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Authors: John Morgan, Bonnie F. Zimble
Behavior Management: The Patient Care Experience
 
for Patients with Disabilities:

Introduction

Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008


Study Questions     

  1. Why might a patient with disabilities present with challenging behavioral patterns?
  2. Define behavior modification?
  3. What are some non-behavioral methods that might be needed when patient behavior cannot be controlled by behavioral procedures alone?

The Patient Care Experience for Patients with Disabilities 

Persons with disabilities, like anybody going to the dentist, have a wide range of likes and dislikes concerning the dental visit. Some disabilities may prevent the person undergoing dental treatment from being able to effectively express their comfort, fears, concerns and understanding of the dental care that is recommended for them.  This may result in behavioral patterns that influence the ability of the dental team to provide that person with safe, effective dental treatment.  

Behavior modification offers a highly effective approach for preventing or responding to behavioral challenges associated with dentistry with patients with disabilities. The term behavior modification refers to the practical application of principles of learning drawn from decades of psychological research. The basic philosophy is that behavior is learned and that the principles of learning can be applied successfully to change behavior. Nevertheless, it is recognized that in certain dental situations other non-behavioral methods, including sedation or anesthesia, may also have to be considered as a means of controlling patient behavior.  If behavior problems are a factor, several options are available to the practitioner.   

Specifying Behavioral Expectations in a Dental Setting  

Identifying a challenging behavior is the first step in effecting a behavioral change. Before attempting any such changes, you will need to clearly specify the expectations you have for behavior in your office. There are some general standards for patient behavior which you and most of your colleagues share, but please keep in mind that individual standards are likely to vary…as will the abilities of some of your patients to meet them. You will need to ask yourself the following questions: 

  • At what point should you decide to refer a patient elsewhere?

  • How much time are you willing to invest?

  • How many resources do you have available?

  • How many “behavioral deviations” can you handle comfortably?

  • What are your alternatives?

Behavior Management: The Patient Care Experience for Patients with Disabilities covers the following topics:  

  • Basic behavior modification techniques, focusing on sensory integration

  • Testimony of a Clinician successfully using behavioral techniques

  • Health related protection

  • A brief word about pharmacologic methods of sedation

In addition, at the end of this module you will find links to more detailed information.

In closing, this module has been designed to give practitioners basic knowledge about the dental management of the patient with disabilities. The information will help you examine your own patient-management skills. The principles and procedures associated with behavior modification are invaluable to anyone interested in teaching people more effective ways of behaving. The principles presented here were chosen because they directly apply to the needs of the dental professional. All of these principles can be readily applied to patients with mental and physical disabilities.