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Child psychology/ oral surgery courses

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Child psychology/ oral surgery courses

  1. 1. www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS  IntroductionIntroduction  Psychosexual theory- Sigmond FreudPsychosexual theory- Sigmond Freud  Psychosocial theory- Erik. H. EriksonPsychosocial theory- Erik. H. Erikson  Cognitive approach theory- Jean PiagetCognitive approach theory- Jean Piaget  Emotional development.Emotional development.  Behavior assessment; Development; ManagementBehavior assessment; Development; Management  Psychological status- Orthodontic patientsPsychological status- Orthodontic patients  Behavior modificationBehavior modification  Creating a compliant patientCreating a compliant patient  Motivational system for orthodontist & patientMotivational system for orthodontist & patient  Clinical motivation of functional jaw orthopedic patientsClinical motivation of functional jaw orthopedic patients  ConclusionConclusion  ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. IntroductionIntroduction  The key to successful orthodontic treatment is aThe key to successful orthodontic treatment is a cooperative patient. To achieve this prerequisite it iscooperative patient. To achieve this prerequisite it is of utmost importance to discover the actions thatof utmost importance to discover the actions that will produce the most positive response from thewill produce the most positive response from the patient.patient.  To determine a child’s behavior in dental office andTo determine a child’s behavior in dental office and the factors influencing it we must study a child’sthe factors influencing it we must study a child’s mental and emotional make up that constitute themental and emotional make up that constitute the “psychology” of that child.“psychology” of that child.  Psychology development is a dynamic process,Psychology development is a dynamic process, which begins at birth and proceeds in an ascendingwhich begins at birth and proceeds in an ascending order through a series of sequential stagesorder through a series of sequential stages manifesting into various characteristic behaviors.manifesting into various characteristic behaviors.www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. PsychologyPsychology Psycho – meaning mind, soul, selfPsycho – meaning mind, soul, self Logas – meaning study.Logas – meaning study. Thus psychology is the study of self, as itThus psychology is the study of self, as it manifests itself in action and behavior.manifests itself in action and behavior. It is the science dealing with human nature,It is the science dealing with human nature, function, and phenomenon of his soul in thefunction, and phenomenon of his soul in the main.main. Child PsychologyChild Psychology It is the science that deals with the mentalIt is the science that deals with the mental power or an interaction between thepower or an interaction between the conscious and subconscious element in aconscious and subconscious element in a child.child. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. Importance of child psychologyImportance of child psychology  To understand the child betterTo understand the child better  To know the problem of psychological originTo know the problem of psychological origin  To deliver dental services in a meaningful & effectiveTo deliver dental services in a meaningful & effective mannermanner  To establish effective communication with the child &To establish effective communication with the child & the parentthe parent  To teach child & the parents importance of primary &To teach child & the parents importance of primary & preventive carepreventive care  To have better treatment planning & interaction withTo have better treatment planning & interaction with other disciplineother discipline  To produce a comfortable environment for the dentalTo produce a comfortable environment for the dental team to work on the patientteam to work on the patient www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. Theories Of Child PsychologyTheories Of Child Psychology I. Psychodynamic theoriesI. Psychodynamic theories  Psychosexual theory –Sigmond Freud (1905)Psychosexual theory –Sigmond Freud (1905)  Psychosocial theory – Erik Erickson (1963)Psychosocial theory – Erik Erickson (1963)  Cognitive theory – Jean Piaget (1952)Cognitive theory – Jean Piaget (1952) II. Behavioral theoriesII. Behavioral theories  Hierarchy of needs – Masler (1954)Hierarchy of needs – Masler (1954)  Social learning theory – Bandura (1963)Social learning theory – Bandura (1963)  Classical conditioning – Pavlov (1927)Classical conditioning – Pavlov (1927)  Operant conditioning – Skinner (1938)Operant conditioning – Skinner (1938) www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. Psychosexual Theory by Sigmond FreudPsychosexual Theory by Sigmond Freud in 1905in 1905 May 6, 1856 to September 23, 1939www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8.  Man’s behavior is determined by innate instincts thatMan’s behavior is determined by innate instincts that are largely unconscious .i.e. thoughts, fears, andare largely unconscious .i.e. thoughts, fears, and wishes of which person is unaware but whichwishes of which person is unaware but which influences his behavior.influences his behavior.  These unconscious impulses find expression inThese unconscious impulses find expression in dreams, slips of speech, mannerism, and symptoms ofdreams, slips of speech, mannerism, and symptoms of neurotic impulses.neurotic impulses.  Freud believed that all of man’s action has a cause,Freud believed that all of man’s action has a cause, but the cause has often some unconscious motivebut the cause has often some unconscious motive rather than any rational reason.rather than any rational reason. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9.  The structure proposed by Freud in PsychodynamicThe structure proposed by Freud in Psychodynamic theory is composed of three parts:theory is composed of three parts:  IdId – represents the primitive biologic impulses. These– represents the primitive biologic impulses. These are instinctual blind drives to seek immediateare instinctual blind drives to seek immediate gratification. (pleasure principle)gratification. (pleasure principle)  EgoEgo – as a sort of mediator between ID-with its blind– as a sort of mediator between ID-with its blind demands for instant gratification and superego-with itsdemands for instant gratification and superego-with its rigid, often irrational rules, prohibition ideals. (realityrigid, often irrational rules, prohibition ideals. (reality principle)principle)  SuperegoSuperego – conceptualized as an observer and– conceptualized as an observer and evaluator of ego, functioning comparing ego with idealevaluator of ego, functioning comparing ego with ideal standard derived from ideal behavior perceived overstandard derived from ideal behavior perceived over time in parents and teachers.time in parents and teachers. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10.  He used notion of unconscious processes to explainHe used notion of unconscious processes to explain why people act in irrational way. He proposed 3why people act in irrational way. He proposed 3 levels of consciousness: -levels of consciousness: -  The conscious level: at which we are aware of certainThe conscious level: at which we are aware of certain things around us and of certain thoughts.things around us and of certain thoughts.  The preconscious level: at this level are memories ofThe preconscious level: at this level are memories of certain things around us and of certain thoughts.certain things around us and of certain thoughts.  