Behavior Management

Effectively managing the behavior of a patient diagnosed with AD can be challenging. Behaviors can vary from compliant to combative and providers should be prepared for patient mood swings. A body of literature suggests a patient’s willingness to receive dental care is influenced by their past dental experiences.94,95 Dental providers should ask about the patient’s past dental experiences and attitudes towards dentistry. This information can be useful for predicting a patients willingness to receive dental care. The use of distraction therapy to redirect the patient’s attention away from the procedure may be useful.75

One way to positively influence patient behavior is determining optimal appointment times and lengths. A patient’s schedule, stage of disease, and the need for caregiver support should be discussed with the patient and health care team to identify what is optimal for each individual situation. Familiar surroundings are also important for boosting cooperation. It is helpful to have the same provider deliver care in the same operatory at each visit.75,89 The dental environment should be quiet with few distractions. Dental providers should work to develop genuine rapport and always use a calm, reassuring voice.77,81,89 Communication can be facilitated by using short sentences and asking questions that require “yes” and “no” answers.75,89 A patient diagnosed with AD should be accompanied by someone they trust and who can offer reassurance throughout the duration of each appointment. Even though a caregiver is present, it is important for providers to keep the patient engaged in all aspects of the conversation. A dental provider should never force a patient into receiving care.77,81

Individuals in later stages of AD may have difficulty communicating their desires and how they feel. During later stages of the disease, a place-based delivery model, which delivers dental care directly where the individual lives, may be necessary. Dental disease that is causing pain or limiting nutrition, in non-compliant patients, may justify the use of psychotropic medications to provide mild sedation.77,81,89 These medications should be prescribed in collaboration with the patient’s health care team.