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INTRODUCTIONPaediatric dentistry, as defined by the American Dental Association, is an age defined speciality that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs 1. As it is an age specific speciality, this branch of dentistry encompasses behavior guidance, care of the medically and developmentally compromised and disabled patients, pharmacological management and sedation apart from the other basic skills required by a dentist 1. Poulter rightly described pediatric dentistry as ‘a most exacting type of dental surgery’ 2.      Behaviour management is an important part of paediatric dentistry. It plays a major role in the quality of treatment that can be provided to the patient. It also helps to deal with patients having disruptive or stubborn temperaments. Behavior management also plays an important role in helping to reduce anxiety and fear.Almost all people suffer from dental anxiety. An essential skill that all dentists should develop is the ability to put people at ease and deliver treatment in a comfortable manner. To achieve this with children is a considerable challenge. In order to make it easier to deal with children a number of management techniques have been introduced.   Every child is a unique individual with social, physical, emotional and intellectual qualities 3. So while applying these techniques a number of factors have to be considered like age, personality and level of anxiety of the child, parental attitudes towards these management techniques and the legal implications of applying such methods 4.    A large amount of research has been done on the parental acceptance of the various methods of behavior management. The aim of this study is to evaluate the perception of children towards various behavior management techniques.MATERIALS AND METHODSThe study sample consisted of 200 children aged 7 to 12 years, who were randomly selected. All 200 children had no prior dental experience. The children included in the study were able to communicate effectively. Parents of the selected children were provided an explanation about the aim of the study and consent for their children to participate in the study was obtained.      The children were given explanations and descriptions about five different behavior management techniques used in paediatric dentistry and were asked to rate it on a scale of 1 to 10 where • 0-3 means the child was not very fond of the technique• 4-7 means the child finds the technique acceptable• 8-10 means the child likes the technique very much.These results were then analysed and tabulated. RESULTS1. SAMPLE SIZE: A total number of 200 children between the ages of 7 to12 years were taken for this study to evaluate their perception of behavior management techniques used in paediatric dentistry.Out of 200 children• 53% were male children • 47% were female children.MALES FEMALES TOTAL106 93 200             DISTRUBUTION OF SAMPLE ACCORDING TO SEX.2. AGE DISTRIBUTIONOut of 200 children• 16% of children were 7 to 8 years old.  • 16.5% of children were 8 to 9 years old• 21% of children were 9 to 10 years old• 24.5% of children were 10 to 11 years old• 21.5% of children were 11 to 12 years oldAGES MALES FEMALES TOTAL7-8 YEARS 12 20 328-9 YEARS 22 11 339-10 YEARS 25 17 4210-11 YEARS 27 22 4911-12 YEARS 20 23 43 AGE DISTRUBITION OF 200 CHILDREN3. TELL-SHOW-DOThis is a method of introducing the procedure to a child in a stepwise manner. First the procedure is described in easy to understand words, then it is demonstrated to the child and finally the procedure is performed 5.44% of male children and 64.5% of female children found the ‘Tell-show-do’ method of behavior management highly favorable, 52.8% of male children and 35.4% of female children found this method of management acceptable.2.8% of the male children who participated in this study found the ‘tell-show-do’ method unfavorable but none of the female children found this method of management unfavorable.SEX 0-3 4-7 8-10MALES 3 56 47FEMALES 0 33 60    PERCEPTION OF TELL-SHOW-DO METHOD OF BEHAVIOURAL MANAGEMENT4. HAND OVER MOUTH EXERCISE This method involves the dentist placing his or her hand over the child’s mouth in order to stop the noise created by the child and allow better communication. It is basically a means of negative reinforcement 678. It is usually used when the child is crying loudly and refusing to cooperate. The dentist must always obtain permission from the parents prior to using this technique.81% of male children and 87% of female children found the HOME technique extremely unfavorable.18.8% of male children and 12.9% of female children found this method of management acceptable. None of the children who participated in this study found the hand over mouth exercise favorable.SEX 0-3 4-7 8-10MALES 86 20 0FEMALES 81 12 0          PERCEPTON OF HOME METHOD OF BEHAVIOR MANAGEMENT5. DISTRACTIONIn this method of behavior management, the child’s attention is diverted away from the procedure by asking the child to do simple tasks like lifting the right or left limb or even allowing the child to watch cartoons during the procedure.11.3% of male children and 2.1% of female children found