Psychology /certified fixed orthodontic courses by Indian dental academy


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Psychology /certified fixed orthodontic courses by Indian dental academy

  1. 1. PSYCHOLOGY INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. ► Introduction. ► Theories of psychology & Behavioral development. ► Psychological status of patients . ► Psychological management.
  3. 3. Introduction. ► Definition:-Psychology is a branch of science which deals with mind & mental processes in relation to human & animal behaviour. ► Psychological growth and development proceed in a sequential order.
  4. 4. ► ► ► ► ► ► Sigmund Freud -1905 “Theory of sexuality”. Karl Abraham subdivided the phases of psychosexual development. Carl-external factors play an important role in personal growth & adaptation. Harry-Human development is largely shaped by external events mainly social interaction. Erickson-developmental potentials at all stages of life. Jean Piaget -Theory of cognitive development.
  5. 5. ► Psychologic Development. Linked to the growth of the brain (cognitive areas) ► Influenced by genetic factor which is modified by the environment.
  6. 6. Theories of Psychology & Behavioural development. ► Behaviour is a result of interaction between innate & behaviour learned after birth.
  7. 7. Learning of Behaviour. ► Behavioural responses can be learned by three mechanisms:-Classical conditioning. -Operant conditioning -Observational learning.
  8. 8. Classical conditioning:described by Ivan Pavlov during his studies on reflexes. ► First ► “Learning by Association”.
  9. 9.
  10. 10. Reinforcement Every time they occur, the association between a conditioned and unconditioned stimulus is strengthened.
  11. 11. Operant conditioning:► According to B.F Skinner – Operant conditioning is a significant extension of classical conditioning. ► Consequence of behaviour is a stimulus for future behaviour. Stimulus Response Consequence
  12. 12. 3. Four basic types of operant conditioning:Positive reinforcement. Negative reinforcement. Omission or Time out. 4. Punishment. ► 1. 2.
  13. 13. ► Positive Reinforcement:- If a pleasant consequence follows a response, the response has been positively reinforced. ► Negative Reinforcement:-Involves the withdrawal of an unpleasant stimulus after a response.
  14. 14. ► Omission :- Involves removal of a pleasant stimulus after a particular response. ► Punishment:-occurs when an unpleasant stimulus is presented after a response.
  15. 15. Four basic types of operant conditioning.
  16. 16. Observational Learning (Modeling). ► This is acquired through imitation of behaviour. ► Two distinct stages :-Acquisition -Performance. ► Children are capable of acquiring any behaviour they observe. ► Performing of an acquired behaviour depends on the role model.
  17. 17. •A child acquires a behaviour by first observing it & then actually performing it. •Important tool in the management of dental treatment.
  18. 18. Freudian or Psychoanalytic Theory ► Freud proposed five stages that each goes through prior to adulthood. -Oral stage (0-1yr) -Anal stage(2-3yrs) -Phallic stage(3-5yrs) -Latency stage(5-12yrs) -Genital stage (puberty).
  19. 19. ► Oral stage:- -Oral region is the main source of satisfaction. -Regular feeding is of prime importance to the infant. -Imbalance at this stage leads to fixation & prevent the transition to the next developmental stage. -Characteristics arising from incomplete resolution of this stage are of addictive behaviour.
  20. 20. ► Anal stage:- -Characterized by marked self centered behaviour. -Anal zone becomes the primary zone of pleasure where functions of retention & elimination take on new importance. Incomplete resolution of this phase results in untidiness. ► Phallic stage:- -Child becomes aware of the differences between the sexes. -Oedipus complex ie the conflictual situation arising between a child and his parents during this phase. Resolution of this is to identify his parent as role models. -Unsatisfactory resolution results in Inability to form intimate sexual relationships.
  21. 21. ► Latency stage:-occurs between 5-12yrs of age & is a period of consolidation. -Increased importance is given to peer development and character formation & previous drives become passive. ► Genital stage:-Begins with puberty & is characterized by the reopening of the ego’s struggle to gain mastery and control over the impulse of id and superego. -During this period , fluctuating extremes in emotional behaviour is seen because of struggle to attain a firm sense of self being.
