Nutter & Baker – WOW Session I: Behavior Management Track

Dr. Dennis Paul Nutter - "12 reasons why pediatric dentists should accept young children’s distress behavior as pain behavior during procedures...

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Last updated May 28, 2023

Dr. Dennis Paul Nutter – “12 reasons why pediatric dentists should accept young children’s distress behavior as pain behavior during procedures involving tissue trauma”

As a child’s age decreases from age seven, children increasingly lack the cognitive development to discriminate between the scale points of self-report pain measures. This forces dentists, physicians and nurses to observe a child’s behavior in order to score their pain intensity. But behavior management authors have long argued that not all of young children’s negative behavior during procedures is related to pain. They contend that children’s ostensible pain behavior during procedures is not always authentic and is largely contaminated by anxiety, fear or intentional “misbehavior”. In 2012, 46 percent of pediatric dentists who were members of AAPD believed that it should be the dentist who decides how much pain a child is experiencing during a procedure and not the child. This presentation will give 12 reasons why a child’s distress behavior that occurs coincident with procedural tissue trauma should be assessed as pain behavior until the child says otherwise.

Dr. Suher Baker – “Efficacy of an Anxiety Reduction Program for minimizing the need for dental treatment under general anesthesia”

The purpose of this retrospective pilot study is to investigate the efficacy of a systematic Anxiety Reduction Program (ARP) using progressive desensitization to reduce anxiety in children to a level allowing dental treatment to be comfortably accomplished in-office and minimizing the need for general anesthesia (GA). In our methods we examined records of 227 patients who underwent ARP during 2017-2019. Inclusion criteria included healthy children who came to our office directly or had been referred by dentists who were not successful at performing in-office treatment due to the child’s high level of anxiety. Data was collected for patients age, gender, referring specialty, anxiety level at first visit, age at 1st ARP, number of ARP’s and whether treatment was provided in- office or with GA subsequent to the ARP visit.

Educational Objectives:

For Dr. Nutter:

  • Three negative procedural sequelae of untreated procedure pain.
  • How a well-recognized tendency of human nature primes dentists to be biased in their assessment of children’s procedure pain.
  • Twelve reasons why pediatric dentists should accept the behavioral pain reports of young children during invasive procedures.

For Dr. Baker:

  • Educate dentists on new alternatives in behavior guidance such as progressive desensitization for the anxious child.
  • Advocate for child management in the dental office using noninvasive non pharmacologic behavior guidance techniques rather than costly pharmacologic management with general anesthesia.
  • Personalize patient behavior guidance techniques for anxious patients to ensure optimal memories at the dental office in order to extinguish long term fear from painful dental experiences.

CE Credit Units:


Level of skill recommended for participants:

Of interest to Dentists, Students & Residents, Dental Auxiliaries and Office Staff

Refund Policy:

There are no refunds for CSPD Online CE courses. For any questions, please contact CSPD Executive Director, Paul Reggiardo, DDS, at 


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Course Materials Features

  • Lessons 2
  • Topics 0
  • Quizzes 1
  • Students 39
  • Certificate Yes
  • Assignment No
  • Category Behavior Management
  • Lecture Length 57 minutes
  • Original Release Date March 21, 2021
  • Review Date March 21, 2021
  • Expiration Date March 21, 2024

Course Materials Content

View lecture, take and pass quiz before receiving your CE certificate. You must score 70% or higher to pass.
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CSPD Instructor

Instructor Info:

Dennis Paul Nutter, DDS, received his BS in Biology, his DDS, and his certificate in pediatric dentistry from the University of Southern California. He is the author of a series of articles on Good clinical pain practice for pediatric procedure pain that changed national guidelines for Behavior Guidance. Dr. Nutter has lectured nationally on pain neurobiology, pain assessment, and pain justification. He lectures regularly to dental residents at California dental schools, the US Air Force, and the Veterans Administration.

Suher Baker, BDS, DMD, MS, MBA,  is a dual trained board-certified pediatric dentist and dental anesthesiologist. Currently, Dr. Baker is the Senior Director of Scholarships and Academic Technologies at Momentous Technologies-WiFiesta Inc. while simultaneously providing clinical patient care in private practice for both pediatric dentistry and anesthesiology. She previously served as the Department Chair for Pediatric Dentistry at both Yale and Oregon Health and Science Universities.

Dr. Baker obtained her dental degree from the University of Pennsylvania, and her pediatric dentistry and a Masters degrees from the University of Michigan, her dental anesthesiology degree from the University of California, Los Angeles and most recently her MBA degree from Oregon Health and Science University. Dr. Baker has also completed 2 years of training with Children with special healthcare needs at Helen Hayes Hospital and the Albert Einstein College of Medicine in New York. She is an active AAPD member and serves on many professional committees.

Instructor Disclosure of any conflicts of interest:

None disclosed

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