Chapter 4

Motivation

In general, patients who are undergoing orthodontic treatment are quite enthusiastic about their treatment.

Maintaining this enthusiasm can be difficult but it truly is the secret of success.

Orthodontic treatment involving fixed appliance therapy takes:

• 18–24 months on average
• regular visits

and the optimum time to do this is in the early second dentition.

For a young patient, perception of time is quite unlike that of their orthodontist or parents. They are brought up in a world of no-waiting, touch-ofa-button, on-demand instant results.

Most patients see a school term as a long period and the time between one birthday and the next is off the scale. So, when they start treatment that is probably the keenest they are going to be.

Orthodontic treatment is like planting a garden; you plant and wait patiently until the flowers appear and you sometimes have a long period before you can see any signs of progress.

Sometimes, in the early stages when the ‘instant fix’ that patients hope for is just not happening, they become despondent when they look at themselves and see little progress.

When we reach this stage, there are often telltale signs:

• oral hygiene can deteriorate
• there are breakages
• there are occasional missed appointments
• the patient can become uncommunicative, even sullen

This is where the motivation has to be rekindled.

Unlike patients in general practice, orthodontic patients:

• are referred in from their regular dentist
• are seen for a course of treatment and retention
• are not routinely seen again

During orthodontic treatment, patients are seen, on average, every 4–6 weeks.

During that, time you get to know them and their parents quite well.

Sometimes they may have had a brother or sister in treatment before them so that both the parents and new patient will be familiar with the surgery and the routine of appliance adjustment appointments.

Many have friends at school who are undergoing the same treatment and may be having similar experiences to cope with.

This can be helpful, if it is constructive.

Not being the only one with a brace helps.

There is much discussion of treatments between patients, especially at school. Like all chatter:

• there are those who tell tales of doom and gloom
• there are others who tease
• on rare occasions, banter may become bullying

If this happens, parents and schools must get involved. It must be stopped.

When orthodontic patients are assessed, the amount of support they will get is important.

The range of scenarios includes:

• a keen patient with a keen and supportive parent
• a keen patient with an indifferent or unsupportive parent. We can get a result, but it is hard work
• a patient who is actively against treatment with a parent who insists they must have it

(These parents want their child to receive treatment and the child has to comply. This may be because the parent wants what they see as the best for their child, maybe they missed having the treatment themselves or failed to complete it and always regretted it.)

As these reluctant patients look you right in the eye with the:

• ‘just you see who is the boss’
• ‘I really, really don’t want this’
• ‘I will have the last word’

look, it is the beginning of an uphill struggle, often littered with many breakages and lost appliances along the way!

When the nurse builds a rapport with a patient it is easier to know what motivates them.

As the treatment progresses, the patient experiences a mixture of:

• seeing the benefits appearing
• wanting the braces removed as soon as possible

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