Técnicas de manejo de conducta en odontopediatría: aspectos éticos y legales / Behavioral management techniques in pediatric dentistry: ethical and legal aspects

Introducción: la profesión odontológica es una actividad orientada al cuidado de personas, entre ellos los niños, que necesitan un cuidado más específico estando en pleno desarrollo físico y emocional. Al trabajar con los niños se tiene que lidiar con la ansiedad con la que el pequeño entra por primera vez a la consulta. Para solucionar este problema, se han descrito diferentes técnicas cuya elección depende de la edad, de las necesidades del paciente y de la habilidad profesional. Estas técnicas se pueden agrupar en tres grupos: técnicas farmacológicas, técnicas comunicativas y técnicas no comunicativas. Objetivo: revisar la evidencia científica sobre los aspectos éticos y legales de las técnicas de manejo de conducta en odontopediatría. Material y método: se realizó una búsqueda en las bases de datos de PubMed/ Medline, Google Scholar y Scopus de acuerdo a unos criterios de inclusión y exclusión. Resultados: los resultados determinan que el empleo de las técnicas de manejo de conducta disminuye los niveles de ansiedad durante el tratamiento dental. El bajo nivel socioeconómico y educativo, y la utilización frecuente de videojuegos aumentan la ansiedad dental mientras la realización de deporte y una vida saludable la disminuyen. Conclusiones: entre las técnicas de manejo de conducta del paciente pediátrico, las de gestión comunicativa son las más aceptadas por los padres. Aunque no hay ninguna prohibición legal en el uso de técnicas farmacológicas o no comunicativas, estas la mayoría de las veces son rechazadas por los padres. (AU)

Introduction: The dental profession is an activity oriented to the people care, including children, who need more specific care being in full physical and emotional development. When working with children you have to deal with the anxiety with which the child first enters the consultation. To solve this problem, different techniques have been described whose choice depends on the age, patient needs and professional skills. These techniques can be grouped into three groups: pharmacological techniques, communicative techniques and noncommunicative techniques. Objective: To review scientific evidence on the ethical and legal aspects of behavioral management techniques in pediatric dentistry. Material and method: A search was performed in the databases of PubMed/ Medline, Google Scholar y Scopus, according to inclusion and exclusion criteria. Results: The results determine that the use of behavioral management techniques decreases anxiety levels during dental treatment. The low socioeconomic and educational level and the frequent use of video games increase dental anxiety while the performance of sports and a healthy life decrease it. Conclusions: Among the pediatric patient behavior management techniques, those with communicative management were the most accepted by parents. Although there is no legal prohibition on the use of pharmacological or non-communicative techniques, these are most often rejected by parents. (AU)

Técnicas de manejo de conducta en odontopediatría: aspectos éticos y legales / Behavioral management techniques in pediatric dentistry: ethical and legal aspects

Introducción: la profesión odontológica es una actividad orientada al cuidado de personas, entre ellos los niños, que necesitan un cuidado más específico estando en pleno desarrollo físico y emocional. Al trabajar con los niños se tiene que lidiar con la ansiedad con la que el pequeño entra por primera vez a la consulta. Para solucionar este problema, se han descrito diferentes técnicas cuya elección depende de la edad, de las necesidades del paciente y de la habilidad profesional. Estas técnicas se pueden agrupar en tres grupos: técnicas farmacológicas, técnicas comunicativas y técnicas no comunicativas. Objetivo: revisar la evidencia científica sobre los aspectos éticos y legales de las técnicas de manejo de conducta en odontopediatría. Material y método: se realizó una búsqueda en las bases de datos de PubMed/ Medline, Google Scholar y Scopus de acuerdo a unos criterios de inclusión y exclusión. Resultados: los resultados determinan que el empleo de las técnicas de manejo de conducta disminuye los niveles de ansiedad durante el tratamiento dental. El bajo nivel socioeconómico y educativo, y la utilización frecuente de videojuegos aumentan la ansiedad dental mientras la realización de deporte y una vida saludable la disminuyen. Conclusiones: entre las técnicas de manejo de conducta del paciente pediátrico, las de gestión comunicativa son las más aceptadas por los padres. Aunque no hay ninguna prohibición legal en el uso de técnicas farmacológicas o no comunicativas, estas la mayoría de las veces son rechazadas por los padres. (AU)

