SCIENCES IN DENTIST

BEHAVIORAL SCIENCES IN DENTISTRY

INTRODUCTION:-

Social environment is a important as the physical and biological environment in relation to health and disease in man.

The five social sciences include,

·        Sociology

·        Cultural anthropology

·        Social psychology

·        Political se,

The first three are together called ‘Behavioral Sciences’.

SOCIOLOGY:-

It is the science concerned with the organization or structure of social groups. It is the science of behavior of man in a society or group of human beings. Sociologists define society as “ a system of uses & procedures of authority & mutual aid of many groups coupled with division of control of human behavior & liberty”.

STRUCTURAL ASPECTS OF SOCIETY

A)   Social institution

B)   Community

C)   Association

FUNCTIONAL ASPECTS OF SOCIETY

A.   Social norms

They are,” the rules that a group uses for appropriate & inappropriate values,beliefs,attitudes & behaviors”.

Folkways :-

Famed American sociologist, William graham Sumner, is credited with coining the term folkways in his monumental work entitled “ folkways: a study of the sociological importance of manners ,customs, mors, & morals in 1907.

Mores :-

Mores are much more strictly enforced than folkways . they are norms or customs which are express fundamental values of society.

Taboo :-

Taboo is a strong social prohibition (or ban) against words,objects,actions, or discussions that are considered undesirable oroffenssive by a group ,culture, society,or community.

e.g : abstinence from beef, pork &  smoking in hindus,muslims & Sikhs respectively.

B. Customs & habits

Custom is a broad term embracing all the norms classified as folkways or mores. It refers to practices that have been repeated by a number of generations, practices that tend to be followed simply because they have been followed in the past.

C. Etiquettes and conventions

Etiquette is a code that governs the expectations of social behavior, according to the contemporary conventional norm within a society, social class, or group.

D. Social Values

They constitute an important part of the selective behavior of man. Values refer to those standards of judgment by which things and actions are evaluated as good or bad.

CULTURAL ANTHROPLOGY:-

Anthropology is the study of man and his works. It has two main divisions,

a)     Physical anthropology

b)    Cultural anthropology

Physical anthropology is the study of man as a biological organism. Cultural anthropology is the branch dealing with man’s behavior and product. Its main them is culture.

Culture has these parts. It is an experience which is “learned, shared and transmitted”.

The branches of cultural anthropology are-

·        ETHNOLOGY: The comparative study of cultures.

·        ARCHEOLOGY: The study of past cultures and civilization using their remains as the principal source of information.

·        LINGUISTICS: the study of speech patterns of man i.e. the study of languages and dialects.

·        SOCIAL ANTHROPOLOGY: a specific branch of cultural anthropology dealing with comparative study of kinship and non kinship organization patterns in different societies.

SOCIAL PSYCHOLOGY

It deals with human nature and attitudes in general. Social psychology studies, how and why perceptions, thoughts, opinions, attitudes and behavior vary in different groups and societies i.t of groups and societies i.e. it studies the effect of social environment on individuals psychology.

ECONOMIC

It studies the economic aspects of man i.e. production, distribution and consumption of the three basic essentials for his living namely food, shelter and clothing. Scarcity or excess of thesan behavior.

POLITICAL SCIENCE

It deals with the constitution, the government and the laws of the state, which impose some sort of discipline on man’s movements or behavior.

HEALTH BEHAVIOR AND LIFE STYLE

Health Behavior

Any activity undertaken regardless of actual or perceived health status, for the purpose of promoting protecting or maintaining health, whether or not such behavior is objectively effective towards that end.

-WHO health promotion glossary, 1986

It is a broad concept implying actions, undertaken by people which have positive or negative consequences to health.

Example- for positive behavior effective tooth cleaning practices.

Example for negative behavior or risk behavior. Frequent consumption o surgery foods.

Illness behavior:

It is the interpretation of symptoms or signs of illness, especially pain and the search for relief,

Labeling behavior:

In the case of conditions that are visible and that affect the social identity or acceptability f a personSex process of decision making are involved.

Factor influencing preventive behavior

Before the dentist can establish sound principles of diagnosis and subsequent application of technical skills to control behavior, he or she must be familiar with those factors that influence behavior. They are

·        Growth and development:

A child’s development involves. Physical, intellectual and emotional aspects of growth and these are constantly changing in magnitude and expanse.

·        Family and peer influences:

Psychosocial factors are probably the strongest influences on human behavior.

·        Past medical and dental experiences:

Past bad medical/dental experiences will adversely shape and influence preventive behavior.

