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MANAGING THE

PATIENT, PRACTICE,AND PARENT I 

“The Behavior of Children in the Dental Environment”  

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CLASSIFYING BEHAVIOR 

• Cooperative

• Lacking Cooperative Ability

• Potentially Cooperative– Uncontrolled Behavior

– Defiant Behavior

– Timid Behavior

– Tense-Cooperative Behavior

– Whining Behavior

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CRYING TYPES 

• Compensatory cry

• Fearful cry

• Obstinate cry

• Painful cry

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FEAR AND ANXIETY 

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ANXIETY 

“…apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognized.Primarily of intrapsychic origin, in distinction to fear , which is the emotional response to a consciously recognized and usually external threat or danger. Anxiety and fear are accompanied by 

similar physiologic changes. May be regarded as  pathologic when present to such an extent as to interfere with effectiveness in living, achievement of desired goals or satisfactions or reasonable emotional control.”  

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FEAR 

• Objective Fears

– Direct stimulation of the sense organs;

personal experience based

• Subjective Fears

– Based on feeling and attitudes suggestedto the child by others, without the childhaving had an experience personally.

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PRINCIPAL FEARS BY AGE 

• THREE YEARS - Visual fears (masks, policeman)

• FOUR YEARS - Auditory fears (sirens)

• FIVE YEARS - Bodily harm (falling, dogs, dentist)

• SIX YEARS - Many fears; especially auditory and spatial• SEVEN YEARS - Deeper fears (not being liked/loved)

• EIGHT YEARS - Fears reduced; continuation of failure,being liked

• NINE YEARS - Few fears; but ability to competesuccessfully exists

• TEN YEARS - School

• ELEVEN YEARS - Major fears re-emerge; health andanimals

• TWELVE YEARS - Fears dissipate; fear is “silly.” 

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RELATING EMOTIONALMATURATION TO THEDENTAL SITUATION 

• Two Year Old• Three Year Old

• Four Year Old

• Five Year Old• Six to Twelve Year Olds 

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VARIABLES AFFECTINGCHILDREN’S BEHAVIORS 

• Parental Behavior

– Overprotection (extreme domination orindulgence)

– Rejection– Over anxiety

– Over-Identification

• Past Medical History • Other Variables: socioeconomic, cultural,

sex, ordinal position, sibling relationships,

number of children in the family

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ASSESSING AND RECORDINGCHILDREN’S BEHAVIOR IN THE

DENTAL SITUATION • Definitely Negative (F1)

– Refusal of treatment, crying forcefully, fearful, or anyovert evidence of extreme negativism

• Negative (F2)– Reluctant to accept treatment; uncooperative; some

evidence of negative attitude, such as sullen orwithdrawn, but not pronounced.

• Positive (F3)

– Acceptance of treatment; at times cautious; willingnessto comply, at times with reservation, but followsdirections

• Definitely Positive (F4)

– Good rapport with dentist; interested in procedures;

enjoys the situation.

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DYNAMICS OF BEHAVIOR 

• These codes should be entered in thepatient’s record, and will provide a cue

for anticipated behavior at a subsequentvisit.

• Children’s behavior will vary through anappointment and the codes should be

used to indicate such: “F1 initially and during anesthesia; F4 after rubber dam  placement and during treatment.”