LARAGA – Pharmacological behaviour management in paediatric dentistry in the UK

Classifying Children’s Behaviour at the Dentist—What about ‘Burnout’?

“…They propose that emotional dysregulation may result from mismatches in expectations, where goals that seem unattainable subsequently lose value [ 45 ], such as if dental treatment over time is perceived as ‘punishing’, and afterwards induces a belief that further effort will not result in attaining their goals [ 37 ]. Although initial behaviour at the new patient appointment can serve as useful foreshadowing into cooperation at future appointments, signs of dental burnout in children can slide under the radar and may not become noticeable until sometime later when there are clear changes to a patient’s behaviour [ 46 ].…”

“…The burnout construct hypothesises that a portion of the battery’s charge (resilience) is used each visit, with treatment visits using considerably more than check-up visits, whereas charge may also be topped up following a positive experience. This also lends itself to the theory of latent inhibition, which postulates that successful experiences may counter the effects of a ‘failure’ [ 46 ]. When the battery depletes, however, such as following a string of treatment visits, we need to replenish the spent resilience, or risk a ‘low battery’ warning, i.e., burnout.…”

“…In addition, the burnout triad model acknowledges parental burnout and the vicarious nature of dental treatment for children and their parents (parental factors); although parents may consent to complex treatment extending many months and multiple visits, factors such as parental anxiety, for example, can have a direct and negative effect on outcomes, as the absence of positive experiences and parental support can be very stressful for children [ 46 , 66 , 67 ]. In addition, parental presence in the dental surgery has been a heated debate for decades, with diverging opinions.…”

Does dental rehabilitation under general anaesthetic contribute to the development of temporomandibular disorders in children and adolescents? A scoping review

“…Despite lacking high quality in vivo evidence, the hypothetical risk of TMD from dental rehabilitation performed under pDGA, alongside the known morbidity and mortality of GA (and repeat GA) usage, should lead a desire to avoid pDGA wherever possible 69 ; however, research shows there are patients for whom pDGA will be the only viable option, such as those who lack cooperative potential, when the proposed treatment is too extensive or when other conscious sedation options have not been successful. 70 Conscious sedation methods allow a patient to provide verbal feedback, for example when the force associated with dental extractions is too great on the TMJ or when their jaw hurts from being open for too long and they need a break as suggested by Sahebi et al 9 and also permit sufficient assessment for occlusal interferences following PMC and/or restoration placement. While Manfredini et al 58 found a lack of clinically relevant association between TMD and dental occlusion in the literature, their findings did highlight a higher prevalence of mediotrusive (non-working side) interferences in TMD patients; hence, further research into novel techniques for checking the occlusion under GA such as those described by Dimashkieh and…”

“…Despite lacking high quality in vivo evidence, the hypothetical risk of TMD from dental rehabilitation performed under pDGA, alongside the known morbidity and mortality of GA (and repeat GA) usage, should lead a desire to avoid pDGA wherever possible 69 ; however, research shows there are patients for whom pDGA will be the only viable option, such as those who lack cooperative potential, when the proposed treatment is too extensive or when other conscious sedation options have not been successful 70 …”