Psycological managemnt /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

The successful practice of orthodontics
is significantly dependent on the
interaction between the orthodontist and
the patient.
It requires active cooperation from the
patient throughout the necessary lengthy
orthodontic procedures.
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THE ORTHODONTIST-PATIENT RELATIONSHIP:
In the practice of orthodontics today, time invested in
creating and maintaining the important patient-doctor
bond.
Patients must be treated as people who have
malocclusions, not malocclusions attached to people.
Orthodontist behaviors such as listening, empathy,
and explanation are important in achieving that goal.

PSYCHOLOGY:
is the science dealing with the human nature,
function, and phenomenon of his soul in the main.
CHILD PSYCHOLOGY:
is the science that deals with the mental power or an
interaction between the conscious and sub conscious
element in a child.
BEHAVIOR:
is any change in the functioning of the organism.

BEHAVIOR:
is an observable act, it is defined as any change
observed in the functioning of an organism.
Learning as related to behavior is a process in which
past experience or practice results in relatively
permanent changes in an individuals behavior.
BEHAVIOR MODIFICATION: (Mathew son)
it is the attempt to alter human behavior and emotion
in a beneficial manner according to the laws of modern
learning theory.

THE NEED FOR ORTHODONTIC TREATMENT:
1. Discrimination because of facial
appearance.
2. Problems with oral function, (difficulty in
jaw movements, TMJ
dysfunction,swallowing or speech).
3. Greater susceptibility to trauma,
periodontal disease, or tooth decay.

CHILD MANAGEMENT

EARLY TREATMENT :
Psychological advantage to the children,
whose
• Self image has been shattered by peer group
teasing. (proclined upper anteriors)
• Self conscious.
• Timid or
• Sensitive about their dental appearance.

BEHAVIOUR MANAGEMENT OF CHILD
1. Non-pharmacological (psychological approach)
2. Pharmacological
Non- pharmacological:
1. Communication
2. Behavior shaping (modification)
• Desensitization
• Modelling
• Contingency management

3. Behavior management
• Audio analgesia
• Biofeed back
• Voice control
• Hypnosis
• Humor
• Coping
• Relaxation
• Implosion therapy
• Aversive conditioning.www.indiandentalacademy.comwww.indiandentalacademy.com

Pharmacological:
1. Pre-medication
• Sedatives And Hypnotics
• Anti-anxiety Drugs
• Anti-histamines
2. Conscious sedation
3. General anesthesia.

Habit correction
(AJO-DO 1979 Nov – Jacobson)
Two main schools of thought prevail :
• The psychoanalysts regard the habit as a symptom of
emotional disturbance,
• Behaviorists view the act as a simple learned habit
with no underlying neurosis.
Thumb-sucking in the schoolchild (6 to 12 years) is
usually a manifestation of a general emotional and
social immaturity. www.indiandentalacademy.comwww.indiandentalacademy.com

In treating habits in this age group, it is necessary to
determine whether the habit is "meaningful" or ''empty.“
If the sucking habit is one of a galaxy of symptoms of
an abnormal behavior problem, a consultation with a
psychiatrist is the first consideration. The habit in these
instances would be regarded as ''meaningful."

PRACTICAL PSYCHOLOGY TO THE
CLINICAL PRACTICE OF
ORTHODONTICS
DIVIDED INTO TWO BROAD CATEGORIES:
1. SOCIAL PSYCHOLOGY OF ORTHODONTICS.
2. ORTHODONTIC MOTIVATIONAL PSYCHOLOGY.
A RELATIVELY NEW AREA OF APPLICATION

SOCIAL PSYCHOLOGY
Why patient’s seek orthodontic treatment ?
• Adolescents : my mom thinks I need braces, to look
better
• Adults : own initiative; to improve facial appearance.
 Clearly a person’s dento facial appearance can
have a significant effect on their overall quality of
life.

