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Child & adult psychology in orthodontics /certified fixed orthodontic courses by Indian dental academy


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  • 2.  Contents.  Introduction  Definitions  Importance of child psychology  Theories of child psychology  Emotional development  Stages of Psychological growth and development  Psychological status of patients seeking orthodontic
  • 3. Social psychology Psychologic outcomes of orthodontic treatment Social factors affecting self concept Motivational Psychology Orthodontist and patient communication Problems of Orthodontists in treating adolescents Psychosomatic considerations in orthodontics Psychosocial implications of facial deformities Psychosocial characteristics of patients with facial deformities CONCLUSION
  • 4. Introduction: Psychological development is a dynamic process. Which begins at birth and proceeds in an ascending order through a series of sequential stages manifesting into various characteristic behaviour, These stages are governed by genetic, familial, cultural, interpersonal and interpsychic factors. The aim of this discussion is to understand the various aspects of child and adult psychology applied to the dental (orthodontic) situation for the successful management of the child and adults.
  • 5. Definition Psychology – the science dealing with human nature, function and phenomenon of his soul in the main. Child psychology –the science that deals with the mental power or an interaction between the conscious and subconscious element in a child. Emotion – An effective state of consciousness in which joy, sorrow, fear, hate or the likes are expressed.
  • 6. Behaviour –is any change observed in the functioning of the organism. Behaviour management – means by which dental health team effectively and efficiently performs treatment for a child and simultaneously instill a positive dental attitude in the child (Wright, 1975)
  • 7. Importance of child psychology  To understand the child better.  To know psychological problem of child.  To deliver dental services in a meaningful and effective manner.  To establish effective communication between the child and parent.
  • 8.  To gain confidence of the child and parent.  To teach the child and parents importance of primary and preventive care.  To produce a comfortable environment for the dental team to work on the patient.
  • 9. Theories of child psychology Psychodynamic theories Psychoanalytical theory Psychosocial theory Cognitive theory Behavioural learning theories Hierachy of needs Social learning theory Classical conditioning Operant conditioning
  • 10. Psychoanalytical theory Sigmond freud – 1905 Freud thought the personality to originate from biological root manly sexual insticts was the most important. He compare the human mind to an iceberg. Conscious experience The unconscious store of impulses
  • 11. Id : Basic structure of personality Serves as a reservoir of instincts or their mental representative It is present at birth Governed by pleasure principle. Exm; The need to eat, eliminate the wastes and to avoid pain etc,. According to SIGMOUND FREUD personality composed of three major system.
  • 12. Ego : Develops out of Id in the 2nd to 6th month of life Governed by reality principle Concerned with memory and judgment Modifies or controls id impules on realistic level Exa; children learn that hunger must wait until some one provides food. Super ego :It is the prohibition learned from environment It acts as a censor of acceptability of thoughts, feelings and behavior. Exm; the patient may deny the anxiety associated with the necessary dental treatment.
  • 13. An Individual goes through five stages prior to adulthood: – Oral – Anal – Phallic – Latency – Genital
  • 14. Oral stage (0-1 year) The oral region (mouth, lips and tongue) is the main source of satisfaction or pleasure. Adequate and regular feeding is of prime importance to the infant. Incomplete resolution of the oral stage is said to provide the basis for the psychopathology of addictive behaviour such as overeating, smoking or drinking. Oral dependency in the form of digit sucking habit is an example of this seen in older
  • 15. The responsibility of the mother during this stage is crucial. She has to take care of the baby addressing all its needs.
  • 16. Anal stage (2-3 years) The main feature of this stage is the child‟s acquisition of voluntary bowel and bladder control. The child derives enjoyment and pleasure from increasing control over bodily functions as well as from his developing autonomy. Toilet training is seen as the first and also as the prototype of co-operative activity between the child and the parent.
  • 17. Phallic stage (3-5 years) The child becomes increasingly aware of his/her genitals, the enjoyment to be derived from them and the differences between the sexes. Freud developed these ideas most clearly for boys and coined the term Oedipus complex to describe the conflictual situation arising between the boy and his parents during this phase.