Introduction: The dental profession is an activity oriented to the people care, including children, who need more specific care being in full physical and emotional development. When working with children you have to deal with the anxiety with which the child first enters the consultation. To solve this problem, different techniques have been described whose choice depends on the age, patient needs and professional skills. These techniques can be grouped into three groups: pharmacological techniques, communicative techniques and noncommunicative techniques. Objective: To review scientific evidence on the ethical and legal aspects of behavioral management techniques in pediatric dentistry. Material and method: A search was performed in the databases of PubMed/ Medline, Google Scholar y Scopus, according to inclusion and exclusion criteria. Results: The results determine that the use of behavioral management techniques decreases anxiety levels during dental treatment. The low socioeconomic and educational level and the frequent use of video games increase dental anxiety while the performance of sports and a healthy life decrease it. Conclusions: Among the pediatric patient behavior management techniques, those with communicative management were the most accepted by parents. Although there is no legal prohibition on the use of pharmacological or non-communicative techniques, these are most often rejected by parents. (AU)

SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion.

PURPOSE: The aim of this randomized controlled trial was to evaluate the effectiveness of a cognitive-behavioral SuperKid intervention, in reducing fear and pain among children undergoing intravenous insertion in outpatient services. DESIGN AND METHODS: This study was designed as a randomized controlled trial, with 96 children aged 5-7 years. SuperKid intervention employed cognitive-behavioral techniques, implemented through a set of prepared cards. Fear was assessed using the Child Fear Scale, while pain status was measured using the Wong Baker Face Pain Scale. Scoring was performed by the mother, child, and researcher. Time series tests were conducted using the Wilks Lambda test. RESULTS: Most children in both the experimental and control groups reported fear regarding hospital procedures, particularly those involving pain and separation from their mothers. However, children in the experimental group who underwent the SuperKid intervention during and after IV insertion procedure experienced significantly less fear and pain than those in the control group. CONCLUSIONS: SuperKid intervention was found to be effective in reducing the procedural fear and pain of children undergoing intravenous insertion in outpatient services. The utilization of cognitive-behavioral techniques through a set of prepared cards provides an accessible and engaging means of alleviating negative emotional experiences among children undergoing medical/nursing procedures. PRACTICE IMPLICATIONS: SuperKid intervention can potentially improve children's attitudes toward medical care and make future procedures easier for them. Healthcare providers could consider incorporating cognitive-behavioral interventions, such as the SuperKid intervention, into their clinical practice to reduce the fear and pain experienced by children during medical/nursing procedures.

PsicAP transdiagnostic protocol of group cognitive-behavioral training for emotional disorders in Dominican Republic: a randomized controlled trial protocol.

Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.

The effect of adaptation theory-based therapeutic approach on adolescents anger management.

PROBLEM: Anger is usually defined as psychometric, rather than a theoretical model and generally, anger treatments have been developed for handling incompatible anger. Roy Adaptation Model-based intervention not only focuses on problematic behaviors but also on healthy behaviors and to evaluate the individual with a holistic perspective. The research aim was the examination of the effect of the Roy adaptation theory-based, cognitive-behavioral approach program on adolescent's anger management. METHODS: In this study, the pretest-posttest control group experimental design, interview, and observation techniques were used. Carried out in a vocational training center, with 60 participants (experimental group 30 and control group 30), who meet the research criteria. The semi-structured interview forms, the state-trait anger expression inventory, multidimensional anger scale, and brief symptom inventory were used for data collection. Results have been evaluated to the 95% confidence interval and p < .05 significance level. In data analysis; descriptive statistics, Pearson's χ2 test, Mann-Whitney U test, and Wilcoxon Sign tests were used. FINDINGS: There was a significant difference in anger management levels of the experimental group after the adaptation theory-based therapeutic approach program. CONCLUSION: Study results showed that the adaptation-base therapeutic approach is effective in adolescent's anger management. This program will contribute to theoretical and practical studies and field experts.

Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process.