“WHY DO PEOPLE WANT TO LOOK BETTER”
Adams suggested
1. Physical attractiveness stimulates differential
expectations toward another.
2. An individual’s attractiveness appears to elicit
differential social exchanges from others.
3. An important developmental outcome results from
this social exchange.
4. Attractive people are more likely to manifest
confident interpersonal behavior patterns than lesser
attractive individual.

PSYCHOLOGICAL OUTCOME OF ORTHODONTIC
TREATMENT
The precise role that dentofacial esthetics plays in the
development of a child’s self-concept and self-esteem
remains controversial.
DANN et al – children with serious malocclusions did
not necessarily have poor self concepts or poor body
images at the out set of orthodontic care.
ALBINO – social competency or social goals did not
improve after braces, nor did subject’s self esteem.

DEVELOPMENTAL PSYCHOLOGY OF ORTHODONTICS:
SHAW et al
BENEFIT OF SOCIAL PSYCHOLOGIC WELL BEING IN TERMS
OF THREE SUB GROUPS:
1. Nick names and teasing.
2. Evaluation of dental appearance and social attractiveness.
3. Self esteem and popularity.
 Concluded that when personal dissatisfaction with dental
appearance is felt in childhood, it might well remain for a life
time.

PATIENT COMPLIANCE:
The success of orthodontic therapy frequently depends
on patient compliance.
EGOLF and others 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.

MANAGEMENT
OF
AN ADOLESCENT
PATIENT

UNDERSTANDING THE ADOLESCENT PATIENT:
Peterson and Kuipers described adolescence as a
period in life between childhood and adulthood when
considerable change is occurring.
Under standing adolescent development can allow the
orthodontist to help overcome obstacles in treating
patients in this age group.

MOTIVATING THE ADOLESCENT PATIENT:
“COOPER and SHAPIRO” Features of adolescent
behavior used to ascertain a particular behavior.
1. Adolescents are concerned with self-image and
identity, which can be useful in motivating them.
2. Independence and autonomy are important to an
adolescent therefore achieving an adult like status
could motivate the adolescent.
3. Peer relationships are important, so this feature
motivate behaviors that meet social needs.

They suggested that more successful motivation can
be accomplished by individualizing the patient and
recognizing adolescent values and issues.
The orthodontist should understand that adolescents
are not influenced strongly by health specific goals.

PERSONALITY TESTING AND COMPLIANCE:
Major orthodontic treatment decisions are based on an
anticipated level of patient compliance.
PERSONALITY TEST:
SOUTHARD et al
“The Millon Adolescent personality inventory” (MAPI)
(MILLON, GREEN, and MEAGHER-1982)
To predict the behavior of adolescent patients in an
orthodontic practice.

ORTHODONTIST AND PATIENT
COMMUNICATION:
KLAGES, SERGL, and BURUCKER – found strong
relationships between clinician’s encouraging behavior
and patient communication cooperation, and concluded
that the orthodontist's behavior may be relevant for
patient verbal cooperation.
The doctor-patient interaction is the best predictor of
how well a patient could be expected to comply with the
doctor’s instructions. www.indiandentalacademy.comwww.indiandentalacademy.com

EDUCATIONAL PSYCHOLOGY:
One of the most promising areas of current research in
patient cooperation is the area of educational
psychology.

The learning styles inventory developed by KOLB, 4 learning styles.
1. ACCOMODATOR
2. DIVERGER
3. ASSIMILATOR
4. CONVERGER.
Concrete experience
Accommodator Diverger
Reflective
observation
Assimilator
Abstract
conceptualization
Converger
Active
experimentation

ACHIEVING PATIENT COMPLIANCE:
ROSEN provided a practical patient-oriented
approach to creating a compliant patient.
Health care providers should develop a
compliance model that is patient-centered rather
than clinician-centered.