  • 18. The boy becomes attached to his mother, leading to rivalry with the father for the affection of the mother; the boy also recognizes that his father is powerful and would be likely to punish him severely if he pursues the rivalry too far. The resolution of the crisis for the boy is to 'identify' with his father and use him as a role model, so that he can hopefully not only reduce the risk of retaliation but also increase his own power by emulating his father.
  • 19. Similar explanations are applied for the girls' sexual conflict, for which the term Electra complex is used. The unsatisfactory resolution of the Oedipus conflict manifests itself in later life as sexual conflicts concerning sexual role and identity and also the inability to form intimate sexual relationships.
  • 20. Latency stage (6-11 years) This period is so called because of its relative tranquility compared with the emotionally stormy periods of the phallic and genital periods. Sexual feelings subside after the resolution of the oedipal crisis. The child focuses his attention on the same-sex parent, leading to increased identification with and role-modeling on this parent.
  • 21. Similarly, peer group relationships are predominantly with the same sex. The exposure to stress and anxiety is essential for the child's well-being, as it provides the child with the opportunity to learn to cope with unpleasant or distressing feelings.
  • 22. Genital stage (12-18 years) The endocrinological and physiological changes occurring at puberty rekindle the individual's interest in sexual matters and heterosexual relationships. A good outcome of this stage is dependent on how well or otherwise the individual has dealt with earlier stages. Two stages, the oral and the phallic, are particularly crucial. Poor resolution of the oral phase may preclude the foundation of close, trusting relationships with the opposite sex, whilst unresolved phallic conflicts may lead to confusion over sexual role and behavior.
  • 23. Basic trust v/s Basic mistrust Autonomy v/s Shame and doubt Initiative v/s Guilt Industry v/s Inferiority Identity v/s Role confusion Generativity v/s Stagnation Intimacy v/s Isolation Integrity v/s Despire Erikson‟s 8 stages of emotional development 0-18m 18m-3y 3-6y 7-11y 12-17y Psychosocial theory Child's development covering the entire span of life cycle from infancy to childhood through old age
  • 24. 1} BASIC TRUST VS MISTRUST •Birth to 18 mon •Infant depends on others for his basic needs •Successful development of trust depends on caring mother who meets both the physiologic and emotional needs of an infant. •Infact physical growth can be retarded if the child receives inadequate maternal support. The syndrome of „Maternal deprivation’ such infant fail to gain weight and are retarded in their physical as well as emotional growth.
  • 25. Dental consideration If it is necessary to provide dental treatment at an early age, it usually is preferable to do so with the parent present, and if possible, while the child is being held by one of the parents present. At later stages, a child who never developed a sense of basic trust will be an extremely frightened and unco- operative patient who needs special effort to establish rapport and trust with the dentist.
  • 26. 2} AUTONOMY VS SHAME, DOUBT 18 m to 3 YRS Child moves away from mother to develop sense of individual identity or autonomy. Children around the age of 2 are said to be undergoing the “terrible twos’ because of their un co-operative behaviour. Their self-control and self-confidence begins to develop at this stage Failure leads to shame or doubt
  • 27. Dental consideration At this age for any simple procedures parents should be present and for complex dental treatment of children at this stages it may require extraordinary behaviour management procedures like sedation or general anesthesia.
  • 28. 3} INITIATIVE VS GUILT: • 3 to 6 yrs • At this stage child wants to take part in many activities, ask more questions • A major task for parents and teachers at this stage is to channel the activity into manageable tasks so that the child is able to succeed. • If child is made to feel that a certain activity is bad, that play is silly and stupid then the child may develop sense of guilt
  • 29. Dental consideration For most children the first visit to the dentist comes during this stage of Initiative. A child at this stage will be intensely curious about the dentists office and eager to learn about the things found there. After initial experience, a child at this stage can usually tolerate being separated from the mother for treatment so that independence rather than dependence is reinforced.
