The Psychology of the Dentist-Patient Relationship

191 Pages·1988·4.466 MB·English

by  Stephen Bochner (auth.)

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and Somatization Disorders
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Individual Differences, Stress, and Health Psychology
Michel Pierre Janisse, Editor
The Psychology of the Dentist-Patient Relationship
Stephen Bochner
Stephen Bochner
The Psychology
of the Dentist-Patient
Rela tionshi p
Springer-Verlag
New York Berlin Heidelberg
London Paris Tokyo
Stephen Bochner
School of Psychology
University of New South Wales
Kensington, New South Wales 2033
Australia
Advisor
J. Richard Eiser
Department of Psychology
University of Exeter
Exeter EX4 4QG
England
Library of Congress Cataloging-in-Publication Data
Bochner, Stephen.
The psychology of the dentist-patient relationship/Stephen
Bochner.
p. cm.-(Contributions to psychology and medicine)
Bibliography: p.
Includes indexes.
ISBN-13:978-1-4613-8767-1
I. Dentistry-Psychological aspects. 2. Dentist and patient.
I. Title. II. Series.
RK53.B66 1988
617.6'023-dcl9 87-33098
© 1988 by Springer-Verlag New York Inc.
Softcover reprint of the hardcover 1st edition 1988
All rights reserved. This work may not be translated or copied in whole or in part without the
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Typeset by Asco Trade Typesetting Ltd., Hong Kong.
9 8 7 6 5 432 I
ISBN-13:978-1-4613-8767-1 e-ISBN-13:978-1-4613-8765-7
DOl: 10.1007/978-1-4613-8765-7
Acknowledgments
The author wishes to acknowledge the assistance provided by the Dental
Health Education and Research Foundation of the University of Sydney, in
particular the active encouragement of the Foundation's Executive Director,
James E. Woolley. Thanks are also due to Ena Nomme, who acted as the
research assistant for this project; Les Wozniczka, who provided statistical
and computing assistance; and to Louise Kahabka, who expertly produced
the various drafts of the manuscript.
The manuscript was completed during the author's tenure as a Visiting
Scholar at the University of Cambridge. I would like to thank Colin Fraser of
the Social and Political Sciences Committee for providing office space, help
ful professional advice, and friendly personal support; and to the Master and
Fellows of St. Edmund's College, where I lived for six months in a warmly
accepting and intellectually stimulating collegiate environment.
Contents
Acknowledgments v
Part I The Interpersonal Dynamics ofD entistry
Chapter 1 Introduction and Overview: Issues and Concepts 3
Chapter 2 The Psychologic Parameters of Dentistry 9
Chapter 3 The Psychology of Pain Tolerance 40
Part II Theoretic Models and Their Practical Implications 55
Chapter 4 Psychoanalysis and Patient Management 57
Chapter 5 Social Learning Theory and Patient Management 74
Chapter 6 Social Psychology and Patient Management 91
Chapter 7 Community-Based Dental Health Education 137
Chapter 8 Common Sense and Patient Management: Implications 149
for Practice, Training, and Research
References 162
Author Index 178
Subject Index 185
Part I
The Interpersonal
Dynamics of Dentistry
1
Introduction and Overview:
Issues and Concepts
In this chapter, the major issues, concepts, and research traditions that have
been employed in studying the dentist-patient relationship will be previewed.
Later in the book, these topics will be explored in greater detail.
Attendance Patterns
In western culture, practically everyone receives dental treatment at some
point in their lives. However, the frequency of visits to the dentist varies
greatly, the rate depending on a number of variables that will be reviewed in
Chapter 2. These include patients' knowledge about oral hygiene, the availa
bility and cost of dental care, patients' attitudes towards and perceptions of
their dentists, and individual differences in the amount offe ar that the dental
situation arouses.
An important condition that interacts with the attendance rate is the poli
cy of the dentist concerning the purpose and frequency of patient visits.
Dental practices can be classified into three broad categories: preventive,
restorative, and emergency. These three terms refer to the stated policy
of the dentist, the emphasis that the practitioner places on the respective
forms of treatment, and the most frequent style of therapeutic intervention
carried out. In reality most practices will be mixed to some extent. Never
theless, most dentists when asked will tend to describe their orientation in
terms of one of these three categories.
Preventive Dentistry
Preventive dentistry, as the name implies, has as its main aim the prevention
of dental disease before decay and other problems arise. Patients are shown
4 I. Introduction and Overview: Issues and Concepts
how to look after their teeth, they are given advice on diet, and consultation
time is taken up with cleaning teeth, applying fluoride, and other preventive
measures. The dentist explicitly adopts the role of dental health educator,
and a personal relationship often develops between the patient and the den
tist. It is customary for patients in preventive practices to visit their own
dentist every six months on a regular basis for perhaps two or three sessions
