Child Psychology Theories for Orthodontic Treatment Compliance

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CONTENTSCONTENTS
 IntroductionIntroduction
 Psychosexual theory- Sigmond FreudPsychosexual theory- Sigmond Freud
 Psychosocial theory- Erik. H. EriksonPsychosocial theory- Erik. H. Erikson
 Cognitive approach theory- Jean PiagetCognitive approach theory- Jean Piaget
 Emotional development.Emotional development.
 Behavior assessment; Development; ManagementBehavior assessment; Development; Management
 Psychological status- Orthodontic patientsPsychological status- Orthodontic patients
 Behavior modificationBehavior modification
 Creating a compliant patientCreating a compliant patient
 Motivational system for orthodontist & patientMotivational system for orthodontist & patient
 Clinical motivation of functional jaw orthopedic patientsClinical motivation of functional jaw orthopedic patients
 ConclusionConclusion
 ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com

IntroductionIntroduction
 The key to successful orthodontic treatment is aThe key to successful orthodontic treatment is a
cooperative patient. To achieve this prerequisite it iscooperative patient. To achieve this prerequisite it is
of utmost importance to discover the actions thatof utmost importance to discover the actions that
will produce the most positive response from thewill produce the most positive response from the
patient.patient.
 To determine a child’s behavior in dental office andTo determine a child’s behavior in dental office and
the factors influencing it we must study a child’sthe factors influencing it we must study a child’s
mental and emotional make up that constitute themental and emotional make up that constitute the
“psychology” of that child.“psychology” of that child.
 Psychology development is a dynamic process,Psychology development is a dynamic process,
which begins at birth and proceeds in an ascendingwhich begins at birth and proceeds in an ascending
order through a series of sequential stagesorder through a series of sequential stages
manifesting into various characteristic behaviors.manifesting into various characteristic behaviors.www.indiandentalacademy.comwww.indiandentalacademy.com

PsychologyPsychology
Psycho – meaning mind, soul, selfPsycho – meaning mind, soul, self
Logas – meaning study.Logas – meaning study.
Thus psychology is the study of self, as itThus psychology is the study of self, as it
manifests itself in action and behavior.manifests itself in action and behavior.
It is the science dealing with human nature,It is the science dealing with human nature,
function, and phenomenon of his soul in thefunction, and phenomenon of his soul in the
main.main.
Child PsychologyChild Psychology
It is the science that deals with the mentalIt is the science that deals with the mental
power or an interaction between thepower or an interaction between the
conscious and subconscious element in aconscious and subconscious element in a
child.child. www.indiandentalacademy.comwww.indiandentalacademy.com

Importance of child psychologyImportance of child psychology
 To understand the child betterTo understand the child better
 To know the problem of psychological originTo know the problem of psychological origin
 To deliver dental services in a meaningful & effectiveTo deliver dental services in a meaningful & effective
mannermanner
 To establish effective communication with the child &To establish effective communication with the child &
the parentthe parent
 To teach child & the parents importance of primary &To teach child & the parents importance of primary &
preventive carepreventive care
 To have better treatment planning & interaction withTo have better treatment planning & interaction with
other disciplineother discipline
 To produce a comfortable environment for the dentalTo produce a comfortable environment for the dental
team to work on the patientteam to work on the patient

Theories Of Child PsychologyTheories Of Child Psychology
I. Psychodynamic theoriesI. Psychodynamic theories
 Psychosexual theory –Sigmond Freud (1905)Psychosexual theory –Sigmond Freud (1905)
 Psychosocial theory – Erik Erickson (1963)Psychosocial theory – Erik Erickson (1963)
 Cognitive theory – Jean Piaget (1952)Cognitive theory – Jean Piaget (1952)
II. Behavioral theoriesII. Behavioral theories
 Hierarchy of needs – Masler (1954)Hierarchy of needs – Masler (1954)
 Social learning theory – Bandura (1963)Social learning theory – Bandura (1963)
 Classical conditioning – Pavlov (1927)Classical conditioning – Pavlov (1927)
 Operant conditioning – Skinner (1938)Operant conditioning – Skinner (1938)

Psychosexual Theory by Sigmond FreudPsychosexual Theory by Sigmond Freud
in 1905in 1905
May 6, 1856 to September 23, 1939www.indiandentalacademy.comwww.indiandentalacademy.com

 Man’s behavior is determined by innate instincts thatMan’s behavior is determined by innate instincts that
are largely unconscious .i.e. thoughts, fears, andare largely unconscious .i.e. thoughts, fears, and
wishes of which person is unaware but whichwishes of which person is unaware but which
influences his behavior.influences his behavior.
 These unconscious impulses find expression inThese unconscious impulses find expression in
dreams, slips of speech, mannerism, and symptoms ofdreams, slips of speech, mannerism, and symptoms of
neurotic impulses.neurotic impulses.
 Freud believed that all of man’s action has a cause,Freud believed that all of man’s action has a cause,
but the cause has often some unconscious motivebut the cause has often some unconscious motive
rather than any rational reason.rather than any rational reason.

 The structure proposed by Freud in PsychodynamicThe structure proposed by Freud in Psychodynamic
theory is composed of three parts:theory is composed of three parts:
 IdId – represents the primitive biologic impulses. These– represents the primitive biologic impulses. These
are instinctual blind drives to seek immediateare instinctual blind drives to seek immediate
gratification. (pleasure principle)gratification. (pleasure principle)
 EgoEgo – as a sort of mediator between ID-with its blind– as a sort of mediator between ID-with its blind
demands for instant gratification and superego-with itsdemands for instant gratification and superego-with its
rigid, often irrational rules, prohibition ideals. (realityrigid, often irrational rules, prohibition ideals. (reality
principle)principle)
 SuperegoSuperego – conceptualized as an observer and– conceptualized as an observer and
evaluator of ego, functioning comparing ego with idealevaluator of ego, functioning comparing ego with ideal
standard derived from ideal behavior perceived overstandard derived from ideal behavior perceived over
time in parents and teachers.time in parents and teachers.

 He used notion of unconscious processes to explainHe used notion of unconscious processes to explain
why people act in irrational way. He proposed 3why people act in irrational way. He proposed 3
levels of consciousness: -levels of consciousness: -
 The conscious level: at which we are aware of certainThe conscious level: at which we are aware of certain
things around us and of certain thoughts.things around us and of certain thoughts.
 The preconscious level: at this level are memories ofThe preconscious level: at this level are memories of
certain things around us and of certain thoughts.certain things around us and of certain thoughts.
 The unconscious level: contains memories, thoughtsThe unconscious level: contains memories, thoughts
and motives which cannot be easily recalled.and motives which cannot be easily recalled.

