
ing a dental restoration." Research should address the
effects of touch during procedures more stressful than a
dental examination and prophylaxis.
The mechanism by which touch affects behavior and
subjective experience is unclear. Some studies of adults
suggest that touching may induce a direct reduction of
arousal in the recipient's physiology, 11.'>2'-29 which then is
manifest inmotor and subjective responses. Alternatively,
touch may work less directly by helping the children to
believe that the dentist is caring and
will
not harm them.
The marginal increase in the touched children's reported
submission found in this study suggests that touch may
communicate to children that they can temporarily give
up control to the dentist. Research which assesses psycho-
physiological responding and interviews children about
their experience may clarify these issues.
Another question for further study isto what extent the
observed effects were a function of touch as opposed to
the combination of touch and a reassuring verbal descrip-
tion. The present study separated the effects of verbal
statements from verbal statements and touch; future re-
search should separate the effects oftouch from the com-
bination, thereby clarifying what elements constitute the
effective intervention.
Several methodological issues render the results of this
study preliminary. First, as noted above, the study in-
cluded only experienced patients having an examination;
the study's applicability to new patients and/ or other
dental procedures is unknown. Second, touching and ver-
bal descriptions of the upcoming procedures are rela-
tively objective interventions; however, the "reassuring"
quality of the touch and verbal statements is admittedly
subjective. Although the dentists' behavior appeared re-
assuring to them and to the investigators, the children's
experiences might have been different, especially to state-
ments such as "This won't hurt." Also, the touches might
have been perceived as artificial by the children, although
both dentists felt that it was a comfortable, natural interac-
tion for them with their patients. Third, the location of the
touch (upper arm or shoulder) and the use of only two
touches during the examination were somewhat arbitrary
decisions that arguably could have been administered
differently (and perhaps with greater effect). Finally, the
gender, appearance, and personality of the dentists might
have influenced the effects of the intervention. This study
included only two dentists, and although no differences
between them were found, the study was not designed to
test the effects of dentist characteristics on children's be-
havior.
These sources of variance are not experimental con-
founds, but they do potentially limit the applicability of
the findings. Future research should seek to control or
experimentally evaluate these variables. Nonetheless, this
study, in combination with the larger literature on the
beneficial effects of touch in general health care, suggests
that the dentist's judicious use of gentle touch while si-
multaneously providing a reassuring description of up-
coming procedures may affect the child's emotional expe-
rience at the dentist positively.
Dr. Greenbaum is visiting associate professor, Department of Child
and Family Studies/Department of Psychology, University of South
Florida. Dr. Lumley is Assistant Professor, Department of Psychol-
ogy, Wayne State University. Dr. Turner
is
associate professor, De-
partment of Pediatric Dentistry, University of Florida. Dr. Melamedis
professor and dean, Ferkauf Graduate School of Psychology, Yeshiva
University.
This research was conducted while all authors were at the University
of Florida. The study was supported,
in
part, by the National Institute
of Dental Research Training Grant 5T32DE07133 to Dr. Melamed.
The authors thank Oreg Ierrell, DDS, for
his
assistance
in
data collec-
tion.
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24 Pediatric Dentistry: January/February, 1993 - Volume 15, Number 1
... Every time a smiley face is achieved and, depending on achievement, it will be filled with decorative stickers with sad or smiley faces and, depending on the outcome, the child will be rewarded with a present, an excursion or something else he likes and, if he does not comply with these little rules, he could have something he likes taken away, such as a videogame, TV or going to the cinema. Ultimately, it is a combination of techniques used in the psychological management of dental treatment, such as tell-show-do and verbal communication 2,14,16 . Moreover, the incentive chart can help the child to understand his routine and assist in introducing daily activities. ...
... If, during treatment, the professional demonstrates sensitivity and affection, some of the anxiety and fear will be allayed. There is no general rule for the procedure, and good sense and intuition on the part of the professional are needed and are fundamental for better management of pediatric dental treatment 2,6,[9][10]12,14,16 . ...