of which one will be devoted exclusively to teeth cleaning and other preven
tive measures. The shared aim of both the dentist and the patient is that in
due course the patient will attend surgery at stated intervals without present
ing any major symptoms, and maintain that condition indefinitely.
Restorative Dentistry
A great many people do not visit their dentist on a regular basis (e.g., every
six or 12 months). They only go "when there is something wrong with
them," that is, when they experience a toothache or some other form of
dental distress. Then they go the dentist "to be cured" of that specific com
plaint. It should be noted that the overall attendance rate of restorative
patients is not necessarily lower than the frequency of preventive patients.
For example, a person may not visit a dentist for several years, ignoring or
adapting to the deterioration that is occurring, but could ultimately require
a great deal of treatment often involving major surgery and reconstruction.
Likewise, the overall relative cost of the two types of treatment is difficult
to estimate, although it is probable that the savings made by not visiting the
dentist every six months will be more than offset by the cost of the more
complicated and protracted restorative treatment. The main difference be
tween preventive and restorative dentistry appears to be psychological, and
concerns the type of relationship between dentists and their patients. Pre
ventive, health-educator dentists, who see their patients on a regular, fairly
frequent basis, are much more likely to establish a personal relationship with
them than restorative dentists, who only see their patients intermittently
and under conditions of stress. This seems to imply that dentists in mainly
preventive practices should experience greater job satisfaction than their
restorative colleagues. However, the author knows of no direct evidence
bearing on this hypothesis.
Emergency Dentistry
Finally, there exist emergency dental services, often operated by clinics and
hospitals, and usually available at weekends and after hours. These facilities
cater to people who need urgent, emergency treatment, perhaps after break
ing a tooth, being in an accident involving the mouth, or suffering from an
abscess.
Patient Reactions 5
Patient Attitudes and Type of Practice
As has already been indicated, very few dental practices belong solely in one
of the three major categories. In particular, preventive practices may often
perform restorative or emergency work. However, the main stamp ofa prac
tice should be readily discernible from the extent to which the dentist insists
on regular preventive appointments.
The three types of dental practices are systematically related to two
aspects of the psychology of the dentist-patient relationship. The first is the
notion of "my dentist," in the same way as people come to regard their doctor,
solicitor, or priest. It can be hypothesized that there will be a descending
order in the extent to which preventive, restorative, and emergency patients
respectively, develop a personal regard for their dentists. The second vari
able is the degree of enthusiasm (or reluctance) with which different cate
gories of patients attend surgery. Again, a descending order of enthusiasm
can be hypothesized for preventive, restorative, and emergency patients. The
first of these hypotheses has received some indirect empiric support in a
study conducted by the author, to be reported later in this book (Chapter 6).
The second hypothesis has not been tested, to the best of the author's knowl
edge. These issues are important because of evidence indicating that both
the nature of the relationship and the motivation to attend surgery, influence
other patient variables, such as anxiety, the experience of pain, and the
patients' regard for the dentist.
Patient Reactions
Very few people enjoy going to the dentist. Practically every patient experi
ences some stress. However, most individuals resign themselves to their fate,
and enter and leave the surgery more or less intact psychologically. A minor
ity, variously described as between 10% and 20% of the population, find
the dental situation extremely aversive, and for these individuals dental
treatment is a terrifying experience. A detailed review of the literature re
garding attendance patterns and the incidence of dental phobia, appears in
Chapter 2.
The reaction of the patient to the dental situation has a major bearing on
the morale of the dentIst, and on how easily dentists can perform their duties.
Dentists do not like to be considered, or consider themselves primarily as
inflictors of pain. Patients who fidget, squirm, and gasp with pain are more
difficult to treat than individuals who accept the therapeutic intervention
placidly. For these reasons, a great deal of research has been carried out into
what determines patient reactions, with a view to reducing some of the more
disruptive responses to treatment. Much of this research has been conducted
by social scientists, or by dentists trained in the social sciences. Consequent
ly, the literature has borrowed some of the concepts, theories, and methods