 He also suggested 5 phases of development based onHe also suggested 5 phases of development based on
theory of energy or drives which he called LIBIDO.theory of energy or drives which he called LIBIDO.
They are:They are:
 Oral PhaseOral Phase (new born child - 1 year)(new born child - 1 year)
Child’s satisfaction and stimulation is through mouthChild’s satisfaction and stimulation is through mouth
which is the organ of desire. Swallowing, suckingwhich is the organ of desire. Swallowing, sucking
gives pleasure.gives pleasure.
 Anal PhaseAnal Phase ( 2 years)( 2 years)
Child obtains pleasure from retention and elimination.Child obtains pleasure from retention and elimination.
He has limits on his gratification but may becomeHe has limits on his gratification but may become
stingy and compulsive.stingy and compulsive.
 Phallic StagePhallic Stage (3-5 years)(3-5 years)
Child explores, expenses his genital organs asChild explores, expenses his genital organs as
pleasurable. Attraction for opposite sex parent andpleasurable. Attraction for opposite sex parent and
jealousy for same sex parent.jealousy for same sex parent.

Oedipus complexOedipus complex
 Young boys have a natural tendency to be attachedYoung boys have a natural tendency to be attached
to the mother & they consider their father as theirto the mother & they consider their father as their
enemy. Hence they strive to imitate their father toenemy. Hence they strive to imitate their father to
gain affection of the mothergain affection of the mother
 Greek mythology: Oedepus the King of Thebe, slewGreek mythology: Oedepus the King of Thebe, slew
his father & married his mother.his father & married his mother.
Electra complexElectra complex
 Similarly young girls develop an attraction towardsSimilarly young girls develop an attraction towards
their father & they resent the mother being close totheir father & they resent the mother being close to
father.father.
 Greek mythology: Electra helped her brother slay theGreek mythology: Electra helped her brother slay the
lover of their father Agemennou, to win her father’slover of their father Agemennou, to win her father’s
love.love.

 Latency StageLatency Stage (6– 10 years)(6– 10 years)
Child develops interests outside home and makesChild develops interests outside home and makes
friends, learns to share thoughts.friends, learns to share thoughts.
 Genital StageGenital Stage (11 – 13 years)(11 – 13 years)
Sexual impulses are increased. Boys/girls shy fromSexual impulses are increased. Boys/girls shy from
each other. Peer pressure increases.each other. Peer pressure increases.

Psychosocial theory by ErikPsychosocial theory by Erik
Erikson in 1963Erikson in 1963
 Erik Homburger Erikson was born in 1902 on June 15Erik Homburger Erikson was born in 1902 on June 15
in Frankfurt, Germany.in Frankfurt, Germany.
 His book “Childhood and Society” was published inHis book “Childhood and Society” was published in
1950.1950.
 In this publication he presented a psychosocialIn this publication he presented a psychosocial
theory.theory.
 His theory covers the entire span of the life cycle,His theory covers the entire span of the life cycle,
from infancy and childhood through old age andfrom infancy and childhood through old age and
senescence.senescence.

Each stage is marked by one or more internalEach stage is marked by one or more internal
crisis. When a crisis is mastered successfully,crisis. When a crisis is mastered successfully,
people gain strength and move on to next stage.people gain strength and move on to next stage.
This stage are not fixed in time development isThis stage are not fixed in time development is
continuous.continuous.

Both these girls are seven years old. The one on the left is normal, whereas the one on the right had
extreme emotional neglect from a mother who rejected her. The effect on physical growth in this
“maternal deprivation syndrome” is obvious, fortunately this condition is rare. The emotional
response probably affects physical growth by altering hormone production, but the mechanism is
not fully understood. www.indiandentalacademy.comwww.indiandentalacademy.com

During the period in which children are developing autonomy, conflicts with
siblings, peers and parents can seem never ending. Consistently enforced limits on
behavior during this stage (terrible two’s) are needed to allow the child to develop
trust in a predictable environment.www.indiandentalacademy.comwww.indiandentalacademy.com

Stage – 3Stage – 3
Initiative Vs guilt (3-5 years)Initiative Vs guilt (3-5 years)
 At these ages children are able to initiate both motorAt these ages children are able to initiate both motor
and intellectual activities.and intellectual activities.
 By playing with peers they learn to interact withBy playing with peers they learn to interact with
others.others.
 They learn that aggressive impulses can beThey learn that aggressive impulses can be
experienced in constructive ways such as healthyexperienced in constructive ways such as healthy
competition playing games and using toys.competition playing games and using toys.
 If toddlers are made to feel inadequate about theirIf toddlers are made to feel inadequate about their
interests they may emerge from this period with theirinterests they may emerge from this period with their
sense of ambition which develops during this stage.sense of ambition which develops during this stage.

Stage - 4Stage - 4
Industry Vs inferiority (6-11 yrs)Industry Vs inferiority (6-11 yrs)
 This stage is the school age period during whichThis stage is the school age period during which
children begin to participate in an organizedchildren begin to participate in an organized
program of learning.program of learning.
 Industry, the ability to work and acquire adult skillsIndustry, the ability to work and acquire adult skills
 Productive children learn the pleasure of workProductive children learn the pleasure of work
completion and the pride of doing something well.completion and the pride of doing something well.
 The potential negative outcome of this stage resultsThe potential negative outcome of this stage results
fromfrom
 Discrimination at schoolDiscrimination at school
 Children may be told they are inferior.Children may be told they are inferior.
 They may be over protected at home.They may be over protected at home.

Instructions for young child who will be wearing a
removable orthodontic appliance should be explicit
and complete. Children at this stage cannot be
motivated by abstract concepts but are influenced by
improved acceptance from the peer group.

Identity Vs role confusion (9- 18 years)Identity Vs role confusion (9- 18 years)
Developing a sense of identity is the main taskDeveloping a sense of identity is the main task
of this period, which coincides with puberty andof this period, which coincides with puberty and
adolescence.adolescence.
Identity is described as the characteristics thatIdentity is described as the characteristics that
establish who people are and where they areestablish who people are and where they are
going.going.
Healthy identity is built on success in passingHealthy identity is built on success in passing
through earlier stages.through earlier stages.