  22. 22. Stages of Emotional development. ► Emotional development generally pass through discrete stages. ► Emotional Development:-
  23. 23. ► Development of Basic trust:-birth to 18months of age. -successful development depends on caring mother. -“Maternal deprivation” syndrome is likely to occur in the child due to inadequate maternal support. ► Development of autonomy:-18months to 3yrs of age. -Terrible two’s. -Sense of autonomy develops as the child is moving away from the mother. -Failure to develop sense of autonomy results in the development of doubts.
  24. 24. ► Development of Initiative:- (3 to 6yrs ) -develops greater autonomy. -initiative is shown by physical activity, extreme curiosity & questioning. -guilt results from goals that are initiated but not completed. ► Mastery of skills:-(7 to 11yrs ) -child acquires industriousness & begins the preparation for entrance into a competitive & working world. -Influence of peer group as role model increases. -Failure to measure up to the peer group develops sense of Inferiority.
  25. 25. ► Development of personality Identity(12 to 17yrs):-Adolescence, a period of intense physical development in which a unique personality identity is acquired. -Members of peer group become important role models. -Motivation for seeking treatment can be internal or external. ► Development of Intimacy (young adult):-development during this stage begins with the attainment of intimate relationships with others. -Failure leads to isolation.
  26. 26. ► Guidance of the Next Generation:-(Adult) -a major responsibility of mature adult is the establishment and guidance of the next generation. -The opposite personality characteristic in mature adults is stagnation characterized by self-centered behaviour. ► Attainment of Integrity:-(Late Adult) -Final stage in the psychosocial development. -Individual has adapted to the combination of gratification & disappointment. -opposite character despair is expressed as disgust & unhappiness.
  27. 27. Cognitive Development. -Jean Piaget. ► Development of intellectual capacities occurs in discrete stages . ► Adaptation occurs through two complementary process:-Assimilation -Accommodation. ► Intelligence develops as an interplay between assimilation & accommodation.
  28. 28. ► 4 stages of cognitive development:-Sensorimotor period. -Preoperational period. -Period of concrete operations. -Period of formal operation.
  29. 29. ► Sensorimotor period:- -Communication between a child & adult is limited due to lack of child’s language capabilities. -Limited ability to interpret sensory data. ► Preoperational period(2-7yrs):- -general feature of thought processes & language during this stage is Egocentrism & Animism. -Child’s thought processes are dominated by the immediate sensory impressions.
  30. 30. ► Period of concrete operations(7-11yrs):- -Improved ability to reason emerges. -Egocentrism and animism declines. ► Period of formal operations(11yrs-adult):- -Ability to deal with abstract concepts develop. -Child thought process is similar to adult. - “Imaginary audience”-Elkind.
  31. 31. Psychological status of patients seeking orthodontic treatment. ► Psychological outcomes of orthodontics on the patients self image is positive. ► Psychology to the clinical practice of orthodontics can be divided into:-Social psychology -Motivational psychology
  32. 32. ► Social Psychology of Orthodontics:- Why patients seek orthodontic treatment? -Dentofacial anomalies such as crooked teeth & skeletal disharmonies have been reported as the cause of teasing & harassment among children. -Bennet & Philip. ► Adults seek for treatment to improve their facial & dental appearance which in turn will lessen social embarrassment & improve the self confidence. -Hunt & Johnston.
  33. 33. Psychologic outcomes of orthodontic treatment:- Dentofacial esthetics play an important role in a individual’s self image. Children with malocclusion did not have poor self image & orthodontic treatment did not improve it-Dann. Dentofacial disharmonies have significant social & psychological effect on the patient-Albino.
  34. 34. ► Kiyak et al reported psychological influences on the timing of orthodontic treatment. -Developing children well being may be an indication for early orthodontic treatment. -Racial differences may be present in the psychological influences of orthodontics.
  35. 35. ► Motivational psychology:- The success of orthodontic therapy depends on patient compliance.   Egolf described a compliant patient as one who practices good oral hygiene, wears appliance, follows an appropriate diet and keeps appointment. Southard et al pointed out that improved co-operation by the patient helps to achieve the treatment objectives within a minimum time.