·        Dental office environment:

A dental office that reflects drabness of lack of warmth lends little to brightening on individuals mind or his or her attitude. Both technical skill and the dentists behavior affects individual behavior.

Szasz and hollender in 195ed three types of relationship that ca occur between professional caregivers and patients. The first type is termed “activity-passivity, where the professional is in complete active control and the patient is a passive recipient of treatment. This usually occurs when the patient is under a general anesthetic. Asecond type of relationship is “guidance-co-operation, when the professional guides like a teacher while the patient co-operates like a student. This describes a situation where the dentist is treating a conscious patient. The third type is termed mutual participation.” This is most dentist ad patient share responsibility for the maintenance of oral health.

LIFESTYLE AND ORAL HEALTH

Lifestyle / lifestylo health

“Lifestyle is a way of living based on identifiable patterns of behavior, which are determined by the interplay between an individual’s personal characteristics, social interactions, and socioeconomic and environmental living conditions”.

-WHO Halth Promotion Glossary, 1998

These patterns of behavior are continually interpreted and tested out in different social situations and are therefore not fixed, but subject to change.

Lifestyle interventions:-

Lifestyle interventions must be based n the co-operation and full participation of the individuals and groups concerned, since if they were dominated by professionals, they would not be health-promoting.

Ethical Issues in lifestyle interventions:-

Privacy:

Lifestyle interventionsh upon the private world of the individual this in itself may be deter mental to health.

Anxiety:

Consciousness raising activity may raise anxiety levels and this may be harmful to health.

Confidentiality:-

When data on lifestyles are acquired, people must feel confident that their private lives will not be further exposed and that data will not be misused.

Choices:-

The essence of health promotion is choice. People must be free to refuse and this must be a prime requisite for all intervention strategies. At the same time, people should assume their social responsibilities towards each other.

SOCIAL AND ORA HEALTH

Different social classes are associated with different personality characteristics. Although all members of a social class do not share a given personality trait, members of one social class exhibit a given characteristic more than members of another class do. The disadvantages social groups have been reported to have a higher proportion of teeth or tooth surfaces with unmet need for treatment, number of restored teeth compared with the advantages groups.

The common characteristics of social groups are:

·        There is a sense of unity and belonging.

·        They have a we-feeling and help each other.

·        They have common objectives and interest.

·        Each group has its own code of conduct and behavior.

·        Every member of the group is expected to follow its norms.

Types of groups

The word ‘Group’ may be defined as a gathering of two or more people who have a common interest.

Group can be classified as

·        Primary gp

·        Secondary group

·        Reference group

A primary group is the one which is small and the members of which come into direct face to face contact with each other for mutual help, companionship and discussion on issues of common interest.

The secondary group is the one in which the relationship of the members is of a formal and impersonal nature.

Reference groups are those groups to which an individual related himself psychologically.

Groups can also classified as

·        Formal group

·        Informal group

Characteristics of formal groups:

·        Are will organized

·        Have a purpose or goal

·        Have seX memberships

·        Have recognized leaders

·        Have SEX rules

·        Have regular meeting

·        Attention is paid for the welfare of the members e.g. Dental Association

Characteristics of informal groups:

·        Are not organized

·        People come and go at will

·        There is no membership or a felling of belonging

·        No special activity is planned by the people

·        No rules apply

·        There is no leader

·        There is more concern for the self and less for those of other people present

Theoretical explanations of social inequalities in oral health:-

The black report (Blane, 1985) considered 4 possible explanations for the existence of a gradient between health and social class.

·        Artifact explanations.

·        The social selections explanation ( or natural selection)

·        The materialist (or structuralist) explanations

·        Cultural (or behavioral) explanations.

Artifact explanations:

According to this explanation, a relationship between social class and health are not really present, but are only due to the way data are collected. E.g. Reliance n death certificate may bias findings inappropriately. However, even when investigators have taken such problems into account. Class difference remains.

The social selections explanations:

This proposes that health inequalities are created by a process whereby the healthy move up the social hierarchy and the less healthy move down.

The materialistic explanation:

According to this explanation, inequalities in health have their origins in social and financil deprivation.

SEX Behavioral explanations:

These explain inequalities in terms of differences in knowledge and behavior. Perhaps people from higher social classes have a greater appreciation of the role of diet and regular preventive care and are more likely to act on this knowledge.

Social science in dental public health:-

One of the important developments in public health during the last decade is that the social scientists have been called in to aid in adapting new health programs to existing cultural patterns.