Adolescence is an extremely complex stage because of many new opportunities and
challenges thrust upon the teenager (emerging sexuality, academic pressures, earning
money, increased mobility, career aspirations and recreational interests combined to produce
stress and rewards www.indiandentalacademy.comwww.indiandentalacademy.com

Intimacy Vs self absorption or isolationIntimacy Vs self absorption or isolation
(18 to 40 years)(18 to 40 years)
 This period extends from late adolescent throughThis period extends from late adolescent through
early middle age.early middle age.
 The intimacy of relations, friendship and other deepThe intimacy of relations, friendship and other deep
associations are not frightening to people withassociations are not frightening to people with
resolved identity crisis.resolved identity crisis.
 In contrast people who reach the adult years in aIn contrast people who reach the adult years in a
stage of continued role confusion cannot becomestage of continued role confusion cannot become
involved in intense and long term relationships.involved in intense and long term relationships.
 Without a friend or a partner, a person may becomeWithout a friend or a partner, a person may become
self absorbed and self-indulgent. As a result a senseself absorbed and self-indulgent. As a result a sense
of isolation may grow.of isolation may grow.www.indiandentalacademy.comwww.indiandentalacademy.com

Generativity Vs stagnation (40 to 65Generativity Vs stagnation (40 to 65
Years)Years)
 Generatively not only concerns a person’s having orGeneratively not only concerns a person’s having or
raising children, but also includes vital interestraising children, but also includes vital interest
outside the home in establishing the guiding, theoutside the home in establishing the guiding, the
oncoming generation or in improving society.oncoming generation or in improving society.
 Stagnation is a barren state. The inability toStagnation is a barren state. The inability to
transcend the lack of creativity is dangerous becausetranscend the lack of creativity is dangerous because
people are unable to accept the eventuality of notpeople are unable to accept the eventuality of not
being and the idea that death is inescapably a part ofbeing and the idea that death is inescapably a part of
life.life.

Integrity Vs despair and isolation (overIntegrity Vs despair and isolation (over
65 years) maturity65 years) maturity
This stage is described as the conflictThis stage is described as the conflict
between the integrity (the sense of satisfactionbetween the integrity (the sense of satisfaction
that a person feels in reflecting on a lifethat a person feels in reflecting on a life
productively lived) and despairs (the senseproductively lived) and despairs (the sense
that life has little purpose/meaning)that life has little purpose/meaning)
Integrity allows people to accept their place inIntegrity allows people to accept their place in
life cycle and to realize that life is eachlife cycle and to realize that life is each
persons responsibility.persons responsibility.

Cognitive Development - Jean Piaget inCognitive Development - Jean Piaget in
19521952
Jean Piaget (1896 – 1980)

 Piaget formulated his theory on how children &Piaget formulated his theory on how children &
adolescents think & acquire knowledge.adolescents think & acquire knowledge.
 According to him the environment does not shapeAccording to him the environment does not shape
child’s behaviour but the child & adult actively seekchild’s behaviour but the child & adult actively seek
to understand the environmentto understand the environment
 This process of adaptation is made up of 3 variants-This process of adaptation is made up of 3 variants-
 Assimilation- observing, recognizing, relating it withAssimilation- observing, recognizing, relating it with
earlier experience or categoriesearlier experience or categories
 Accommodation- changing concepts & strategiesAccommodation- changing concepts & strategies
 Equilibration- changing basic assumptions followingEquilibration- changing basic assumptions following
assimilated knowledge so that the facts fit betterassimilated knowledge so that the facts fit betterwww.indiandentalacademy.comwww.indiandentalacademy.com

•Beginning of thinking
•Development of
elementary schemes
•Changing
strategies
•Symbols
•Playing
•Classify things
•Logical thinking
•Mental operations
•Others point view
Abstract thinking
Vast imagination
Decisions
Solve problems

Hierarchy of needs by Massler inHierarchy of needs by Massler in
19541954
 Self actualization theory – the need to understand the totality ofSelf actualization theory – the need to understand the totality of
a persona person
 Needs are arranged in hierarchyNeeds are arranged in hierarchy
 As one general type is satisfied another higher order willAs one general type is satisfied another higher order will
emergeemerge
Self
actualization
Security
Social
Psychology of needs
Esteem

Social learning theory by Bandura in 1963Social learning theory by Bandura in 1963
 The learning of behavior is affected by 4The learning of behavior is affected by 4
principle elements-principle elements-
1. Antecedent determinants1. Antecedent determinants
2. Consequent determinants2. Consequent determinants
3. Modeling3. Modeling
4. Self regulation4. Self regulation

EmotionEmotion
 Emotion is a state of mental excitement characterizedEmotion is a state of mental excitement characterized
by physiological, behavioral changes & alterations ofby physiological, behavioral changes & alterations of
feelingsfeelings
 Subjective feelingSubjective feeling
 Bodily stateBodily state
 Expression of emotion by language gesture or facialExpression of emotion by language gesture or facial
expressions.expressions.
 So it is many things at once. Most emotions can beSo it is many things at once. Most emotions can be
divided in to those are:divided in to those are:
 Pleasant (joy, love)Pleasant (joy, love)
 Unpleasant (Anger, fear)Unpleasant (Anger, fear)www.indiandentalacademy.comwww.indiandentalacademy.com

AngerAnger
Outburst of emotion is caused by the child’sOutburst of emotion is caused by the child’s
lack of skill in handling the situation.lack of skill in handling the situation.
Infants & children respond in anger in a directInfants & children respond in anger in a direct
& primitive manner but as they develop the& primitive manner but as they develop the
responses become violent & more symbolic.responses become violent & more symbolic.

FearFear
 Fear is an emotion occurring in situations of stressFear is an emotion occurring in situations of stress
and uncertainty where in the person experiencingand uncertainty where in the person experiencing
sees himself as being threatened or helpless andsees himself as being threatened or helpless and
whose reaction is to resist or free the situation out ofwhose reaction is to resist or free the situation out of
an anticipation of pain, distress or destruction.an anticipation of pain, distress or destruction.
 Types of FearTypes of Fear
 Objective Fears:Objective Fears: are those fears produced by directare those fears produced by direct
physical stimulation of sense organs. Objective fearsphysical stimulation of sense organs. Objective fears
respond to stimuli that are felt, seen or tasted.respond to stimuli that are felt, seen or tasted.
 Subjective Fears:Subjective Fears: based on feeling and attitudesbased on feeling and attitudes
that have been suggested to the child by other aboutthat have been suggested to the child by other about
him without the child’s having experience personally.him without the child’s having experience personally.