  • 30. 4} INDUSTRY OR MASTERY VS INFERIORITY: • 7 TO 11 YRS • Child acquires academic and social skills } preparation to enter competitive world. • Sense of inferiority crops when child compares academically, socially and physically and finds that someone else can do things better than him/her.
  • 31. Orthodontic treatment in this age group involves wearing of removable appliances. Whether a child will do so is mainly determined whether he or she understands what is needed to please the dentists and parents, whether the peer group is supportive and whether the desired behaviour is reinforced by the dentist. Children at this stage are motivated by improved acceptance from the peer group. Dental consideration
  • 32. 5} IDENTITY VS ROLE OF CONFUSION: • 12 to 18yrs • Adolescence, a period of intense physical development, is also the stage in psychosocial development in which a unique personal identity is acquired. • It is extremely complex stage because of physical ability changes, academic responsibilities increase and career possibilities begin to be defined. • Failure to solve this conflict leads to confusion
  • 33. Orthodontic consideration Most orthodontic treatment is carried out during this period and behavioural management of adolescents can be extremely challenging since parental authority is rejected, a poor psychological situation is created by orthodontic treatment if it is carried out primarily because the parents want it, not the child. At this stage, orthodontic treatment should be instituted only if the patient wants it, not just to please the parents.
  • 34. 6} INTIMACY VS ISOLATION: 21 to 40 yrs The adult realizes the need for one truly intimate relationship with others. Successful development of intimacy depends on a willingness to compromise and even to sacrifice to maintain relationship. Failure leads to isolation
  • 35. Orthodontic consideration At this stage they seek orthodontic care. often, these individuals are seeking to correct dental appearance they perceive as flawed. They may feel that a change in their appearance will facilitate attainment of intimate relationships. A new look resulting from orthodontic treatment may interfere with previously established relationships.
  • 36. 7} GENERATIVITY VS STAGNATION • 45 to 60 yrs • Major responsibility of an adult is to guide next generation • Guidance should not be only to one‟s own children but also by supporting the network of social services needed to ensure the next generation‟s success.
  • 37. 8} INTEGRITY VS DESPAIR: over 65 yrs Final stage in psychosocial devlp Integrity – sense of satisfaction that a person feels, in a productive life lived Despair – sense that life has had little purpose or meaning, It is expressed as disgust and unhappines on a broad scale
  • 38. Cognitive theory  Jean piaget in 1952  Based on how children and adolescents think and acquire knowledge  Environment does not shape child behavior but the child and adult actively seek to understand the environment
  • 39. Adaptation occurs through two processes Assimilation: Accommodation:
  • 40.  Assimilation: From the beginning, a child incorporates or assimilates events within the environment into mental categories called cognitive structures.  Accommodation: Accommodation occurs when the child change his or her cognitive structure to better represent the environment
  • 41. The sequence of development has been categorized into 4 major stages 1)Sensoriomotor stage (0 to 2 yrs) 2)Pre –operational stage (2 to 6 yrs) 3)Concrete operational stage (6 to 12 yrs) 4)Formal operation stage (11 to 15 yrs)
  • 42.  1}Sensorimotor stage:  Birth to 18mon.  Every child is born with certain Strategies for interacting with the environment.  Beginning of thinking process.  Not yet have capacity to represent objects or people.
  • 43. 2} Pre-operational stage: Because children above the age of 2 begin to use language in ways similar to adults, It appears that their thought processes are more like those of adults. A general feature of thought processes and language during the preoperational period is egocentrism, meaning that the child is incapable of assuming another person‟s point of view. At this stage, capabilities for logical reasoning are limited and the child thought processes are dominated by the immediate sensory impressions
  • 44.  3} Concrete operational stage:  7 to 12 years  By this stage egocentrism and animism declines.  Thinking process becomes logical  Able to use complex mental operations  Able to understand the others point of view
  • 45.  4} Formal operational stage:  12 to18 years  Child‟s thought process is similar to adult.  Adolescents assume that others are concerned with their actions and feeling. They feel as though they are constantly being observed and criticized by those around them. This phenomenon has been called the “Imaginary Audience” by Elkind.  This has powerful influence on young adolescents making them quiet self-conscious and susceptible to peer influence.
