Tufts OpenCourseware
Authors: John Morgan, Bonnie F. Zimble

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

Alternatives and the Patient Cooperation Scale

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

Study Questions

1.     What three alternative modalities may be needed?

2.     Describe the purpose of, use of, and behavioral descriptors used in the Patient Cooperation Scale.

Sometimes a flexible set of alternatives is needed …

Many patients may require additional modalities to prepare them for dental care. Behavior problems can prohibit safe, effective dental treatment. Health related protection, conscious sedation, and general anesthesia may be indicated based on an assessment of the patient’s medical profile, behavioral issues and dental needs.  Using a combination of techniques may improve the patient’s behavior over time and result in a cooperative patient with minimal levels of intervention. Some patients often require deep sedation for initial visits, but as they gain confidence, require minimal sedative agents for future visits. Also, some dental procedures are more stimulating than others and may require varying levels of sedation depending on the nature of the treatment being provided.

The Cooperation Scale to Evaluate Patient Behavior

Tracking patient behavior from visit to visit is difficult.  Decisions concerning the effectiveness of various modalities of health related protection, behavior management and sedation are usually based on the ability of the patient to cooperate for the dental visit.  In order to monitor the patient’s behavior a cooperation scale is used.  Recorded at every visit, this simple measurement tool allows the dental practitioner to assess the cooperation level of the patient and receive feedback concerning the effectiveness of the comprehensive patient management program in use. 

Patient Cooperation Scale




Did not enter clinic/dental chair


Sat in dental chair but did not allow exam


Allows only brushing of teeth and/ or visual exam


Allows instruments placed in mouth and exam with help from staff and/or assistant


Allows complex procedure with stabilization more than 50% of the time


Allows complex procedure with stabilization less than 50% of the time


Allow complex procedure with no stabilization