 Suggestive Fears:Suggestive Fears: may be acquired by imitationmay be acquired by imitation
and child observing fear in other may soon acquire aand child observing fear in other may soon acquire a
fear for the same object. If the parent is sad child feelsfear for the same object. If the parent is sad child feels
sad. If the parent displays fear, the child is fearfulsad. If the parent displays fear, the child is fearful
 Imitative Fears:Imitative Fears: Imitative fears may be transmittedImitative fears may be transmitted
subtly and may be displayed by parent and acquiredsubtly and may be displayed by parent and acquired
by child without either being aware of it.by child without either being aware of it.
 Irrational Fears:Irrational Fears: The child does not know why he isThe child does not know why he is
frightened. Memories of past experience may fadefrightened. Memories of past experience may fade
entirely from his consciousness, but emotionentirely from his consciousness, but emotion
associated with the forgotten experience determinesassociated with the forgotten experience determines
to a large measureto a large measure

Fear of SeparationFear of Separation
 If a child is thrust into a new situation when he isIf a child is thrust into a new situation when he is
separated from his parents whom he has learned toseparated from his parents whom he has learned to
depend upon for security, he has a fear of beingdepend upon for security, he has a fear of being
abandoned.abandoned.
 ManagementManagement
 Pictures/ photographs of animals, cartoons, treesPictures/ photographs of animals, cartoons, trees
should he there in the clinic.should he there in the clinic.
 The mother should be instructed before hand not toThe mother should be instructed before hand not to
project her feeling and remain as silent observer.project her feeling and remain as silent observer.
Later try to separate the parent from the child andLater try to separate the parent from the child and
not the child from parent.not the child from parent.

Fear of UnknownFear of Unknown
 Unfamiliar person wearing white gowns will arouse fearUnfamiliar person wearing white gowns will arouse fear
especially if the environment is suggestive of painful experienceespecially if the environment is suggestive of painful experience
in the past.in the past.
 The noise and vibration of dental drill and pressure exerted inThe noise and vibration of dental drill and pressure exerted in
the use of hand instrument is conducive of fear.the use of hand instrument is conducive of fear.
 Quick and jerky movement of chair is frightening.Quick and jerky movement of chair is frightening.
 Intense light is also fear producing.Intense light is also fear producing.
ManagementManagement
 Tell show do (T.S.D)Tell show do (T.S.D)
 Models can be used.Models can be used.
 Avoid sudden movement of dental chair.Avoid sudden movement of dental chair.
 Keep talking to child so as to distract his attention fromKeep talking to child so as to distract his attention from
treatment.treatment.
 Encourage him to see instruments and walk around clinic andEncourage him to see instruments and walk around clinic and
get familiar with surrounding.get familiar with surrounding.

8-14 years8-14 years
Eager to learn.Eager to learn.
Begins to trust.Begins to trust.
Learns to tolerate unpleasant situations.Learns to tolerate unpleasant situations.
Willing to listen to others and accept their pointWilling to listen to others and accept their point
of view.of view.
Increased ability to conceptualize.Increased ability to conceptualize.
TSDwww.indiandentalacademy.comwww.indiandentalacademy.com

Behavior Assessment; DevelopmentBehavior Assessment; Development
and Managementand Management
• Behavior is the manner in which anything actsBehavior is the manner in which anything acts
or operates.or operates.
Healy ; Bronner ; BowersHealy ; Bronner ; Bowers – behavior as– behavior as
sum total of response to stimuli, internal andsum total of response to stimuli, internal and
external.external.
Halmuth H. ShaferHalmuth H. Shafer – behavior as what an– behavior as what an
organism does including actions which takeorganism does including actions which take
place inside the organisms body and thereforeplace inside the organisms body and therefore
which cannot be seen.which cannot be seen.

ClassificationClassification
Frankel’s Classification (1962)Frankel’s Classification (1962)

Wilson’s classification (1933)Wilson’s classification (1933)
Normal or bold- child is brave enough to faceNormal or bold- child is brave enough to face
new situations, is co-operative, & friendly withnew situations, is co-operative, & friendly with
the dentist.the dentist.
Tasteful or timid- child is shy, but does notTasteful or timid- child is shy, but does not
interfere with the dental procedures.interfere with the dental procedures.
Hysterical or rebellious- child is influenced byHysterical or rebellious- child is influenced by
home environment- throws temper tantrums &home environment- throws temper tantrums &
is rebelliousis rebellious
Nervous or fearful- child is tense & anxious,Nervous or fearful- child is tense & anxious,
fears dentistryfears dentistry

Lampshire (1979)Lampshire (1979)
 Co-Operative:Co-Operative: the child is physically and emotionally relaxed.the child is physically and emotionally relaxed.
Is cooperative throughout the entire procedure.Is cooperative throughout the entire procedure.
 Tense Co-Operative:Tense Co-Operative: the child is tensed and cooperative atthe child is tensed and cooperative at
the same timethe same time
 Outwardly Apprehensive:Outwardly Apprehensive: avoids treatment initially, usuallyavoids treatment initially, usually
hides behind the mother, and avoids looking or talking to thehides behind the mother, and avoids looking or talking to the
dentist. Eventually accepts dental treatment.dentist. Eventually accepts dental treatment.
 Fearful:Fearful: requires considerable support so as to overcome torequires considerable support so as to overcome to
fears of dental treatment.fears of dental treatment.
 Stubborn / Defiant:Stubborn / Defiant: passively resists treatment by usingpassively resists treatment by using
techniques that have been useful in other situations.techniques that have been useful in other situations.
 Hypermotive:Hypermotive: the child is acutely agitated and resorts tothe child is acutely agitated and resorts to
screaming, kicking etc.screaming, kicking etc.
 Handicapped:Handicapped: physically/ mentally/ or emotionallyphysically/ mentally/ or emotionally
handicapped.handicapped.
 Emotionally immatureEmotionally immaturewww.indiandentalacademy.comwww.indiandentalacademy.com