  • 46. LEARNING & DEVELOPMENT OF BEHAVIOUR: Psychologists generally consider that there are 3 distinct mechanisms by which behavioural responses are learned. •Classical conditioning •Operant conditioning •Observational learning
  • 47. CLASSICAL CONDITIONING: This was first described by the Russian Physiologist Ivan Pavlov who discovered in 19th century during his studies of reflexes that apparently unassociated stimuli could produce reflexive behaviour.
  • 48. Pavlov‟s classical dog experiments involved the presentation of food to a hungry animal along with some other stimulus like ringing of a bell. The sight and sound of food normally elicit salivation by a reflex mechanism. If a bell is rung each time food is presented the conditioning stimulus of the ringing bell will became associated with the food presentation stimulus and in a short time ringing of a bell itself will elicit salivation.
  • 49. Classical conditioning occurs readily with young children and has a considerable impact on a young child‟s behaviour on the first visit to the dental office. By the time the child is brought to the dental office he or she might have many experiences with pediatricians and medical personnel when a child experiences pain, the reflex reaction produced is crying and withdrawal. According to Pavlov the infliction of pain is an unconditioned stimulus. If the unconditioned stimulus of white coats a child may cry and withdraw immediately at the first sight of white coated dentists.
  • 50.
  • 51. The association between a conditioned and an unconditioned stimulus is strengthened or reinforced every time they occur together Every time they occur, the association between a conditioned and unconditioned stimulus is strengthened.
  • 52. OPERANT CONDITIONING: According to behavioural theorists B.F.Skinner this operant conditioning is viewed conceptually as a significant extension of classical conditioning. Operant conditioning differs from classical conditioning in that the consequence of behaviour is considered as a stimulus for future behaviour. This means that the consequence of any particular response will affect the probability of that response occurring again in a similar situation.
  • 53. Skinner described 4 basic types of operant conditioning distinguished by the nature of the consequence
  • 54. Positive reinforcement: -If a pleasant consequence follows a response, the response has been positively reinforced, and the behaviour that lead to this pleasant consequence becomes more likely in the future. eg:- If a child is given a reward for such as a toy for behaving well during her first dental visit, she is more likely to behave well during future dental visits her behaviour was positively reinforced. Negative reinforcement:- involves the withdrawal of an unpleasant stimulus after a response. eg:- a child who views a visit to the dental clinic as an unpleasant experience may throw a temper tantrum at the prospect of having to go there. If this behaviour (response) succeeds in allowing the child to escape the visit to the clinic, the behaviour has been negatively reinforced and is more likely to occur the next time a visit to the clinic is proposed.
  • 55. Omission or Time out: - Involves removal of a pleasant stimulus after a particular response. Eg:- If a child who throws a his favorite toy taken away for a short time as a consequence of this behavior, probability of similar misbehavior is decreased. Punishment:- This occurs when an unpleasant stimulus is presented after a response. This also decreases the probability that the behavior that prompted punishment will occur in the future.
  • 56. Simply praising a child for desirable behaviour produces positive reinforcement and additional positive reinforcement can be achieved by presenting some reward. The other two types of operant condition omission and punishment should be used with caution in the dental office since a positive stimulus is removed in omission, the child may react with anger or frustration. When punishment is used, both fear and anger sometimes results. Infact punishment can lead to a classically conditioned fear response.
  • 57. OBSERVATIONAL LEARNING (Modelling):- This behaviour is acquired through imitation of behaviour observed in a social context. There are 2 distinct stages in observational learning. Acquisition of the behaviour by observing it. Children are capable of acquiring almost any behaviour that they observe and that is not too difficult for them to perform at their level of psychical development. Actual performance of the behaviour Whether a child will actually perform an acquired behaviour depends on several factors like characteristics of role model. If the model is liked or respected the child is more likely to imitate them eg:- for adolescents the peer group are the major source of role models.