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Em Dezembro de 2019, o mundo assistiu à emergência de uma zoonose provocada por um novo tipo de Corona vírus o SARS CoV 2. Esta infeção rapidamente evoluiu para uma disseminação pandémica com consequências pesadas em todos os planos civilizacionais. O SARS CoV 2 e a Covid 19 persistem presentemente sem previsões para a sua eliminação, com grande incerteza sobre a sua evolução e extensão quer das consequências sanitárias quer do impacto económico. Desta forma importa desenvolver estratégias que possibilitem o funcionamento das estruturas produtivas, combatendo o congelamento económico e social enquanto consequências absolutamente nefastas no contexto pandémico. A Medicina Dentária, pela sua natureza, nomeadamente a produção de aerossóis, foi classificada como sendo uma atividade no topo do risco de aquisição/disseminação da doença por parte dos profissionais que a exercem. Muitos países suspenderam o exercício de Medicina Dentária como medida preventiva. Importa, pois, agora e na perspetiva de regresso criar mecanismos que permitam o exercício profissional em segurança. No entanto existe uma lacuna extensa sobre a própria definição de segurança no exercício profissional em Medicina Dentária no contexto SARS CoV 2 /Covid 19. O objetivo destas Normas de Orientação Clínica (NOC) foi compilar de forma sistematizada a evidência existente sobre esta temática e conferir a maior robustez possível à decisão clínica no pré per e pós consulta.
... The effectiveness of the programme on reducing fear and anxiety can be explained by the potentially additive effect of multiple psychological behaviour control methods. Providing procedural and sensory information about treatment through a familiar character equated with symbolic modelling and systematic desensitisation [Suls and Wan, 1989], and providing feedback based on the patient's anxiety level showed effects of positive reinforcement and praise [Greenbaum et al., 1993]. Considering that the control group also watched TV cartoons during treatment, it can be inferred that the difference resulted from providing information and feedback through video, not from distraction with watching video itself. ...
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Aim: A psychological behaviour management programme with information and communications technology was developed that includes symbolic modelling, tell-show-do, positive reinforcement and distraction, and provides real-time treatment information. We hypothesised that the programme would help patients feel less stressed and show less uncooperative behaviours and subjective pain. Materials and methods: Forty-eight paediatric patients were recruited from May 2016 to January 2017, and randomly divided into a control group and an experimental group. In the control, patients watched cartoon animations during the first and second treatments. The experimental group watched cartoon animations during the first treatment, and they used the programme during the second treatment. To measure stress, uncooperative behaviour and subjective pain, we recorded the heart rate, Procedure Behaviour Checklist (PBCL) and Wong and Baker's Faces Pain Rating Scale (FPRS). Results: The experimental group resulted in a significantly lower mean heart rate, uncooperative behaviour and subjective pain in the second treatment than did the control group (p<0.001). The differences in heart rate and uncooperative behaviour between the treatments were also significantly greater in the experimental group than in the control group (p<0.001). Conclusion: The programme was effective in relieving fear and anxiety as well as learning cooperative behaviour.
... This kind of physical contacts helped 7-10-year-old children relax. [9,10] Appearance Colors used in the dental office, attire of the dental team, hairstyles, and appearance of the dentist can influence the emotions of the child. Research on color psychology has demonstrated that different colors can evoke different moods. ...
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Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”
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Kapitel enthält: emotionale, soziale und ethische Aspekte von Berührungen; Placeboeffekte; Embodiment; Haus- und Therapietiere; Einsamkeit. - Abstract: Im medizinischen Kontext können von erforderlichen Berührungen, die einem medizinischen oder pflegerischen Zweck dienen, soziale Berührungen unterschieden werden. Diese, oft spontan auftretenden Berührungen, erfüllen soziale oder emotionale Funktionen. Soziale Berührungen können beruhigend, tröstend, angst-, schmerz- oder stressreduzierend wirken. Es besteht somit die Möglichkeit, soziale Berührungen im medizinischen oder pflegerischen Kontext gezielt zu diesen Zwecken einzusetzen.