WHITE suggested
1. Use of soft-bristle tooth brush and, if necessary,
chlorhexidine rinses.
2. Us the simplest appliance necessary to achieve
treatment objectives with forces that are continuous
and of low magnitude.
3. Prescribe analgesics when needed.
4. Expedite treatment time.
5. Let the fees reflect the challenges of a difficult
patient. www.indiandentalacademy.comwww.indiandentalacademy.com

JCO 1996 Sep MELVIN MAYERSON, R.G “WICK” ALEXANDER
• Patient Education
• Patient Motivation
• Office Environment
• Communication Techniques
• Monitoring Progress
REATING A COMPLIANT PATIEN

Patient Education
They need to know the costs and benefits of treatment, in
time, money, and effort.
Patient education booklets, used to reinforce instructions
throughout treatment, are written in positive tone to encourage
and motivate patients.

Procedures and appliances explained to patient by Dr. Wick
Alexander before treatment.
INFORM BEFORE WE PERFORM

Patient Motivation
WILLIAM JAMES “The most important discovery
of the 20th
century is that the attitudes of an
individual can change”.
The only truly motivational technique is self-
motivation

Office Environment
Every office reflects the personality of the orthodontist.
• The goal is to maintain a friendly, warm, caring, professional
atmosphere in which patients know that they will receive the
highest-quality treatment.

Communication Techniques
An effective communication technique is to look in their eyes
before you look in their mouths.
"Horizontal communication": Dr. J. Moody Alexander looking in patient's
eyes before looking in the mouth.
Good communication should be honest as well as two-way,
the orthodontist should be “askable”www.indiandentalacademy.comwww.indiandentalacademy.com

Monitoring Progress
Each patient’s progress must be monitored constantly
to maintain motivation and compliance throughout
treatment.
When improvement is seen, praise the patient and
share the achievement with the parent.
If slow progress is due to non-compliance, it is crucial
that the patient and parents be informed as early as
possible in a “mini-consultation”.

Methods of improving patient compliance
(A.O. 1998 No. 2, T. Mehra, R.S. Nanda, P.K Sinha.)
Verbally praising the patient,
Discussing treatment goals and poor patient
cooperation with the patient and parent.
Educating the parent about the use of
orthodontic appliances, and about the
consequences of poor compliance.

Special considerations for adults
• Invisible orthodontic appliances.
Tooth colored brackets, fixed lingual appliances
• Separate treatment area for adults or in a open
area for interacting with other patients.
• Orthognathic surgery.

PSYCHOLOGY – ORTHOGNATHIC
SURGERY:
Psychological impact-
• Some patients are under prepared for
change in appearance.
• some were surprised by the degree of
reaction of others to the results.
• further surprised by the amount of change
they subsequently realized in their own
attitudes and personality.www.indiandentalacademy.comwww.indiandentalacademy.com

 Pre operative counseling with patients,
relatives, and friends.
The importance of detailed preoperative
discussions is very evident in this series of
patients. These discussions must cover technical
aspects of treatment and inconveniences that the
patient will encounter during treatment.

RESULTS OF NON COMPLIANT PATIENT:
 It is necessary to compromise treatment
methods and treatment objectives.
 Increase of expenses involved in orthodontic
treatment.

ACHIEVEMENTS THROUGH ADHERENCE BY
PATIENT : (compliant patient)
 Achieve the treatment objectives in minimum
treatment time.
 Reduction of expenses involved in orthodontic
treatment.
 Improved oral hygiene can minimize damage to the
periodontal tissues, limit the deleterious effects of
decalcification, and even frank caries.www.indiandentalacademy.comwww.indiandentalacademy.com

CONCLUSION
One golden thread that runs through
out the literature of orthodontic
psychology is the importance of the
doctor-patient relationship.
Once the orthodontist has earned the
trust and respect of the patient by
establishing a good rapport , the task ofwww.indiandentalacademy.comwww.indiandentalacademy.com

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Psycological managemnt /certified fixed orthodontic courses by Indian dental academy

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