Behavioral First 2 Chapters

7/30/2019 Behavioral First 2 Chapters

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Table of Contents

Topic Page

What is behavioral dentistry? 2

Chapter 1: Health care communication skills 3

Chapter 2: Dentist patient relationship 18

Chapter 3: Behavior Management of Pediatric patient 26

Chapter 4: Dental Care for People with Disabilities 39

Chapter 5:Management of dental Fear and Anxiety 48

Chapter 6: Dental Management of Geriatric Patients 57

Chapter 7: Understanding Conflict Management 67

Chapter 8: Patient compliance and Behavior modification 80

Chapter 9: Handling the Difficult Patient 90

What Is Behavioral Dentistry?

Application of behavioral science in the clinical practice of dentistry.


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What Is Dentistry?

Dentistry is a science and an art:

The science of dentistry concerned with diagnosis, prevention and

treatment of diseases of teeth, gum and related structure of the mouth.

The art of dentistry involve the application of dental science and

technology to individuals, families and communities provided by a dentist

with the scope of his education, training and experience according the

professional ethics and law.

Importance OF Behavioral Dentistry:

Dentist can be better by adding: clinical and technical skillstogether with the application of behavioral principles.

Dentists understand behaviors of people whom he will meet in hiscareer (patient and colleagues).

The Dentist Treat A Range of Patients, From Those Who

are:

Dentally anxious and fearful patients.Patient with sever pain.Difficult personality.Physically disabled and handicapped.People of various ages: Children (pediatrics) and elderly (geriatric).

Chapter 1

Health Care Communication skills


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What is communication?

The sharing of information between two or more individuals to reach a

common understanding throughout the exchange of verbal and nonverbal

messages

The Benefits of Good Communication in health care:

Dentists know their patients. Essential for good patient-doctor relationship. Essential for diagnosing and treating illness. Advice, reassurance and support from the doctor can have a

significant effect on recovery (The placebo effect).

Patients who feel at ease and who are encouraged to talk freely aremore likely to disclose the real reason for consultation.

Manage anxiety and fear. Improved satisfaction. Improved patient compliance to treatment. Better health outcomes. Decreased malpractice claims. Ensures good working relationship and teamwork. Facilitates educating patients.

So To Be a Good Doctor, we have to Be a Good

Communicator.


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Health care professionals must communicate effectively and

appropriately with other health care workers, patients and their

families.

Doctor Patient Doctor Colleagues Doctor Nurse

Communications Process:

The steps between a source and a receiver that result in the transference

and understanding of meaning.

Communication is a complex process. To better understand this it is

helpful to break this down into components.

Elements of the Communications Process

The Sender. The Message. The Receiver. The Channel. Feedback - the Receivers Response.


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1-Sender:

Senderis the person who starts the communication of information

(sending the message). In health care he may be doctor or nurse.

Sender has an idea to communicate. The idea is encoded into message.

2-Encoding:

Putting the message into a form that the receiver will understand.

How may the sender encode a message?

Verbally or nonverbally (by speaking, writing, body language).

3- The message:

The information which communicator transmits to audience.

4-Channel:

Method used to transfer the message from sender to receiver.

It can impact the message positively or negatively, so the sender must

choose the best method for assuring effective communication.

5- Decoding:

The receivers process of translating the message into a meaningful form.

How does a receiver decode a message?

Hearing, reading, and observing.

6-Receiver:

Person to whom we are sending the information.

Message received.


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Message decoded. Idea understood.

7-Feedback:

A response by the receiver to the senders communication.

Feedback helps to ensure that the message received has been decoded

correctly.

Can be: Verbal and Non-Verbal Reactions.

Positive and Negative feedback.

8- Communication barrier:Anything that gets in the way of clear communication.

May be in sender, message, or receiver.

Communication barriers from senders side:

Vagueness about the purpose of communication. Choice of wrong language, resulting in badly encoded message. Wrong choice of the channel.

Communication barriers from receivers side:

Poor listener.


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Inattention. Lack of interest. Lack of trust. Physical disabilities:

Deafness or hearing loss.

Blindness or impaired vision.

Aphasia or speech disabilities.

Common barriers both sender & receiver:

Physical noise & other faults in surroundings & instruments of

transmission of message relate mainly to the channel.