  • 58. Observational learning can be used to advantage in the design of treatment areas. At one time, it was routine for dentists to provide small private cubicles in which all patients, children and adults, were treated. the modern treatment particularly in treatment of children and adolescent is to carry out dental treatment in open areas with several treatment stations.
  • 59. Stages of Psychological growth and development Infant (first year of life) Toddler (second year of life) Preschool child (3rd to 6th year of life) School age child (6th year to puberty) Adolescent (12th to 18 years of life) Early adolescent Middle adolescent Late adolescent
  • 60. Infant: Human infant is totally dependent upon another person for survival during a significant period of early childhood. This dependency exceeds the simple physical care of feeding and cleansing and emotional needs. By 4-6 weeks the child acknowledges someone outside himself by social smile. This is one of the first social interactions in which the child participates. Psychoanalysts describe the early interdependency of mother and child as a symbiotic relationship.
  • 61. Toddler (2nd year of life): It is usually, called as the “terrible two’s” because of the negativism, anger, temper-tantrums are characteristics of this period. These behaviors represent the child‟s desire to control when faced with restrictions set by adults. Language skills develop rapidly so that by 18 months the child can understand and follow simple directions.
  • 62. Preschool child (3-6 years of life): Language skills develop and allows for meaningful conversation. Playing becomes a major preoccupation and it serves a necessary function in maturation of the child. The child often thinks that every thing is a magic i.e events are reversible.
  • 63. School age child (6th year of life to puberty): At school age child is required to leave the home to enter the school. The child is expected to give up certain idiosyncrasies developed in the home to live in less co-operative society. This is a major step in the separation – individualization. school phobia develops due to increased separation anxiety to cope up with this anxiety child gains support from the peer group. The child from 6-12 years is perceived as a untroubled individual who is acquiring new knowledge in school and actively engaged in play with friends
  • 64. Adolescent age (12th-18 years of life): Adolescence is a psychological state of development in puberty which is a physical state. The beginning of adolescence coincides with the onset of puberty but ends with the accomplishment and completion of the developmental tasks of this age period. The longer the period of dependency exists, the longer is the state of adolescence. It is sub-divided into 3 stages: Early adolescence: Middle adolescence: Late adolescence:
  • 65. Early adolescence: This period begins with the pubertal growth spurt and continues for 12- 18 months corresponding approximately to 12-14 in girls and 13-15 in boys Middle adolescence: This period is from 14-16 years. It is the middle point of teenage development with the surging drive forward toward adulthood with all its responsibilities but with the regressive pull backward towards his security and known comfort of childhood. Late adolescence: This is the final stage of transition to adulthood. Two major tasks to be achieved during this stage are ego identity and the capacity for intimate relationships. He must develop as self sufficient individual independent of his family and capable of filling his role as a person in society.
  • 66. Psychological status of patients seeking orthodontic treatment Psychological and behavioural sciences play an important role and it had been in research and in clinical practice. Numerous studies have showed that psychological outcomes of orthodontics on the patients self image are positive. The areas of behavioural research and the application of practical psychology to the clinical practice of orthodontics can be divided into 2 broad categories. 1. Social psychology 2. Motivational psychology
  • 67. Social psychology Encompasses divergent fields like Why patients seek orthodontic treatment? Use of standardized psychological instruments to assess prospective orthodontic patients.
  • 68. Why patients seek orthodontic treatment? Majority of orthodontic patients who seeks care under their own initiative (ie) Adult patients do so to improve their facial appearance. Most adolescents on the other hand seek care because their parents wants them to look better. so the answer to why patients seek orthodontic treatment was to improve their facial appearance, Many patients seek orthodontic treatment to improve the quality of life because it has a significant effect on their overall quality of life. william R Proffit, DDS, PHD text book of contemporery orthodontics 4rt
  • 69. Phillips C, Bennett ME, Broder HL: Dentofacial disharmony: psychological status of patient seeking treatment conclusion, Angle Orthod 68(6):547-556, 1998. Adolescents with significant dento facial disharmonies are frequently considered to be at risk for negative self-esteem and social maladjustment. According to studies done by Philip dentofacial anomalies such as crooked teeth and skeletal disharmonies, have been reported as the cause of teasing and general playground harassment among children and are associated with lowered social attractiveness.