  36. 36. ► Improved oral hygiene can decrease damage to the periodontal tissues and limit the effects of enamel decalcification and caries -Nanda & Sinha
  37. 37. Patient Management. ► Motivation. ► Communication. ► Pre appointment behaviour modification. ► TSD technique (Addelston). ► Efficiency & organization.
  38. 38. Psychology of malocclusion. ► An acquired habit is nothing but a new pathway of discharge formed in the brain, by which certain incoming currents ever after tend to escape – William James ► Habits can be classified as  useful habits  harmful habits
  39. 39. ► Developmental psychologists have produced a number of theories to explain thumb sucking -Digital sucking has been related to inadequate suckling activity - Freud. -Prolonged suckling can lead to thumb sucking – Sears & Wise. ► Thumb sucking is a simple learned habit and contradicts the psychoanalytic theory which uses the habit as a symptom of a deeper emotional disturbance – Haryett et al
  40. 40. According to Dr.Barton ► Lack of love and affection ► Habit is evidence of a feeling of personal inadequacy, frustration & insecurity. ► Improper nursing .
  41. 41. •Malocclusion can have a profound psychological impact and most of these children are shy, self-conscious and withdrawn. •The youngster who sucks his finger beyond the time that is normal, faces a psychological problem as he knows that this habit is not liked by parents or the society and also realizes that he is causing a facial abnormality. ►Unfavorable psychological effects tend to accompany speech defects that are attributable to dental malocclusions.
  42. 42. Psychosocial implications of facial deformities H. Asuman Kiyak Rebecca Bell ► Meanings of the Face ► Psychosocial characteristics of patients with facial deformities
  43. 43. 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.
  44. 44. Meanings of the Face ► Berscheid et al – the area of greatest dissatisfaction for subjects in their large sample was the appearance of their teeth ► Attractive adults & children are evaluated as more successful and more intelligent than are unattractive persons and are viewed as more socially skilled – GR Adams
  45. 45. Psychosocial characteristics of patients with facial deformities ► Children with craniofacial anomalies are more introverted, neurotic and demonstrate poor self-concept – Perschuk 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 – Strauss et al
  46. 46. Psychosocial characteristics of patients with facial deformities ► 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
  47. 47. Summary ► Research in the areas of self-esteem and attractiveness indicates that the face is a major source of one’s psychologic identity ► 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
  48. 48. Psychosocial studies of patients with dentofacial deformities - Kiyak et al ► The First Study  To study patient’s motives for seeking orthognathic surgery, the effect of this procedure on people with diverse needs, and patient’s satisfaction with treatment outcomes  6 questionnaires were asked over a 26 month period ► The Second Study  Attempted to examine in greater detail the variables that emerged as significant predictors of long-term outcomes  The effect of orthognathic surgery was measured by comparing patients who underwent surgery and orthodontics with those who were recommended to have both but elected orthodontics alone  6 questionnaires were asked before and up to 24 months after surgery
  49. 49. Patients before surgery ► ► ► ► ► Motives for treatment A scale to assess patient’s motives Self-perceptions of facial profile Sex differences Orthognathic-surgery patients
  50. 50. Motives for surgery Parameter Male Female Orthodontist 24(83%) 34(76%) Family dentist 12(41%) 17(38%) Other 5(17%) 1(2%) Desire esthetic changes 12(41%) 13(53%) Mastication 12(41%) 13(29%) Speech 4(14%) 1(2%) TM joint 1(3%) 7(16%) Social: family, friends 12(41%) 24(53%) Professional advice Functional problems
  51. 51. A scale to assess patient’s motives ► Subjective Expected Utility (SEU) Model  Items are based on interviews with orthognathic surgery patients, orthodontists, and oral-maxillofacial surgeons  Using a 10 point scale, patients are asked to indicate the importance of each item in the list above and whether they consider it positive , negative or neutral.  In this study, SEU suggest that the decision to seek surgical correction is influenced by functional reasons. Conversely, the decision to reject surgery and undergo conventional orthodontics seems to be based more on a desire for improved esthetics
  52. 52. A scale to assess patient’s motives Questions Score Less difficulty with chewing 3 Stop jaw from clicking 0 Eat foods unable to eat now 0 Better fit of upper/lower teeth 1.5 General health improvement 1.5 Possible pain after surgery 0 Better smile 0 Improved profile, jaw and chin 0 Straight teeth 0 Cost of surgery 0 Lost time from work/school 0.8 Chance of unsuccessful surgery 1.9 Be able to speak clearer 0 Less self-conscious 0 Perform better in job/school 0 Advice of family/friends 0 Advice of dentist/orthodontist 0.9 Know of someone else’s surgery 0
  53. 53. Self-perceptions of facial profile ► For all dimensions of facial deformity, patients who accept surgical treatment view themselves as less normal than do those who opt for no treatment or orthodontics ► At the 24-month follow-up assessment, nearly all the surgery patients rated themselves as normal. Orthodonticsonly patients also rated themselves improved on all scales, but the improvement was not as great.