Wright (1975)Wright (1975)
A Cooperative (positive behavior)A Cooperative (positive behavior)
1. Cooperative behavior1. Cooperative behavior
 Child is cooperative, relaxed, wit minimal apprehension.Child is cooperative, relaxed, wit minimal apprehension.
2. Lacking cooperative ability2. Lacking cooperative ability
 Usually seen in young children (0-3 years), disabled,Usually seen in young children (0-3 years), disabled,
physically and mentally handicapped children.physically and mentally handicapped children.
3. Potentially cooperative3. Potentially cooperative
 Has the potential to cooperate, but because of the inherentHas the potential to cooperate, but because of the inherent
fears (subjective/ objective) the child does not cooperate.fears (subjective/ objective) the child does not cooperate.
B Uncooperative (negative behavior)B Uncooperative (negative behavior)
 Uncontrolled/ HystericalUncontrolled/ Hysterical
Usually seen in preschool children, at their first dental visit.Usually seen in preschool children, at their first dental visit.
Temper tantrum i.e. physical lashing out of legs and arms,Temper tantrum i.e. physical lashing out of legs and arms,
loud crying and refuses to cooperate with the dentistloud crying and refuses to cooperate with the dentistwww.indiandentalacademy.comwww.indiandentalacademy.com

 Defiant / Obstinate BehaviorDefiant / Obstinate Behavior
Usually seen in spoilt or stubborn children. These children canUsually seen in spoilt or stubborn children. These children can
be made cooperative.be made cooperative.
 Tense CooperativeTense Cooperative
These children are borderline between positive and negativeThese children are borderline between positive and negative
behavior. Does not resist treatment but the child is tensed atbehavior. Does not resist treatment but the child is tensed at
mind.mind.
 Timid/Shy BehaviorTimid/Shy Behavior
Usually seen in overprotective child at the first visit.Usually seen in overprotective child at the first visit.
 Whining TypeWhining Type
Complaining type of behavior, allows for treatment butComplaining type of behavior, allows for treatment but
complains throughout the procedure.complains throughout the procedure.
 Stoic BehaviorStoic Behavior
Seen in physically abused children. They are cooperative andSeen in physically abused children. They are cooperative and
passively accept all treatment without any facial expression.passively accept all treatment without any facial expression.

Learning and Development ofLearning and Development of
BehaviorBehavior
 Psychologists generally consider that therePsychologists generally consider that there
are 3 distinct mechanisms by which behaviorare 3 distinct mechanisms by which behavior
responses are learned:responses are learned:
 Classical conditioning- Pavlov 1927Classical conditioning- Pavlov 1927
 Operant conditioning- Skinner 1938Operant conditioning- Skinner 1938
 Observational learning- Bandura 1969Observational learning- Bandura 1969

Operant conditioningOperant conditioning
B.F Skinner 1938

If parent gives into the temper
tantrums thrown by child

Observational Learning (modeling)Observational Learning (modeling)
Bandura 1969Bandura 1969
Acquisition
Performance

Behavior ManagementBehavior Management
Definition: defined as the means by which theDefinition: defined as the means by which the
dental health team effectively and efficientlydental health team effectively and efficiently
performs dental treatment and thereby instills aperforms dental treatment and thereby instills a
positive dental attitude (Wright 1975)positive dental attitude (Wright 1975)
Behavior ModificationBehavior Modification
Definition: defined as the attempt to alterDefinition: defined as the attempt to alter
human behavior and emotion in a beneficialhuman behavior and emotion in a beneficial
way and in accordance with the laws ofway and in accordance with the laws of
learning.learning.

Behaviour ManagementBehaviour Management
Non
pharmacological
methods
Communication
Behaviour
shaping
Behaviour
management
Pharmacological
Pre-
medication
Conscious
sedation
General
anesthesia

 Non Pharmacological Methods of BehaviorNon Pharmacological Methods of Behavior
Management:Management:
I. CommunicationI. Communication
 Types:Types:
a. Verbal Communication- Speecha. Verbal Communication- Speech
b. Non verbal / Multisensory Communicationb. Non verbal / Multisensory Communication
 Body languageBody language
 SmilingSmiling
 Eye contactEye contact
 Showing concernShowing concern
 TouchingTouching
 PattingPatting
 HuggingHugging
c. Both using nonverbal and verbalc. Both using nonverbal and verbalwww.indiandentalacademy.comwww.indiandentalacademy.com

Looking in patient's eyes before looking inLooking in patient's eyes before looking in
the mouth.the mouth.

II. Behavior Modification (behaviorII. Behavior Modification (behavior
shaping)shaping)
1. Desensitization1. Desensitization
 It is accomplished by teaching the child a competingIt is accomplished by teaching the child a competing
response such as relaxation and then introducingresponse such as relaxation and then introducing
progressively more threatening stimuli.progressively more threatening stimuli.
 Method popularly used nowadays – Tell shows DoMethod popularly used nowadays – Tell shows Do
(TSD) technique (Addlesion 1959). By having verbal(TSD) technique (Addlesion 1959). By having verbal
(tell) and nonverbal (show and do) interactions,(tell) and nonverbal (show and do) interactions,
available, one can overcome many small dentalavailable, one can overcome many small dental
related anxieties of any child.related anxieties of any child.

2. Modeling2. Modeling
 Introduced by (Bandura 1969) developed fromIntroduced by (Bandura 1969) developed from
social learning principle procedure involves allowingsocial learning principle procedure involves allowing
a patient to observe one or more individualsa patient to observe one or more individuals
(models) who demonstrate a positive behavior in a(models) who demonstrate a positive behavior in a
particular situation.particular situation.
 Modeling can be done by:Modeling can be done by:
 Live models – siblings, parents of a childLive models – siblings, parents of a child
 Filmed modelsFilmed models
 PostersPosters
 Audiovisual aidsAudiovisual aids www.indiandentalacademy.comwww.indiandentalacademy.com

3. Contingency Management3. Contingency Management
 It is a method of modifying behavior of children byIt is a method of modifying behavior of children by
presentation /withdrawal of reinforcers.presentation /withdrawal of reinforcers.
 These reinforcers can be: -These reinforcers can be: -
 Positive reinforcer- whose contingent presentationPositive reinforcer- whose contingent presentation
increases the frequency of behavior. (Henry Wincreases the frequency of behavior. (Henry W
Fields 1984)Fields 1984)
 Negative reinforcer – whose contingent withdrawalNegative reinforcer – whose contingent withdrawal
increases the frequency of behavior. (Stokes andincreases the frequency of behavior. (Stokes and
Kennedy 1980)Kennedy 1980)

