Psychological management

INDIAN DENTAL ACADEMY
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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.

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.

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

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

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


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


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.


INFORM BEFORE WE PERFORM

Procedures and appliances explained to patient by Dr. Wick
Alexander before treatment.


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


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


Communication Techniques
An effective communication technique is to look in
their eyes before you look in their mouths.

"Horizontal communication": Dr. J. Moody Alexander looking in
patient's eyes before looking in the mouth.

Good communication should be honest as well as
two-way, the orthodontist should be “askable”

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”.


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.


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.

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."


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

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

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


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

A RELATIVELY NEW AREA OF APPLICATION
3. EDUCATIONAL PSYCHOLOGY.


SOCIAL PSYCHOLOGY
Why patient’s seek orthodontic treatment ?
• Adolescents : my mom thinks I need braces, to look
better
• Adults : own initiative; to improve facial appearance.

 Clearly a person’s dento facial appearance
can have a significant effect on their overall
quality of life.


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


PSYCHOLOGICAL OUTCOME OF ORTHODONTIC
TREATMENT
The precise role that dentofacial esthetics plays in the
development of a child’s self-concept and self-esteem
remains controversial.
DANN et al
ALBINO


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.

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.


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


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

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


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

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


EDUCATIONAL PSYCHOLOGY:

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


The learning styles inventory developed by KOLB, 4 learning
styles.
1. ACCOMODATOR
2. DIVERGER
3. ASSIMILATOR

Concrete experience

4. CONVERGER.
Accommodator
Active
experimentation
Converger

Diverger

Reflective
observation

Assimilator

Abstract
conceptualization

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.


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.

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.

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.


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


RESULTS OF NON COMPLIANT PATIENT:

 It is necessary to compromise treatment
methods and treatment objectives.
 Increase of expenses involved in orthodontic
treatment.


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

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.

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Psychological management

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