Psychological management


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Psychological management

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. I N T R O D U C T I O N The successful practice of orthodontics is significantly dependent on the interaction between the orthodontist and the patient. Doctor-patient relationships in orthodontics can positively influence treatment outcomes by encouraging the patient to cooperate in following prescribed instructions related to appliance wear and maintenance of oral hygiene. Successful orthodontic treatment requires active cooperation from the patient throughout the necessary lengthy orthodontic procedures.
  3. 3. THE ORTHODONTIST-PATIENT RELATIONSHIP: Orthodontist-patient relationships have significant effects on the success of orthodontic treatment. 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.
  4. 4. 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.
  5. 5. 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: it is the attempt to alter human behavior and emotion in a beneficial manner according to the laws of modern learning theory.
  6. 6. 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.
  7. 7. CREATING A COMPLIANT PATIENT (JCO 1996 Sep MELVIN MAYERSON, DDS, MSD, R.G. “WICK” ALEXANDER, DDS, MSD, C..) •Patient Education •Patient Motivation •Office Environment •Communication Techniques •Monitoring Progress
  8. 8. 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.
  9. 9. INFORM BEFORE WE PERFORM Procedures and appliances explained to patient by Dr. Wick Alexander before treatment.
  10. 10. 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
  11. 11. 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.
  12. 12. 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”
  13. 13. 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”.
  14. 14. EARLY TREATMENT : Psychological advantage to the children, whose • self image has been shattered by peer group teasing. •Self conscious. •Timid or •Sensitive about their dental appearance.
  15. 15. Habit correction (AJO-DO 1979 Nov; Psychology and early orthodontic treatment – Jacobson) Two main schools of thought prevail. The psychoanalysts regard the habit as a symptom of emotional disturbance, and the 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.
  16. 16. In treating habits in this age group, it is necessary to determine whether the habit is "meaningful" or ''empty."24 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."
  17. 17. BEHAVIOUR MANAGEMENT OF CHILD 1. Non-pharmacological (psychological approach) 2. Pharmacological Non- pharmacological: 1. Communication 2. Behavior shaping (modification) • Desensitization • Modelling • Contingency management
  18. 18. 3. Behavior management • Audio analgesia • Biofeed back • Voice control • Hypnosis • Humor • Coping • Relaxation • Implosion therapy • Aversive conditioning.
  19. 19. Pharmacological: 1. Pre-medication • Sedatives And Hypnotics • Anti-anxiety Drugs • Anti-histamines 2. Conscious sedation 3. General anesthesia.
  21. 21. 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.
  22. 22. “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.
  23. 23. 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 ALBINO
  24. 24. 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.
  25. 25. 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.
  26. 26. 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.
  27. 27. 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.
  28. 28. 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.
  29. 29. 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.
  30. 30. 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.
  31. 31. EDUCATIONAL PSYCHOLOGY: One of the most promising areas of current research in patient cooperation is the area of educational psychology.
  32. 32. The learning styles inventory developed by KOLB, 4 learning styles. 1. ACCOMODATOR 2. DIVERGER 3. ASSIMILATOR Concrete experience 4. CONVERGER. Accommodator Active experimentation Converger Diverger Reflective observation Assimilator Abstract conceptualization
  33. 33. 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 cliniciancentered.
  34. 34. 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.
  35. 35. Methods of improving patient compliance A.O. 1998 No. 2, T. Mehra, R.S. Nanda, P.K Sinha. (1) verbally praising the patient, (2) educating the patient about the consequences of poor compliance, (3) discussing treatment goals with the patient, (4) educating the patient about the proper use of elastics, (5) educating the parent about the consequence of poor compliance, (6) discussing poor patient cooperation with the patient, (7) educating the patient about the proper use of headgear, (8) discussing poor patient cooperation with the parent, (9) discussing treatment goals with the parent, and (10) educating the parent about the use of orthodontic appliances.
  36. 36. 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.
  37. 37.  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.
  38. 38. RESULTS OF NON COMPLIANT PATIENT:  It is necessary to compromise treatment methods and treatment objectives.  Increase of expenses involved in orthodontic treatment.
  39. 39. 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.
  40. 40. 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 of achieving a good treatment result is made remarkably easier.
  41. 41. Thank you For more details please visit