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Dentists who provide care to children often face patients who are uncooperative in the dental situation. This chapter reviews the most common causes for uncooperative behavior and dental fear (including classical conditioning, social learning theory, cognitive bases of dental fear, helplessness, and loss of control), as well as more recent understandings of how genetics, family stressors, parenting styles, and other parental factors are related to child fear and uncooperative behavior. The chapter also describes the most common ways of measuring dental fear and uncooperative behavior, the importance of pain in the etiology of dental fear, and the relationships between verbal and nonverbal aspects of dentist-patient communication and how these may help both to reduce dental fear and increase children’s cooperation. Attention is also paid to how dentists may best work with adolescents’ developmental needs for increased autonomy in the dental setting.
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Pediatric dentistry is an age-defined specialty and is distinguished by the art of behavior guidance. Whether introducing a toddler to dentistry or continuing to care for a middle-aged patient with intellectual disability, behavior guidance is essential to the delivery of quality dental care while building a trusting and positive relationship. Treating children can be one of the most rewarding experiences a dentist will encounter. With the proper mind-set, training, and environment, dentistry for children should be enjoyable for both the child and practitioner. The concept of behavior management has evolved over the years from the notion of “dealing with” the child to building a relationship with the child, parent, and dentist that is focused on meeting the child's oral health care needs. Hence, the terminology has also evolved from behavior management to behavior guidance. While behavior guidance is the preferred term, behavior management will also be used in this chapter when referring to previously published works on the subject. The American Academy of Pediatric Dentistry (AAPD) defines behavior guidance as “the process by which practitioners help patients identify appropriate and inappropriate behavior, learn problem solving strategies, and develop impulse control and self-esteem.” The overall goal is the delivery of quality, safe dental care in an environment that is as pleasant as possible for children and that promotes a positive attitude toward oral health and future dental care. Dental treatment makes great demands on children, and they need the help of a caring practitioner to be able to cope with these demands. Dentists of every personality type can successfully treat children, and like all other aspects of dentistry, behavior guidance is a skill that requires practice, self-reflection, and effort to improve.
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Background: The appropriate use of touch is central to effective and compassionate care in the clinical environment; however, in a time of the #MeToo movement, and with heightened awareness of child and elder abuse, the notion of physical contact is frequently viewed negatively, and may be associated with gender and power divides. The use of touch in the clinical context has increasing layers of complexity and is highly context specific. … in a time of the #MeToo movement … the notion of physical contact is frequently viewed negatively … METHODS: We reviewed relevant literature, including textbooks, and have drawn on our own experiences to explore the concept and use of touch across medicine, nursing and dentistry. Results: In the context of learning and teaching in health we recognised two types of physical touch: expressive and procedural. Discussion: Our review legitimises the importance of learners and educators being equipped to consider the role and nuances of touch when engaging in professional behaviour. We provide suggestions for how this complex concept may be embedded into entry-to-practice curricula and approached in faculty development.
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Palavras-chave: Maus-tratos Infantis. Violência Doméstica. Odontopediatria. RESUMO Introdução: A violência doméstica contra as crianças interfere no seu desenvolvimento psicológico, levando a sequelas que se manifestam e persistem até a idade adulta. A evidência física da violência doméstica é facilmente observada no complexo orofacial e, eventualmente, é detectada pelos dentistas. Relato do Caso: Relatamos o caso de uma vítima de maus-tratos, de 9 anos de idade, que foi diagnosticada durante o tratamento odontológico. Um odontopediatra, durante as consultas de rotina, após identificar injúrias físicas (hematoma na órbita esquerda e queimaduras na mão esquerda e lábios), suspeitou tratar-se de maus tratos, levando o caso às autoridades responsáveis. A custódia da criança foi concedida à avó por uma decisão judicial, o que permitiu a recuperação da saúde e qualidade de vida. Conclusão: Os profissionais devem conduzir adequadamente os casos de abuso, a fim de proteger as crianças de ocorrências futuras. ABSTRACT Introducition: Domestic violence against children interferes in their psychological development, leading to sequels that manifest and persist up to adulthood. Physical evidence of domestic violence is easily observed in the orofacial complex and eventually becomes detected by dentists. Case Report: We report the case of a 9-year-old victim of maltreatment who was diagnosed during dental treatment. The existence of physical injuries (a hematoma in the left orbit and burns on the left hand and in the lips) aroused the attention of the pediatric dentistry, whose brought the case to the responsible authorities. Custody of the child was granted to the grandmother by a court decision, which enabled the recovery of health and quality of life. Conclusion: Professionals must properly conduct cases through complaints in order to protect children from future occurrences.
