Comparative Study of Behavioral Management Techniques on Orthodontic Treatment Acceptance in Children with Special Health Care Needs

Abstract

Background: Orthodontic treatment in children with special health care needs (SHCN) is often complicated by behavioral challenges, anxiety, and reduced cooperation. Effective behavioral management is essential to enhance treatment acceptance and ensure successful clinical outcomes. However, evidence comparing different behavioral techniques specifically in SHCN populations undergoing orthodontic procedures remains limited.

Aim: To compare the effectiveness of different behavioral management techniques on Orthodontic treatment acceptance in children with SHCN.

Materials and Methods: This prospective randomized controlled clinical trial included 60 children aged 6–14 years diagnosed with SHCN requiring orthodontic treatment. Participants were randomly allocated into three groups (n=20 each): Group I (tell-show-do), Group II (audiovisual distraction), and Group III (combination of tell-show-do and positive reinforcement). Baseline demographic data and anxiety levels were recorded. Orthodontic procedures were standardized across all groups. Treatment acceptance was assessed using the Frankl Behavior Rating Scale, procedure completion rate, and physiological parameter (heart rate). Observations were recorded at baseline, first visit, 2 weeks, and 1 month. Data were analyzed using ANOVA, repeated measures ANOVA, Chi-square test, and t-tests with significance set at p < 0.05.

Results: All groups demonstrated significant improvement in behavior and reduction in anxiety over time. However, Group III showed the highest increase in Frankl scores (p < 0.01), highest procedure completion rate (90%), and greatest reduction in heart rate (mean reduction: −12.6 bpm). Audiovisual distraction (Group II) was more effective than tell-show-do alone (Group I), particularly during initial visits. Intergroup comparisons revealed statistically significant differences favoring the combination technique.

Conclusion: The combination of tell-show-do and positive reinforcement is significantly more effective than individual behavioral techniques in improving Orthodontic treatment acceptance among children with SHCN. A multimodal behavioral approach is recommended for optimal clinical outcomes in this population. This study supports Sustainable Development Goals (SDG) 3, 4 and 17 by enhancing equitable access to orthodontic care through effective behavioral management strategies in children with special health care needs