·        The upper middle class

·        The lower middle class

·        The upper lower class

·        The lower class

·        Castration complex

·        Contractiction of common sense

·        Coming in crowds

·        The last ditch effort

·        If it hurts, you are a quack

·        Unclean or dirty feeling

·        The clinic was built there, not here

·        Cold professional attitudes

·        Difference in pain threshold

·        Complication of the unknown

·        The pills don’t work

·        Appointment are not important

·        Teeth lost anyhow DUE TO LOW SEX

·        Traditions

RISK BEHAVIOUR

Risk behavior (WHO health promotion glossary, 1998) “specific forms of behavior which are proven to be associated with increased susceptibility to a specific disease or ill-health”.

Risk behaviors are usually defined as “risky” on the basis of epidemiological or other social data.

Risk factor

“Social economic or biological status, behaviors or environments which are associated with or cause increased susceptibility to a specific disease ill health or injury.

WHO health promotion glossary, 1998

As is the case with risk behaviors, once risk factors have been identified, they can become the entry point or focus for health promotion strategies and actions.

HARMFUL DENTAL HEALTH BEHAVIORS

·        Alcohol use

·        Smoking

·        Nutrition

·        Drug use

UTILIZATION OF DENTAL SERVIES

Definition:

Utilization is the actual attendance by members of the public at health care facilities to receive care

The factors which influence an individual to utilize a health service are,

·        Individual must feel susceptible to the disease.

·        Individual must feel that the disease is potentially serious in its effects in regard to him.

·        Individual must feel that course of action that will prevent or alleviate the disease is available to him.

Need for dental care:-

The different types of need for dental care are,

·        Normative need: it is the requirement for care as determined by expert opinion.

·        Felt need: (Perceived need): it is the requirement of or care as determined by the patient or the public.

·        Expressed need: (Demands for health care) it arises out of attempts by members of the public to seek attention for their perceived needs.

The four different approaches to estimating need are,

·        Surveys of dental health status(normative needs)

·        Surveys of need for dental care using questionnaires (felt needs)

·        Analyses of service or treatment records (expressed needs)

Factors affecting utilization

·        Age

·        Sex

·        Education

·        Socio-economic status

·        Occupation

·        Residence

·        Socio-cultural factors

·        Organizational factors

·        Cost of health servies

·        Triggers for the utilization of health servies are,

BEHAVIOR OF THE CHILD IN THE DENTAL OFFICE

Human personality is the characteristic pattersn of thought, emotion and behavior that define an individual’s personal style and influence his or her interactions with the environment.

Psychodynamic theories

·        Classical Psychoanalytical theory by Sigmund freud (1905)

·        Developmental Tasks theory by Erik Erikson(1963)

Behavior learning theories

·        Classical conditioning theory by lvan Pavlov (1927)

·        Operant conditioning theory by B.F.Skinner(1938)

·        Theory of Cognitive Development by Jean Piaget (1952)

·        Social learning theory by albert Bandura (1963)

PSYCHODYNAMIC THEORIES:

Classical psychoanalytical theory by Sigmund Freud

Freud compared the human mind to an iceberg. The small part that shows above this surface of the water represents the conscious experience and the much larger mass below the water level represents the unconscious store house of impulses, passions and inaccessible memories that affects thoughts and behaviors.

The id is the most primitive part of the personality from which the other two sytems develop later.

·        Oral Stage:-

The first year of life is called by Freud as the oral stage and is characterized by passivenesand dependency. The primary zone of pleasure is the oral region because hunger is satisfied by oral stimulation.

·        Anal Stage:-

This stage occurs between the ages 1 and 3 years and is marked by the egocentric behavior. During this stage, the anal zone becomes the priamary zone of pleasure gratification is derived from expelling or with holding feces.

·        Phalic Stage:-

The sex identification, which occurs between 3 an 6 years of age, is an important feature of this stage. The children begin to direct their awakened sexual impulses towards the parent of the opposite sex. This character observed in males is called “Oedipus complex”. Characterized by the tendency of the young child boy being attached more to the mother than the father.

·        Latency Stage:-

This stage occurs during the ages of six and twelve and is a period of consolidation. Their attention turns to the skills needed for coping with the environment. The superego becomes firmly internalized.

·        Genital Stage:-

This stage begins with puberty and is characterized by reopening of the egos struggle to gain mastery and contrl over the impulses of id and superego. Fluctuating extrmes in emotional behavior and preoccupation with philosophical and obstract thoughts predominate due to the stuggle to attain a firm sense of self.

·        Developmental tasks theory by Erik Erikson

Erikson was of the view that freud overmphasized the biological and sexual determinants of developmental chnge and underemphasized the imporatance of child rearing experiences, social relationships and cultural influences on the development of ego or self.

