Navigating New Guidelines by Dr. Jonelle Anamelechi

Categories: Pediatric;
Navigating New Guidelines 

Unpacking nonpharmaceutical and behavior management strategies for kids in dentistry


by Dr. Jonelle Anamelechi


As a dedicated dental professional, it’s critical for you to stay updated on new guidelines and practices to deliver the best care for our younger patients. In October 2023, the American Academy of Pediatric Dentistry (AAPD) released new guidelines focusing on nonpharmaceutical behavior management strategies.

The new guidelines are not simply a list of do’s and don’ts; instead, they provide a comprehensive framework for you to understand and manage pediatric patient behavior during dental visits. Appreciating these guidelines can help make your patients more comfortable, cultivate mutual trust and ultimately lead to more efficient and effective treatment, both emotionally and medically.

Behavior management is the art and science in pediatric dentistry. It is considered a vital part of treatment planning for success and it begins with you.

Why opt for nonpharmaceutical behavior management?
Nonpharmaceutical behavior management options offer a less invasive approach to managing pediatric dental patients. Such strategies involve creating an environment that encourages patients’ cooperation through trust and communication, rather than relying on medications for behavior control. In addition, when we rely on nonpharmaceutical techniques, kids may develop greater coping mechanisms at an early age, which then hopefully translates into a willing adult for dental care.

Wait … do we throw out the idea of medications?

Let me say “No!” before I lose you readers … but there is a time and place.

There is always a reason behind updates from organizations like the AAPD. The primary motivation for the recent update is founded on growth and evolution in the field of pediatric dentistry. The AAPD recognizes that kids have varying needs, and successful practices must encompass all spectrums. Hence, understanding nonpharmaceutical alternatives for behavior management has become increasingly important to create an all-encompassing approach toward dentistry. The updated guidelines offer insights into methods that can work effectively across different levels of anxiety, attention span and cooperation among young patients, reducing risk without relying on pharmaceutical measures.

The updates are also timely as a response to evolving societal attitudes toward medication and interventions in children, with more parents and caregivers seeking nonpharmacological options. These revisions seek to address these concerns while providing practical, evidence-based strategies for dentists to manage their young patients’ behavior during dental procedures effectively and safely.

Pharmacological methods still play a vital role in pediatric behavior management during dental procedures.

Recommendations
Let’s dive into the practical applications of the key recommendations the AAPD stressed in its recent guidelines, focusing on nonpharmaceutical behavior management for children.

Tell-Show-Do (TSD): This classic technique comes first. Introduce a new dental tool or procedure verbally (tell), demonstrate how it functions or is carried out (show) and, lastly, implement it (do). This simplified, sequential approach minimizes surprises and helps children feel more in control and willing to cooperate during the procedure.

Distraction: Using distraction techniques can effectively draw a child’s attention away from potentially stressful dental procedures. Examples may include playing calming or favorite music, displaying visuals like bubbles or videos, using virtual goggles and even telling engaging stories. Be creative in using this powerful tool to achieve a calm and cooperative patient.

Positive reinforcement: Positive reinforcement is key in promoting good behavior in a dental setting. Praise, rewards and even something as simple as a high-five for demonstrating good dental behavior can motivate kids to be more cooperative during their dental visits. Remember, these rewards should ideally be consistent and immediate to leave a lasting impression.

Parental presence/absence: The presence or absence of parents during dental procedures can influence a child’s behavior significantly. Some kids might feel more at ease with their parents at their side, while others may behave more calmly and independently without them. Remember to discuss this with the parents and adapt according to what works best for each child-patient relationship.

Modeling: Exposing a child to another patient (a peer or a sibling) undergoing a dental procedure can be helpful. This modeling technique enables the apprehensive child to observe and understand that the dental process is not as daunting as they had perceived.

Guidelines and great team members

In the AAPD guidelines, the evidence base was evaluated on two different patient groups (children with and without special health care needs) and two different settings (restorative and preventive care). The diagram in the guidelines is an excellent depiction of the evidence base we have for nonpharmaceutical behavior management for children, but if we look closely, we’ll see there is no one-size-fits-all or guaranteed method. Dentists have somewhat of a toy box of options, and you may need one or, if you are hanging in there long enough, 20 techniques.

The one missing element in the evidence base is you and your team. Your preparation, mindset, gentle approach and willingness to be “led” by a child to see their perspective and have a team equally well trained will be extremely valuable, in my 18 years of practice in pediatrics.

Helping each other grow
Remember, guidelines like these provide us with a standard to adhere to and a platform for improvement and growth in our profession. Apply these recommendations and share your experiences with colleagues. Together, as we evolve our practice around these guidelines, we’re not only bettering ourselves but also enhancing pediatric dental care universally.

The key takeaway here is this: We have a responsibility to balance the needs of effective treatment with the emotional well-being of our patients. These new AAPD guidelines help us imagine new ways to do just that. Pediatric dentistry doesn’t have to be a scary experience for our young patients! With the right approach, it can be a positive step toward a lifetime of healthy smiles.

The decision to use pharmacological aids should be individualized, considering the child’s physical and emotional health, and always with the informed consent of the parents or caregivers. But remember, the ultimate aim is to ensure the child’s comfort while delivering effective dental care. This is why incorporating nonpharmaceutical strategies into your practice as a team effort is so important.


Author Bio
Dr. Jonelle Anamelechi Dr. Jonelle Anamelechi earned an undergraduate degree from Duke University, her dental degree at the University of North Carolina at Chapel Hill (UNC-CH) Adams School of Dentistry, and her master’s of public health in maternal and child health at the UNC-CH School of Global Health. For her pediatric dental residency program, she attended St. Joseph Regional Medical Center.

The owner of Children’s Choice Pediatric Dentistry and Orthodontics practices in New Carrollton, Maryland, and Washington, D.C., Anamelechi is attending faculty for the division of oral health at Children’s National Hospital, the department of pediatric medicine at Medstar Georgetown Hospital, and guest faculty at Georgetown School of Law School. Her work has focused on children with craniofacial abnormalities, tethered tissues and their link to poor oral health, and health equity for children with special challenges. She is the co-editor of the book
What Should Mommy Do? For Their Child’s Oral Health.

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