Psychological attitudes. Cultural diversity. Language differences.

Environmental barrier:

Noise.Interference.

Lack of privacy

Fear of being overheard

Inadequate lighting (for lip reading).

Chapter 16: PowerPoint 16.4

(Adapted from Figure 16.1)

Receiver

provides verbal

and nonverbal

responses to sender

Receiver

perceives and

decodes

message

Sender has

idea

Sender

encodes idea

into a

message

Message

travels over

one or more

channels

Summary of Communication Process


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Effective Communication Occurs When

Message is understood by sender as it was intended by receiver = mutual

understanding.

For effective communication the sender should:

Know the audience and establish a rapport with them. Know his objectives. Know the topic well. Be interested in the topic. Select the best channel.

For effective communication the message should be:

Accurate. Brief. Clear. Understandable and memorable.

For effective communication the channel should be:

Appropriate. Accessible. Affordable. Appealing.

For effective communication the receiver should:

Be aware, interested, Willing to accept the message. Listen attentively. Provide feedback.

Listening Skills


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Paying attention to the message, not merely hearing it

1- Active listening: Use of open questions. Non-verbal communication. Show interest and pay attention. Avoid interrupting and watch the speaker closely for

nonverbal communication.

Do not judge.2- Paraphrasing (Restatement):Involves repeating the message back to the sender in the receivers

own words. Restatement ensures that the correct message has been

heard and understood.

Use phrases such as: In other words I gather that If I understand what you are sayingWhat I hear you saying isSorry for my interruption, but let me see if I understand you

correctly

3-Reflection involves responding with empathy.

Empathy is the ability to share in someone elses feelings or emotions.

Patients who are in special need of empathy:

Lonely. Facing serious surgeries. Terminal illnesses.


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3- Clarification occurs when the receiver asks questions to get amore concise explanation or to clear up any confusion about the

message.

Open-Ended Questions:

Questions that clients cannoteasily answer with Yes,, No,.

Purpose of Closed-Ended Questions:

To begin an interview. To encourage client elaboration. To motivate clients to communicate.

Closed-Ended Questions:

Questions that the other can easily answer with a Yes, No,.

Purpose of Closed-Ended Questions:

To narrow the topic of discussion. To obtain specific information. To interrupt an over talkative client.

Reassurance is valuable in the clinical session

Positive supportive statements to the patient that he or she is going to do

well or be all right are an important part of treatment.

The best time for reassurance is after the examination, when a tentative

diagnosis is reached. The support is best received by the patient at this

point.

Types of communication:

1. Verbal Messages - the words we choose.

body

language

55%

words

7%

tone of

voice

38%


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2. Paraverbal Messages - how we say the words.

3. Nonverbal Messages - our body language.

1- Verbal communication:

Verbal communication is the use of words to send and receive

information.

Goals for verbal communication:

Obtain information from patients. Give instructions to patients. Confirm understanding.

The words we use either spoken or written.

Spoken Communication should be:

Be Undrestandable!

Avoid Latin Words

Avoid Medical Terms

When interacting with patients, dentist must translate medical

terminology to the patient cultural background.

Written Communication:

Example for it in healthcare is well

written prescription.

It should be:Completeincludes medication,

dosage, and frequency.

Clear clearly written.Concise (Brief) contains only the necessary information.

2- Para-verbal (Voice control):

Involves the way a speaker speaks


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Word Stress: Meaning can be changed by changing stress. Rate of speed: When a speaker speaks too fast, he is seen as more

competent.

Loudness:Loud people are perceived as aggressive.

Soft-spoken voices are perceived as polite.

If doctor can adjust their tone of voice appropriately to the situation, it

can become an effective communication tool.

3- Non-verbal (Body language):

Doesnt use the words but involve use of body language. What a speaker

looks like while sending a message affects the listeners understanding.

a- Appearance:

Importance Of First Impression

It influences the patients perception of carereceived.

A nice, look sends the message of a competent

professional who has paid attention to these details

of personal appearance and hygiene

Traditional items of dressing (wear uniform) such

as: Name tag, white coat, pants, preferred overcasual wear (blue jeans).

b- Gestures:

Movement of our arms, legs, hands, and head are called gestures. We can

send powerful messages to others by the way we walk, talk, stand and sit.