The unconscious level: contains memories, thoughtsThe unconscious level: contains memories, thoughts and motives which cannot be easily recalled.and motives which cannot be easily recalled. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  He also suggested 5 phases of development based onHe also suggested 5 phases of development based on theory of energy or drives which he called LIBIDO.theory of energy or drives which he called LIBIDO. They are:They are:  Oral PhaseOral Phase (new born child - 1 year)(new born child - 1 year) Child’s satisfaction and stimulation is through mouthChild’s satisfaction and stimulation is through mouth which is the organ of desire. Swallowing, suckingwhich is the organ of desire. Swallowing, sucking gives pleasure.gives pleasure.  Anal PhaseAnal Phase ( 2 years)( 2 years) Child obtains pleasure from retention and elimination.Child obtains pleasure from retention and elimination. He has limits on his gratification but may becomeHe has limits on his gratification but may become stingy and compulsive.stingy and compulsive.  Phallic StagePhallic Stage (3-5 years)(3-5 years) Child explores, expenses his genital organs asChild explores, expenses his genital organs as pleasurable. Attraction for opposite sex parent andpleasurable. Attraction for opposite sex parent and jealousy for same sex parent.jealousy for same sex parent. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. Oedipus complexOedipus complex  Young boys have a natural tendency to be attachedYoung boys have a natural tendency to be attached to the mother & they consider their father as theirto the mother & they consider their father as their enemy. Hence they strive to imitate their father toenemy. Hence they strive to imitate their father to gain affection of the mothergain affection of the mother  Greek mythology: Oedepus the King of Thebe, slewGreek mythology: Oedepus the King of Thebe, slew his father & married his mother.his father & married his mother. Electra complexElectra complex  Similarly young girls develop an attraction towardsSimilarly young girls develop an attraction towards their father & they resent the mother being close totheir father & they resent the mother being close to father.father.  Greek mythology: Electra helped her brother slay theGreek mythology: Electra helped her brother slay the lover of their father Agemennou, to win her father’slover of their father Agemennou, to win her father’s love.love. www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  Latency StageLatency Stage (6– 10 years)(6– 10 years) Child develops interests outside home and makesChild develops interests outside home and makes friends, learns to share thoughts.friends, learns to share thoughts.  Genital StageGenital Stage (11 – 13 years)(11 – 13 years) Sexual impulses are increased. Boys/girls shy fromSexual impulses are increased. Boys/girls shy from each other. Peer pressure increases.each other. Peer pressure increases. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Psychosocial theory by ErikPsychosocial theory by Erik Erikson in 1963Erikson in 1963  Erik Homburger Erikson was born in 1902 on June 15Erik Homburger Erikson was born in 1902 on June 15 in Frankfurt, Germany.in Frankfurt, Germany.  His book “Childhood and Society” was published inHis book “Childhood and Society” was published in 1950.1950.  In this publication he presented a psychosocialIn this publication he presented a psychosocial theory.theory.  His theory covers the entire span of the life cycle,His theory covers the entire span of the life cycle, from infancy and childhood through old age andfrom infancy and childhood through old age and senescence.senescence. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. Each stage is marked by one or more internalEach stage is marked by one or more internal crisis. When a crisis is mastered successfully,crisis. When a crisis is mastered successfully, people gain strength and move on to next stage.people gain strength and move on to next stage. This stage are not fixed in time development isThis stage are not fixed in time development is continuous.continuous. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. Both these girls are seven years old. The one on the left is normal, whereas the one on the right had extreme emotional neglect from a mother who rejected her. The effect on physical growth in this “maternal deprivation syndrome” is obvious, fortunately this condition is rare. The emotional response probably affects physical growth by altering hormone production, but the mechanism is not fully understood. www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. During the period in which children are developing autonomy, conflicts with siblings, peers and parents can seem never ending. Consistently enforced limits on behavior during this stage (terrible two’s) are needed to allow the child to develop trust in a predictable environment.www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. Stage – 3Stage – 3 Initiative Vs guilt (3-5 years)Initiative Vs guilt (3-5 years)  At these ages children are able to initiate both motorAt these ages children are able to initiate both motor and intellectual activities.and intellectual activities.  By playing with peers they learn to interact withBy playing with peers they learn to interact with others.others.  They learn that aggressive impulses can beThey learn that aggressive impulses can be experienced in constructive ways such as healthyexperienced in constructive ways such as healthy competition playing games and using toys.competition playing games and using toys.  If toddlers are made to feel inadequate about theirIf toddlers are made to feel inadequate about their interests they may emerge from this period with theirinterests they may emerge from this period with their sense of ambition which develops during this stage.sense of ambition which develops during this stage. www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. Stage - 4Stage - 4 Industry Vs inferiority (6-11 yrs)Industry Vs inferiority (6-11 yrs)  This stage is the school age period during whichThis stage is the school age period during which children begin to participate in an organizedchildren begin to participate in an organized program of learning.program of learning.  Industry, the ability to work and acquire adult skillsIndustry, the ability to work and acquire adult skills  Productive children learn the pleasure of workProductive children learn the pleasure of work completion and the pride of doing something well.completion and the pride of doing something well.  The potential negative outcome of this stage resultsThe potential negative outcome of this stage results fromfrom  Discrimination at schoolDiscrimination at school  Children may be told they are inferior.Children may be told they are inferior.  They may be over protected at home.They may be over protected at home. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Instructions for young child who will be wearing a removable orthodontic appliance should be explicit and complete. Children at this stage cannot be motivated by abstract concepts but are influenced by improved acceptance from the peer group. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. Stage – 5Stage – 5 Identity Vs role confusion (9- 18 years)Identity Vs role confusion (9- 18 years) Developing a sense of identity is the main taskDeveloping a sense of identity is the main task of this period, which coincides with puberty andof this period, which coincides with puberty and adolescence.adolescence. Identity is described as the characteristics thatIdentity is described as the characteristics that establish who people are and where they areestablish who people are and where they are going.going. Healthy identity is built on success in passingHealthy identity is built on success in passing through earlier stages.through earlier stages. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. Adolescence is an extremely complex stage because of many new opportunities and challenges thrust upon the teenager (emerging sexuality, academic pressures, earning money, increased mobility, career aspirations and recreational interests combined to produce stress and rewards www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. Stage – 6Stage – 6 Intimacy Vs self absorption or isolationIntimacy Vs self absorption or isolation (18 to 40 years)(18 to 40 years)  This period extends from late adolescent throughThis period extends from late adolescent through early middle age.early middle age.  The intimacy of relations, friendship and other deepThe intimacy of relations, friendship and other deep associations are not frightening to people withassociations are not frightening to people with resolved identity crisis.resolved identity crisis.  In contrast people who reach the adult years in aIn contrast people who reach the adult years in a stage of continued role confusion cannot becomestage of continued role confusion cannot become involved in intense and long term relationships.involved in intense and long term relationships.  Without a friend or a partner, a person may becomeWithout a friend or a partner, a person may become self absorbed and self-indulgent. As a result a senseself absorbed and self-indulgent. As a result a sense of isolation may grow.of isolation may grow.www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. Stage – 7Stage – 7 Generativity Vs stagnation (40 to 65Generativity Vs stagnation (40 to 65 Years)Years)  Generatively not only concerns a person’s having orGeneratively not only concerns a person’s having or raising children, but also includes vital interestraising children, but also includes vital interest outside the home in establishing the guiding, theoutside the home in establishing the guiding, the oncoming generation or in improving society.oncoming generation or in improving society.  Stagnation is a barren state. The inability toStagnation is a barren state. The inability to transcend the lack of creativity is dangerous becausetranscend the lack of creativity is dangerous because people are unable to accept the eventuality of notpeople are unable to accept the eventuality of not being and the idea that death is inescapably a part ofbeing and the idea that death is inescapably a part of life.life. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Stage – 8Stage – 8 Integrity Vs despair and isolation (overIntegrity Vs despair and isolation (over 65 years) maturity65 years) maturity This stage is described as the conflictThis stage is described as the conflict between the integrity (the sense of satisfactionbetween the integrity (the sense of satisfaction that a person feels in reflecting on a lifethat a person feels in reflecting on a life productively lived) and despairs (the senseproductively lived) and despairs (the sense that life has little purpose/meaning)that life has little purpose/meaning) Integrity allows people to accept their place inIntegrity allows people to accept their place in life cycle and to realize that life is eachlife cycle and to realize that life is each persons responsibility.persons responsibility. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. Cognitive Development - Jean Piaget inCognitive Development - Jean Piaget in 19521952 Jean Piaget (1896 – 1980) www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29.  Piaget formulated his theory on how children &Piaget formulated his theory on how children & adolescents think & acquire knowledge.adolescents think & acquire knowledge.  According to him the environment does not shapeAccording to him the environment does not shape child’s behaviour but the child & adult actively seekchild’s behaviour but the child & adult actively seek to understand the environmentto understand the environment  This process of adaptation is made up of 3 variants-This process of adaptation is made up of 3 variants-  Assimilation- observing, recognizing, relating it withAssimilation- observing, recognizing, relating it with earlier experience or categoriesearlier experience or categories  Accommodation- changing concepts & strategiesAccommodation- changing concepts & strategies  Equilibration- changing basic assumptions followingEquilibration- changing basic assumptions following assimilated knowledge so that the facts fit betterassimilated knowledge so that the facts fit betterwww.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. •Beginning of thinking •Development of elementary schemes •Changing strategies •Symbols •Playing •Classify things •Logical thinking •Mental operations •Others point view Abstract thinking Vast imagination Decisions Solve problems www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Hierarchy of needs by Massler inHierarchy of needs by Massler in 19541954  Self actualization theory – the need to understand the totality ofSelf actualization theory – the need to understand the totality of a persona person  Needs are arranged in hierarchyNeeds are arranged in hierarchy  As one general type is satisfied another higher order willAs one general type is satisfied another higher order will emergeemerge Self actualization Security Social Psychology of needs Esteem www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. Social learning theory by Bandura in 1963Social learning theory by Bandura in 1963  The learning of behavior is affected by 4The learning of behavior is affected by 4 principle elements-principle elements- 1. Antecedent determinants1. Antecedent determinants 2. Consequent determinants2. Consequent determinants 3. Modeling3. Modeling 4. Self regulation4. Self regulation www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. EmotionEmotion  Emotion is a state of mental excitement characterizedEmotion is a state of mental excitement characterized by physiological, behavioral changes & alterations ofby physiological, behavioral changes & alterations of feelingsfeelings  Subjective feelingSubjective feeling  Bodily stateBodily state  Expression of emotion by language gesture or facialExpression of emotion by language gesture or facial expressions.expressions.  So it is many things at once. Most emotions can beSo it is many things at once. Most emotions can be divided in to those are:divided in to those are:  Pleasant (joy, love)Pleasant (joy, love)  Unpleasant (Anger, fear)Unpleasant (Anger, fear)www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. AngerAnger Outburst of emotion is caused by the child’sOutburst of emotion is caused by the child’s lack of skill in handling the situation.lack of skill in handling the situation. Infants & children respond in anger in a directInfants & children respond in anger in a direct & primitive manner but as they develop the& primitive manner but as they develop the responses become violent & more symbolic.responses become violent & more symbolic. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. FearFear  Fear is an emotion occurring in situations of stressFear is an emotion occurring in situations of stress and uncertainty where in the person experiencingand uncertainty where in the person experiencing sees himself as being threatened or helpless andsees himself as being threatened or helpless and whose reaction is to resist or free the situation out ofwhose reaction is to resist or free the situation out of an anticipation of pain, distress or destruction.an anticipation of pain, distress or destruction.  