The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
2. ► Introduction.
► Theories
of psychology & Behavioral
development.
► Psychological
status of patients .
► Psychological
management.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
5. ►
Psychologic Development.
Linked to the growth of the brain (cognitive areas)
► Influenced by genetic factor which is modified by
the environment.
www.indiandentalacademy.com
6. Theories of Psychology & Behavioural
development.
► Behaviour
is a result of interaction between
innate & behaviour learned after birth.
www.indiandentalacademy.com
7. Learning of Behaviour.
► Behavioural
responses can be learned by
three mechanisms:-Classical conditioning.
-Operant conditioning
-Observational learning.
www.indiandentalacademy.com
8. Classical conditioning:described by Ivan Pavlov during his
studies on reflexes.
► First
► “Learning
by Association”.
www.indiandentalacademy.com
10. Reinforcement
Every time they occur, the association between a
conditioned and unconditioned stimulus is strengthened.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
12. 3.
Four basic types of operant conditioning:Positive reinforcement.
Negative reinforcement.
Omission or Time out.
4.
Punishment.
►
1.
2.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
14. ► Omission
:- Involves removal of a pleasant
stimulus after a particular response.
► Punishment:-occurs
when an unpleasant stimulus
is presented after a response.
www.indiandentalacademy.com
15. Four basic types of operant conditioning.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
17. •A child acquires a behaviour by first observing it &
then actually performing it.
•Important tool in the management of dental treatment.
www.indiandentalacademy.com
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).
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
22. Stages of Emotional development.
►
Emotional development generally pass through
discrete stages.
►
Emotional Development:-
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
28. ►
4 stages of cognitive development:-Sensorimotor period.
-Preoperational period.
-Period of concrete operations.
-Period of formal operation.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
36. ► Improved
oral hygiene can decrease damage to
the periodontal tissues and limit the effects of
enamel decalcification and caries
-Nanda & Sinha
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
40. According to Dr.Barton
► Lack of love and affection
► Habit is evidence of a feeling of personal
inadequacy, frustration & insecurity.
► Improper nursing .
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
42. Psychosocial implications of facial deformities
H. Asuman Kiyak
Rebecca Bell
►
Meanings of the Face
►
Psychosocial characteristics of patients with facial
deformities
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
49. Patients before surgery
►
►
►
►
►
Motives for treatment
A scale to assess patient’s motives
Self-perceptions of facial profile
Sex differences
Orthognathic-surgery patients
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
Know of someone else’s surgery
0
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
63. Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com