Psychological management of maxillofacial prosthetic patient/ Labial orthodontics

PSYCHOLOGICAL MANAGEMENT OFPSYCHOLOGICAL MANAGEMENT OF
MAXILLOFACIAL PROSTHETIC PATIENTMAXILLOFACIAL PROSTHETIC PATIENT
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing dental educationLeader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.com

CONTENTSCONTENTS
 INTRODUCTIONINTRODUCTION
 DEFINITIONDEFINITION
 CLASSIFICATIONCLASSIFICATION
 DISTRIBUTIONDISTRIBUTION
 GENERAL PSYCHOLOGICAL IMPAIRMENTGENERAL PSYCHOLOGICAL IMPAIRMENT
 MENTAL ATTITUDE OF MAXILLOFACIALMENTAL ATTITUDE OF MAXILLOFACIAL
PATIENTPATIENT
 CLINICAL REFERRALCLINICAL REFERRAL
 CONCLUSIONCONCLUSION
 BIBLIOGRAPHYBIBLIOGRAPHY

INTRODUCTIONINTRODUCTION
 WHO defined health is a "the state of complete
physical, mental and social well-being not merely the
absence of disease or infirmity".
 Behavior of the patientBehavior of the patient
 Why do they behave, as they do?Why do they behave, as they do?
 How can a prosthodontist respond?How can a prosthodontist respond?

 These examples illustrate the human element inThese examples illustrate the human element in
health care, particularly with patients with functionalhealth care, particularly with patients with functional
deficits or cosmetic deformity secondary to treatmentdeficits or cosmetic deformity secondary to treatment
of underlying diseases.of underlying diseases.
 ““Meet the mind of the patient before meeting theMeet the mind of the patient before meeting the
mouth of the patient”mouth of the patient”..
 Proper evaluation of the patients.Proper evaluation of the patients.
 Etiology of the behavior and its impact on treatment.Etiology of the behavior and its impact on treatment.
 Such assessment is necessary for the successfulSuch assessment is necessary for the successful
outcome.outcome.

DEFINITION:DEFINITION:
 Psychology is defined as the study of thePsychology is defined as the study of the
human mind, mental characteristics of a personhuman mind, mental characteristics of a person
or group, mental aspects of an activity,or group, mental aspects of an activity,
situation etc.situation etc.

CLASSIFICATION:CLASSIFICATION:
 II :: philosophicalphilosophical
::ExactingExacting
:: HystericalHysterical
:: IndifferentIndifferent
 II Reasonable (realistic)II Reasonable (realistic)
Unreasonable (unrealistic)Unreasonable (unrealistic)

DISTRIBUTION:DISTRIBUTION:
 Mental illness affects people of all ages, races,Mental illness affects people of all ages, races,
cultures, and socioeconomic classes.cultures, and socioeconomic classes.
 common disorders are anxiety disorders, alcoholcommon disorders are anxiety disorders, alcohol
dependence, various phobias schizophrenia, bipolardependence, various phobias schizophrenia, bipolar
disorder, or a severe form of depression or panicdisorder, or a severe form of depression or panic
disorder.disorder.
 Among prosthodontic patients, children most oftenAmong prosthodontic patients, children most often
present with congenital defects or alterations inpresent with congenital defects or alterations in
growth and development, whereas adolescents andgrowth and development, whereas adolescents and
young adults often present with developmentalyoung adults often present with developmental
defects or trauma.defects or trauma.

 Mental illness among the elderly has grownMental illness among the elderly has grown
significantly as a greater percentage of people livesignificantly as a greater percentage of people live
beyond the age of 65 , characterized by impairedbeyond the age of 65 , characterized by impaired
intellectual functioning and memory loss .intellectual functioning and memory loss .
 the highest rates of mental illness occur amongthe highest rates of mental illness occur among
people in the lower socioeconomic classes, especiallypeople in the lower socioeconomic classes, especially
those living in severe poverty. Rates of almost allthose living in severe poverty. Rates of almost all
mental illnesses decline as levels of income andmental illnesses decline as levels of income and
education increase.education increase.

