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 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
 behavioural sciences & Patient motivation
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behavioural sciences & Patient motivation

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  • Custom animation effects: faded zoom entrance and exit(Basic)To reproduce the picture effects on this slide, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click Picture. In the Insert Picture dialog box, select a picture, and then click Insert.On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 5.5” and the Width box is set to 6.5”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes.Select the picture. 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In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 5.5” and the Width box is set to 6.5”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes.Press and hold CTRL, and then select all three pictures. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Middle.Click Align Center. In the Custom Animation task pane, select the sixth animation effect (faded zoom exit effect for the third picture). Click the arrow to the right of the effect, and then click Remove.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. 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  • Transcript

    • 1. BEHAVIOURAL SCIENCE & PATIENT MOTIVATION GUIDED BY : DR.PREETI DHAWAN(READER) DEPT. OF PREVENTIVE & PEDIATRIC DENTISTRY DR.RAVNEET ARORA(SENIOR LECTURER) DEPT OF ORAL MEDICINE & RADIOLOGY BY : ADITI SINGH (P.G I YEAR) DEPT.OF PREVENTIVE & PEDIATRIC DENTISTRY
    • 2. THE “KHAN”DAAN..
    • 3. CONTENTS Introduction Behaviour theories The child patient The adolescent patie nt The adult patient The geriatric patient God’s people Patient motivation Conclusion Bibliography
    • 4. BEHAVIOR It is defined as any change observed in the functioning of an organism.
    • 5. BEHAVIORAL SCIENCE It is the science which deals with the observation of behavioral habits of man and lower animals in various physical and social environment.
    • 6. Behavioral dentistry is an interdisciplinary science which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care delivery system.
    • 7. BEHAVIOR DEVELOPMENT • Behavior development is dynamic process, which begins at birth and proceed in ascending order through a series of sequential stages. • The development of behavior initiates at childhood and persist forever.
    • 8. BEHAVIORAL THEORIES • CLASSICAL CONDITIONING • OPERANT CONDITIONING • SOCIAL LEARNING THEORY • HIERARCHY OF NEEDS
    • 9. CLASSICAL CONDITIONING • PAVLOV(1927) • The conditioning is the relation between the conditioned stimulus and the unconditioned stimulus.
    • 10. OPERANT CONDITIONING • SKINNER (1938) • Individual response is changed as a result of reinforcement or extinction of previous responses. • The consequence of behaviour itself acts as a stimulus and affects future behaviour.
    • 11. SOCIAL LEARNING THEORY Albert Bandura, "Social learning theory approaches the explanation of human behavior in terms of a continuous reciprocal interaction between cognitive, behavioral, and environmental determinants" (Social Learning Theory, 1977).
    • 12. THE CHILD PATIENT
    • 13. CLASSIFICATION OF CHILD’S BEHAVIOUR FRANKEL’S CLASSIFICATION (1962) RATING BEHAVIOUR Definitely negative Refuses treatment, negative behaviour associated with fear. Negative Reluctant to accept treatment, displays evidence of slight negativism. Positive Accepts treatment, but if the child has a bad experience during treatment, may become uncooperative. Definitely positive Unique behaviour, looks forward to and understands the importance of good preventive care.
    • 14. FACTORS WHICH AFFECT CHILD’S BEHAVIOR IN DENTAL OFFICE
    • 15. UNDER THE CONTROL OF THE DENTIST A) Dental Clinic B) Effect of dentist’s activity and attitudes C) Effect of dentist’s attire D) Presence or absence of parents in the operatory E) Presence of an older sibling
    • 16. OUT OF CONTROL OF THE DENTIST  Growth & Development  Nutritional factors  Past medical and dental experiences  School environment  Socio-economic status
    • 17. UNDER THE CONTROL OF PARENTS 1) Home environment 2) Family development and peer influences 3) Maternal Behavior
    • 18. BEHAVIOR MANAGEMENT Behavior management : is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude. (Wright 1975) Behavior shaping: is the procedure which slowly develops behavior by reinforcing a successive approximation of the desired behavior until the desired behavior comes into being.