III. Behavior managementIII. Behavior management
a) Audio analgesia:a) Audio analgesia:
This technique consists of providing a soundThis technique consists of providing a sound
stimulus of such intensity that the patient findsstimulus of such intensity that the patient finds
it difficult to attend to anything else. (Gardnerit difficult to attend to anything else. (Gardner
Licklider 1959)Licklider 1959)
b) Humor:b) Humor:
It helps to elevate the mood of the child,It helps to elevate the mood of the child,
which helps the child to relax. Functions ofwhich helps the child to relax. Functions of
humor are – social, emotional, informative,humor are – social, emotional, informative,
Motivational, cognitive.Motivational, cognitive.www.indiandentalacademy.comwww.indiandentalacademy.com

c) Coping:c) Coping:
It is the mechanism by which a child copes upIt is the mechanism by which a child copes up
with the dental treatment. It is defined as thewith the dental treatment. It is defined as the
cognitive and behavioral efforts made by ancognitive and behavioral efforts made by an
individual to master, tolerate or reduceindividual to master, tolerate or reduce
stressful situations. (Lazaue 1980).stressful situations. (Lazaue 1980).
Signal system: by Musslemann 1991.Signal system: by Musslemann 1991.
d) Voice control:d) Voice control:
It is the modification of intensity and pitch ofIt is the modification of intensity and pitch of
one’s own voice in an attempt to dominate theone’s own voice in an attempt to dominate the
interaction between the dentist and the child.interaction between the dentist and the child.

e) Relaxation :e) Relaxation :
It involves a series of basic exercises, whichIt involves a series of basic exercises, which
may take months to learn, and which requiremay take months to learn, and which require
the patient to practice at home for at least 15the patient to practice at home for at least 15
min per day.min per day.
f) Hypnosis :f) Hypnosis :
It is an altered state of consciousnessIt is an altered state of consciousness
characterized by a heightened susceptibility tocharacterized by a heightened susceptibility to
produce desirable behavioral andproduce desirable behavioral and
psysiological changes. When used in dentistrypsysiological changes. When used in dentistry
it can be termed as “hypnodontics”it can be termed as “hypnodontics”
(Richardson 1980) , or psychosomatic or(Richardson 1980) , or psychosomatic or
suggestion therapy.suggestion therapy.www.indiandentalacademy.comwww.indiandentalacademy.com

g) Implosion therapy :g) Implosion therapy :
Sudden flooding with a stimuli which have affectedSudden flooding with a stimuli which have affected
him adversely and the child has no other choice buthim adversely and the child has no other choice but
to face the stimuli until a negative responseto face the stimuli until a negative response
disappears. It mainly comprises of HOME, voicedisappears. It mainly comprises of HOME, voice
control, an physical restraints.control, an physical restraints.
h) Aversive Conditioningh) Aversive Conditioning
It can be a safe and effective way of managing anIt can be a safe and effective way of managing an
extremely negative behavior. Those dentists whoextremely negative behavior. Those dentists who
contemplate using it should obtain parental consentcontemplate using it should obtain parental consent
prior to its use (Patricia P Hagan 1984)prior to its use (Patricia P Hagan 1984)

Hand over mouth exercise (HOME)Hand over mouth exercise (HOME)
 Introduced by Evangeline Jordan in 1920.Introduced by Evangeline Jordan in 1920.
 The purpose is to gain attention of the child so thatThe purpose is to gain attention of the child so that
communication can be established.communication can be established.
 IndicationsIndications
 A healthy child who can understand but who exhibits defianceA healthy child who can understand but who exhibits defiance
and hysterical behavior during treatment.and hysterical behavior during treatment.
 3-6 year old children.3-6 year old children.
 A child who can understand simple verbal commands.A child who can understand simple verbal commands.
 Children displaying uncontrollable behavior.Children displaying uncontrollable behavior.
 ContraindicationsContraindications
 Child under 3 years of age.Child under 3 years of age.
 Handicapped /immature/frightened child.Handicapped /immature/frightened child.
 Physical, mental, and emotional handicap.Physical, mental, and emotional handicap.

TechniqueTechnique
 Behavioral expectations are calmly explained close to theBehavioral expectations are calmly explained close to the
child’s ear.child’s ear.

Physical Restraints:Physical Restraints:
Restraints are usually needed for children who areRestraints are usually needed for children who are
hypermotive, stubborn or defiant (Kelly 1976)hypermotive, stubborn or defiant (Kelly 1976)
For mouthFor mouth
•Mouth blocksMouth blocks
•Banded tongue bladesBanded tongue blades

For bodyFor body
Pedi wrap
• SheetsSheets
• Beanbag with strapsBeanbag with straps
• Towel and tapesTowel and tapes
Papoose board

For extremitiesFor extremities
Velcro straps
Towel and tapeTowel and tape
Posey
straps

For headFor head
Head positionerHead positioner
Forearm body supportForearm body support

Psychological Status of PatientsPsychological Status of Patients
Seeking Orthodontic TreatmentSeeking Orthodontic Treatment77
Numerous studies have showed thatNumerous studies have showed that
psychological outcome of orthodontics on thepsychological outcome of orthodontics on the
patient’s self image are positive.patient’s self image are positive.
The areas of behavioral research and theThe areas of behavioral research and the
application of practical psychology to theapplication of practical psychology to the
clinical practice of orthodontics can be dividedclinical practice of orthodontics can be divided
into 2 broad categories –into 2 broad categories –
Social PsychologySocial Psychology
Motivational PsychologyMotivational Psychology

Social PsychologySocial Psychology
 Why patients seek orthodontic treatment?Why patients seek orthodontic treatment?
 Use of standardized psychological instruments toUse of standardized psychological instruments to
assess prospective orthodontic patientsassess prospective orthodontic patients
According to studies done by Philip, dentofacialAccording to studies done by Philip, dentofacial
anomalies such as crooked teeth and skeletalanomalies such as crooked teeth and skeletal
disharmonies have been reported as the cause ofdisharmonies have been reported as the cause of
teasing and general playground harassment amongteasing and general playground harassment among
children and are associated with lowered socialchildren and are associated with lowered social
attractiveness.attractiveness.