Article
A revision of our theoretically based classification of nonverbal behavior is presented, as it relates to the interpretation and measurement of hand movements. On the basis of the origins, usage and coding of the behavior distinctions are drawn and hypotheses offered about three classes of behavior: emblems, illustrators and adaptors. Findings from our own cross-cultural studies, our studies of psychiatric patients, and our studies of deceptive interactions, together with research by Kumin and Lazar, and a study by Harrison and Cohen are summarized to demonstrate the utility of this classification of hand movements. The differences between our formulation and those proposed by Freedman and Hoffman, Mahl, and Rosenfeld are discussed.
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This exploratory study was designed to observe distressed children's responses to verbal and tactile comfort measures. A convenience sample of 63 children between 3 days and 44 months old was drawn from a pediatric unit of a large midwestern hospital. On a random basis, one group of children received verbal, comfort measures for 5 minutes or until they quieted, whichever came first. At the end of 5 minutes, tactile comfort was added if the children were still distressed. The other group received simultaneous tactile-verbal comfort from the beginning. One hundred interventions were carried out on the 63 children. Forty interventions were initially verbal and 60 were tactile-verbal. Among the verbal group, 7 of the interventions were successful in quieting the children as compared to 53 successes of 60 interventions in the tactile-verbal group. This was a highly significant difference. Verbal interventions were more successful for children over 1 year old and tactile comfort was least effective with children in the 13 to 18 month age group. No differences were noted in terms of sex, presence of equipment including restraints, diagnosis, and recency of last feeding.
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Evaluated the influence of film preparation on 80 4–11 yr old children undergoing 3 dental sessions (prophylaxis, examination, and restorative treatment) with respect to (a) peer modeling vs demonstration of procedures and (b) amount of information. It was found that, by evaluating self-report (Children's Fear Survey Schedule), and behavioral (Behavior Profile Rating Scale), and visceral-arousal indices in a factorial design, Ss exposed to a peer-model videotape presentation immediately preceding their own restorative treatment exhibited fewer disruptive behaviors and reported less apprehension than those watching a videotaped demonstration without a peer model. The modeling film elicited less heart rate activity in the Ss than the demonstration. 4–6 yr old Ss had lower self-reports of fear after viewing a more complete synopsis of what to expect, whereas the 8–21 yr old Ss had the lowest report of fears after viewing the peer model receiving a local anesthetic and brief intraoral examination. Ss with previous treatment experience benefitted most from viewing the peer model undergoing the entire restorative procedure or a demonstration of the administration of local anesthetic in the absence of a peer model. Ss with no prior experience were sensitized by being shown the demonstration. It is concluded that the age and previous experience of the viewer are important factors in determining childrens' fear-related behaviors after exposure to preparatory stimuli. (17 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In a study of 62 coronary care patients, 31 of whom exhibited types of cardiac arrhythmia, the frequency of ectopic beats changed significantly when a nurse palpated the pulse. This finding suggests that autonomic responses to human contact can significantly alter the rate of ectopic impulse generation. These findings further suggest that studies of cardiac arrhythmia should attend to the nature of the social field in which data are collected.