Action Result


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Leaning forward and head nodding Interest

Pointing at people Perceived as giving orders

Leaning backwards Disinterested

Crossed arms Defensiveness

Hands in pockets- Shows disrespect

Shaking feet or legs- Disinterest

Most appropriate: leaning forward communicates to your audience that

you are, receptive and friendly. While speaking with your back turned or

looking at the floor or ceiling should be avoided; it communicates

disinterest to your audience.

c -Facial expression:

The human face is able to express countless emotions without saying a

word especially pain.

Common facial gestures

are:

Happiness Sadness Anger Tension

Smiling is a powerful keythat transmits:

Happiness Warmth.

d - Eye contact:


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Eye contact is one form of facial expression. Different types of eye ccontact:

Action Result

Direct eye contact Confidence and interest

Looking downwards guilt/shame

Single eyebrow raised Doubt

Both eyebrows raised Admiring, encouragement

Tears Emotional - pain

e - Proximity

Distance between sender and receiver, the way that people use physical

space to convey messages.

Differ from one person to another according to:

Age. Sex. Cultural values.

Intimate distance telling secrets. Personal distance for talking with friends. Social distance business transactions. Public distance giving a talk to a group.


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6-19

Doctors and nurses can use either personal or social according to

situation in order to perform their duties.

f - Touch:

Touch is an important part of the doctor or nurse-patient

relationship.

- Handshaking shows respect when greeting someone.

A gentle grip is appropriate.

- Pat on hand or back of patients to show empathy is

appropriate especially in children and elderly patients.

- Physical contact during physical examination

(Functional professional touch).

Touch can communicate many things.

Health care workers must always to touch patients with

only kindness and respect.


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Chapter 2

The Dentist-Patient Relationship

What do patients expect from doctors??

The patient expects a good relationship as much as a cure.

Thedoctor-patientrelationshipbecomes center to the practiceof dental care and is essential for the delivery of high-quality

health care in the diagnosis and treatment of disease.

Nature of relationship determines success or not.Definition

It is clinical interaction between the doctor and a patient which arises

when the doctor in a professional capacity; interact with the patient.

Factors affecting dentist patient relationship:

Differences in:

Educational level. Social class (rich doctor- poor patient). Gender (male doctor- female patient). Different languages. Personality. Background and experiences. Behavioral view towards patient illness (dentists and patients

point of view).

Types and models of doctor-patient relationships.

Inequality (Different view between doctors and Patient's

explanations about diseases):
http://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Physicianhttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Healthcarehttp://en.wikipedia.org/wiki/Patienthttp://en.wikipedia.org/wiki/Physician


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The Doctor and the Patient are on two opposite ends. Behavioral view of the dentist about patient illness.

Dentists think of dental symptoms in physical terms (pain= dental caries).

The Doctor is often concern with the disease diagnosis and treatments

(finds and fix approach). The Doctor has a high level of knowledge on a

problem the patientalmost knows nothing.

Behavioral view of the patient about his illness:While the patient view their illness in how they affect their life (personal-

work and social relations) (disruption of life). Patients view their

symptoms in their own psychological and social relations.

Differing perceptions of dental care by the patient and dentist contribute

to inequalities between the two.

Importance of Equality in the Dentist-Patient Relationship

Equality in the dentist-patient relationship encourages effective dental

practice and behavioral management of patients.

Methods of patient management help dentists reducing stress in

demanding, anxious and difficultpatients.

Various models have been suggested to explain the dentistpatient

interaction: Active Passive model Guidance-Cooperation model Mutual Participation model1- Active Passive Model:

In this type dentist is active and patient is passive.


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Doctor takes complete responsibility for the patientstreatment (as in dental operation).

Dentist focuses on reaching diagnosis and treatment ofdisease but ignore patient needs and history:

Ask closed questions. Carried out appropriate examination. Know diagnosis. Decides on the appropriate treatment then do it. Whatever dentist does to patient, patient respond without complaint

supposing that the doctor knows best.

Disadvantages

The greatest deficiency with model is that it ignores thechoices of the patient.

Ignores needs of patient. The balance decision making is shifted to the dentist side.

