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Classification of patients mainly in concerned with Prosthodontics
Ideal Patient: There are four traits of the responses of an “ideal patient” who needs denture, according to Winkler. They are: the patient realizes the need for the treatment; wants the prostheses; accepts them and learns to utilize the dentures by giving attempts.
THERE ARE VARIOUS CLASSIFICATION
M M House Classification
In 1950, House who contributed to science and prosthodontic’s art development, devised a classification system of patient’s psychological response to condition of being edentulous and denture.
House classified this system into four types :
| Philosophical mind | Exacting mind | Hysterical mind | Indifferent mind |
1. Philosophical mind
- Reasonable, calm, and involved in the treatment procedure at every step.
- Understand the treatment.
- Listen to the dentist’s advice and are willing to follow the instruction.
- This type would follow dentist’s suggestion about convert the old denture to a new one.
2. Exacting mind
- This type has similar characteristic to philosophical mind, yet the dentist need more attempts, patience, and attention to patient of this type.
- These types are methodist, precise, strict, and often make excessive demand.
- The patient may be in poor health condition and desperately need for treatment, still they are not willing to accept dentist’s suggestion on extract the untreatable teeth and wear a denture.
- The patient with history of dental treatment dissatisfaction often doubt dentist’s ability to design a denture that can work functionally and aesthetically.
- Moreover, this patient often want a guarantee of the treatment and demand more with no additional fee.
- However, once this patient satisfy with the treatment, this patient can be clinician’s greatest supporter.
3. Hysterical mind
- This type is emotionally unstable, easily happy and easily anxious. This type have negative attitude, lack of maintaining their oral health, dentophobic, sometimes exacting but with unfounded complaint, lack of effort to adapt with denture, and have unrealistic expectation.
- Although they try to fit with denture, they often fail to wear because they think his denture will appear and function as natural teeth.
- The prognosis of treatment in this patient is poor.
4. Indifferent mind
- This patient is aphatetic, uninterested, and lack of motivation.
- This patient is more likely not concern about their appearance and not motivated to enjoy their meal.
- They can survive without denture. This patient do not concern to the instruction, no effort to cooperate with clinician, and more likely to blame dentist regarding a poor oral health of patient.
- The prognosis of this patient is doubtful or bad.
Winkler Classification
Winkler proposed several patient categories;
| The Hardy Elderly | Physically and psychologically ready, active in social and professional life, and easily adapt to age change |
| The Senile Aged Syndrome | physically may be ill,disabled or aged - psychologically and emotionally weak - cannot cope with stress and vulnerable to ailments. |
| The Satisfied Old Denture Wearer | This type is satisfied with the old denture despite the severe problem. They have adapted and happy with their old denture |
| Geriatric Patient who doesn’t Want Denture | This type is elderly patient who has been living with no teeth for years and doesn’t have any desire to wear full denture and lack of motivation. |
Gamer Classification
In 2003, Simon Gamer et al presented the expansion of House classification including dentist’s attitude as defining factor of patient’s attitude. Gamer classification is based on two factors, i.e:
Patient’s engagement level to dentist and treatment procedure in a continuum from totally engaged (++++) to disengaged (+)
| Ideal patient | Submitter Patient | Reluctant | Indifferent Patient | Resistant Patient |
1. Ideal patient
- Reasonably engaged i.e. (+ + +)
- Reasonably trusts the dentist i.e. (+ + +)
- May skeptically distrust also .
- Mature
- May ask questions and need satisfying answers for the same from the dentist.
- May not be over suspicious or over accepting of the dentist’s opinions.
- Similar to Philosophical type of patient in House’s classification.
2. Submitter Patient
- Submitter patient are scored ++++ for involvement and ++++ for willingness to trust dentist.
- They do not discriminate.
- Submitter do not have capacity to provide pure informed consent because they submit everything to dentist’s skill.
- Engages in the treatment completely.
3. Reluctant
- Engagement level is + +
- Trust for the treatment is ++
- Skeptic
4. Indifferent Patient
- They are scored + for involvement and + for willingness to trust dentist.
- They are often forced to come to dentist by their relative and family.
- Minimal involvement.
5. Resistant Patient
- Engaged with treatment but with an adverse mindset.
- Trust is very minimal or not there.
- Question or doubt if they receive help from anyone in any situation.
- Instead of acknowledging or accepting, they challenge the dentist.