  • 70. Psychologic outcomes of orthodontic treatment Dentofacial esthetics plays an important role in a child‟s self concept. According to the studies done by Dann et al, Children with serious malocclusions did not necessarily have poor self-concept and they also noted that the patients self concept did not improve significantly with orthodontic treatment. Dann C et al : self concept Class II malocclusion, and early treatment , Angle orthod 65(6) : 411-416, 1995.
  • 71. But contrary to Dann et al, Albino showed the psychological and social effects of orthodontic treatment. He investigated the hypothesis that dentofacial disharmonies may have important social and significant psychological effect on the patient and found that parent, peer and self reported evaluations of dentofacial specific self image improved significantly after the patient received orthodontic treatment . (ie) children who received orthodontic treatment felt better about their facial appearance after braces than they did before them. Albino JE psychological reasons for orthodontic treatment explored, J Am Dent Assoc 98 : 1002- 1003 , 1979
  • 72. According to the studies done by Varela psychological outcomes of orthodontic treatment differ for adult and adolescent patients with the aid of standardized psychological tests. These researchers found a significantly positive effect of orthodontic treatment on adult paitents self-concept and after treatment these adult patients felt better about themselves, regardless of their state of mind at the outset of treatment. Varela M, Garcia-Camba JE: impact of orthodontics on the psychologic profile of adult patients: a prospective study, Am J Orthop 108 (2):142-148,
  • 73. Social factors affecting self concept.( from Tung AW, Kiyak HA: Am J Orthod Dentofacial Orthop 113 (1):29-39, 1998) Social factors affecting self-concept: age Influences Young child parent Teachers Preadolescent peers Perceived attractions Perceived competence Self-concept Adolescent peers Adults Achievements Social roles
  • 74. preadolescent children are at a stage of developing a sense of selfconfidence and competence. They are aware of their own physical appearance and that of their peers. They can accurately describe their own facial features Another strength of this stage of development is that these children are more focused on the future, less concerned about peer approval than are adolescents. They generally are still seeking the approval of significant adult role models (e.g., parents, health care providers); Alice W. Tung, BS,a and H. Asuman Kiyak, MA, PhDb Seattle,
  • 75. Their research also suggests that there may be racial differences in the psychological influences of orthodontics. They state “although white and minority children were similar in their self rating and expectations for orthodontics, the former were more critical in their esthetic judgments”. They rated faces with crowded teeth, diastema, and overbite more negatively than did ethnic minorities.
  • 76. Motivational Psychology The success of orthodontic therapy frequently depends on patient compliance. Headgear effects, functional appliances treatment, oral hygiene and keeping appointments are all dependant on the patient complying with the doctors instructions. Egolf described a compliant patient as one who practices good oral hygiene, wears appliances as instructed without abusing them, follows an appropriate diet and keeps appointments. Adults are generally compliant patients but adolescents are generally in the orthodontist‟s office because a parent has brought them there and their goals for treatment are frequently nonspecific Eglof RJ, BeGole EA, Upshaw HS : Factors associated with orthodontic patient compliance with intra oral elastic and head gear wear Am J orthod Dentofacial orthop 97:336-348,
  • 77. Southard et al pointed out that the assurance of good compliance can be difficult in the case of adolescent. Compliance by the patient helps achieve the treatment objectives in minimum treatment objectives in a minimum treatment time and improved co-operation by the patient can also reduce expenses of orthodontic treatment Southard KA et al : Application of the millon adolescent personality inventory in evaluating orthodontic compliance, Am J Orthod Dentofacial Orthop 100:553- 561,1991.
  • 78. According to Nanda, Sinha, the efficiency of care and improved oral hygiene can decrease damage to the periodontal tissues and limit the effects of enamel decalcification and caries. Sinha PK , Nanda RS, McNeil DW : Perceived orthodontist behaviors that patient satisfaction orthodontist patient relationship, and patient compliance in orthodontic treatment, Am J Orthod Dentofacial Orthop 100: 370-377,1996.
