 The aim of continuous dental care is for dentists to be able to make contact with patients in an easy and acceptable manner.  For patients who may be described as ‘regular attender's dentists have been able to form and maintain a ‘treatment’ relationship.  This enables patients to accept the care which has been negotiated and offered.

 From a psychodynamic viewpoint dental healthcare is a 2-person Endeavour  There are three aspects of the psychodynamic model which must be considered in this regard. These are,first the real relationship, secondly, the treatment alliance and thirdly, the transference.

 The real relationship is an equal and unique relationship between two adults  This is a genuine interaction in which the uniqueness of the dentist is complemented by the uniqueness of the patient.  Within the adult-to-adult equality of the relationship the dentist will have been chosen by the patient because of his clinical attributes and skills.  The real relationship, in this regard, will remain unaffected by any anxieties or concerns the patient may have about dental treatment.

 The treatment alliance is an equal relationship between two adults.  However, while it possesses the same status equality of the real relationship, it differs.  It is not only a development of the real relationship but is affected by the patient's anxieties and concerns with regard to accepting dental treatment.  For the first time in the dentist– patient relationship the patient's concerns and anxiety about dental treatment seem to merge with the dentist's clinical and patient management skills.

 Like the treatment alliance the transference develops with time but unlike the real relationship or the treatment alliance this is not an interaction between adults.  The transference represents the past.  as the transference represents the past, it sometimes becomes intrinsically associated with regression.  The interaction is no longer one of equality between adults but one between the dentist as 'parent' and patient as 'child'

 Dentist patient relationship have been described by various authors in different ways. A. SZASZ and HOLLANDER have described 3 basic type of doctor patient relationship. 1) ACTIVE PASSIVE 2) GUIDANCE-COOPERATION 3) MUTUAL PARTICIPATION

ACTIVE –PASSIVE  In this type dentist is active and patient is passive.  Whatever dentist does to patient, patient remain helpless.  Mostly, dentist is concerned with operatory part and has nothing to do with prevention of disease.  The treatment session: an example of the activity– passivity model

 Patient is expected to follow dentist direction.  Dentist tell his patient,what is good for him and expect full cooperation from him.  Patient cooperation is prerequisite in this type of relationship.  The dental check-up visit: an example of the guidance– cooperation model

MUTUAL PARTICIPATION  Offers best hope for establishing growth oriented relationship between dentist and patient.  Suited for chronic disease such as dental caries and periodontal disease.  Dentist help patient in every sphere.  Negotiating preventive health goals: an example of the mutual-participation model

 B. GAZDA ET AL put forward a new approach to dentist patient relationship which describes as a helping relationship. FACILITATIVE DIMENSION TRANSITION DIMENSION ACTION DIMENSIONS EMPATHY CONCRETENESSFORMULATE GOALS DEVELOP ALTERNATIVES RESPECTHONESTYCONSIDER CONSEQUENCES SELECT ALTERNATIVES WARMTHSELF-DISCLOSUREACT ON SELECTION SELF-EVALUATION

GOALS OF DISCOURSE 1. Information for dental diagnosis and treatment 2. Communication for establishing a relationship 3. Feedback of information for health care and prevention 4. Information for understanding the patient’s attribution, requests and feelings etc

i. Patient’s name,age, family background and, ii. Complaint of patient and his expectation from dentist. iii. Patient’s attribution or his own diagnosis iv. Patient if willing or unwilling to undergo treatment v. Certain dental habits vi. History of his being to past dentists vii. Medical conditions, especially those which exaggerate dental conditions

 It is evident that desirable interaction between dentist and patient leads to more satisfied patients  Patients satisfaction has been widely recognized as a principal outcome measure of health care quality

Kress in 1988 elaborated three basic questions regarding patients satisfaction A. What are the factors that affect dental patient satisfaction? B. How does satisfaction affect the behavior of dental patients? C. What are the implications for the care provider?

conclusion Dental healthcare which acknowledges the role of the real relationship, the treatment alliance and the transference within a dynamic framework, will maintain the equality of the dentist-patient relationship. It is by an appreciation of the complexities of the dentist–patient interaction that the dental health professional will be able to enable patients not only to accept dental care but also to empower them to take responsibility for their own oral health.