    • 19. THE CLASSIFICATION.. • Non pharmacological (Psychological approach) • Pharmacological
    • 20. Non-pharmacological methods 1. Communication 2. Behaviour shaping ( modification) a) Desensitization b) Modelling c) Contingency management 3.Behaviour management
    • 21. COMMUNICATIVE MANAGEMENT TYPES OF COMMUNICATION: a) Verbal communication is by speech b) Nonverbal (multisensory communication) c) Both using verbal and non-verbal
    • 22. HOW TO COMMUNICATE? • Compliment him about his appearance. • Communication should be from a single source. USE OF EUPHEMISMS: • Euphemisms are substitute words,which can be used in the presence of children
    • 23. Dental Nomenclature Euphemisms
    • 24. DESENSITISATION Tell show do technique (TSD): • Addleston 1959. • This is effective in children more than 3 years of age.
    • 25. MODELLING • • Introduced by Bandura(1969) It developed from socio-learning principle procedure
    • 26. CONTINGENCY MANAGEMENT • It is a method of modifying the behavior of children by presentation or withdrawal of reinforcers. These reinforcers can be : a) Positive reinforcer b) Negative reinforcer
    • 27. BEHAVIOR MANAGEMENT
    • 28. Aversive conditioning : • It is used for definitive negative behaviour child. • Two common methods used in the clinical practice are HOME and physical restraints:
    • 29. HOME HOME (Hand over Mouth exercise) Introduced by Evangeline Jordan 1920.
    • 30. b) Physical restraints (Kelly 1976). - Active - Passive
    • 31. THE ADOLESCENT…
    • 32. THE ADOLESCENT • Adolescents – young people between the ages of 10 and 19 years – are often thought of as a healthy group( WHO 2012)
    • 33. THE MANAGEMENT.. Is insecure and unable to cope with many Be kind and understanding situations Have varied interest Determine what these are and encourage discussion on these issues.considerable rapport can be gained through discussion when handle properly Tend to reject adult authority Responsive to empathetic guidance. Be firm but kind; display authority in clinical matters,but do not be authoritarian Preoccupied with health matters in general and appearance in particular. Use these concerns as mechanism for motivating the type of behavior conducive to enhancing rapport and improving oral health
    • 34. Often regress to childlike behavior in clinic. this age group is particularly sensitive to being treated as a child. Be extremely careful not to cause the patient obvious embarrassment. Tend to worry about many circumstances; conditions in home, parent, school, social injustice, peer relationship Clinician should encourage conversation to develop a better rapport. Nutritional factors Clinician should motivate patient toward adequate nutritional intake and proper dietary practice from perspectives of obesity and oral health.
    • 35. THE ADULT PATIENT
    • 36. DENTAL PATIENT’S FEARS • Fear from pain & treatment procedure • Fear from unknown • Fear from past dental history • Fear from the financial cost • Fear from treatment outcomes
    • 37. HEALTH BELIEF MODEL
    • 38. • WHO IS BETTER??? DURYODHAN ARJUN
    • 39. THE VICIOUS CIRCLE..
    • 40. CHAIRSIDE TECHNIQUES FOR BEHAVIOUR CHANGE • NON RELAXATION BASED TECHNIQUES COMMUNICATION LISTENING DISTRACTION • QUASI RELAXATION BASED TECHNIQUES GUIDED IMAGERY • RELAXATION BASED TECHNIQUES COGNITIVE COMPONENT SOMATIC COMPONENT
    • 41. COMMUNICATION FOR HEALTH BEHAVIOUR CHANGE • Patient Clinician Relationship “FIRST IMPRESSION IS THE LAST IMPRESSION”
    • 42. VERBAL EXCHANGE Styles of communication(Rollnick et al 2007): • 1.Directing(most common) • 2.Following • 3.Guiding (OARS)
    • 43. OARS
    • 44. THE ART OF LISTENING “Apparently the act of attending carefully to another person is a difficult task for most people.” —Carl Rogers
    • 45. HOW TO LISTEN • have a calm manner • say reassuring things • take seriously what the patient has to say • tell the patient what is to be done • encourage the patient to ask questions
    • 46. “An inability to listen will be judged harshly.” —Stanley Weiss
    • 47. NON VERBAL EXHANGE • EYE CONTACT • FACIAL EXPRESSIONS
    • 48. • VOCAL CHARACTERISTICS • BODY LANGUAGE
    • 49. DISTRACTION PHYSICAL PSYCHOLOGICAL
    • 50. QUASI RELAXATION TECHNIQUES Helen Lindquist Bonny (1921 – May 25, 2010) Music therapist Kenneth Bruscia defined Guided Imagery and Music as “All forms of music-imaging in an expanded state of consciousness, including not only the specific individual and group forms that Bonny developed, but also all variations and modifications in those forms created by her followers."
