Acceptability of various behavior management techniques relative to types of dental treatment.

The purpose of this study was to determine if acceptability of behavior management techniques was dependent upon the type of dental procedure to be accomplished. Sixty-seven parents viewed videotaped segments of actual treatment of threeto five-year-old children with whom 10 behavior management echniques were used successfully. After rating the general acceptability of these techniques, they viewed six dental procedures: intraoral examination, radiographic technique, fluoride treatment, injection, restoration, and emergency extraction. The parents then were asked to indicate in which treatment situations each management procedure was acceptable or unacceptable for use on their child. The parents also were asked which behavior management techniques were totally unacceptable in any situation. The proportion of parents who found behavior techniques acceptable for each dental procedure, differences in proportions of approval for different techniques, and the proportion of parents finding a technique totally unacceptable were calculated. The pharmacological techniques of general anesthesia and sedation were judged acceptable by a majority of parents only for the extraction and extraction and restoration, respectively. The Papoose Board® and HOME never were viewed as justified by the majority of parents. Physical restraint by the assistant was acceptable in more situations than restraint by the dentist. Other techniques were acceptable to the majority of parents for nearly all procedures. Use of the Papoose Board was the technique most often judged totally unacceptable. However, all techniques were judged totally unacceptable by some parents. Successful treatment of a disruptive child depends partially upon selection of an appropriate behavior management technique. When evaluating a child and selecting a management approach many factors should be assessed. These include: the type of behavior,~3 the child’s anxiety, 3 age of the child, 46 child rearing techniques, ~ personality variables, 8 parental attitudes toward behavior management techniques, dental treatment to be rendered, and the legal implications. 9 Data reported in a companion paper1° note that all behavior management techniques are not equally acceptable to parents and several techniques are generally unacceptable. The acceptability of a behavior management technique depends on the child’s needs at the time of treatment, with the type and urgency of treatment influencing both the selection of a particular technique and parental acceptance of that technique. The purpose of this portion of the study was to determine if acceptability of behavior management techniques was dependent upon the type of dental procedure to be accomplished. Methods and Materials As reported in the previous study1° parents viewed 10 videotaped segements of actual behavior management sequences. They were asked to rate the acceptabilty of each management technique by placing a sticker along a line that had end points labeled most acceptable and least acceptable. Data reported in this study are an extension of that study. Sixty-seven parents participated in this portion of the study (demographic data are described elsewhere). ~o Ten behavior management techniques were explained and demonstrated to them. These included: tell-show-do; voice control; mouth prop; positive reinforcement; hand-over-mouth exercise (HOME): physical restraint by the dentist; physical restraint by the assistant; Papoose Boards~ and PediWraps®b’; sedation; and general anesthesia. The parents then viewed six dental procedures: Dental exam: An intraand extraoral examination of " Olympic Medical Corp, Seattle, WA. ~’ Clark Associates, Worcester, MA. PEDIATRIC DENTISTRY: December 1984/Vol. 6 No. 4 199 the soft and hard tissues was performed using a dental mirror and explorer. Radiographic technique: A radiographic film was placed in the child’s mouth and exposed. Fluoride treatement: Two paper trays containing fluoride gel were placed in the mouth for 4 minutes while excess gell was removed with suction. Injection: An anesthetic solution was infiltrated in the maxillary anterior region. Restoration: Caries was removed using a high-speed handpiece and bur. The tooth was restored with silver amalgam. Emergency extraction: An infected, painful tooth was elevated and removed with forceps after adequate anesthesia was obtained. All procedures were segments of actual dental treatment. The validity of the videotaped dental procedures was established by having eight pedodontists on the faculty at the University of North Carolina view the videotape and evaluate the material for presentation accuracy. Two dental p.rocedures were retaped at the recommendation of the group and subsequently approved. The acceptability of a behavior management technique could depend on the parent’s perception of the type and urgency of the required treatment. For instance, an elective procedure may not be viewed as important enough to warrant the use of several of the behavior management techniques presented; yet, an emergency dental need might be perceived as important enough to use those same techniques. The questionnaire allowed participants to evaluate and record this information. (At this point, the parents had recorded the general acceptability of each management technique as previously described I° on the continuum from least to most acceptable, and had viewed the dental procedures.) The parent were asked to mark each management technique that was acceptable to gain cooperation for each specific dental procedure. Thus, each technique and its acceptability for each dental procedure could be assessed. The parents also were asked to determine which behavior management techniques were unacceptable for use on a child in any situation. To establish reliability, a pilot group of 13 participants was tested twice with six weeks. Results were analyzed using the paired t-test and signed rank test. The t-test focused on whether or not the differences between the responses for the first or second test were significant. The signed rank test was more appropriate for this small sample size. The proportion of participants who approved or disapproved the use of specific behavior management techniques for particular dental procedures established "acceptability." The percentages of yes/no responses and their standard errors were calculated for each behavior management technique and dental procedure. Asymtotic regression was used to comTABLE 1. Proportion of Parents Indicating Acceptability of Behavior Management Techniques for Each Dental Procedure (N = 67)