THE EDITOR'S CORNER
It should be possible to identify the attitudes of prospective orthodontic patients and to make an assessment of levels of cooperation to be expected in treatment. Potentially uncooperative patients could be screened out or exposed to motivation techniques which could convert them to potentially cooperative patients.
It should be possible to determine what the initial motivation of cooperative patients is and what sustains them over the long period of treatment. Techniques could then be developed to reinforce the initial motivation and to introduce new sources of motivation for potentially cooperative patients and to apply these to changing the attitudes of potentially uncooperative patients.
At the same time, we must recognize that there may be an element of inability to cooperate rather than an unwillingness. If we recognize that there is such a condition prior to or early along in treatment, we have an opportunity to overcome the inability or to modify the treatment and the treatment goals; to discontinue treatment or not undertake it in the first place.
Orthodontic treatment depends so much for its success on patient cooperation that it is surprising how relatively little attention has been paid to motivation research in orthodontics and the application of motivational techniques.
Appearance is recognized as a powerful motivator. People, including young girls and boys, may be more concerned about their appearance than almost anything else in life. I think that we should be stressing not necessarily facial esthetics, but dental esthetics. That is something that is simple to demonstrate and, moreover, it is something that we can deliver.
Health benefits may be a prime motivation for an adult orthodontic patient. However, children are not usually motivated by considerations such as improved function, improved speech, improved periodontal health, long life for the teeth, and avoiding future trouble.
There are still some children around who do things because they are obedient and do what is expected of them. Some people are competitive and to them orthodontics is the game. They play to win. Some aim to please. Some are seeking praise for accomplishment. Some children will do things because they like you. Conversely, fear of the orthodontist is also a motivating factor but, I think, a poor one. Just to avoid having the orthodontist rant and rave at each visit will motivate a patient to make an effort to show some progress.
There are practice administration devices that are related to patient motivation including patient and parent conferences and more and better audiovisual material. A fee range has been used as a patient motivator. This may be more effective at motivating parents than patients. Accordingly, some orthodontists have recommended offering the financial reward for early completion directly to the patient.
It is interesting to read the article by Dr. White in this issue of JCO in which he advocates a system of rewards to patients for cooperation. Some of the rewards are simple and immediate. Some are given for an accumulation of points. Such a system is easy to administer as long as it is confined to yes or no questions. Did you keep your appointment on time? Were your teeth clean? Did you wear your headgear into the office? And, it has value in these areas of cooperation. It would be more difficult if it tried to evaluate cooperation in wearing appliances. You might be rewarding one patient who didn't wear his elastics much, but grew suddenly. You might be not rewarding a patient who made a genuine effort, but whose teeth did not move as planned. For appliance cooperation, it might be feasible to assess progress in treatment on the basis of completion of stages of treatment and award points or rewards on that basis.
The point of the points and the reward of the rewards is that it is a motivating device which has the potential to create a spirit of cooperation in a practice, and the name of this game is cooperation.