Types of FearTypes of Fear  Objective Fears:Objective Fears: are those fears produced by directare those fears produced by direct physical stimulation of sense organs. Objective fearsphysical stimulation of sense organs. Objective fears respond to stimuli that are felt, seen or tasted.respond to stimuli that are felt, seen or tasted.  Subjective Fears:Subjective Fears: based on feeling and attitudesbased on feeling and attitudes that have been suggested to the child by other aboutthat have been suggested to the child by other about him without the child’s having experience personally.him without the child’s having experience personally. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36.  Suggestive Fears:Suggestive Fears: may be acquired by imitationmay be acquired by imitation and child observing fear in other may soon acquire aand child observing fear in other may soon acquire a fear for the same object. If the parent is sad child feelsfear for the same object. If the parent is sad child feels sad. If the parent displays fear, the child is fearfulsad. If the parent displays fear, the child is fearful  Imitative Fears:Imitative Fears: Imitative fears may be transmittedImitative fears may be transmitted subtly and may be displayed by parent and acquiredsubtly and may be displayed by parent and acquired by child without either being aware of it.by child without either being aware of it.  Irrational Fears:Irrational Fears: The child does not know why he isThe child does not know why he is frightened. Memories of past experience may fadefrightened. Memories of past experience may fade entirely from his consciousness, but emotionentirely from his consciousness, but emotion associated with the forgotten experience determinesassociated with the forgotten experience determines to a large measureto a large measure www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. Fear of SeparationFear of Separation  If a child is thrust into a new situation when he isIf a child is thrust into a new situation when he is separated from his parents whom he has learned toseparated from his parents whom he has learned to depend upon for security, he has a fear of beingdepend upon for security, he has a fear of being abandoned.abandoned.  ManagementManagement  Pictures/ photographs of animals, cartoons, treesPictures/ photographs of animals, cartoons, trees should he there in the clinic.should he there in the clinic.  The mother should be instructed before hand not toThe mother should be instructed before hand not to project her feeling and remain as silent observer.project her feeling and remain as silent observer. Later try to separate the parent from the child andLater try to separate the parent from the child and not the child from parent.not the child from parent. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Fear of UnknownFear of Unknown  Unfamiliar person wearing white gowns will arouse fearUnfamiliar person wearing white gowns will arouse fear especially if the environment is suggestive of painful experienceespecially if the environment is suggestive of painful experience in the past.in the past.  The noise and vibration of dental drill and pressure exerted inThe noise and vibration of dental drill and pressure exerted in the use of hand instrument is conducive of fear.the use of hand instrument is conducive of fear.  Quick and jerky movement of chair is frightening.Quick and jerky movement of chair is frightening.  Intense light is also fear producing.Intense light is also fear producing. ManagementManagement  Tell show do (T.S.D)Tell show do (T.S.D)  Models can be used.Models can be used.  Avoid sudden movement of dental chair.Avoid sudden movement of dental chair.  Keep talking to child so as to distract his attention fromKeep talking to child so as to distract his attention from treatment.treatment.  Encourage him to see instruments and walk around clinic andEncourage him to see instruments and walk around clinic and get familiar with surrounding.get familiar with surrounding. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. 8-14 years8-14 years Eager to learn.Eager to learn. Begins to trust.Begins to trust. Learns to tolerate unpleasant situations.Learns to tolerate unpleasant situations. Willing to listen to others and accept their pointWilling to listen to others and accept their point of view.of view. Increased ability to conceptualize.Increased ability to conceptualize. TSDwww.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. Behavior Assessment; DevelopmentBehavior Assessment; Development and Managementand Management • Behavior is the manner in which anything actsBehavior is the manner in which anything acts or operates.or operates. Healy ; Bronner ; BowersHealy ; Bronner ; Bowers – behavior as– behavior as sum total of response to stimuli, internal andsum total of response to stimuli, internal and external.external. Halmuth H. ShaferHalmuth H. Shafer – behavior as what an– behavior as what an organism does including actions which takeorganism does including actions which take place inside the organisms body and thereforeplace inside the organisms body and therefore which cannot be seen.which cannot be seen. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. ClassificationClassification Frankel’s Classification (1962)Frankel’s Classification (1962) www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Wilson’s classification (1933)Wilson’s classification (1933) Normal or bold- child is brave enough to faceNormal or bold- child is brave enough to face new situations, is co-operative, & friendly withnew situations, is co-operative, & friendly with the dentist.the dentist. Tasteful or timid- child is shy, but does notTasteful or timid- child is shy, but does not interfere with the dental procedures.interfere with the dental procedures. Hysterical or rebellious- child is influenced byHysterical or rebellious- child is influenced by home environment- throws temper tantrums &home environment- throws temper tantrums & is rebelliousis rebellious Nervous or fearful- child is tense & anxious,Nervous or fearful- child is tense & anxious, fears dentistryfears dentistry www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Lampshire (1979)Lampshire (1979)  Co-Operative:Co-Operative: the child is physically and emotionally relaxed.the child is physically and emotionally relaxed. Is cooperative throughout the entire procedure.Is cooperative throughout the entire procedure.  Tense Co-Operative:Tense Co-Operative: the child is tensed and cooperative atthe child is tensed and cooperative at the same timethe same time  Outwardly Apprehensive:Outwardly Apprehensive: avoids treatment initially, usuallyavoids treatment initially, usually hides behind the mother, and avoids looking or talking to thehides behind the mother, and avoids looking or talking to the dentist. Eventually accepts dental treatment.dentist. Eventually accepts dental treatment.  Fearful:Fearful: requires considerable support so as to overcome torequires considerable support so as to overcome to fears of dental treatment.fears of dental treatment.  Stubborn / Defiant:Stubborn / Defiant: passively resists treatment by usingpassively resists treatment by using techniques that have been useful in other situations.techniques that have been useful in other situations.  Hypermotive:Hypermotive: the child is acutely agitated and resorts tothe child is acutely agitated and resorts to screaming, kicking etc.screaming, kicking etc.  Handicapped:Handicapped: physically/ mentally/ or emotionallyphysically/ mentally/ or emotionally handicapped.handicapped.  Emotionally immatureEmotionally immaturewww.