1. BEHAVIOURAL SCIENCE & PATIENT MOTIVATION GUIDED BY : DR.PREETI DHAWAN(READER) DEPT. OF PREVENTIVE & PEDIATRIC DENTISTRY DR.RAVNEET ARORA(SENIOR LECTURER) DEPT OF ORAL MEDICINE & RADIOLOGYBY : ADITI SINGH (P.G I YEAR) DEPT.OF PREVENTIVE & PEDIATRIC DENTISTRY

2. THE KHANDAAN.. 3. CONTENTS Introduction Behaviour theories The child patient The adolescent patie nt The adult patient The geriatric patient Gods people Patient motivation Conclusion Bibliography 4. BEHAVIOR It is defined as any change observed in the functioning of an organism. 5. BEHAVIORAL SCIENCE It is the science which deals with the observation of behavioral habits of man and lower animals in various physical and social environment. 6. Behavioral dentistry is an interdisciplinary science which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care delivery system. 7. BEHAVIOR DEVELOPMENT Behavior development is dynamic process, which begins at birth and proceed in ascending order through a series of sequential stages. The development of behavior initiates at childhood and persist forever. 8. BEHAVIORAL THEORIES CLASSICAL CONDITIONING OPERANT CONDITIONING SOCIAL LEARNING THEORY HIERARCHY OF NEEDS 9. CLASSICAL CONDITIONING PAVLOV(1927) The conditioning is the relation between the conditioned stimulus and the unconditioned stimulus. 10. OPERANT CONDITIONING SKINNER (1938) Individual response is changed as a result of reinforcement or extinction of previous responses. The consequence of behaviour itself acts as a stimulus and affects future behaviour. 11. SOCIAL LEARNING THEORY Albert Bandura, "Social learning theory approaches the explanation of human behavior in terms of a continuous reciprocal interaction between cognitive, behavioral, and environmental determinants" (Social Learning Theory, 1977). 12. THE CHILD PATIENT 13. CLASSIFICATION OF CHILDS BEHAVIOUR FRANKELS CLASSIFICATION (1962)RATINGBEHAVIOURDefinitely negativeRefuses treatment, negative behaviour associated with fear.NegativeReluctant to accept treatment, displays evidence of slight negativism.PositiveAccepts treatment, but if the child has a bad experience during treatment, may become uncooperative.Definitely positiveUnique behaviour, looks forward to and understands the importance of good preventive care. 14. FACTORS WHICH AFFECT CHILDS BEHAVIOR IN DENTAL OFFICE 15. UNDER THE CONTROL OF THE DENTIST A) Dental Clinic B) Effect of dentists activity and attitudes C) Effect of dentists attire D) Presence or absence of parents in the operatory E) Presence of an older sibling 16. OUT OF CONTROL OF THE DENTIST Growth & Development Nutritional factors Past medical and dental experiences School environment Socio-economic status 17. UNDER THE CONTROL OF PARENTS 1) Home environment 2) Family development and peer influences 3) Maternal Behavior 18. BEHAVIOR MANAGEMENT Behavior management : is defined as the means by which the dental health team effectively and efficiently performs dental treatment and thereby instills a positive dental attitude. (Wright 1975) Behavior shaping: is the procedure which slowly develops behavior by reinforcing a successive approximation of the desired behavior until the desired behavior comes into being. 19. THE CLASSIFICATION.. Non pharmacological (Psychological approach) Pharmacological 20. Non-pharmacological methods 1.Communication2. Behaviour shaping ( modification) a) Desensitization b) Modelling c) Contingency management 3.Behaviour management 21. COMMUNICATIVE MANAGEMENT TYPES OF COMMUNICATION: a) Verbal communication is by speech b) Nonverbal (multisensory communication) c) Both using verbal and non-verbal 22. HOW TO COMMUNICATE? Compliment him about his appearance. Communication should be from a single source. USE OF EUPHEMISMS: Euphemisms are substitute words,which can be used in the presence of children 23. Dental Nomenclature Euphemisms 24. DESENSITISATION Tell show do technique (TSD): Addleston 1959. This is effective in children more than 3 years of age. 25. MODELLING Introduced by Bandura(1969) It developed from socio-learning principle procedure 26. CONTINGENCY MANAGEMENT It is a method of modifying the behavior of children by presentation or withdrawal of reinforcers. These reinforcers can be : a) Positive reinforcer b) Negative reinforcer 27. BEHAVIOR MANAGEMENT 28. Aversive conditioning : It is used for definitive negative behaviour child. Two common methods used in the clinical practice are HOME and physical restraints: 29. HOME HOME (Hand over Mouth exercise) Introduced by Evangeline Jordan 1920. 