 The overall prevalence rates of mental illnessesThe overall prevalence rates of mental illnesses
among men and women are similar. However, menamong men and women are similar. However, men
have much higher rates of antisocial personalityhave much higher rates of antisocial personality
disorder and substance abuse.disorder and substance abuse.
 In the United States, women suffer from depressionIn the United States, women suffer from depression
and anxiety disorders at about twice the rate of men.and anxiety disorders at about twice the rate of men.
The gender gap is even wider in some countries. ForThe gender gap is even wider in some countries. For
example, women in china suffer form depression atexample, women in china suffer form depression at
nine times the rate of men.nine times the rate of men.

GENERAL PSYCHOLOGICALGENERAL PSYCHOLOGICAL
IMPAIRMENTSIMPAIRMENTS
 ANXIETY DISORDERSANXIETY DISORDERS
 MOOD DISORDERSMOOD DISORDERS
 SCHIZONPHRENIASCHIZONPHRENIA
 PERSONALITY DISORDERSPERSONALITY DISORDERS
 COGNITIVE AND DISSOCIATIVE DISORDERSCOGNITIVE AND DISSOCIATIVE DISORDERS
 SOMATOFORM AND FACTITIOUS DISORDERSSOMATOFORM AND FACTITIOUS DISORDERS
 SUBSTANCE-RELATED DISORDERSSUBSTANCE-RELATED DISORDERS
 EATING DISORDERSEATING DISORDERS
 IMPULSE CONTROL DISORDERSIMPULSE CONTROL DISORDERS

ANXIETY DISORDERSANXIETY DISORDERS
 It involves excessive apprehension, worry, andIt involves excessive apprehension, worry, and
fear.fear.
 Adults aged between 18 to 54 are suffered fromAdults aged between 18 to 54 are suffered from
anxiety disorders which includeanxiety disorders which include
1. panic disorder,1. panic disorder,
2. obsessive-compulsive disorder (OCD),2. obsessive-compulsive disorder (OCD),
3. posttraumatic stress3. posttraumatic stress
disorder (PTSD),disorder (PTSD),
4. social phobia4. social phobia

panic disorderpanic disorder
 where people experience sudden, intense terror and physicalwhere people experience sudden, intense terror and physical
symptoms such as rapid heartbeat and shortness of breadth.symptoms such as rapid heartbeat and shortness of breadth.
 young adulthood. before age 24young adulthood. before age 24
 Women are twice as likely as men to developWomen are twice as likely as men to develop
 also suffer from depression and substance abuse.also suffer from depression and substance abuse.
 About 30% of people with panic disorder abuse alcohol andAbout 30% of people with panic disorder abuse alcohol and
17% abuse drugs such as cocaine and marijuana.17% abuse drugs such as cocaine and marijuana.
 About one third of all people with panic disorder developAbout one third of all people with panic disorder develop
agoraphobia,agoraphobia,

 obsessive-compulsive disorderobsessive-compulsive disorder
experience intrusive thoughts or images or feelexperience intrusive thoughts or images or feel
compelled to perform certain behaviors.compelled to perform certain behaviors.
OCD affects men and women ages 18 to 24OCD affects men and women ages 18 to 24
with equal frequency.with equal frequency.

 posttraumatic stress disorderposttraumatic stress disorder
They relive traumatic events from their pastThey relive traumatic events from their past
and feel extreme anxiety and distress about theand feel extreme anxiety and distress about the
event.event.
About 30% of men and women who haveAbout 30% of men and women who have
spent time in war zones experience PTSD.spent time in war zones experience PTSD.
The disorder also frequently occurs afterThe disorder also frequently occurs after
violent personal assaults, such as rape,violent personal assaults, such as rape,
mugging, or domestic violence; terrorism;mugging, or domestic violence; terrorism;
natural or human-caused disasters; andnatural or human-caused disasters; and
accidents.accidents. www.indiandentalacademy.com

social phobiasocial phobia
occurs in women twice as often as men, atoccurs in women twice as often as men, at
the age of 18 to 54, although, a highestthe age of 18 to 54, although, a highest
proportion of men seek help for this disorder.proportion of men seek help for this disorder.
The disorder typically begins in childhood orThe disorder typically begins in childhood or
early adolescence and rarely develops afterearly adolescence and rarely develops after
age 25. Social phobia is often accompanied byage 25. Social phobia is often accompanied by
depression and may lead to alcohol or otherdepression and may lead to alcohol or other
drug abuse.drug abuse.