  54. 54. Sex differences ► Broverman and colleagues have found experimental evidence that women place relatively greater importance on physical attractiveness ► Kurtz et al found that women can more easily distinguish what they like and dislike about their bodies than can men of the same age, who give only global self-descriptions.
  55. 55. Orthognathic surgery patients ► In present study both men and women scored within the normal range, notably better than the cosmetic-surgery population. ► Sex differences were not significant in post surgical satisfaction or in self-reports of pain.
  56. 56. Response to treatment ► ► ► ► ► ► Overall satisfaction with the outcomes is generally high at all post surgical assessments Overall body image was found to be in the moderate range throughout the course of treatment Surgery patients initially expressed a lower body image than did non surgical and no-treatment patients Surgical patients had high levels of tension and anxiety just before surgery, with a steady decline later Orthodontics-only patients had negative mood states at 6 months which later improved In surgical-orthodontic patients, expectations matched the actual experience for most patients.
  57. 57. Application of research findings to patient management ► Summary of research findings  The patients undergoing orthognathic surgery are always within the psychologically normal range  They are more stable than people who seek plastic surgery  Their greatest concern before treatment appears to be self-consciousness regarding their facial body image, but functional problems also are important
  58. 58. Application of research findings to patient management ► Summary of research findings  Orthodontics-only patients report negative emotions during the later stages of their treatment  Contrary to literature on cosmetic surgery, most patients undergoing orthognathic surgery readily accept changes in appearance and are satisfied with the esthetic effects  85% to 90% of the patients undergoing surgicalorthodontic treatment eventually indicate that they are satisfied with the treatment
  59. 59. Recommendations for interaction with patients ► ► ► There is a need for systematic selection of patients, preparation for surgical treatment, and careful psychologic management throughout the course of surgical and orthodontic treatment Provide greater psychosocial support and encouragement for the patient with a neurotic personality style, especially in the early stages of treatment Patient education materials provide information in a standard way so that no important points are omitted, and the patient can review it repeatedly to gain a better understanding of the process.
  60. 60. Pre- and post surgical psycho-emotional aspects of the orthognathic surgery patient - Bertolini et al ► ► ► Levels of pre surgical anxiety, post surgical depression, body concept, and all the important changes in physiologic functions were measured by 4 questionnaires. The results of this study suggest that surgery does in fact, produce improvements in self-esteem and body image and in mastication and speech, and therefore in their lifestyles All patients experienced a medium to high level of pre surgical anxiety, but no major problems after surgery.
  61. 61. Psychological status of cleft lip & palate patients. ► A study comparing the self-concept of children with cleft lip and palate to children without these conditions found a significantly lower self-concept in the former group – JE Jones ► Serious social and psychological difficulties were encountered in everyday life . The social rejection for these facially disabled patients extended to their attempts to obtain jobs, make friends, set apart as different from others, frequently developed psychological disturbances – -Mac Gregor
  62. 62. ► Public perception of cleft lip & palate patients least liked by children & adults. -Landsdown & polak -Glass et al ► Also, lip impairment & hypernasality of voice were considered most favorable in these children.
  63. 63. Thank you For more details please visit