Wright’s Classification of Cooperativeness of Children in Dental Office (1975)

Wrights classification of children’s operative behaviour under the following categories:
• Cooperative children
• Children lacking cooperative ability
• Potentially cooperative children

  1. Uncontrolled behaviour
  2. Defiant behaviour
  3. Timid behaviour
  4. Tense cooperative behaviour
  5. Whining behaviour

• Most of the children whom we see in day to day practice fall under this category.
• They show minimal apprehension and are reasonably released.
• These children usually have good rapport with the dentist and the dental team.
• They show interest in the dental procedures and often enjoy the situation.
• The dentist can work effectively and efficiently with these children.
• They follow the guidelines established, perform within the framework provided and present reasonable level of cooperation.

• Children lacking cooperative ability are in total contrast to the cooperative children as they lack the ability to cooperate because of their mental and physical immaturity due to age or some special condition.
• This includes two group of children:
One,being very young who are emotionally immature because of age (less than 2% years). These children can pose a major behavior problem and are often referred to as ‘preoperative children or children in pre-cooperative stage.

The second includes children with specific debilitating or handicapping conditions with mental and physical deficiencies. The severity of the condition will not allow them to cooperate like normal children of their same age. These are called special children’ and the number of these children you see in dental office is increasing recently.

• These children are otherwise termed as ‘behaviour problem’ children.
• They differ from the children lacking cooperative ability because they have the ability to cooperate but they do not.
• This can be because of objective/subjective no other face which can influence behavior can children in dental setting.
• The behaviour of these children can be modified by different techniques and can become operative children.

  1. Uncontrolled behaviour:
    • This type of behaviour is seen in a young child of age to 6 years.
    • The reaction is seen in the form of a tantrum, which may begin at the reception area or even before the child enters the dental clinic.
    • This behaviour is also known as incorrigible.
    • It is characterized by tears, loud cry, physical lashing out, flailing of hands and legs. All are suggestive of a state of acute anxiety or fear.
    • These children are termed as hypermotive by Lampshire.
    • School age children tend to model their behaviour on adults or other older children.
    • Uncontrolled and immature behaviour is not seen in older children, but if it is seen there will be deep rooted reasons for it and these children may reveal adjustment problems in other settings.
    • Immediate measures to manage the uncontrolled behaviour is seen.

2. Defiant Behaviour:

This behaviour is typical of the elementary school years but can be observed in other age groups also.
• Defiant behaviour is controlled to an extent and is distinguished by “I don’t want to’, I don’t need to’,
• They protest as they would do at home when they were brought to the dental office against their wish.
• These children are often referred to as ‘stubborn’ or ‘spoiled’.
• They frequently become highly cooperative after establishment of guidelines for their behaviour and gaining their confidence.
• Defiance can be passive as seen in older children approaching adolescence.
• Failure of communication results when the dentist tries to involve the child in the dental procedure and the youngster refuses to respond verbally.
• He may avoid eye contact and also reject the situation by clenching his teeth when an intraoral exam nation is attempted.
• Passive resistance is often observed in older children approaching adolescence.
They have the freedom to express their likes and dislikes at home and when brought to the dental office unwillingly their self-image is affected and they rebel.

3.Tense cooperative behavior:
• The behaviour of these children is termed borderline.
• They accept the treatment and cooperate but are extremely tense, which is typical of these children.
• The tension is often revealed by the body language.
• The child patient’s eyes may follow the movements of both the dentist and the dental assistant.
• A tremor in the voice heard when they speak, perspiration on the palms of the hands or the eye brows are some features of tense cooperative behaviour.

4. Timid Behaviour:
• Timidity is milder when compared to uncontrolled and defiant behaviour but when managed incorrectly they may become uncontrolled.
• The timid child may hide behind a parent but usually offers no physical resistance during the separation procedure.
• Some may pause or hesitate when given directions. They may sob or whimper out but not cry hysterically.
• They lift their hands occasionally to cry but withhold tears.
• Reasons for timidity can overprotective home environment, living in isolated areas without any contact with strangers.
• They are often overawed by strangers and strange situations.


5. Whining Behaviour:
• Whining can be seen in timid or tense-cooperative children.
• Since whining plays the prominent role in their behaviour, it is described as a separate entity.
• They allow the dentist to perform the procedure but whine through out despite encouragement.
• They frequently complain of pain.
• Whining can be a compensatory mechanism to control their fear.
• The cry is controlled, constant and not particularly loud, often without any tears.
• Continuous whining can be a source of irritation and frustration to those involved in the treatment and great patience is required in dealing with whining children.

• Pediatric Dentistry: Principles and Practice, MS Muthu (2nd Edition).
• Slideplayer.com
• Collegevillepediatricdentist.com
• Wintergardensmiles.com
• Shutterstock.com

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