  • 79. Motivating the adolescent patient: First- As adolescents are mainly concerned with self-image and identity which can be used for motivating them. Secondly independence and autonomy are important to adolescent; therefore achieving an adult like status could motivate the adolescent. Third, peer relationships are important, so this feature may motivate behaviors that meet social needs. But most successful motivation can be accomplished by individualizing the patient and recognizing adolescent values and issues
  • 80. Personality testing and compliance: Southard et al examined the feasibility of using a commercially available Adolescent Personality Test, the Million Adolescent Personality Inventory (MAPI), to predict the behavior of adolescent patient to orthodontic practice. The results of MAPI were then correlated to the results of an ordinary assessment of the patients compliance, over 2 years of orthodontic treatment. Finally authors concluded that the MAPI is a useful instrument for predicting adolescent orhthodontic patient compliance behavior.
  • 81. Orthodontist and patient communication: Nanda et al conducted an extensive prospective study of patient compliance by investigating numerous variables that had been suggested to affect patient compliance. The variables they looked at included parent-child relationship Psychosocial characteristics of the patient patient attitude and opinion about orthodontics parents attitude and opinion about orthodontics parents perceptions of the child‟s degree of social compromise Parent and child relationship with orthodontist. Of all these possible predictors of compliance the authors found that the variables assessing the orthodontist‟s perception of the doctor-patient relationship had the strongest association with patient‟s compliance.
  • 82. If the doctor wants good co-operation from a patient, the most important factor in obtaining it is the establishment of good rapport with the patient.
  • 83. Achieving patient compliance: White proposed a new way to look at motivation for the typical orthodontic patient. He believed that positive reinforcement for good behavior is a key to conditioning patients to co-operation Rosen suggests that the orthodontists should first provide the patient with the information necessary to educate them about their malocclusion. Next, the orthodontist should motivate the patient by being open and straight forward and by building a relationship of mutual respect. Third, patients need support from family and peers to be compliant.
  • 84. Problems of Orthodontists in treating adolescents Adolescence:- has been defined as “the period extending from the time of puberty to the attainment of complete maturity. With individual variations it begins at about 10 in girls and 12 in boys. They are in a constant state of transition. It encompasses an extensive period of physical and psychological growth. Onset can be determined by observation of physical changes. Modification of the psychological structure take place at the same time as physical changes but there no accurate measuring techniques for determining psychological growth patters.
  • 85. It terminates physically at about the age of 20 with the establishment of mature body structures. Adolescence is a period of stress and strain for the maturing person. It involves complex changes in body structure and functions and accompanying changes in emotional maturation and mental expansions. Recognizing the strength of the adolescent social drives one can understand the effect that orthodontic appliances may have on the patient in his trying period.
  • 86. As a result of the application of braces their appearance which vitally affects their standing with their group is altered. Furthermore, the adolescent may associated the wearing of an appliance with being a child. Hence it represents regression, which is frustrating to a young person who is attempting to establish himself as an adult.
  • 87. Problems arising in consultation Resistance to treatment –forcefully brought by parents Reactions to retarded growth. Exaggerated sensitivity to pain.
  • 88. Adolescent rebellion:- In any specific age group, adolescents show wide variation with respect to Physical development, Emotional maturity, and Social experiences. Therefore, no general set of suggestions is applicable for handling patients as a group.
  • 89. It is important to establish a rapport with adolescents which makes it possible for them to have the freedom that they need and yet assures their acceptance of guidance and restrictions. Early in the course of treatment we should attempt to learn some things of each patient as a person rather than merely to categorize the malocclusion. Patients should be encouraged to share their feeling about concerning orthodontics. Negative feelings, should be accepted in a sincere manner rather than to suppress his dissentient feelings.