2- Guidancecooperation Model:Dentist tells his patient, what is good for him (guide).Patient cooperation is a must.Patient follows dentist direction. He depends on doctors for

decision making.The dental check-up visit: an example of the guidancecooperation

model.

3- Mutual-participation Model:Dentist and patients are equal partners. Both share

responsibility, exchange of information.


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The doctor uses open questions to encourage the patient totalk about his complaint. He listen and trying to understand

the patients point of view.

Dentist provides the patient with all information about: The disease state. The possible diagnostic and treatment options. The risks and benefits of options. The cost. The doctor emerges as an advisor of the patient. Not just by presenting information, but advising a specific course

of action he tries to persuade the patient to make the best choice.

Taking into account both clinical judgment and the patients needsand wishes.

Best model for relationship between dentist and patient.Suitable for chronic disease such as dental caries and periodontal

disease.There is shared decision making responsibility (mutuality).

Requirements for Shared Decision making:

Both doctor and patient are involved in:

Sharing information. Looking together for solutions about

the preferred treatment.

Aim to enlarge the space in the middle where both needs overlap.


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Doctor andpatientsMost chronicillnesses,

psychoanalysi

s, etc.

Participant inpartnership

(uses expert

help)

Helps patientto help

himself

Mutualparticipation

DoctorDental

chechup

Cooperator

(obeys)

Tells patient

what to do

Guidance-

cooperation

DoctorAnesthesia,

acute trauma,

coma

Operative

dental

treatment

Passive

(unable to

respond or

inert) receive

ttt

Does

something to

patient

Activity

passivity

model

Decision

making

Clinical

Application

of Model

Patients RolePhysicians

Role

Model

Three Basic Models of the Dentist-Patient Interaction

Ways for improvement of dentist patient relationship:

Using behavioral concepts in the diagnosis and treatment of dentalpatient.

Good Communication Skills In medical interview: Use patient centered

approach

1- Initiating the session (initial rapport):

First minutes

Great the patient and introduce yourself Organize the environment. Concentrate fully and only at the patient. Pay attention to the physical distance.


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2- Gathering information (exploring the problem, understanding the

patients views): The collection of information from the patient by

history taking and proper examination.

The Art of asking questions:

- Narrowing down the questions (general to specific).

- The first question: Use of open questions e.g.

How do you feel?

What can I do for you?

Tell me about the pain you have been having?Then a closed question is now where is the pain?

Language: Must be matched to patients level by avoiding the

professional language.

Information-gathering:

Patients name, age, family background.Obtain the patients chief complaint and history of chief complaint

as well as the patients expectations for resolution.

Medical conditions, especially those which exaggerate dentalconditions.

Obtain the past medical, family and psychosocial histories.

Obtain a past dental history.Perform an oral examination.Perform a head and neck examination.Determine the need for other diagnostic tests such as radiographs,

diagnostic casts and other appropriate diagnostic aids/tests.

Treatment planning

It is recommended that the patient should be involved, in one way or


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another, in the decisions to be made in the treatment planning process.

In treatment planning dentist should consider.

Patient goals, values and concerns.Scheduling, records, recall system; andDevelop a treatment plan. Obtain the patients consent for therapy

proposed.

3- Building the relationship (How to maintain the rapport?)

Verbal signals: Yes, I understand, Yhym Could you tell me more

about this?

Nonverbal signals:

include Improve body language

Physical appearance Take care of your appearanceProximity Keep appropriate distanceEye contact Maintain eye contactFacial expressions SmileBody movement Forward lean head noddingTouch Only when appropriate

4- Closing the session: When the interview comes to a close:

Check whether all problems have been discussed and leave some time for

their discussion.

Try to summarize the interview.

Finish the conversation stressing your interest in the patient and in whathas been said.


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You can ask the patient to evaluate the conversation.

Say good-bye, get up and thank the patient for coming.

The following are elements of a successful medical interview session:GATHER model

G = Greet patient in a friendly, helpful, and respectful manner.

A= Ask patient about needs, concerns.

T = Tell patient about different treatment options and methods.

H = Help patient to make decision about choice of method she or he

prefers.E = Explain to patient how to use the treatment.

R = Return: Schedule and carry out return visit and follow-up of patient.

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Behavioral First 2 Chapters