Pediatric Dentists' Use of Nonpharmacological Behavior Guidance Techniques and Experiences with Parent/Caregiver Acceptance: A National Survey

Purpose: To determine: (1) which nonpharmacological behavior guidance techniques recommended in the American Academy of Pediatric Dentistry's (AAPD) best practice statement are currently routinely used by pediatric dentists; and (2) their perception of parent/caregiver acceptance of the techniques. Methods: All active AAPD dentist members were invited to participate in this cross-sectional study. Participants (n equals 518) completed an online questionnaire that queried the use of each nonpharmacological behavior guidance technique outlined in the AAPD best practice statement, the frequency with which parent/caregiver hesitancy/refusal is encountered for each, and practice characteristics and demographics. Data were analyzed using descriptive statistics and tests of group differences. Results: Nearly all participants endorsed routine use of the foundational techniques tell-show-do (98.6 percent), counseling skills to build rapport (97.7 percent), and positive reinforcement (95.6 percent). Fewer endorsed using more complex techniques like desensitization (75.3 percent), memory restructuring (22.6 percent), and cognitive behavioral therapy (4.4 percent). There were significant differences in mean years of clinical experience between those who used and did not use some of the more complex techniques. Of the 26 techniques queried, parent/caregiver hesitancy/refusal was encountered most frequently for parental absence, physical restraints, and voice control, and never to rarely for the others. Conclusions: This first-ever study of all nonpharmacological behavior guidance techniques outlined in the AAPD's best practice statement suggests that pediatric dentists routinely use foundational techniques but less frequently use more resource-intensive or complex techniques. With few exceptions, these techniques are well accepted by parents/caregivers. (Pediatr Dent 2023;45(5):418-24) Received March 3, 2023 | Last Revision May 12, 2023 | Accepted May 15, 2023