Psychological Outcomes of OrthodonticPsychological Outcomes of Orthodontic
TreatmentTreatment
 Albino showed the psychological and social effects ofAlbino showed the psychological and social effects of
orthodontic treatmentorthodontic treatment
 Self image improved significantly after the patient receivedSelf image improved significantly after the patient received
orthodontic treatment felt better about their facialorthodontic treatment felt better about their facial
appearance after braces than they did before them.appearance after braces than they did before them.
 Kiyak reported on the psychological influences on the timingKiyak reported on the psychological influences on the timing
of orthodontic treatment. Social factors affecting self –of orthodontic treatment. Social factors affecting self –
concept:concept:
 Young child – Parent ; teacherYoung child – Parent ; teacher
 Preadolescent – Peers ; perceived attraction ; perceivePreadolescent – Peers ; perceived attraction ; perceive
competencecompetence
 Adolescent – PeersAdolescent – Peers
 Adults – Achievements ; social rolesAdults – Achievements ; social roleswww.indiandentalacademy.comwww.indiandentalacademy.com

Motivational PsychologyMotivational Psychology
 The success of orthodontic therapy frequentlyThe success of orthodontic therapy frequently
depends on patient compliance.depends on patient compliance.
 Headgear effects, functional appliance treatment,Headgear effects, functional appliance treatment,
oral hygiene and keeping appointment are alloral hygiene and keeping appointment are all
dependent on the patient coping with the doctor’sdependent on the patient coping with the doctor’s
instructionsinstructions
 EgolfEgolf described a compliant patient as one whodescribed a compliant patient as one who
practices good oral hygiene, wears appliances aspractices good oral hygiene, wears appliances as
instructed without abusing them, follows aninstructed without abusing them, follows an
appropriate diet and keeps appointmentsappropriate diet and keeps appointments

Creating the Compliant PatientCreating the Compliant Patient99
1. Clinician must believe in his or her technique, whatever it may1. Clinician must believe in his or her technique, whatever it may
be.be.
 Kenneth Cooper says, “Your beliefs are the most powerfulKenneth Cooper says, “Your beliefs are the most powerful
motivational tools you have—if you can just learn how to usemotivational tools you have—if you can just learn how to use
them.”them.”
 Keeping treatment simple and executing a step-by-step planKeeping treatment simple and executing a step-by-step plan
will make explanation and monitoring easier.will make explanation and monitoring easier.
2. Patient Education2. Patient Education
 The patient and parents must understand exactly what to doThe patient and parents must understand exactly what to do
and why it is important..and why it is important..
 Thorough patient education at the beginning of treatment canThorough patient education at the beginning of treatment can
eliminate many problems down the road. We must “informeliminate many problems down the road. We must “inform
before we perform” .before we perform” .

Patient motivationPatient motivation
 Fig. 1 Patient education booklets, used to reinforce instructions throughoutFig. 1 Patient education booklets, used to reinforce instructions throughout
treatment, are written in positive tone to encourage and motivate patients.treatment, are written in positive tone to encourage and motivate patients.www.indiandentalacademy.comwww.indiandentalacademy.com

4. Office Environment4. Office Environment
Every office reflects the personality of theEvery office reflects the personality of the
orthodontist.orthodontist.
 The key is to create a positive environmentThe key is to create a positive environment
that fits within your personal comfort zone.that fits within your personal comfort zone.
The goal is to maintain a friendly, relaxed,The goal is to maintain a friendly, relaxed,
warm, caring, professional atmosphere inwarm, caring, professional atmosphere in
which patients know that they will receive thewhich patients know that they will receive the
highest-quality treatmenthighest-quality treatment

5. Communication Techniques5. Communication Techniques
 Most patients open their mouths as soon as theMost patients open their mouths as soon as the
orthodontist sits down at the chair. An effectiveorthodontist sits down at the chair. An effective
communication technique is to look in their eyescommunication technique is to look in their eyes
before you look in their mouths. This simple act helpsbefore you look in their mouths. This simple act helps
us remember that we are dealing with human beings,us remember that we are dealing with human beings,
not typodonts.not typodonts.
6. Monitoring Progress6. Monitoring Progress
 Each patient’s progress must be monitoredEach patient’s progress must be monitored
constantly to maintain motivation and complianceconstantly to maintain motivation and compliance
throughout treatment.throughout treatment.
 When improvement is seen, praise the patient andWhen improvement is seen, praise the patient and
share the achievement with the parent.share the achievement with the parent.www.indiandentalacademy.comwww.indiandentalacademy.com

Motivational system for orthodontists andMotivational system for orthodontists and
their patientstheir patients 1010
BehaviorismBehaviorism
 The underlying basis of behaviorism is thatThe underlying basis of behaviorism is that
consequences dictate behavior.consequences dictate behavior.
 There are three broad categories of consequences:There are three broad categories of consequences:
 Positive reinforcersPositive reinforcers
 Negative reinforcersNegative reinforcers
 Punishment.Punishment.
 Punishment can only extinguish behaviors, not teachPunishment can only extinguish behaviors, not teach
them, so it has limited use in orthodontics.them, so it has limited use in orthodontics.
 Punishment must be severe to be effective, and itPunishment must be severe to be effective, and it
often results in counterproductive behavior such asoften results in counterproductive behavior such as
resentment, aggression, emotional arousal, orresentment, aggression, emotional arousal, or
avoidance.avoidance.

When orthodontists want to increase patientWhen orthodontists want to increase patient
compliance, they should increase positivecompliance, they should increase positive
reinforcements while limiting negative onesreinforcements while limiting negative ones
such as pain, fear, frustration, and humiliation.such as pain, fear, frustration, and humiliation.
Orthodontists can also improve compliance byOrthodontists can also improve compliance by
providing patients with feedback that isproviding patients with feedback that is
immediate, accurate, and specificimmediate, accurate, and specific

Arriving on time — 1 point
Wearing headgear into office — 1 point
No broken wires — 1 point
Absolutely clean mouth — 2 points
No broken or loose bands — 3 points
Correct wearing of headgear — 3 points
Correct wearing of elastics — 3 points

Children are excited by their own digital imagesChildren are excited by their own digital images

Study by Alexander and Chase (1987)Study by Alexander and Chase (1987)
suggested that there are at least ninesuggested that there are at least nine
congenital temperaments that make childrencongenital temperaments that make children
easy or difficult to manage:easy or difficult to manage:

 The most important of these personality features toThe most important of these personality features to
orthodontists is the sensitivity threshold.orthodontists is the sensitivity threshold.
 People with an inherited low sensitivity thresholdPeople with an inherited low sensitivity threshold
have diminished tolerances for all the senses.have diminished tolerances for all the senses.
 That is, what might be an acceptable tactileThat is, what might be an acceptable tactile
stimulation for a person with ordinary sensitivity willstimulation for a person with ordinary sensitivity will
be painful for a person with a low sensitivitybe painful for a person with a low sensitivity
threshold.threshold.
 These people do not tolerate items such as woolThese people do not tolerate items such as wool
sweaters, shirt labels, new shoes, or tight clothes.sweaters, shirt labels, new shoes, or tight clothes.
 They are highly selective about the foods they eat—They are highly selective about the foods they eat—
their foods must have the right texture.their foods must have the right texture.

