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Consent for Behavior Management Techniques

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There is several behavior management techniques that are used by Pediatric Dentists which can help the child develop a positive attitude toward dental care and allow the successful completion of dental procedures. Some of the methods are intended to maintain the communication process while others are intended to minimize the distressed behavior.

Tell Show Do The dentist explains to the child what is to be done, then demonstrates with instruments, and then the procedure is performed in the child’s mouth.

Tell Show Do The dentist explains to the child what is to be done, then demonstrates with instruments, and then the procedure is performed in the child’s mouth.

Initial

Positive Reinforcement Desirable behavior is constantly rewarded by compliments, praise, a pat or a prize.

Positive Reinforcement Desirable behavior is constantly rewarded by compliments, praise, a pat or a prize.

Initial

Voice Control The attention of a distressed child is gained by changing the tone, volume or pace to influence and direct the child’s attention and behavior.

Voice Control The attention of a distressed child is gained by changing the tone, volume or pace to influence and direct the child’s attention and behavior.

Initial

Nitrous Oxide The gas is administered to the child by a nose mask. The mask remains in place throughout the dental appointment so that the child can remain relaxed and make his/her dental experience as pleasant as possible.

Nitrous Oxide The gas is administered to the child by a nose mask. The mask remains in place throughout the dental appointment so that the child can remain relaxed and make his/her dental experience as pleasant as possible.

Initial

Oral Sedation Medications are used to sedate a child who does not respond to other behavior management techniques or is unable to comprehend the dental procedures. These drugs are administered orally and require an extended dental appointment.

Oral Sedation Medications are used to sedate a child who does not respond to other behavior management techniques or is unable to comprehend the dental procedures. These drugs are administered orally and require an extended dental appointment.

Protective Active Stabilization: Protective stabilization of the child may be necessary to protect the patient from making movements, which may otherwise cause him/her harm. Protective stabilization can be performed by the dentist or assistant.Most often, parents may be asked to assist in restraining the child as he/she may feel more secure around mom or dad.

Protective Active Stabilization: Protective stabilization of the child may be necessary to protect the patient from making movements, which may otherwise cause him/her harm. Protective stabilization can be performed by the dentist or assistant.Most often, parents may be asked to assist in restraining the child as he/she may feel more secure around mom or dad.

Protective Passive Stabilization: In some circumstances, a patient stabilization device called “Pediwrap” may be used to prevent injury to the child so the dentist can perform the procedure safely.

Protective Passive Stabilization: In some circumstances, a patient stabilization device called “Pediwrap” may be used to prevent injury to the child so the dentist can perform the procedure safely.

I realize that dental treatment for my child may require special behavior management techniques in order to accomplish the treatment. I give my consent for the use of behavior management techniques deemed appropriate by the dentist to render the necessary treatment for my child. I have read and discussed this consent form and understand to my satisfaction the techniques.

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