Tufts OpenCourseware
Search
Authors: John Morgan, Bonnie F. Zimble

Behavior Management: The Patient Care Experience
 
for Patients with Disabilities:

A Practical Clinical Application of Desensitization

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


Study Questions  

  1. Describe some approaches that can be taken with patients with sensory integration problems.

  2. What are some of the options for outside help?

Systematic Desensitization 

Systematic desensitization is an effective behavioral strategy for helping people overcome fears and phobias. It involves identifying responses a person might learn that are opposite to his fear responses, such as becoming relaxed. The individual is then taught to engage in those responses when gradually being exposed to the precise situations that produce fear. 

Desensitization is a gradual exposure technique that relies on the behavioral principle of shaping. Shaping involves teaching a new behavior (such as relaxing) gradually, by practicing and reinforcing its application in small steps of increasing exposure (approximations) to the full fearful situation. The first step is to work with the patient to establish a fear hierarchy. This is a list of fear-producing situations ordered from “least amount of fear” at the bottom to “most amount of fear” at the top. Through any number of methods, the patient should learn to relax on cue, releasing the tension in muscles while taking slow, deep breaths.  

Once the patient can relax, this response is applied during exposure to the fearful situations on the fear hierarchy, starting at the bottom – approximations to the end goal - and working towards the top. Patients need lots of positive reinforcement and support as they work through their fears. This approach should be tailored to the specific ability of the patient to understand and give feedback.     

Sensory Integration 

We are acutely affected by all of our senses: hearing, sight, smell, touch and taste. Here are some tips for reducing sensory-related anxiety in each of these areas. 

Sound 

  • Voice Control: Many patients are overly sensitive to the sound of our voices. Using quiet and smooth tones (voice control) is more relaxing than allowing yourself to use a voice that is hurried and rough.

  • Noise generated by dental equipment: Sounds produced by the suction, dental handpiece or amalgamator can cause stress. When possible, clinicians should relate these items to familiar and non-threatening objects. For example, the suction can be referred to as a loud straw or Mr. Thirsty; the handpiece as a tooth tickler or dust buster; and the amalgamator as a filling machine.

  • Music: Some patients enjoy listening to relaxing music such as soft instrumental, rain or water sounds. Others may choose to bring in their own music and listen to it on headphones. This allows them to drown out extraneous noise. A few patients will prefer to have no music playing, as they find the background noise too distracting.

Smell

  • Surface cleaners and disinfectants have strong odors. Try to find alternative cleaners that don’t contain these additives.

  • Use light, clean-smelling air fresheners

  • Consider aroma therapy

  • It may be necessary in some instances to eliminate all odors as best as possible 

 Touch 

  • Touching firmly but gently will reassure the patient.

  • Unexpected touch can be difficult for patients who are sensory defensive. Approach the person from the front and provide a warning before touching.

  • It may be helpful to allow patients to touch some of the equipment. Once they have felt some of the tools they seem less concerned about them.

  • Allow patients to help by holding the saliva ejector, using it when they want to. They may enjoy being your helper.

  • Place a small bean bag chair or pillow on top of the dental chair to help make the patient feel more secure.

  • Leaving small children in their stroller is another possibility.

  • Patients with autism often have a sensory integrative problem with balance and movement, and with proprioception. They may even like being wrapped in the pedi-blanket or papoose wrap. Several companies design and produce equipment for this purpose. This topic is covered more in depth later in the module.

Taste
  • Some patients are very sensitive to strong tastes. Ask the patient, or a parent or care provider, if they know of a preference, such as fruit bubble-gum or mint flavor. In some cases you may find it more suitable to use a toothpaste brought from the patient’s home.

  • Rinsing or wiping out the patient’s mouth quickly can eliminate an unpleasant taste.

Seeking Outside Help

What about patients whose problems are more extensive than what you may be able to manage? Several resources such as the ones listed below are available:

  • Your local mental health clinic

  • Your local college or university psychology department

  • The counseling staff of your local hospital

  • Private therapists

  • Extension courses, workshops and other forms of short-term specific instruction for your dental staff

  • University dental school with a special treatment clinic for dental phobics