行為管理對學齡前兒童牙科診療合作度之影響

The Influence of Dentist's Experiences on the Behavior of Preschool Children

劉惠文(Huei Wen Liu) ； 謝承祐(Chen-Yu Hsieh) ； 林彥光(Yen-Kuang Lin) ； 項家蘭(Chia-Lan Hsiang)

《臺灣兒童牙醫學雜誌》 16卷4期 (2016/12) Pp. 131-139

https://doi.org/10.6319/TJPD.2016.16(4).1

摘要

孩童看牙時因恐懼、焦慮而產生不合作行為會妨礙治療的進行，而行為誘導技術能有效降低孩童對牙科的恐懼，增加合作度。然而年輕牙醫師可能因診療經驗不足，無法及時對孩童行為變化做出適當反應。本研究目的為分析不同職級醫師對學齡前兒童進行初次牙科診療時，所使用行為誘導方式，以及對孩童合作度之影響。研究對象包含本院第一次牙科就診且無牙科經驗之3到6歲健康孩童，以影像分析孩童在認識牙科環境與器械過程中合作度，及醫師所使用的行為誘導方式，統計結果利用SPSS軟體16版分析。結果顯示專科訓練醫師看診孩童年齡較小且行為較為合作，和其他兩組比較有顯著差異。專科訓練醫師看診過程中最常使用行為誘導方式為正向強化及指示動作；PGY住院醫師與實習醫師為介紹器械和說明動作；不同職級醫師看診對孩童合作度有顯著差異性。結論為年輕牙醫師在初診過程中，除了基本介紹器械與說明動作，要多加強正向強化與指示動作的使用。

關鍵字

初診 ； 行為管理

並列摘要

Behavior management is a key factor in providing dental care for children. Young dentists usually take time to learn the behavior management techniques by trial and error. This study aimed to analyze the behavior management skills of dentists at Taipei Municipal Wan-Fang Hospital, it's influence to the preschool children's behavior at the first visit has also been evaluated. 3-to-6-year-old children for first dental visit at pediatric dentistry department of Taipei Municipal Wan- Fang Hospital were included. All subjects were healthy and denied previous dental experience. Behavior shaping process in the visit was video recorded. The cooperation of patients and the behavior management techniques used by the dentist in the visit were recorded by the author and analyzed by SPSS vol.16. The results showed a total of 92 patients were included ( 50 boys and 42 girls.) There was a positive correlation between the age of subjects and their cooperation during the visit. The pedo resident group treated patients whose age were significantly younger than those in the intern group and the GP resident group. However, patients in the pedo resident group were significantly more cooperative than the other 2 groups. The pedo resident group used significantly more positive reinforcement and instruction than the other 2 groups during treatment. The intern group and the GP resident groups spent more time on Tell-Show-Do and explanation. The older the patient, the more cooperative during first dental visit. Pedo residents treat younger patients with better cooperation. Young dentists should use more positive reinforcement and instruction in behavior shaping.

並列關鍵字

First dental visit ； behavior management