  • 90. Psychosomatic considerations in orthodontics – Arthur Ash The prime considerations of the orthodontist is the establishment of an adequate and healthy occlusion in making his diagnosis he has come to realize more and more the necessity for evaluating the biologic and physiologic totality of the patient. In short the orthodontist has attempted to keep pace with the advance of medical knowledge (ie) current concept of psychosomatic medicine should be evaluated as to its application to orthodontics. Emotional factors play a major role in the course and outcome of orthodontic treatment. The connection between the underlying emotion and its effect upon occlusion are evident, as in habit formation. Thumb and finger sucking are generally attributed to a child‟s need for security and affection.
  • 91. Psychosocial implications of facial deformities H. Kiyak Meanings of the Face The face is the area of one‟s body that produces the greatest concern regarding physical attractiveness; it is the individual‟s focal point and the source of vocal and emotional communications with others Berscheid et al in a survey of over 1000 adults found that people who were satisfied with their facial features expressed greater self- confidence. The greatest dissatisfaction for subjects in their large sample was the appearance of their teeth
  • 92. Attractive adults & children are evaluated as more successful and more intelligent than are unattractive persons and are viewed as more socially skilled Adams G: physical attractiveness, personality ,and social reaction to peer pressure J Psych 96:287-296,1977
  • 93. Psychosocial characteristics of patients with facial deformities Children with craniofacial anomalies are more introverted, neurotic and demonstrate poor self-concept Strauss et al Children with Down’s syndrome were rated as being less intelligent, less attractive, and less socially acceptable. Postoperative ratings of these same children were significantly more positive in all three domains
  • 94. A seriously handicapping orthodontic condition is the one that “severely compromises a person‟s physical or emotional health” – AL Morris et al Physical compromise – serious problems with breathing, speaking, or eating, especially if accompanied by tissue destruction Emotional health – includes other‟s reactions to the individual in a way that influences self-esteem Research in the areas of self-esteem and attractiveness indicates that the face is a major source of one‟s psychological identity
  • 95. Orthognathic surgery differs from surgery for congenital anomalies (in that the changes in appearance are less dramatic and improvements in occlusion, mastication, speech, and TM joint function are likely to be major reasons for treatment) – but patients undergoing this surgeries also expect esthetic changes. They must adapt not only to changes in their oral function, but also to changes in their perceived appearance and interactions with others
  • 96. CONCLUSION Psychology and Behavioural sciences have been an integral part of orthodontics both in research and in clinical practice since the early days of this century. Through out the course of orthodontic treatment, the orthodontist should keep in mind the fact that the psychological outcomes of treatment are as important as the occlusal and functional outcomes of treatment. In broad terms, straight teeth make for more attractive smiles. More attractive smiles make for more positive self-image.
  • 97. References William r. proffit, raymond p. white, david m. Sarver. Contemporary treatment of dentofacial deformity, Mosby, London. Vanserdall RL ,Musich DR. Adult Orthodontics: Diagnosis and Treatment in Graber TM Vanarsdall RL. Orthodontics . Current principles and pratice 2 nd ed .C.V.Mosby . St Louis 1994.pp 750-836 Shobha Tandon : Text book of pedodontics.
  • 98. Park and park ; Text book of preventive and community dentistry. Samir E. bishara, text book of orthodontics. Phillips C, Bennett ME, Broder HL. Dentofacial dishar-mony; psychological status of patients seeking treatment consultation. Angle Orthod 1998; 68: 547-56. Adams G: Physical attractiveness, personality, and social reactions to peer pressure, J Psych 96; 287-296,1977. Dann C et al Self concept, Class II malocclusion , and early treatment, Angle orthod 65(6):411-416,1995.
  • 99. Tung AW, Kiyak HA: psychological influences on the timing of orthodontic treatment, Am J Orthod Dentofacial Orthopedics 97:336-348, 1990. Egolf RJ, BeGole EA, Upshaw HS: Factors associated with orthodontic patient compliance with intraoral elastic and head gear wear, Am J Orhod dentofacial Othop 97:336-348, 1990. Sinha PK, Nanda RS, McNeil DW: Perceived orthodontist behaviors that predict patient satisfaction, orthodontist patient relationship, and patient compliance in orthodontic treatment, Am J Orthod Dentofacial Orthop 100:370-377,1996.
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