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Lecture 1: Basic concepts

Both reinforcement and punishment can be manipulated by adding or removing fortune or mishap.
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Welcome back to the course Brain, Behaviour, and Dentistry. Now we begin the fourth session of the course, which will focus on the issues of motivation and decision-making of dental patients. After this class, you will learn some basic concepts regarding motivation and reward, and identify the role of these concepts in dental care. From this session, we will talk about the ‘ultimate’ human behaviour, i.e., how people make a decision. Now, patients have different memory and emotion toward dental treatment. For example, they may feel scared of dental treatment. However, the most important thing is that they decide to see the dentist, so that we can handle their fear. If they decide not to see the dentist, we can’t do anything for them.
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So, their choices really matter! Researchers have proposed a general framework of decision-making, which starts from our understanding of a scenario of decision-making. The scenario is usually presented by dentists, such as different treatment plans and the pros and cons of each choice. Then, patients need to evaluate these pros and cons and select the choice that works for their own benefits. It is also important for them to evaluate the outcome of their choice so that they can modify their future decisions based on the experience they have gained this time. This general framework is very critical to clinical practice. Now in most countries, ‘shared decision-making’ has been a popular way to achieve an ideal treatment plan between patients and dentists.
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The most critical part of making a decision is to share the information related to treatment. That is, the pros and cons of treatment choices need to be clearly presented to patients by dentists, the patients’ needs have to be presented to dentists. This representation of the decision-making scenario is fundamental for reaching an ideal treatment plan. As shown in the general framework, patients will decide what to do next, according to their prior experience of their choices. To we dentists, what we hope is that patients can maintain their good behaviour, such as regular dental scaling. From the point of operant conditioning, psychologists found that the frequency of our actions can be influenced by the outcomes of the action.
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We will increase the frequency to do something that helps us to gain something good and avoid something bad. In the Chinese language, we call it ‘Qū jí bì xiōng’, that means to pursue fortune ‘Jí’ and to avoid mishap ‘Xiōng’. For example, patients may keep regular dental scaling to improve oral health and avoid periodontitis.
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In fact, dentists are following the same principle: we do more things to help patients feel satisfied and avoid doing things too risky. We need to clarify further that in operant conditioning, to motivate someone to do something more, that means reinforcement, and to discourage someone to do something, that means punishment. Both reinforcement and punishment can be manipulated by adding or removing fortune or mishap. For example, smokers may smoke less when they find smoking leads to poor health or makes them less attractive to others. However, you will find that patients behaviour is far more complicated than the prediction by theories. Why is that?
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Because patients may have a different view on the pros and cons, the fortune and mishap, and ‘Jí Xiōng’, compared to dentists. In other words, they may have a different feeling about what is called a ‘reward’. Rewards are objects, events, situations or activities that attain positive motivational properties. The judgment of a reward is very subjective and usually in a relative sense.
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Here is an example: most dental patients are motivated to see a dentist because of toothache. They expect to get relived from toothache, and therefore pain relief, but not pain itself, is the major reward they expect to get. Here pain relief is defined in a relative sense. For example, when the toothache is strong, a moderate degree of relief can be very rewarding to patients. However, if the toothache is just mild, patients may not feel a strong relief from the treatment. In other words, the perception of reward may change along with the reference point, i.e., the status quo, and one’s expectation, i.e., what they anticipate to get. I have to say that the idea of ‘utility’ is sometimes confusing.
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On the one hand, it is associated with the good feelings or satisfaction of our choice. This is very subjective. On the other hand, it can be observed by people’s preference – we choose the option that renders us higher utility, and people’s preference can be measured objectively. But from the perspective of cognitive neuroscience, these two aspects are related. Either the subjective feelings or the behaviour of choice-making is associated with the brain processing of reward.

Motivation and decision-making

Now we begin the fourth session, which will focus on the issues of motivation and decision-making of dental patients. After this class, you will learn some basic concepts regarding motivation and reward, and identify the role of these concepts in dental care.

In this step, we will mainly talk about the ‘ultimate’ human behaviour, i.e., should I go to the dentist today or next week?

Does it matter?
Of course, Patients’ choices and decisions do matter!

We know that patients have different memory and emotion toward dental treatment. They often feel scared of dental treatment. However, the most important thing is that they decide to see the dentist.

Therefore, as a dentist, it’s our job to do more things to help patients feel satisfied and avoid doing things too risky.

What’s your suggestion? By telling them the pros and cons? Giving them more information?

Please share your ideas with us!

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Brain, Behaviour, and Dentistry

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