MOOD DISORDERS:MOOD DISORDERS:
 Depression,Depression,
 mania, andmania, and
 bipolar disorderbipolar disorder

DepressionDepression
 is a frequent and serious complication thatis a frequent and serious complication that
follows heart attack, stroke, diabetes, andfollows heart attack, stroke, diabetes, and
cancer, but it is very treatable.cancer, but it is very treatable.
 Individuals with a history of major depressionIndividuals with a history of major depression
were four times as likely to suffer a heartwere four times as likely to suffer a heart
attack compared with people without such aattack compared with people without such a
history.history.
 Symptoms of depression may include feelingsSymptoms of depression may include feelings
of sadness, hopelessness, and worthlessness, asof sadness, hopelessness, and worthlessness, as
well as complaints of physical pain andwell as complaints of physical pain and
changes in appetite, sleep patterns, and energychanges in appetite, sleep patterns, and energy
level.level.

 ManiaMania
An individual experiences an abnormally
elevated mood, often marked by exaggerated
self-importance, irritability, agitation and a
decreased need for sleep.

Bipolar disorderBipolar disorder
also called manic-depressive illness, aalso called manic-depressive illness, a
person’s mood alternates between extremes ofperson’s mood alternates between extremes of
mania and depression. As many as 20% ofmania and depression. As many as 20% of
people with manic depressive illness die bypeople with manic depressive illness die by
suicide. Men and women are equally likely tosuicide. Men and women are equally likely to
develop manic- depressive illness.develop manic- depressive illness.

SCHIZONPHRENIASCHIZONPHRENIA
 symptoms like delusions and hallucinations,symptoms like delusions and hallucinations,
disorganized thinking and speech, bizarredisorganized thinking and speech, bizarre
behavior, a diminished range of emotionalbehavior, a diminished range of emotional
responsiveness, and social withdrawal.responsiveness, and social withdrawal.
 People are inability to function in one or morePeople are inability to function in one or more
important areas of life, such as social relations,important areas of life, such as social relations,
work or school.work or school.

PERSONALITY DISORDERSPERSONALITY DISORDERS
 Personality disorders are mental illnesses in whichPersonality disorders are mental illnesses in which
one’s personality results in personal distress or aone’s personality results in personal distress or a
significant impairment in social or work functioning.significant impairment in social or work functioning.
In general, people with personality disorders haveIn general, people with personality disorders have
poor perceptions of themselves or others. They maypoor perceptions of themselves or others. They may
have low self-esteem or overwhelming narcissism,have low self-esteem or overwhelming narcissism,
poor impulse control, troubled social relationships,poor impulse control, troubled social relationships,
and inappropriate emotional responses.and inappropriate emotional responses.

COGNITIVE DISORDERSCOGNITIVE DISORDERS
such as delirium and dementia, involve asuch as delirium and dementia, involve a
significant loss of mental functioning.significant loss of mental functioning.
Dementia, is characterized by impairedDementia, is characterized by impaired
memory and difficulties in functions such asmemory and difficulties in functions such as
speaking, abstract thinking, and the ability tospeaking, abstract thinking, and the ability to
identify familiar objects. The conditions in thisidentify familiar objects. The conditions in this
category usually result from a medicalcategory usually result from a medical
condition, substance abuse or adversecondition, substance abuse or adverse
reactions to medication or poisonousreactions to medication or poisonous
substances.substances.

DISSOCIATIVE DISORDERSDISSOCIATIVE DISORDERS
 It involve disturbances in a person’s consciousness,It involve disturbances in a person’s consciousness,
memories, identity, and perception of thememories, identity, and perception of the
environment. It include amnesia that has no physicalenvironment. It include amnesia that has no physical
cause.cause.
 Here person has two or more distinct personalitiesHere person has two or more distinct personalities
that alternate in their control of the person’s behavior.that alternate in their control of the person’s behavior.
 In some parts of the world, people experienceIn some parts of the world, people experience
dissociative states as possession by a god or ghostdissociative states as possession by a god or ghost
and are considered as normal parts of cultural andand are considered as normal parts of cultural and
religious practices and are not dissociative disorders.religious practices and are not dissociative disorders.