30. b) Physical restraints (Kelly 1976). - Active- Passive 31. THE ADOLESCENT 32. THE ADOLESCENT Adolescents young people between the ages of 10 and 19 years are often thought of as a healthy group( WHO 2012) 33. THE MANAGEMENT.. Is insecure and unable to cope with many Be kind and understanding situations Have varied interestDetermine what these are and encourage discussion on these issues.considerable rapport can be gained through discussion when handle properlyTend to reject adult authorityResponsive to empathetic guidance. Be firm but kind; display authority in clinical matters,but do not be authoritarianPreoccupied with health matters in general and appearance in particular.Use these concerns as mechanism for motivating the type of behavior conducive to enhancing rapport and improving oral health 34. Often regress to childlike behavior in clinic.this age group is particularly sensitive to being treated as a child. Be extremely careful not to cause the patient obvious embarrassment.Tend to worry about many circumstances; conditions in home, parent, school, social injustice, peer relationshipClinician should encourage conversation to develop a better rapport.Nutritional factorsClinician should motivate patient toward adequate nutritional intake and proper dietary practice from perspectives of obesity and oral health. 35. THE ADULT PATIENT 36. DENTAL PATIENTS FEARS Fear from pain & treatment procedure Fear from unknown Fear from past dental history Fear from the financial cost Fear from treatment outcomes 37. HEALTH BELIEF MODEL 38. WHO IS BETTER??? DURYODHAN ARJUN 39. THE VICIOUS CIRCLE.. 40. CHAIRSIDE TECHNIQUES FOR BEHAVIOUR CHANGE NON RELAXATION BASED TECHNIQUES COMMUNICATION LISTENING DISTRACTION QUASI RELAXATION BASED TECHNIQUES GUIDED IMAGERY RELAXATION BASED TECHNIQUES COGNITIVE COMPONENT SOMATIC COMPONENT 41. COMMUNICATION FOR HEALTH BEHAVIOUR CHANGE Patient Clinician Relationship FIRST IMPRESSION IS THE LAST IMPRESSION 42. VERBAL EXCHANGE Styles of communication(Rollnick et al 2007): 1.Directing(most common) 2.Following 3.Guiding (OARS) 43. OARS 44. THE ART OF LISTENING Apparently the act of attending carefully to another person is a difficult task for most people. Carl Rogers 45. HOW TO LISTEN have a calm manner say reassuring things take seriously what the patient has to say tell the patient what is to be done encourage the patient to ask questions 46. An inability to listen will be judged harshly. Stanley Weiss 47. NON VERBAL EXHANGE EYE CONTACT FACIAL EXPRESSIONS 48. VOCAL CHARACTERISTICS BODY LANGUAGE 49. DISTRACTION PHYSICALPSYCHOLOGICAL 50. QUASI RELAXATION TECHNIQUES Helen Lindquist Bonny (1921 May 25, 2010) Music therapist Kenneth Bruscia defined Guided Imagery and Music as All forms of music-imaging in an expanded state of consciousness, including not only the specific individual and group forms that Bonny developed, but also all variations and modifications in those forms created by her followers." 51. TO SUM IT ALL UP 52. THE GERIATRIC PATIENT 53. What happens in themouth is often a reflection of what happens in the body. Oral Health as been linked to diabetes, heart disease, stroke, and pneumonia.5 9 Research also linksPeriodontal disease, a chronic inflammatory disease to cardiovascular disease, diabetes, Alzheimer's and other diseases (Journal of Periodontology Aug 2008 Supplemental Issue) 54. GERIATRIC PSYCHOLOGY (MM HOUSE) PHILOSOPHICAL : well motivated realizes his part in the success of the treatment. Cooperative and adjustable. They are rational, sensible, calm and composed even in difficult situations. 55. EXACTING (critical): Methodical and precise He likes each step of the procedure explained in detail. Proposes alternative treatment MANAGEMENT: Extra care, efforts and especially patience is required. The physician must listen to there demands but not give in, especially if they are unresonable. 