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. Wright (1975)Wright (1975) A Cooperative (positive behavior)A Cooperative (positive behavior) 1. Cooperative behavior1. Cooperative behavior  Child is cooperative, relaxed, wit minimal apprehension.Child is cooperative, relaxed, wit minimal apprehension. 2. Lacking cooperative ability2. Lacking cooperative ability  Usually seen in young children (0-3 years), disabled,Usually seen in young children (0-3 years), disabled, physically and mentally handicapped children.physically and mentally handicapped children. 3. Potentially cooperative3. Potentially cooperative  Has the potential to cooperate, but because of the inherentHas the potential to cooperate, but because of the inherent fears (subjective/ objective) the child does not cooperate.fears (subjective/ objective) the child does not cooperate. B Uncooperative (negative behavior)B Uncooperative (negative behavior)  Uncontrolled/ HystericalUncontrolled/ Hysterical Usually seen in preschool children, at their first dental visit.Usually seen in preschool children, at their first dental visit. Temper tantrum i.e. physical lashing out of legs and arms,Temper tantrum i.e. physical lashing out of legs and arms, loud crying and refuses to cooperate with the dentistloud crying and refuses to cooperate with the dentistwww.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45.  Defiant / Obstinate BehaviorDefiant / Obstinate Behavior Usually seen in spoilt or stubborn children. These children canUsually seen in spoilt or stubborn children. These children can be made cooperative.be made cooperative.  Tense CooperativeTense Cooperative These children are borderline between positive and negativeThese children are borderline between positive and negative behavior. Does not resist treatment but the child is tensed atbehavior. Does not resist treatment but the child is tensed at mind.mind.  Timid/Shy BehaviorTimid/Shy Behavior Usually seen in overprotective child at the first visit.Usually seen in overprotective child at the first visit.  Whining TypeWhining Type Complaining type of behavior, allows for treatment butComplaining type of behavior, allows for treatment but complains throughout the procedure.complains throughout the procedure.  Stoic BehaviorStoic Behavior Seen in physically abused children. They are cooperative andSeen in physically abused children. They are cooperative and passively accept all treatment without any facial expression.passively accept all treatment without any facial expression. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. Learning and Development ofLearning and Development of BehaviorBehavior  Psychologists generally consider that therePsychologists generally consider that there are 3 distinct mechanisms by which behaviorare 3 distinct mechanisms by which behavior responses are learned:responses are learned:  Classical conditioning- Pavlov 1927Classical conditioning- Pavlov 1927  Operant conditioning- Skinner 1938Operant conditioning- Skinner 1938  Observational learning- Bandura 1969Observational learning- Bandura 1969 www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Operant conditioningOperant conditioning B.F Skinner 1938 www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. If parent gives into the temper tantrums thrown by child www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. Observational Learning (modeling)Observational Learning (modeling) Bandura 1969Bandura 1969 Acquisition Performance www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Behavior ManagementBehavior Management Definition: defined as the means by which theDefinition: defined as the means by which the dental health team effectively and efficientlydental health team effectively and efficiently performs dental treatment and thereby instills aperforms dental treatment and thereby instills a positive dental attitude (Wright 1975)positive dental attitude (Wright 1975) Behavior ModificationBehavior Modification Definition: defined as the attempt to alterDefinition: defined as the attempt to alter human behavior and emotion in a beneficialhuman behavior and emotion in a beneficial way and in accordance with the laws ofway and in accordance with the laws of learning.learning. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. Behaviour ManagementBehaviour Management Non pharmacological methods Communication Behaviour shaping Behaviour management Pharmacological Pre- medication Conscious sedation General anesthesia www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55.  Non Pharmacological Methods of BehaviorNon Pharmacological Methods of Behavior Management:Management: I. CommunicationI. Communication  Types:Types: a. Verbal Communication- Speecha. Verbal Communication- Speech b. Non verbal / Multisensory Communicationb. Non verbal / Multisensory Communication  Body languageBody language  SmilingSmiling  Eye contactEye contact  Showing concernShowing concern  TouchingTouching  PattingPatting  HuggingHugging c. Both using nonverbal and verbalc. Both using nonverbal and verbalwww.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Looking in patient's eyes before looking inLooking in patient's eyes before looking in the mouth.the mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. II. Behavior Modification (behaviorII. Behavior Modification (behavior shaping)shaping) 1. Desensitization1. Desensitization  It is accomplished by teaching the child a competingIt is accomplished by teaching the child a competing response such as relaxation and then introducingresponse such as relaxation and then introducing progressively more threatening stimuli.progressively more threatening stimuli.  Method popularly used nowadays – Tell shows DoMethod popularly used nowadays – Tell shows Do (TSD) technique (Addlesion 1959). By having verbal(TSD) technique (Addlesion 1959). By having verbal (tell) and nonverbal (show and do) interactions,(tell) and nonverbal (show and do) interactions, available, one can overcome many small dentalavailable, one can overcome many small dental related anxieties of any child.related anxieties of any child. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. 2. Modeling2. Modeling  Introduced by (Bandura 1969) developed fromIntroduced by (Bandura 1969) developed from social learning principle procedure involves allowingsocial learning principle procedure involves allowing a patient to observe one or more individualsa patient to observe one or more individuals (models) who demonstrate a positive behavior in a(models) who demonstrate a positive behavior in a particular situation.particular situation.  Modeling can be done by:Modeling can be done by:  Live models – siblings, parents of a childLive models – siblings, parents of a child  Filmed modelsFilmed models  PostersPosters  Audiovisual aidsAudiovisual aids www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. 3. Contingency Management3. Contingency Management  It is a method of modifying behavior of children byIt is a method of modifying behavior of children by presentation /withdrawal of reinforcers.presentation /withdrawal of reinforcers.  