以摺疊束縛進行行為管理：病例報告

Behavior Management with Folding Technique: A case Report

盧俊君(Chun-Chun Lu) ； 蘇若梅(Jo-Mei Su)

《臺灣兒童牙醫學雜誌》 20卷2期 (2020/06) Pp. 54-58

https://doi.org/10.6319/TJPD.202006_20(2).0001

摘要

在臨床工作中面對極端情緒的病人，常見的治療方式有束縛板、鎮靜麻醉及全身麻醉，或者是過去的手掩口（鼻），但部分家長對於麻醉的疑慮或對於束縛板及手掩口（鼻）觀感不佳，希望牙醫師以「溝通」的方式讓孩子接受，同時必須確保病人、牙科團隊（牙醫師及助理）以及家長的人身安全，經協商並獲得同意後，採取「摺疊」的手法進行行為管理。當病人處於極端情緒時，不僅面對一般的溝通方式無效，更可能因為伴隨情緒的動作而造成病人自我及他人危險時，以「摺疊」的手法暫時性的固定病人，同時拉近醫師及病人的臉部距離，以此吸引孩子的注意並建立溝通。本病例報告為一名3歲8個月女孩，先前因溝通無效而束縛治療，利用三次約診完成前牙根管治療並追蹤討論，經家屬溝通及同意後，在第四次約診時以「摺疊」的手法與孩子建立溝通，當次可以完成介紹器械並以慢速手機全口清潔，後續約診病人可以自主上治療椅且跟醫師說話，並完成後續牙科治療，也對牙科有正面積極的態度。

關鍵字

行為處理 ； 摺疊

並列摘要

When facing patients with extremely terrified behavior, the methods that are usually used include papoose board, sedation, general anesthesia, and hand-over-mouth-and-nose. However, some parents doubt the safety of general anesthesia, or they feel uncomfortable about the papoose or hand-over-mouth-and-nose. These parents hope the children will accept the dental work via ＂conversation＂. All the while, we must ensure the safety of the patient, dental team, and parents. With the consent of parents, we can do behavior management using ＂folding technique＂. When the patient is extremely terrified, not only the commonly used methods of behavior management are ineffective, but also may put the patient and others in danger because of the patient's struggling. Using the folding technique, we can immobile the patient temporarily. In this way, the distance between the dentist and patient is closer, and therefore attracts the attention of the patient more easily, which makes it easier to start a conversation. This case report was regarding with a 3-year-8-month old female, who came to the clinic with extremely fear and frightened behavior. During the first three appointments, the papoose board was used to finish the pulp treatment over upper-anterior teeth and then discussed with the parent about the technique of behavior management. With the consent of the parents, the folding technique was performed on the fourth visit, thereby establishing the communication between the patient and the dentist. Also on the fourth visit, the introduction of all the instruments and FM cleaning using low speed handpiece were done. During the following visits, the patient was willing to sit on the dental chair by herself and talked to the dentist. On the fifth visit and thereafter, a positive attitude was noted.

並列關鍵字

Behavior management ； Folding technique