56. INDIFFERENT PATIENT Lacks motivation Usually not interested in treatment Tries to find faults in the treatment Tend not to cooperate or follow instruction MANAGEMENT: Difficult to manage An attempt is made to educate the patient and improve his interest 57. HYSTERICAL PATIENT Easily excited Highly apprehensive Rarely cooperate with the treatment Tend to have unfounded complaints and unrealistic expectation. MANAGEMENT: require lot of time and effort. Often medical consultation or professional help is required. 58. SKEPTICAL PATIENT Had bad result with previous treatment Doubtful if their problem can be solved psychological disturbance from some recent personal tragedy. MANAGEMENT Genuine kindness, care and sympathy should be offered. More time and attention to detail should be given. These patient can be made into excellent patient if handle properly. 59. M M HOUSE REVISITED 60. HEARTWELL THE REALIST. Philosophical + Exacting type Follow instructions properly Maintain a good oral hygiene Seek dental care Take good diet 61. THE RESENTERS Indifferent + Hysterical type Second childhood stage.. Will NOT listen to instructions properly Negligent in oral care Rarely seek dental care MANAGEMENT : Palliative treatment 62. THE RESIGNED Variable emotional & systemic status Passive submission MANAGEMENT : Definitive or palliative 63. MANAGEMENT OF ANXIOUS GERIATRIC PATIENT 64. STATUSPREOPERATIVEMANAGEMENTORAL SEDATIONBEHAVIORAL1. ANSWERING PATIENTS QUESTIONS 2. REASSURANCEPHARMACOLOGICALEFFECTIVE LOCAL ANESTHESIA ORAL SEDATIONBEHAVIOURALINSTRUCTION TO PATIENT DESCRIPTION OF COMPLICATIONSPHARMACOLOGICALPOSTOPERATIVE1. EFFECTIVE COMMUNICATION 2. MAKE THE PATIENT RELAX 3. EXPLAIN THE PROCEDUREPHARMACOLOGICAL OPERATIVEBEHAVIORALANALGESICS, ADJUNCTIVE MEDICATIONSZwetchkenbaum S et al Prosthodontic considerations for older patient. The Dental clinics of North America 1997;41:817-46 65. THE 5As Assess Advise. Agree Assist Arrange Follow up 66. Before meeting the mouth of the patient, we must meet the mind of the patient- DeVan The Golden Handshake.. The Schizophrenic patient Patient having Alzheimers disease 67. A WORD OF CAUTION EXTREMELY STRESSED OUT PATIENTS SATISFIED WEARER OF OLD DENTURES GERIATRIC PATIENTS WHO DO NOT WANT DENTURESTHE GERIATRIC PROSTHODONTIC PATIENT 68. Prefer short morning appointments Avoid exagerrated treatment options Consider partial transitional denture , over dentures etc. 69. GODS PEOPLE 70. They form one of the more neglected population as far as oral health care is concerned They need special considerations & strategies beyond those required for other people 71. THE HINDRANCES INFORMATION OBSTACLE PHYSICAL OBSTACLE BEHAVIORAL OBSTACLE ORGANIZATIONAL OBSTACLE 72. PYRAMID TRAINING MODULE.. 73. MODIFIED ARMAMENTARIUM MODIFIED TOOTH BRUSH TONGUE BLADE MOUTH PROP 74. BEHAVIOR SUPPORT STRUCTURING THE ENVIRONMENT INVOLVING THE INDIVIDUAL EDUCATING THE CAREGIVER 75. PATIENT MOTIVATION 76. MOTIVATIONAL INTERVIEWING a client- centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Rollnick and Miller 1995 ) 77. STRATEGY PRINCIPLE SPIRIT 78. IN THE DENTAL OPERATORY.. AIM IS TO (1) assess motives,(2) raise awareness, (3) support a change. 79. Modus operandi.. Health history form (objective) Open ended questions 80. Raise awareness Vs Giving information 81. Support a change Encouraging patient problem solving offering a set of strategies or options planning steps for the change. 82. THE CHANGE TALK.. ELLICIT PROVIDE ELLICIT ROLL WITH RESISTANCE A BRIEF INTERVENTION 83. OUTSIDE THE DENTAL OFFICE DENTAL HEALTH CAMPS 1. COMMUNITY LEVEL HEALTH PROGRAMMES 2.SCHOOL ORAL HEALTH PROGRAMMES 3.HEALTH AWARENESS CAMPAIGNS 84. COMMUNITY DENTAL HEALTH CAMPS 85. THE SATELLITE CLINIC 86. COMMUNITY DENTAL CAMPS 87. SCHOOL DENTAL HEALTH CAMPS 88. HEALTH AWARENESS CAMPS 89. FINALLY 90. REFERENCES Ralphe E McDonald ,Avery R D, Dean J A ;Dentistry for the child and Adolescent;8Ed Mosby;2004 Mostofsky I D, Fortune Farida; Behavioral Dentistry;2Ed;Wiley BlackWell;2012 Glanz K, Rimer B, Vishwanath K;Health Behavior & Health Education Theory, Research & Practice;4Ed;Jossey-Bass;2008 Ramseier C, Suvan J;Health Behavioral Change in Dental Practice; 1Ed;Wiley-Blackwell;2010 Tandon ShobhaTextbook of Pedodntics;2Ed Paras Medical;2009 Ernest R. Hilgard ;Introduction to psychology; 6Ed;Mosby Charles M heartwell ;Syllabus of complete dentures Module 4. Behaviour Modification ;UNESCO ;February 2000 91. 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