Objective: This study determined the effect of an educational program based on cognitive behavioral techniques (CBT) provided for pregnant women to address their fear of childbirth. Methods: This study was conducted experimentally using pretest-posttest and a control group. A total of 111 Turkish pregnant women were recruited with 52 in the intervention group and 59 in the control group. The intervention group attended the educational program on coping with childbirth fears based on CBT, which took 3 weeks over six sessions. The Wijma Delivery Expectancy/Experience Questionnaire, version-A (W-DEQ-A) was administered to both groups as the posttest. The researchers monitored the pregnant women's labor and delivery and the State Anxiety Inventory (SAI), Numeric Pain Rating Scale (NPRS) and Birth Process Evaluation Form were completed. Results: The post-education W-DEQ-A score was 63.5 in the control group and 39.4 in the intervention group (p < .001). Their labor pain was lower, the second stage of labor was shorter and birth was more satisfactory for the intervention group than for the control group (p < .05). The CBT-based educational program and pain severity during childbirth were the significant predictors of satisfaction with childbirth (ß = 0.354; ß = -0.324, respectively; p < .05 for all). Conclusions: The CBT-based educational program on coping with childbirth fears reduced pregnant women's fear of childbirth and positively affected their birth experience.

A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial.

BACKGROUND: Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i.e., pain education) in older adults with chronic musculoskeletal pain in Hong Kong. METHODS/DESIGN: We are conducting a double-blind, cluster-randomized controlled trial. A sample of 160 participants aged ≥ 60 years will be recruited from social centers or outpatient clinics and will be randomized on the basis of center/clinic to either the multicomponent intervention or the pain education program. Both interventions consist of ten weekly sessions of 90 minutes each. The primary outcome is pain intensity, and the secondary outcomes include pain interference, pain persistence, pain self-efficacy, pain coping, pain catastrophizing cognitions, health-related quality of life, depressive symptoms, and hip and knee muscle strength. All outcome measures will be collected at baseline, postintervention, and at 3 and 6 months follow-up. Intention-to-treat analysis will be performed using mixed-effects regression to see whether the multicomponent intervention alleviates pain intensity and associated outcomes over and above the effects of pain education (i.e., a treatment × time intervention effect). DISCUSSION: Because the activities included in the multicomponent intervention were carefully selected for ready implementation by allied health professionals in general, the results of this study, if positive, will make available an efficacious, nonpharmacological pain management program that can be widely adopted in clinical and social service settings and will hence improve older people's access to pain management services. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IIR-16008387. Registered on 28 April 2016.

Cognitive Behavioral Therapy for Psychosis (CBT-p) Delivered in a Community Mental Health Setting: A Case Comparison of Clients Receiving CBT Informed Strategies by Case Managers Prior to Therapy.

This exploratory case comparison examines the influence of case management activities on engagement and progress in psychotherapy for clients with schizophrenia. Six clients were recruited to participate in ten sessions of Cognitive Behavioral Therapy for psychosis (CBT-p). Three clients who had received Cognitive Behavioral techniques for psychosis (CBt-p, a low-intensity case management intervention) prior to receiving therapy were selected from referrals. A comparison group of three clients who had received standard case management services was selected from referrals. Cases within and across groups were compared on outcome measures and observations from case review were offered to inform future research. Delivering CBT-p services on a continuum from low- to high-intensity is discussed.

Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients.

The aim of the study was to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cross-sectional study was conducted to evaluate the knowledge, attitude, and practices of dental surgeons in the city of Karachi providing treatment to pediatric patients. A cluster-sampling technique was used and 200 dental surgeons from six different dental institutions were selected. A self-constructed questionnaire was distributed to the dental surgeons that comprised 20 closed-ended questions. The data was entered and analyzed for frequency and percentages by using Statistical Package for the Social Sciences (SPSS) version 19. The results showed that 76 (38%) dental surgeons took the responsibility of managing pediatric patient when given; 68 (34%) dental surgeons allowed the parents in the clinic; 111 (55.5%) dental surgeons are of the view that colorful and fun environment in dental clinic make the child at ease; 59 (29.5%) always demonstrate the dental procedure to the child to eradicate imaginary fears; 94 (47.0%) dental surgeons preferred the child to be treated in general anesthesia (GA) to avoid difficult behavior of the child; 135 (67.5%) dental surgeons did not show syringe needle or any instrument to the child. All the members of dental profession must be aware of patient perceptions, preferences, and fear to meet patient's needs. Dental studies should include guidelines and techniques to train the upcoming dentists for excellent practice in pediatric dentistry. HOW TO CITE THIS ARTICLE: Wali A, Siddiqui TM, Khan R, Batool K. Knowledge, Attitude, and Practices of Dental Surgeons in managing Child Patients. Int J Clin Pediatr Dent 2016;9(4):372-378.