And they show an unusually high socialAnd they show an unusually high social
sensitivity, perceiving insults where none aresensitivity, perceiving insults where none are
intended.intended.
 Bright lights and loud or repetitive noisesBright lights and loud or repetitive noises
irritate them greatly, so it should come as noirritate them greatly, so it should come as no
surprise to orthodontists that they show littlesurprise to orthodontists that they show little
inclination to tolerate the demands, discomfort,inclination to tolerate the demands, discomfort,
and inconvenience of orthodontic therapy.and inconvenience of orthodontic therapy.
Many of their broken brackets and bands resultMany of their broken brackets and bands result
from when they touch, tug on, and damage thefrom when they touch, tug on, and damage the
appliances that are discomforting themappliances that are discomforting themwww.indiandentalacademy.comwww.indiandentalacademy.com

•• Use bonded brackets instead of bands wherever possible.Use bonded brackets instead of bands wherever possible.
•• Use brackets with the greatest inter- and intrabracket distances.Use brackets with the greatest inter- and intrabracket distances.
•• Use the most resilient wires possible.Use the most resilient wires possible.
•• Change the orthodontic forces gradually.Change the orthodontic forces gradually.
•• Use segmented arches to involve fewer teeth.Use segmented arches to involve fewer teeth.
•• Use continuous forces rather than intermittent ones.Use continuous forces rather than intermittent ones.
•• Prevent periodontal capillary strangulation by having the patientPrevent periodontal capillary strangulation by having the patient
chew on a bite wafer or gum immediately after adjustments.chew on a bite wafer or gum immediately after adjustments.
•• Prescribe analgesics (non-steroidal anti-inflammatory agents)Prescribe analgesics (non-steroidal anti-inflammatory agents)
immediately after adjustments.immediately after adjustments.
•• Reduce gingival inflammation with better brushing instructions,Reduce gingival inflammation with better brushing instructions,
antibiotics, chemotherapeutics, and prophylaxis.antibiotics, chemotherapeutics, and prophylaxis.
•• Use the simplest mechanics possible.Use the simplest mechanics possible.

Gag reflexGag reflex

Oral Hygiene for Orthodontic PatientsOral Hygiene for Orthodontic Patients
Cycle of inflammationCycle of inflammation

 Plaque staining to disclose areas of poor oral hygiene.Plaque staining to disclose areas of poor oral hygiene.

 Before patients get to this point, orthodontists shouldBefore patients get to this point, orthodontists should
exercise an aggressive remedial strategy thatexercise an aggressive remedial strategy that
includes:includes:
 Thorough prophylaxis by the general dentist orThorough prophylaxis by the general dentist or
hygienist.hygienist.
 Use of chlorhexidine rinse twice a day for severalUse of chlorhexidine rinse twice a day for several
weeks.weeks.
 Oral medication of tetracycline, 250mg four times aOral medication of tetracycline, 250mg four times a
day for two weeksday for two weeks

Clinical Motivation of the Functional JawClinical Motivation of the Functional Jaw
Orthopedic PatientOrthopedic Patient66
An assistant points out the
balance and beauty of the
models' faces. www.indiandentalacademy.comwww.indiandentalacademy.com

Fig. 3 Patient is asked to hold a lip disk (A) between the lips for 30 minutes per day while
watching TV (B). Patients with "golf ball chin" (C) are instructed to hold the chin with the
lip disk between the lips (D). www.indiandentalacademy.comwww.indiandentalacademy.com

ConclusionConclusion
Creating the compliant patient begins with theCreating the compliant patient begins with the
attitude of the orthodontist.attitude of the orthodontist.
Our goals will be achieved if we believe in ourOur goals will be achieved if we believe in our
delivery system, properly educate our patients,delivery system, properly educate our patients,
and learn how to motivate them to followand learn how to motivate them to follow
instructions.instructions.
This kind of communication takes time, but theThis kind of communication takes time, but the
results are well worth it.results are well worth it.

1.1. BibliographyBibliography
1.1. Proffit William R.: Contemporary Orthodontics, 4thProffit William R.: Contemporary Orthodontics, 4th
Edition ,2006, C.V . MosbyEdition ,2006, C.V . Mosby
2.2. Bishara Sameer E., Text book of Orthodontics,Bishara Sameer E., Text book of Orthodontics,
W.B. Saunders, 2001W.B. Saunders, 2001
3.3. Mc Donald, Dentistry for the Child and AdolescentMc Donald, Dentistry for the Child and Adolescent
, 3, 3rdrd
Edition, MosbyEdition, Mosby
4.4. Shobha Tandon ,text book of pedodontics; FirstShobha Tandon ,text book of pedodontics; First
Edition.100-120Edition.100-120
5.5. Albert H Owen III. Clinical Motivation of theAlbert H Owen III. Clinical Motivation of the
Functional Jaw Orthopedic Patient. J.clin. orthod;Functional Jaw Orthopedic Patient. J.clin. orthod;
1983 Mar (192 –198)1983 Mar (192 –198)

6.6. Larry W.White. Behavior Modification of OrthodonticLarry W.White. Behavior Modification of Orthodontic
Patients. J.Clin. Orthod; 1974 Sep (501-505)Patients. J.Clin. Orthod; 1974 Sep (501-505)
7.7. R.G. Alexander. The Vari-Simplex Discipline: Part 5 PracticeR.G. Alexander. The Vari-Simplex Discipline: Part 5 Practice
Management. J. Clin.Orthod; 1983 Oct (680-687)Management. J. Clin.Orthod; 1983 Oct (680-687)
8.8. Melvin Mayerson. Management and Marketing: Creating theMelvin Mayerson. Management and Marketing: Creating the
compliant patient. J. Clin. Orthod; 1996 Sep (493-497)compliant patient. J. Clin. Orthod; 1996 Sep (493-497)
9.9. Melvin Mayerson, Larry W. White. A New Paradigm ofMelvin Mayerson, Larry W. White. A New Paradigm of
Motivation. J. Clin. Orthod. 1996 June (337-341)Motivation. J. Clin. Orthod. 1996 June (337-341)
10.10. T.Mehara, R.S.Nanda, P.K.Sinha. Orthodontist’sT.Mehara, R.S.Nanda, P.K.Sinha. Orthodontist’s
Assessment and Management of Patient Compliance. AngleAssessment and Management of Patient Compliance. Angle
Orthod; 1998;2; (115-122)Orthod; 1998;2; (115-122)

Child Psychology Theories for Orthodontic Treatment Compliance

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