Behavior of dental assistants managing young children in the operatory.

This paper describes the behavior of 30 dental assistants over 72 appointments in the management of threeto Five-year-old children. Guidance, empathy, verbalization, and physical contact were major provider categories; a dichotomous measure of fear-related behavior was derived from child categories. The distribution of duration and Frequency of behaviors within each category indicate that the assistants did little child management. Lag sequential analyses calculated conditional probabilities For child behavior, given assistant behavior. These probabilities were compared to results when child fear-related behavior was lagged on dentist behavior. Results suggest relative effectiveness o[ a set of dental assistant behaviors. Patterns of dentist and assistant management behaviors also were explored. The interaction between health care provider and patient is extremely important. Though difficult to assess, studies in medicine indicate patient behaviors, including satisfaction, appointment keeping, medication errors, and compliance with a wide variety of recommendations, are a function of clinician communication or management? ,2 Most studies of dental provider and patient interaction have focused on the dentist or dental student. 36 Few studies have examined the influence of auxiliaries on patient behavior or have ever described clinical auxiliary behavior vis-a-vis the patient. Weinstein7 assessed the influence of hygiene student personality characteristics on patient anxiety levels over time, and Strack et al. ~ attempted to establish a relationship between hygienist empathy and patient compliance with home care recommendations. MacKenzie t al. 9, in the context of assessing the impact of a behavioral dental assistant-hygienist curriculum, summarized the self-reported behaviors of graduates. Materials exist that describe optimal auxiliary management of handicapped ~° and child patients? 1-I3 However, the procedures discussed and recommended are basically the same procedures recommended for the dentist. The role of the auxiliary in assisting the management of child patients as part of a team has not received much attention. Starkey~4 discussed office personnel training in child management. Though he wrote that each member of the team contributes to management of the child, he did not specify auxiliary management responsibilities beyond transfer of the child from reception room to operatory. As each dentist has a different philosophy and set of competencies, Starkey recommends in-office instruction and the importance of assigning specific assignments and roles to the auxiliary. Though few dentists practice without auxiliaries, there has been little research in child management to provide direction to either formal auxiliary training programs or informal in-service education. This study, part of a larger study of child management in the operatory, attempts both to describe the behavior of a sample of assistants in child management and to begin to identify patterns of interaction between dentist and assistant in child management. Methods and Materials Subjects and Design Subjects in this study were solicited by mail after selection of a random list of dentists from the files of the King County Dental Association and the Washington State Academy of Pediatric Dentists. Twenty-two general practitioners and three pedodontists allowed their assistants to participate. Fifty child patients of these dentists participated. Dentists identified threeto five-year-old children in their practice. These children then were screened by the dentist. At that time child behavior during prophylaxis was observed and dental health recorded. PEDIATRIC DENTISTRY: Volume 5 Number 2 115 Children eligible for participation in the study required injections during two or more sessions. In all, each dental team was to provide two or more treatment sessions to two children, a total of 100 appointments. All participating dentists and assistants completed questionnaires regarding their confidence, experience, and expectations of child behavior at each session. Dentists also agreed not to use nitrous oxide or any other premedication. Aside from this prohibition, they were asked to treat the child as they ordinarily would. All sessions were videotaped. Eighty-seven usable videotapes from 20 offices (20 dentists and 30 auxiliaries) have been analyzed Figure 1. Coding schemes for provider and child. and provide the basis for the data presented in this paper. Figure 1 presents the coding scheme used in this study. Coding Scheme Behaviors are separated into major child and provider dimensions, categories that are mutually exclusive (only one behavior within each dimension can be scored at any time) and exhaustive (no time can pass without a codable behavior occurring). Reliabilities were adequate and have been published elsewhere (Weinstein, et al.lS). facilitate data analysis, child behaviors were grouped into fear and nonfear categories. The fear-related behavior