SOMATOFORM DISORDERSSOMATOFORM DISORDERS
 Characterized by the presence of physical symptomsCharacterized by the presence of physical symptoms
that cannot be explained by a medical condition orthat cannot be explained by a medical condition or
other mental illness. Physicians often conclude thatother mental illness. Physicians often conclude that
such symptoms result from psychological conflicts orsuch symptoms result from psychological conflicts or
distress.distress.
 In conversion disorder, also called hysteria, a personIn conversion disorder, also called hysteria, a person
may experience blindness, deafness or seizures, yet amay experience blindness, deafness or seizures, yet a
physician can find nothing wrong with the person.physician can find nothing wrong with the person.
 People with another somatoform disorder,People with another somatoform disorder,
hypochondriasis, constantly fear that they willhypochondriasis, constantly fear that they will
develop a serious disease and misinterpret minordevelop a serious disease and misinterpret minor
physical symptoms as evidence of illness.physical symptoms as evidence of illness.

FACTITIOUS DISORDERSFACTITIOUS DISORDERS
 Intentionally produce fake physical orIntentionally produce fake physical or
psychological symptoms in order to receivepsychological symptoms in order to receive
medical attention and care. For example, anmedical attention and care. For example, an
individual might falsely report shortness ofindividual might falsely report shortness of
breath to gain admittance to a hospital, reportbreath to gain admittance to a hospital, report
thoughts of suicide to solicit attention, orthoughts of suicide to solicit attention, or
fabricate blood in the urine or the symptoms offabricate blood in the urine or the symptoms of
rash so as to appear ill.rash so as to appear ill.

SUBSTANCE-RELATEDSUBSTANCE-RELATED
DISORDERSDISORDERS
 this result from the abuse of drugs, side effects ofthis result from the abuse of drugs, side effects of
medications, or exposure to toxic substances,medications, or exposure to toxic substances,
alcoholism and other forms of drug dependence .alcoholism and other forms of drug dependence .
 These disorders are regarded as behavioral orThese disorders are regarded as behavioral or
addictive disorders rather than as mental illnessesaddictive disorders rather than as mental illnesses
 Drug use can contribute to symptoms of other mentalDrug use can contribute to symptoms of other mental
disorders, such as depression, anxiety and psychosis.disorders, such as depression, anxiety and psychosis.
 Drugs associated with substance-related disordersDrugs associated with substance-related disorders
include alcohol, caffeine, nicotine cocaine, heroin,include alcohol, caffeine, nicotine cocaine, heroin,
amphetamines, hallucinogens, and sedatives.amphetamines, hallucinogens, and sedatives.

EATING DISORDERSEATING DISORDERS
 People with anorexia nervosa have an intensePeople with anorexia nervosa have an intense
fear of gaining weight and refuse to eatfear of gaining weight and refuse to eat
adequately to maintain a normal body weight.adequately to maintain a normal body weight.
 People with bulimia nervosa repeatedlyPeople with bulimia nervosa repeatedly
engage in episodes of binge eating, usuallyengage in episodes of binge eating, usually
followed by self induced vomiting or the usefollowed by self induced vomiting or the use
of laxatives, diuretics, or other medications toof laxatives, diuretics, or other medications to
prevent weight gain.prevent weight gain.
 Eating disorders occur mostly among youngEating disorders occur mostly among young
women in western societies and certain partswomen in western societies and certain parts
of Asia.of Asia. www.indiandentalacademy.com

IMPULSE CONTROL DISORDERSIMPULSE CONTROL DISORDERS
 People with impulse control disorders cannotPeople with impulse control disorders cannot
control an impulse to engage in harmfulcontrol an impulse to engage in harmful
behaviors such as explosive anger, stealing,behaviors such as explosive anger, stealing,
setting fires, gambling, or pulling out theirsetting fires, gambling, or pulling out their
own hair.own hair.

MAXILLOFACIAL DEFECTMAXILLOFACIAL DEFECT
 Acquired defectsAcquired defects
 Congenital defectsCongenital defects
 Developmental defects.Developmental defects.

 THE HEAD AND NECK CANCERTHE HEAD AND NECK CANCER
PATIENTPATIENT
Cancer is a potentially life threatening diseaseCancer is a potentially life threatening disease
with both physical and psychologicalwith both physical and psychological
component. Both components require carefulcomponent. Both components require careful
assessment and intervention if the patient’sassessment and intervention if the patient’s
recovery is to be maximized .recovery is to be maximized .