Temporomandibular disorders, headaches and chronic pain.

Temporomandibular disorders (TMDs) are a major cause of non-dental orofacial pain with a suggested prevalence of 3% to 5% in the general population. TMDs present as unilateral or bilateral pain centered round the pre-auricular area and can be associated with clicking and limitation in jaw movements. It is important to ascertain if there are other comorbid factors such as headaches, widespread chronic pain and mood changes. A biopsychosocial approach is crucial with a careful explanation and self-care techniques encouraged.

Medo de escrever em público: um estudo de caso / Fear of writing in public: a case study

Este artigo tem por objetivo apresentar intervenções nos comportamentos problemáticos de um paciente de 38 anos, o qual relatou experimentar medo de escrever em público. Com base nos relatos e registros do paciente, o terapeuta cognitivo-comportamental pôde descrever as contingências das quais seu comportamento era função, e deste modo ensinou ao paciente maneiras do manejo desta ansiedade. Tendo por diagnóstico a fobia social, com quadro circunscrito de medo de escrever em público, o paciente foi submetido a técnicas cognitivo-comportamentais de modo a adquirir um novo repertório para responder adequadamente às situações aversivas.

This article aims to present interventions in problematic behaviors of a 38-year-old patient, who reported experiencing fear of writing in public. Based on reports and patient records, cognitive-behavioral therapist might describe the contingencies of which his behavior was function, and thus taught to the patient, management of ways this anxiety. Having a diagnosis, social phobia, with circumscribed framework of fear of writing in public, the patient underwent cognitive-behavioral techniques to acquire a new repertoire to respond adequately to aversive situations.

Medo de escrever em público: um estudo de caso / Fear of writing in public: a case study

Este artigo tem por objetivo apresentar intervenções nos comportamentos problemáticos de um paciente de 38 anos, o qual relatou experimentar medo de escrever em público. Com base nos relatos e registros do paciente, o terapeuta cognitivo-comportamental pôde descrever as contingências das quais seu comportamento era função, e deste modo ensinou ao paciente maneiras do manejo desta ansiedade. Tendo por diagnóstico a fobia social, com quadro circunscrito de medo de escrever em público, o paciente foi submetido a técnicas cognitivo-comportamentais de modo a adquirir um novo repertório para responder adequadamente às situações aversivas. (AU)

This article aims to present interventions in problematic behaviors of a 38-year-old patient, who reported experiencing fear of writing in public. Based on reports and patient records, cognitive-behavioral therapist might describe the contingencies of which his behavior was function, and thus taught to the patient, management of ways this anxiety. Having a diagnosis, social phobia, with circumscribed framework of fear of writing in public, the patient underwent cognitive-behavioral techniques to acquire a new repertoire to respond adequately to aversive situations. (AU)

The effect of stress management training on stress and depression in women with depression disorders: Using cognitive-behavioral techniques.

BACKGROUND: The present study aimed to investigate the effect of stress management training through cognitive-behavioral techniques on stress, social adaptability and depression in women with depression disorders. MATERIALS AND METHODS: In this study, 40 patients diagnosed with depression who had referred to psychiatry and consultation clinics of Isfahan were randomly selected and assigned to intervention and control groups (20 patients in each group). The intervention group received eight 90-min sessions of stress training through cognitive-behavioral techniques. Data collection tools included Cooper's stress questionnaire, Bell's social adaptability questionnaire and Hamilton's depression scale questionnaire. The participants completed the questionnaires before the intervention and 1 month after the same. Data analysis was performed using covariance analysis. RESULTS: Based on the results, considering variables of stress, social adaptability and depression, the equal variance hypothesis was confirmed. The relationship between pre- and post-test scores on stress, social adaptability and depression was statistically significant (P < 0.001). The modified mean difference was F = 12.45, P < 0.001 on stress; F = 6.88, P < 0.01 on social adaptability; and F = 5.36, P < 0.02 on depression, all of which were significant. CONCLUSION: Stress management training through cognitive behavioral techniques can play a main role in depression reduction and development of social adaptability through modifying inappropriate social information-processing patterns.