Pediatric Dentistry

Aversive conditioning as a technique of behavior modification

Aversive conditioning

 

– The most controversial issue in behavior modification is aversive conditioning.

– Modern literature has criticized the use of hand-over-mouth technique to a great extent.

– The method has been debated a lot not only because of the ethical issues involved but also because it is such an effective tool of achieving instant change in the child behavior that it is likely to be misused beyond its actual need!

– The aversive conditioning has still a place in the dentist’s armamentarium of child
management techniques (especially in a society like ours), where dental treatment under sedation or general anesthesia is questioned, under-recommended, under-utilized, and considered unsafe and expensive.

– Consider a situation in which the dentist’s attempts of behavior modification in a potentially cooperative child have been unsuccessful.

– The dentist either has to abort the procedure or consider immediate pharmacological means to complete it.

– The former is not really appropriate because the situation might be repeated again and the child would know that he/she can avoid the treatment by throwing a tantrum.

– Also, the dentist as well as the parent would regard it as a failed outcome.

– The latter is either unavailable or dreaded by the parents’ due to safety issues.

– The dentist now recommends that only use of momentary force on the part of the team can compel the child to comply and the treatment may be completed thereafter.

– There is nothing wrong in accepting the limitations of other behaviour modification
techniques.

– There is also no guarantee that the pharmacological methods are technically the best and risk-free.

– At times, it is not practical to go in for a single extraction under GA in a needle phobic
potentially cooperative child (we are talking about a scenario where nitrous oxide: oxygen inhalation sedation is not practiced) because even that would necessitate a prick or two (one: to draw blood for investigations, and two: I.V/I.M. for the induction).

– Under such circumstances, aversive conditioning would really be the method of choice.

– The indications, contraindications and the manner in which aversive conditioning is practiced are mentioned in most textbooks of pediatric dentistry.

– Sadly, the literature has succumbed to the pressure of objections raised against its use and advocates great caution while using the same.

– The author feels that judicious use of aversive conditioning only increases the spectrum of non-pharmacological child management.

 

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