·        Trust versus mistrut

·        Autonomy versus shame, doubt.

·        Initiative versus guilt

·        Industry versus inferiority

·        Identity versus role confusion

BEHAVIOR LEARNING THEORIES

Classical Conditioning Theory by Ivan Pavlov

Ivan Pavlov proved that two events observed to occur together would tend to be associated or period together by the observer.

Theory of Operation Conditioning by B.F. Skinner

The main concept of this theory is that an individual learns to produce a voluntary response where the consequences or the outcome are instrumental in bringing about the recurrence of the stimulus.

Theory of Cognitive Development by Jean Piaget

The word “Cognitive” refers to elements of perception, awareness, judgment and the ability to comprehend empirical knowledge.

A Central concept in piaget’s theory is the operation or the operational structure. Operations are actions, which the child performs mentally and which have the added property of being reversible.

Sensorimotor stage(0-18 months)

Preoperational Stage (18 months to 7 Years)

Concrete operational stage(7-12years)

Formal operational stage (12 years to onwords)

Rating No.1 Definitely negative

·        Refuses treatment

·        Cries Forcefully

·        Is extremely negative, associated with fear.

Rating No.2 Negative

·        Is reluctant to accept treatment

·        Displays slight negativism

Rating No.3 Positive

Accept treatment with tense co-operative whining or timed behavior.

Rating No.4 Definitely positive

Looks forward to and understand the importance of good preventive care.

Social Learning theory by Albert Bandura

In the social learning theory, reinforcement is consideration a facilitative rather than a necessary condition for learning.

Behavior Management:-

Behavior management is as much an art for, as it is a science. It is not a mere application of individual technique formulated to deal with individuals but rather a comprehensive methodology meant to build a relationship between the patient and the dental professionals which ultimately builds trust relieves fear and anxiety.

Communicative management:-

Communicative management is used universally for both the cooperative and uncooperative child.

The specific techniques associated with this process are

·        Voice control

·        Nonverbal communication

·        Tell-show-do

·        Modeling

·        Positive reinforcement

·        Systematic desensitization

·        Distraction

·        Parental presence/ absence

·        HOME

Voice Control

Objective of the voice control

·        To gain the patients attention and compliance.

·        To avert negative or avoidance behavior.

·        To establish appropriate adult child roles.

Non verbal communication

Objective of nonverbal communication:

·        To enhance the effectiveness of other communicative management techniques.

·        To gain or maintain the patients attention and compliance.

Tell Show Do

Objective of Tell Show Do

·        To teach the patient important aspects of the dental visit and familiaze the patient with the dental setting.

·        To shape the patient’s response to procedure through desensitization and well described expectations.

Modeling

Bandrura in 1969 developed a behavior modification technique called “Modeling” or “imitation”.

·        Concentrated attention must be expended towards the witnessing of the model.

·        There must be sufficient retention of desirable behavior in the absence of a model.

·        One must be able to reproduce effectively the behavior modeled.

·        The newly acquired behavior must be appropriately rewarded to retain it.

Reinforcement

The term “reinforce” means, any consequence which increases the likelihood of a behavior being shown.

Positive reinforcement

A” Positive reinforcement” is a consequence, which is pleasant nd increases the likelihood of behavior when it is offered.

Negative reinforcement

An unpleasant event that can be avoided through some kind of action is called a Negative Reinforcement.

Systematic Desensitization

Research carried out by Wolpe in 1952, led to the development of a behavior modification technique, called “systematic desensitization”.

Distraction

Distraction is a type of cognitive approach, which is aimed at preventing any kind of anxiety-provoking thoughts that heightens a patient’s anxiety level.

Objectives of distraction

To decrease the perception of unpleasantness.

To avert negative or avoidance behavior

Parent Presence/ Absence

This technique involves using the presence or absence of the parent to gain cooperation for treatment.

Hand-over-mouth Exercise (home)

HOME is an accepted technique for intercepting and managing demonstrably unsuitable behavior that cannot be modified by basic behavior management techniques.

Method:-

The dentist firmly but gently places his had on the Childs mouth and whispers in his ear that when he cooperates, the hand will removed.

The decision to use HOME must take into consideration,

·        Other alternate behavioral modalities.

·        Patient’s dental needs.

·        The effect on the quality of dental care.

·        Patient’s emotional development

·        Patient’s physical consideration.

Contraindications:

In children who, due to age, disability medication, or emotional immaturity are unable to verbally communicate, understand and cooperate.

CONCLUSION

Behavioral science plays a major role in understanding the individual, his community and his environment.

BEHAVIORAL SCIENCES IN DENTISTRY