These reinforcers can be: -These reinforcers can be: -  Positive reinforcer- whose contingent presentationPositive reinforcer- whose contingent presentation increases the frequency of behavior. (Henry Wincreases the frequency of behavior. (Henry W Fields 1984)Fields 1984)  Negative reinforcer – whose contingent withdrawalNegative reinforcer – whose contingent withdrawal increases the frequency of behavior. (Stokes andincreases the frequency of behavior. (Stokes and Kennedy 1980)Kennedy 1980) www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. III. Behavior managementIII. Behavior management a) Audio analgesia:a) Audio analgesia: This technique consists of providing a soundThis technique consists of providing a sound stimulus of such intensity that the patient findsstimulus of such intensity that the patient finds it difficult to attend to anything else. (Gardnerit difficult to attend to anything else. (Gardner Licklider 1959)Licklider 1959) b) Humor:b) Humor: It helps to elevate the mood of the child,It helps to elevate the mood of the child, which helps the child to relax. Functions ofwhich helps the child to relax. Functions of humor are – social, emotional, informative,humor are – social, emotional, informative, Motivational, cognitive.Motivational, cognitive.www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. c) Coping:c) Coping: It is the mechanism by which a child copes upIt is the mechanism by which a child copes up with the dental treatment. It is defined as thewith the dental treatment. It is defined as the cognitive and behavioral efforts made by ancognitive and behavioral efforts made by an individual to master, tolerate or reduceindividual to master, tolerate or reduce stressful situations. (Lazaue 1980).stressful situations. (Lazaue 1980). Signal system: by Musslemann 1991.Signal system: by Musslemann 1991. d) Voice control:d) Voice control: It is the modification of intensity and pitch ofIt is the modification of intensity and pitch of one’s own voice in an attempt to dominate theone’s own voice in an attempt to dominate the interaction between the dentist and the child.interaction between the dentist and the child. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. e) Relaxation :e) Relaxation : It involves a series of basic exercises, whichIt involves a series of basic exercises, which may take months to learn, and which requiremay take months to learn, and which require the patient to practice at home for at least 15the patient to practice at home for at least 15 min per day.min per day. f) Hypnosis :f) Hypnosis : It is an altered state of consciousnessIt is an altered state of consciousness characterized by a heightened susceptibility tocharacterized by a heightened susceptibility to produce desirable behavioral andproduce desirable behavioral and psysiological changes. When used in dentistrypsysiological changes. When used in dentistry it can be termed as “hypnodontics”it can be termed as “hypnodontics” (Richardson 1980) , or psychosomatic or(Richardson 1980) , or psychosomatic or suggestion therapy.suggestion therapy.www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. g) Implosion therapy :g) Implosion therapy : Sudden flooding with a stimuli which have affectedSudden flooding with a stimuli which have affected him adversely and the child has no other choice buthim adversely and the child has no other choice but to face the stimuli until a negative responseto face the stimuli until a negative response disappears. It mainly comprises of HOME, voicedisappears. It mainly comprises of HOME, voice control, an physical restraints.control, an physical restraints. h) Aversive Conditioningh) Aversive Conditioning It can be a safe and effective way of managing anIt can be a safe and effective way of managing an extremely negative behavior. Those dentists whoextremely negative behavior. Those dentists who contemplate using it should obtain parental consentcontemplate using it should obtain parental consent prior to its use (Patricia P Hagan 1984)prior to its use (Patricia P Hagan 1984) www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Hand over mouth exercise (HOME)Hand over mouth exercise (HOME)  Introduced by Evangeline Jordan in 1920.Introduced by Evangeline Jordan in 1920.  The purpose is to gain attention of the child so thatThe purpose is to gain attention of the child so that communication can be established.communication can be established.  IndicationsIndications  A healthy child who can understand but who exhibits defianceA healthy child who can understand but who exhibits defiance and hysterical behavior during treatment.and hysterical behavior during treatment.  3-6 year old children.3-6 year old children.  A child who can understand simple verbal commands.A child who can understand simple verbal commands.  Children displaying uncontrollable behavior.Children displaying uncontrollable behavior.  ContraindicationsContraindications  Child under 3 years of age.Child under 3 years of age.  Handicapped /immature/frightened child.Handicapped /immature/frightened child.  Physical, mental, and emotional handicap.Physical, mental, and emotional handicap. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. TechniqueTechnique  Behavioral expectations are calmly explained close to theBehavioral expectations are calmly explained close to the child’s ear.child’s ear. www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Physical Restraints:Physical Restraints: Restraints are usually needed for children who areRestraints are usually needed for children who are hypermotive, stubborn or defiant (Kelly 1976)hypermotive, stubborn or defiant (Kelly 1976) For mouthFor mouth •Mouth blocksMouth blocks •Banded tongue bladesBanded tongue blades www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. For bodyFor body Pedi wrap • SheetsSheets • Beanbag with strapsBeanbag with straps • Towel and tapesTowel and tapes Papoose board www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. For extremitiesFor extremities Velcro straps Towel and tapeTowel and tape Posey straps www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. For headFor head Head positionerHead positioner Forearm body supportForearm body support www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. Psychological Status of PatientsPsychological Status of Patients Seeking Orthodontic TreatmentSeeking Orthodontic Treatment77 Numerous studies have showed thatNumerous studies have showed that psychological outcome of orthodontics on thepsychological outcome of orthodontics on the patient’s self image are positive.patient’s self image are positive. The areas of behavioral research and theThe areas of behavioral research and the application of practical psychology to theapplication of practical psychology to the clinical practice of orthodontics can be dividedclinical practice of orthodontics can be divided into 2 broad categories –into 2 broad categories – Social PsychologySocial Psychology Motivational PsychologyMotivational Psychology www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. Social PsychologySocial Psychology  Why patients seek orthodontic treatment?Why patients seek orthodontic treatment?  Use of standardized psychological instruments toUse of standardized psychological instruments to assess prospective orthodontic patientsassess prospective orthodontic patients According to studies done by Philip, dentofacialAccording to studies done by Philip, dentofacial anomalies such as crooked teeth and skeletalanomalies such as crooked teeth and skeletal disharmonies have been reported as the cause ofdisharmonies have been reported as the cause of teasing and general playground harassment amongteasing and general playground harassment among children and are associated with lowered socialchildren and are associated with lowered social attractiveness.attractiveness. www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. Psychological Outcomes of OrthodonticPsychological Outcomes of Orthodontic TreatmentTreatment  Albino showed the psychological and social effects ofAlbino showed the psychological and social effects of orthodontic treatmentorthodontic treatment  Self image improved significantly after the patient receivedSelf image improved significantly after the patient received orthodontic treatment felt better about their facialorthodontic treatment felt better about their facial appearance after braces than they did before them.appearance after braces than they did before them.  