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This study compared psychological dimensions of blood phobics and nonphobic controls, examined affect in response to phobic and neutral stimuli, and investigated the relationship between reported feelings of faintness and blood pressure. Blood phobics (24 adults with extreme Mutilation Questionnaire scores) and 24 nonphobics completed several psychological measures and viewed one of two 60 sec surgery scenes and a 60 sec neutral scene in counterbalanced order. Subjective, psychophysiologic, and motoric measures of affect were assessed. On questionnaires, phobics reported greater anxiety sensitivity, empathic distress, fear and insecurity, and nightmares, but no difference in autonomic arousal, muscle tension, motion sickness, or other empathy domains. During surgery scenes, phobics had more negative affect than controls; however, phobics were more anxious during only one of the two surgeries, and often only when the surgery was presented prior to the neutral scene. Fainting did not occur, and self-reported feelings of faintness were unrelated to blood pressure changes. The findings highlight the lack of information on blood phobic stimulus properties, fainting's relationship to self-reports and blood pressure, and the specific emotion experienced in blood phobia.
Article
Two hundred and sixty-seven Australian dentists from the State of Victoria, representing members of the Australian Society of Dentistry for Children (AusSDC) and randomly selected practitioners, responded to a survey on attitudes and practices in the management of anxious children or children with behavior problems. The most common strategies used by dentists in this study were: permitting the child to exercise some form of control over terminating the treatment, if they were experiencing difficulties; furnishing waiting areas with play materials; and using a Tell-Show-Do approach to the provision of dental care. Members of the Australian Society of Dentistry for Children differed from general dentists by more frequently teaching anxious children a technique of relaxation and also by more frequently using a mouth prop or rubber dam during the delivery of care. Younger dentists tended to use behavioral strategies more frequently than older practitioners. Women dentists more frequently than male dentists, used strategies including: spending more time with the child before entering the operatory; setting shorter appointment sessions; and permitting the child to hold a toy or a mirror during dental treatment. In contrast to North American studies, few of the Australian dentists used the Hand-Over-Mouth technique to control hysteria. Australian dentists appeared to rely more frequently than their North American colleagues on setting shorter appointment sessions as a major strategy in managing children with anxiety or other behavioral difficulties.
Article
Voice control, a punishment technique based on loud commands, has been used widely in pediatric dentistry. This study examined whether (a) loudness is a necessary component of the technique, (b) voice control actually reduces children's disruptive behavior, and (c) after treatment, children's negative affect increases. Subjects were forty 3 1/2- to 7-year-olds who posed potential behavior problems and who were scheduled for cavity restoration. Children were assigned randomly to either loud- or normal-voice groups. Children who were assigned to either group but who were not disruptive formed a nonexperimental control group. Prior to and after treatment, children reported their feelings using the Self-Assessment Mannequin. Disruptive behavior was scored using the Behavior Profile Rating Scale. Results indicated that, following loud, but not normal voice commands, children reduced their disruptive behavior (p less than .004) and self-reported lower arousal (p less than .09) and greater pleasure (p less than .10). Theoretical and practical implications of these findings are discussed.
Article
The physiological and subjective effects of being touched on the wrist by another person were investigated in 20 normal adults at rest and during immersion of the hand in ice water. Touching reliably reduced heart rate compared to an immediate preceding baseline and compared to an alpha biofeedback condition. Heart rate during painful ice water stimulation was also lower when the subject was touched as compared to when he/she practiced alpha biofeedback, but this effect was not mediated by a reduction in the perceived painfulness of the ice water. Instead, touching and pain had independent, additive effects on heart rate. Touching did not produce generalized reductions in respiratory rate, SRR frequency, or frontalis EMG activity, although subjects did rate being touched as more pleasant and more relaxing than practicing alpha.
Article
Rumination syndrome--the frequent regurgitation of previously ingested food into the mouth where it is chewed--is a common, life-threatening disorder of retarded individuals. Four cases are described in which holding a retarded, ruminating child for 10-15 min before, during, and after meals, was associated with remission of rumination. Simple holding was effective in three; in the fourth, it was necessary to punish the child by putting her into a separate room for 3 min immediately after regurgitation. A within-subject reversal experimental design suggested that holding and not simple distraction was the effective component of the treatment. Treatment benefits were well maintained when the child returned to a home environment in which he or she continued to be held periodically. It is proposed that there are two behavioral etiologies for idiopathic rumination syndrome--social deprivation and reward learning through increased attention for regurgitation. Holding is the treatment of choice for the first type, and punishment with time out may be necessary to suppress regurgitation in the second type.