Evaluation of behavior management t

Evaluation of behavior management technology dissemination in pediatric dentistry Keith D. Allen, PhD Robert T. Stanley, DDS Keith McPherson, MA Abstract A su rvey of the behavior ~nanagement practices of pediatric dentistry diplomates was conducted. One hundred sixty respondents reported the frequency of use of 15 different management practices. Results show preference for traditional management practices, such as hand-over-mouth, tellshow-do, sedation, and restraint, over newer technology such as live modeling, fihned modeling, contingent distraction, or contingent rewards. Respondents reported management difficulties with nearly one in four children seen and reported the need for alternative, safe, effective management techniques. Reasons are discussed for reliance on traditional management techniques and methods for increasing exposure to newer ~nanagementechnology. Introduction In 1972, a survey was published regarding the behavior management techniques of the American Association of Pedodontic Diplomates. The respondents strongly supported the notion that psychological principles are important in the successful management of disruptive children; however, their managementechniques focused primarily on pharmacotherapy and variations of physical restraint (American Association of Pedodontic Diplomates 1972). By 1979, pediatric dentists reported that the noncompliant and disruptive child was a common problem faced in clinical work (Ingersoll et al. 1978). Perhaps as a result, some pediatric dentists began to expand their management repertoires (Levy and Demoto 1979). Many more, however, continued to rely on physical restraint and sedation as a primary means of management. Indeed, in 1981 20% more pediatric dentists were using the hand-overmouth (with airway restricted) technique than in 1971 (American Association of Pedodontic Diplomates 1981). At that time, however, the efficacy of a wide range of technology for child management yet had not been demonstrated clearly in the dental office or operatory. In recent years, research in the dental operatory has proven the value of psychological techniques in preparo ing children for (Anderson and Masur 1983) and managing children during (Allen and Stokes 1989) dental treatment. Research published in both psychological and dental literature has demonstrated the efficacy of a variety of noninvasive techniques. The effectiveness of some procedures, such as filmed modeling, has been shown primarily with "normal" (nondisruptive) clinic samples. Its effectiveness appears to be dependent, at least in part, on a variety of variables such as age and previous experience with the dentist (Melamed et al. 1975; 1978; 1984). Other procedures have been found to be quite effective with children selected based on high levels of fear or disruptiveness. These include live modeling (Williams et al. 1983), desensitization (Klesges et al. 1984), and contingency management procedures such as contingent distraction (Ingersoll et al. 1984), and contingent escape and reward (Allen and Stokes 1987; Allen et al. 1988). Not since 1981 (Weinstein et al. 1981), however, has an assessment been conducted to determine the extent to which new technology has been successfully disseminated. More important, there are no data available concerning the factors responsible for the acceptance of new management technology by pediatric dentists. Finally, there are no recent assessments of the prevalence of management problems in pediatric dental practices or of the need for continued development of new management technology. The present survey provides an assessment of the types of management needs and management techniques currently used by pediatric dentists. Previous research has suggested that the practices of pediatric dentists can be evaluated accurately by assessing the practices of those with Diplomate status (American Association of Pedodontic Diplomates 1981). These dentists have advanced training and experience in pediatric dentistry and typically have well-developed behavior management armamentariums. The survey also provides information about the variables dentists consider most important to theif adoption of new behavior management technology. PEDIATRIC DENTISTRY: APRIl/MAY, 1990 ~ VOLUME 12, NUMBER 2 79