6: Sequential Treatment Planning

Chapter 6

Sequential Treatment Planning


The aim of this chapter is to demonstrate how a sequential treatment plan can be built to facilitate successful child management.


Having read this chapter the practitioner should be able to adopt a step-by-step approach to treatment planning for operative procedures in children irrespective of their initial presenting level of cooperation (Fig 6-1).


Fig 6-1 Scales of anxiety.


Previous chapters have shown that emotional maturity, previous dental experience and the influence of the family, the dental surgery environment and the dental team all affect child management. Behavioural management techniques have been reviewed and in subsequent chapters we will explore the use of conscious sedation. At this stage it is appropriate to demonstrate how non-pharmacological and pharmacological techniques can be woven together in a sequential treatment plan (Fig 6-2).


Fig 6-2 Behavioural management, preventive care and operative dentistry are interwoven.

Gradual Introduction of Instruments and Procedures

Hill and O’Mullane (1976) show that 60% of anxious children can be helped by sequential treatment planning in which dental instruments and procedures are introduced gradually. This has to be carried out in a prearranged manner and therefore involves forward planning. It need not be time consuming. A typical treatment plan that could be used to treat an anxious child is shown in Table 6-1(a). It shows that some items of treatment can be completed while other instruments and procedures are being introduced (Fig 6-3).

Table 6-1 Sequential treatment planning
(a) Behavioural management (b) How to add inhalation sedation

Visit 1

  • Simple oral examination

  • Discuss diet

  • Invite child to bring tooth brush next visit

  • Take radiograph home to practise with

  • Show inhalation sedation equipment on leaving

  • Let child help to assemble it (“Are you good at LEGO?”)

Visit 2

  • Brush the child’s teeth using his or her own toothbrush

  • Invite the child to sit in the chair

  • Take radiographs

  • Introduce “Mr Buzzy brush” at slow speed by polishing the teeth

  • Blow the teeth dry with the 3:1 (“wind”)

  • Introduce and briefly use inhalation sedation using oxygen only with child standing, just before they leave (they will happily try this, especially in the knowledge that their treatment is already finished for this visit)

  • Parent-dentist conference and signed consent.

  • Give parent the information leaflet

Visit 3

  • Apply fissure sealant and/or temporary dressings in stages

  • Introduce saliva ejector (“sucky-straw”)

  • Use inhalation sedation

Visit 4

  • Remove carious tooth tissue with a hand excavator

  • Introduce slow-speed drill (“bumpy brush”)

  • Perform small buccal and cervical restorations

  • Let child position the nosepiece for themselves

Visit 5

  • Continue to use inhalation sedation

Items 1(a) and 2(a) can often be combined in the first visit


Fig 6-3 Dentist and child acclimatising.

Acclimatisation is about taking a child with no dental experience and assisting them to become ready to accept dental care. It is a combination of techniques (“Tell-Show-Do”, behaviour shaping, positive reinforcement and psychological planning), integrating these, with conscious sedation if required, into the operative plan.


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Jan 16, 2015 | Posted by in Periodontics | Comments Off on 6: Sequential Treatment Planning
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