Kiyak reported on the psychological influences on the timingKiyak reported on the psychological influences on the timing of orthodontic treatment. Social factors affecting self –of orthodontic treatment. Social factors affecting self – concept:concept:  Young child – Parent ; teacherYoung child – Parent ; teacher  Preadolescent – Peers ; perceived attraction ; perceivePreadolescent – Peers ; perceived attraction ; perceive competencecompetence  Adolescent – PeersAdolescent – Peers  Adults – Achievements ; social rolesAdults – Achievements ; social roleswww.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Motivational PsychologyMotivational Psychology  The success of orthodontic therapy frequentlyThe success of orthodontic therapy frequently depends on patient compliance.depends on patient compliance.  Headgear effects, functional appliance treatment,Headgear effects, functional appliance treatment, oral hygiene and keeping appointment are alloral hygiene and keeping appointment are all dependent on the patient coping with the doctor’sdependent on the patient coping with the doctor’s instructionsinstructions  EgolfEgolf described a compliant patient as one whodescribed a compliant patient as one who practices good oral hygiene, wears appliances aspractices good oral hygiene, wears appliances as instructed without abusing them, follows aninstructed without abusing them, follows an appropriate diet and keeps appointmentsappropriate diet and keeps appointments www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. Creating the Compliant PatientCreating the Compliant Patient99 1. Clinician must believe in his or her technique, whatever it may1. Clinician must believe in his or her technique, whatever it may be.be.  Kenneth Cooper says, “Your beliefs are the most powerfulKenneth Cooper says, “Your beliefs are the most powerful motivational tools you have—if you can just learn how to usemotivational tools you have—if you can just learn how to use them.”them.”  Keeping treatment simple and executing a step-by-step planKeeping treatment simple and executing a step-by-step plan will make explanation and monitoring easier.will make explanation and monitoring easier. 2. Patient Education2. Patient Education  The patient and parents must understand exactly what to doThe patient and parents must understand exactly what to do and why it is important..and why it is important..  Thorough patient education at the beginning of treatment canThorough patient education at the beginning of treatment can eliminate many problems down the road. We must “informeliminate many problems down the road. We must “inform before we perform” .before we perform” . www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. Patient motivationPatient motivation  Fig. 1 Patient education booklets, used to reinforce instructions throughoutFig. 1 Patient education booklets, used to reinforce instructions throughout treatment, are written in positive tone to encourage and motivate patients.treatment, are written in positive tone to encourage and motivate patients.www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. 4. Office Environment4. Office Environment Every office reflects the personality of theEvery office reflects the personality of the orthodontist.orthodontist.  The key is to create a positive environmentThe key is to create a positive environment that fits within your personal comfort zone.that fits within your personal comfort zone. The goal is to maintain a friendly, relaxed,The goal is to maintain a friendly, relaxed, warm, caring, professional atmosphere inwarm, caring, professional atmosphere in which patients know that they will receive thewhich patients know that they will receive the highest-quality treatmenthighest-quality treatment www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. 5. Communication Techniques5. Communication Techniques  Most patients open their mouths as soon as theMost patients open their mouths as soon as the orthodontist sits down at the chair. An effectiveorthodontist sits down at the chair. An effective communication technique is to look in their eyescommunication technique is to look in their eyes before you look in their mouths. This simple act helpsbefore you look in their mouths. This simple act helps us remember that we are dealing with human beings,us remember that we are dealing with human beings, not typodonts.not typodonts. 6. Monitoring Progress6. Monitoring Progress  Each patient’s progress must be monitoredEach patient’s progress must be monitored constantly to maintain motivation and complianceconstantly to maintain motivation and compliance throughout treatment.throughout treatment.  When improvement is seen, praise the patient andWhen improvement is seen, praise the patient and share the achievement with the parent.share the achievement with the parent.www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. Motivational system for orthodontists andMotivational system for orthodontists and their patientstheir patients 1010 BehaviorismBehaviorism  The underlying basis of behaviorism is thatThe underlying basis of behaviorism is that consequences dictate behavior.consequences dictate behavior.  There are three broad categories of consequences:There are three broad categories of consequences:  Positive reinforcersPositive reinforcers  Negative reinforcersNegative reinforcers  Punishment.Punishment.  Punishment can only extinguish behaviors, not teachPunishment can only extinguish behaviors, not teach them, so it has limited use in orthodontics.them, so it has limited use in orthodontics.  Punishment must be severe to be effective, and itPunishment must be severe to be effective, and it often results in counterproductive behavior such asoften results in counterproductive behavior such as resentment, aggression, emotional arousal, orresentment, aggression, emotional arousal, or avoidance.avoidance. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. When orthodontists want to increase patientWhen orthodontists want to increase patient compliance, they should increase positivecompliance, they should increase positive reinforcements while limiting negative onesreinforcements while limiting negative ones such as pain, fear, frustration, and humiliation.such as pain, fear, frustration, and humiliation. Orthodontists can also improve compliance byOrthodontists can also improve compliance by providing patients with feedback that isproviding patients with feedback that is immediate, accurate, and specificimmediate, accurate, and specific www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Arriving on time — 1 point Wearing headgear into office — 1 point No broken wires — 1 point Absolutely clean mouth — 2 points No broken or loose bands — 3 points Correct wearing of headgear — 3 points Correct wearing of elastics — 3 points www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. Children are excited by their own digital imagesChildren are excited by their own digital images www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. Study by Alexander and Chase (1987)Study by Alexander and Chase (1987) suggested that there are at least ninesuggested that there are at least nine congenital temperaments that make childrencongenital temperaments that make children easy or difficult to manage:easy or difficult to manage: www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86.  The most important of these personality features toThe most important of these personality features to orthodontists is the sensitivity threshold.orthodontists is the sensitivity threshold.  