 CRISIS SET FOR THE HEAD AND NECKCRISIS SET FOR THE HEAD AND NECK
CANCER PATIENTCANCER PATIENT
1. illness1. illness
2. cancer as a illness2. cancer as a illness
-- fear of death and of dyingfear of death and of dying
-- Fear of stigma and ostracismFear of stigma and ostracism
-- Fear of punishmentFear of punishment;;
3. deformity with therapy.3. deformity with therapy.

MENTAL ATTITUDE OFMENTAL ATTITUDE OF
MAXILLOFACIAL CANCER PATIENTMAXILLOFACIAL CANCER PATIENT
 Physical trauma, body image and self-esteemPhysical trauma, body image and self-esteem
 Facial disfigurementFacial disfigurement
 Individual difference in patient responseIndividual difference in patient response
 Age and sexAge and sex
 Functional disabilitiesFunctional disabilities

CLINICAL REFERRALCLINICAL REFERRAL
 In practice, if at the examination level oneIn practice, if at the examination level one
recognizes a patient with underlyingrecognizes a patient with underlying
psychological conditions or confoundingpsychological conditions or confounding
emotional factors, it may be best to not treatemotional factors, it may be best to not treat
until these are addressed. If treatmentuntil these are addressed. If treatment
commences without the fundamental controlscommences without the fundamental controls
or sufficient rapport in place, the clinician isor sufficient rapport in place, the clinician is
likely to wonder in the middle of treatmentlikely to wonder in the middle of treatment
how things ever went awry and regret thathow things ever went awry and regret that
treatment ever began.treatment ever began.

 The practitioner would be well advised toThe practitioner would be well advised to
consult with a social worker, psychologist, orconsult with a social worker, psychologist, or
psychiatrist as a part of the treatment team topsychiatrist as a part of the treatment team to
aid in preparing a plan that will achieve theaid in preparing a plan that will achieve the
desired goal of the patient.desired goal of the patient.
 Without a complete assessment of the patientWithout a complete assessment of the patient
it is difficult to project the reaction that ait is difficult to project the reaction that a
patient might have to the surgical procedure orpatient might have to the surgical procedure or
the placement of prosthesis.the placement of prosthesis.

 Family supportFamily support
 Patient-centered treatment planningPatient-centered treatment planning
 Mental health servicesMental health services
- social workers- social workers
- psychologists- psychologists
- Psychiatrists- Psychiatrists

Patient support groupsPatient support groups
 About faceAbout face
 Support for people with oral and head and neckSupport for people with oral and head and neck
cancer, Inccancer, Inc
 Let’s face itLet’s face it

CONCLUSIONCONCLUSION
 The prosthodontist who can learn to actively listen toThe prosthodontist who can learn to actively listen to
patients, Proper communication with them, anpatients, Proper communication with them, an
understanding of their emotional status, feelings andunderstanding of their emotional status, feelings and
desires for the treatment plans, will aid in positivedesires for the treatment plans, will aid in positive
results in gaining their trust and confidence, thusresults in gaining their trust and confidence, thus
affects the patient’s ability to accept the prosthesisaffects the patient’s ability to accept the prosthesis
and the successful outcome of the treatment plan.and the successful outcome of the treatment plan.

BIBLIOGRAPHYBIBLIOGRAPHY
 Clinical maxillofacial prosthetics – Thomas D.Clinical maxillofacial prosthetics – Thomas D.
TaylorTaylor
 Maxillofacial rehabilitation – John Beumer.Maxillofacial rehabilitation – John Beumer.
 Maxillofacial Prosthetics – Varoujan A.ChalianMaxillofacial Prosthetics – Varoujan A.Chalian
 Daly B, Watt R, Batchelor P and Treasure E.Daly B, Watt R, Batchelor P and Treasure E.
Overview of behavior change, Textbook ofOverview of behavior change, Textbook of
essential Dental Public Health [Oxford], 1st EDessential Dental Public Health [Oxford], 1st ED
2003:2003:
 Mc Goldrick PM. Principles of Health BehaviorMc Goldrick PM. Principles of Health Behavior
and health education, Text book of Communityand health education, Text book of Community
Oral Health [ Author: Cynthia M Pine. WrightOral Health [ Author: Cynthia M Pine. Wright
publications] 5th Ed 1997:publications] 5th Ed 1997:

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