this method of behavior management unfavorable.45.2% of male children and 33.3% of female children found distraction as an acceptable means of behavior management.43.3% of male children and 64.5% of female children were of the opinion that distraction was a highly favorable method of management.SEX 0-3 4-7 8-10MALES 12 48 46FEMALES 2 31 60  PERCEPTION OF DISTRACTION METHOD OF BEHAVIOUR MANAGEMENT6. POSITIVE REINFORCEMENTBehavior can be reinforced by either punishment or rewards. If a child receives a reward for a particular behavior, it means that the behavior has been positively reinforced 9. Behaviour can also be negatively reinforced. A child being punished or scolded for shouting or for throwing a temper tantrum, is an example of negative reinforcement 10.72.6% of male children and 75.2% of female children found positive reinforcement as a highly favorable means of behavior management.27.3% of male children and 24.7% of female children found this method of management acceptable.None of the children surveyed in this study found this method of management unfavorable.SEX 0-3 4-7 8-10MALES 0 29 77FEMALES 0 23 70 PERCEPTION OF POSITIVE REINFORCEMENT METHOD OF BEHAVIOUR MANAGEMENT7. VOICE CONTROLThe tone and level of loudness of the voice are increased in order to gain the attention of a child in this method of behavior management. Change in facial expression may also be used along with the voice modulation 11. According to Szasz and Hollander, voice control helps in reestablishing a cooperative relationship between doctor and patient 12. 72.6% of male children and 95.6% of female children found this method of behavior management extremely unfavorable.27.3% of male children and 4.3% of female children found the voice control method of management acceptable. None of the children who participated in this study found the voice control method of behavior management highly favorable. SEX 0-3 4-7 8-10MALES 77 29 0FEMALES 89 4 0 PERCEPTION OF VOICE CONTROL METHOD OF BEHAVIOUR MANAGEMENTDISCUSSIONChildren’s position in society has slowly changed with the increase in awareness about child rights 13. Nowadays children are given the opportunity to voice their opinion on all subjects. Parents are letting their children make their own choices from a very young age.It is important to consider the child as a unique individual with a distinctive personality. The dentist – child patient relationship has moved from an authoritative to a supporting position giving children the right to be involved in treatment options 14. Marshman et al. found that most researches were conducted on children, rather than with children, totally disregarding the views of the child. In his study he concluded by recommending that future researches should involve children as much as possible 15. This study aimed at evaluating children’s perception of behavior management techniques used in pediatric dentistry.In this study, positive reinforcement was found to be the most preferred method of behavior management for all children who participated in this study. 73.5% of the children were highly approving of this method as a means of management. On the other hand, hand over mouth exercise or HOME was the least favored method of management for both male and female children with 83.5% of the 200 children surveyed finding this method objectionable.Voice control method of behavior management was also equally unpopular across both the male and female population. 83% of the total children surveyed found this method highly unacceptable with more female children rating this method as unfavorable.  But in a study conducted by Benjamin Peretz et al, where an evaluation of parents’ attitude towards behavior management techniques was done, they found that voice control was a totally acceptable means of management to most parents 16.The female children preferred both the ‘tell show do’ method as well as the distraction methods of behavior management equally. No female children found the ‘tell show do’ technique of behavior management unfavorable whereas almost 3% of the male children who took part in this study found this method unacceptable.Distraction as a means of behavior management was also rated as unacceptable by 7% of the total children surveyed. More number of male children found this unfavorable when compared to female children, of which only 2% found it unacceptable.In a study conducted by Fields et al, it was concluded that parents found voice control, positive reinforcement and tell-show-do as acceptable means of behavior management 4.Taalat evaluated children’s perception of non-pharmacologic behavior management techniques and concluded that positive reinforcement was the most accepted technique while voice control was the least accepted 14. These results are almost similar to the results obtained in our study.CONCLUSIONIt is important to consider the attitude and opinion of the child while planning treatment. In our study, we found that positive reinforcement was the most accepted technique by all the children while HOME and voice control were found to be equally unacceptable and unfavorable methods of behavior management.  


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