    • 51. TO SUM IT ALL UP …
    • 52. THE GERIATRIC PATIENT
    • 53.  What happens in the mouth is often a reflection of what happens in the body.  Oral Health as been linked to diabetes, heart disease, stroke, and pneumonia. 5 9  Research also links Periodontal disease, a chronic inflammatory disease to cardiovascular disease, diabetes, Alzheimer's and other diseases  (Journal of Periodontology Aug 2008 Supplemental Issue)
    • 54. GERIATRIC PSYCHOLOGY (MM HOUSE) PHILOSOPHICAL : • well motivated • realizes his part in the success of the treatment. • Cooperative and adjustable. • They are rational, sensible, calm and composed even in difficult situations.
    • 55. EXACTING (critical): • Methodical and precise • He likes each step of the procedure explained in detail. • Proposes alternative treatment MANAGEMENT: Extra care, efforts and especially patience is required. The physician must listen to there demands but not give in, especially if they are unresonable.
    • 56. INDIFFERENT PATIENT Lacks motivation Usually not interested in treatment Tries to find faults in the treatment Tend not to cooperate or follow instruction MANAGEMENT: Difficult to manage An attempt is made to educate the patient and improve his interest
    • 57. HYSTERICAL PATIENT • Easily excited • Highly apprehensive • Rarely cooperate with the treatment • Tend to have unfounded complaints and unrealistic expectation. MANAGEMENT: require lot of time and effort. Often medical consultation or professional help is required.
    • 58. SKEPTICAL PATIENT • Had bad result with previous treatment • Doubtful if their problem can be solved • psychological disturbance from some recent personal tragedy. MANAGEMENT Genuine kindness, care and sympathy should be offered. More time and attention to detail should be given. These patient can be made into excellent patient if handle properly.
    • 59. M M HOUSE REVISITED
    • 60. HEARTWELL THE REALIST…. Philosophical + Exacting type Follow instructions properly Maintain a good oral hygiene Seek dental care Take good diet
    • 61. • THE RESENTERS… Indifferent + Hysterical type Second childhood stage.. Will NOT listen to instructions properly Negligent in oral care Rarely seek dental care MANAGEMENT : Palliative treatment
    • 62. • THE RESIGNED… Variable emotional & systemic status Passive submission MANAGEMENT : Definitive or palliative
    • 63. MANAGEMENT OF ANXIOUS GERIATRIC PATIENT
    • 64. STATUS PREOPERATIVE MANAGEMENT ORAL SEDATION BEHAVIORAL 1. ANSWERING PATIENT’S QUESTIONS 2. REASSURANCE PHARMACOLOGICAL EFFECTIVE LOCAL ANESTHESIA ORAL SEDATION BEHAVIOURAL INSTRUCTION TO PATIENT DESCRIPTION OF COMPLICATIONS PHARMACOLOGICAL POSTOPERATIVE 1. EFFECTIVE COMMUNICATION 2. MAKE THE PATIENT RELAX 3. EXPLAIN THE PROCEDURE PHARMACOLOGICAL OPERATIVE BEHAVIORAL ANALGESICS, ADJUNCTIVE MEDICATIONS Zwetchkenbaum S et al Prosthodontic considerations for older patient. The Dental clinics of North America 1997;41:817-46
    • 65. THE 5A’s … • • • • • Assess Advise. Agree Assist Arrange Follow up
    • 66. • “Before meeting the mouth of the patient, we must meet the mind of the patient”- DeVan • The Golden Handshake.. • The Schizophrenic patient • Patient having Alzheimer’s disease
    • 67. A WORD OF CAUTION… EXTREMELY STRESSED OUT PATIENTS SATISFIED WEARER OF OLD DENTURES GERIATRIC PATIENTS WHO DO NOT WANT DENTURES THE GERIATRIC PROSTHODONTIC PATIENT
    • 68. • Prefer short morning appointments • Avoid exagerrated treatment options • Consider partial transitional denture , over dentures etc.