People with an inherited low sensitivity thresholdPeople with an inherited low sensitivity threshold have diminished tolerances for all the senses.have diminished tolerances for all the senses.  That is, what might be an acceptable tactileThat is, what might be an acceptable tactile stimulation for a person with ordinary sensitivity willstimulation for a person with ordinary sensitivity will be painful for a person with a low sensitivitybe painful for a person with a low sensitivity threshold.threshold.  These people do not tolerate items such as woolThese people do not tolerate items such as wool sweaters, shirt labels, new shoes, or tight clothes.sweaters, shirt labels, new shoes, or tight clothes.  They are highly selective about the foods they eat—They are highly selective about the foods they eat— their foods must have the right texture.their foods must have the right texture. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. And they show an unusually high socialAnd they show an unusually high social sensitivity, perceiving insults where none aresensitivity, perceiving insults where none are intended.intended.  Bright lights and loud or repetitive noisesBright lights and loud or repetitive noises irritate them greatly, so it should come as noirritate them greatly, so it should come as no surprise to orthodontists that they show littlesurprise to orthodontists that they show little inclination to tolerate the demands, discomfort,inclination to tolerate the demands, discomfort, and inconvenience of orthodontic therapy.and inconvenience of orthodontic therapy. Many of their broken brackets and bands resultMany of their broken brackets and bands result from when they touch, tug on, and damage thefrom when they touch, tug on, and damage the appliances that are discomforting themappliances that are discomforting themwww.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. •• Use bonded brackets instead of bands wherever possible.Use bonded brackets instead of bands wherever possible. •• Use brackets with the greatest inter- and intrabracket distances.Use brackets with the greatest inter- and intrabracket distances. •• Use the most resilient wires possible.Use the most resilient wires possible. •• Change the orthodontic forces gradually.Change the orthodontic forces gradually. •• Use segmented arches to involve fewer teeth.Use segmented arches to involve fewer teeth. •• Use continuous forces rather than intermittent ones.Use continuous forces rather than intermittent ones. •• Prevent periodontal capillary strangulation by having the patientPrevent periodontal capillary strangulation by having the patient chew on a bite wafer or gum immediately after adjustments.chew on a bite wafer or gum immediately after adjustments. •• Prescribe analgesics (non-steroidal anti-inflammatory agents)Prescribe analgesics (non-steroidal anti-inflammatory agents) immediately after adjustments.immediately after adjustments. •• Reduce gingival inflammation with better brushing instructions,Reduce gingival inflammation with better brushing instructions, antibiotics, chemotherapeutics, and prophylaxis.antibiotics, chemotherapeutics, and prophylaxis. •• Use the simplest mechanics possible.Use the simplest mechanics possible. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. Gag reflexGag reflex www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. Oral Hygiene for Orthodontic PatientsOral Hygiene for Orthodontic Patients Cycle of inflammationCycle of inflammation www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91.  Plaque staining to disclose areas of poor oral hygiene.Plaque staining to disclose areas of poor oral hygiene. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92.  Before patients get to this point, orthodontists shouldBefore patients get to this point, orthodontists should exercise an aggressive remedial strategy thatexercise an aggressive remedial strategy that includes:includes:  Thorough prophylaxis by the general dentist orThorough prophylaxis by the general dentist or hygienist.hygienist.  Use of chlorhexidine rinse twice a day for severalUse of chlorhexidine rinse twice a day for several weeks.weeks.  Oral medication of tetracycline, 250mg four times aOral medication of tetracycline, 250mg four times a day for two weeksday for two weeks www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. Clinical Motivation of the Functional JawClinical Motivation of the Functional Jaw Orthopedic PatientOrthopedic Patient66 An assistant points out the balance and beauty of the models' faces. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. Fig. 3 Patient is asked to hold a lip disk (A) between the lips for 30 minutes per day while watching TV (B). Patients with "golf ball chin" (C) are instructed to hold the chin with the lip disk between the lips (D). www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. ConclusionConclusion Creating the compliant patient begins with theCreating the compliant patient begins with the attitude of the orthodontist.attitude of the orthodontist. Our goals will be achieved if we believe in ourOur goals will be achieved if we believe in our delivery system, properly educate our patients,delivery system, properly educate our patients, and learn how to motivate them to followand learn how to motivate them to follow instructions.instructions. This kind of communication takes time, but theThis kind of communication takes time, but the results are well worth it.results are well worth it. www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. 1.1. BibliographyBibliography 1.1. Proffit William R.: Contemporary Orthodontics, 4thProffit William R.: Contemporary Orthodontics, 4th Edition ,2006, C.V . MosbyEdition ,2006, C.V . Mosby 2.2. Bishara Sameer E., Text book of Orthodontics,Bishara Sameer E., Text book of Orthodontics, W.B. Saunders, 2001W.B. Saunders, 2001 3.3. Mc Donald, Dentistry for the Child and AdolescentMc Donald, Dentistry for the Child and Adolescent , 3, 3rdrd Edition, MosbyEdition, Mosby 4.4.   Shobha Tandon ,text book of pedodontics; FirstShobha Tandon ,text book of pedodontics; First Edition.100-120Edition.100-120 5.5. Albert H Owen III. Clinical Motivation of theAlbert H Owen III. Clinical Motivation of the Functional Jaw Orthopedic Patient. J.clin. orthod;Functional Jaw Orthopedic Patient. J.clin. orthod; 1983 Mar (192 –198)1983 Mar (192 –198) www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. 6.6. Larry W.White. Behavior Modification of OrthodonticLarry W.White. Behavior Modification of Orthodontic Patients. J.Clin. Orthod; 1974 Sep (501-505)Patients. J.Clin. Orthod; 1974 Sep (501-505) 7.7. R.G. Alexander. The Vari-Simplex Discipline: Part 5 PracticeR.G. Alexander. The Vari-Simplex Discipline: Part 5 Practice Management. J. Clin.Orthod; 1983 Oct (680-687)Management. J. Clin.Orthod; 1983 Oct (680-687) 8.8. Melvin Mayerson. Management and Marketing: Creating theMelvin Mayerson. Management and Marketing: Creating the compliant patient. J. Clin. Orthod; 1996 Sep (493-497)compliant patient. J. Clin. Orthod; 1996 Sep (493-497) 9.9. Melvin Mayerson, Larry W. White. A New Paradigm ofMelvin Mayerson, Larry W. White. A New Paradigm of Motivation. J. Clin. Orthod. 1996 June (337-341)Motivation. J. Clin. Orthod. 1996 June (337-341) 10.10. T.Mehara, R.S.Nanda, P.K.Sinha. Orthodontist’sT.Mehara, R.S.Nanda, P.K.Sinha. Orthodontist’s Assessment and Management of Patient Compliance. AngleAssessment and Management of Patient Compliance. Angle Orthod; 1998;2; (115-122)Orthod; 1998;2; (115-122) www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. www.indiandentalacademy.comwww.indiandentalacademy.com

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