    • 69. GOD’S PEOPLE…
    • 70. • They form one of the more neglected population as far as oral health care is concerned • They need special considerations & strategies beyond those required for other people
    • 71. THE HINDRANCES… • INFORMATION OBSTACLE • PHYSICAL OBSTACLE • BEHAVIORAL OBSTACLE • ORGANIZATIONAL OBSTACLE
    • 72. PYRAMID TRAINING MODULE..
    • 73. MODIFIED ARMAMENTARIUM • MODIFIED TOOTH BRUSH • TONGUE BLADE MOUTH PROP
    • 74. BEHAVIOR SUPPORT • STRUCTURING THE ENVIRONMENT • INVOLVING THE INDIVIDUAL • EDUCATING THE CAREGIVER
    • 75. PATIENT MOTIVATION
    • 76. MOTIVATIONAL INTERVIEWING “ a client- centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence ” (Rollnick and Miller 1995 )
    • 77. STRATEGY PRINCIPLE SPIRIT
    • 78. IN THE DENTAL OPERATORY.. • AIM IS TO … (1) assess motives, (2) raise awareness, (3) support a change.
    • 79. Modus operandi.. • Health history form (objective) • Open ended questions
    • 80. • Raise awareness Vs Giving information
    • 81. Support a change • Encouraging patient problem solving • offering a set of strategies or options • planning steps for the change.
    • 82. THE CHANGE TALK.. • ELLICIT – PROVIDE – ELLICIT • ROLL WITH RESISTANCE • A BRIEF INTERVENTION
    • 83. OUTSIDE THE DENTAL OFFICE • DENTAL HEALTH CAMPS 1. COMMUNITY LEVEL HEALTH PROGRAMMES 2.SCHOOL ORAL HEALTH PROGRAMMES 3.HEALTH AWARENESS CAMPAIGNS
    • 84. COMMUNITY DENTAL HEALTH CAMPS
    • 85. THE SATELLITE CLINIC
    • 86. COMMUNITY DENTAL CAMPS
    • 87. SCHOOL DENTAL HEALTH CAMPS
    • 88. HEALTH AWARENESS CAMPS
    • 89. FINALLY…
    • 90. REFERENCES • Ralphe E McDonald ,Avery R D, Dean J A ;Dentistry for the child and Adolescent;8Ed Mosby;2004 • Mostofsky I D, Fortune Farida; Behavioral Dentistry;2Ed;Wiley BlackWell;2012 • Glanz K, Rimer B, Vishwanath K;Health Behavior & Health Education Theory, Research & Practice;4Ed;Jossey-Bass;2008 • Ramseier C, Suvan J;Health Behavioral Change in Dental Practice; 1Ed;Wiley-Blackwell;2010 • Tandon ShobhaTextbook of Pedodntics;2Ed Paras Medical;2009 • Ernest R. Hilgard ;Introduction to psychology; 6Ed;Mosby • Charles M heartwell ;Syllabus of complete dentures • Module 4. Behaviour Modification ;UNESCO ;February 2000
    • 91. • Diana M Gardnier;Psychosocial behaviour pattern for adolescence- dental clinics of north america; vol-50 (17-32) • David Kohllo;Child & adolescence psychology ; journal of clinical psychology ; vol 13; (47-53) • Ripa & Barenier;Management of dental behavior in children • Busschots G Milzman B Dental patients with neurologic & psychiatric concerns. The Dental Clinics of North America.1999;43:471-83 • Laxman Rao Polsani,AjayKumar G,Githanjali M, Anjana Raut;Geriatric Psychology & Prosthodontic Patient;IJOPRD,AprilJune 2011;1(1):1-5 • Thomas A. Cavalieri, DO;Managing pain in Geriatric Patient; J Am Osteopath Assoc. 2007;107(suppl 4):ES10-ES16 • Gamer S,Tuch R,Garcia L T;M. M. House mental classification revisited: Intersection of particular patient types and particular dentist’s needs; J Prosthet Dent 2003;89:297-302.
    • 92. • Freeman R;Strategies for motivating the noncompliant patient;British Dental Journal; Vol 187(6)1999-307 • Anne E, Halvari M,Halvari H, Bjørnebekk G, Deci L E; Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance; Motiv Emot;2010(34):15–33 • Anne E, Halvari M,Halvari H, Bjørnebekk G, Deci L E;Motivation for Dental Home Care:Testing a SelfDetermination Theory Mode; Journal of Applied Social Psychology,:2012;42(1)1–39.

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