Difficult denture patients: observations and hypothesis

The similarities between the HRC and the DDP have been presented. The HRC has been described by many investigators in the psychoanalytic literature. Indications are that both the HRC and the DDP are working through the same mechanism. The similarities are as follows: Both types of patients are driven by a need to seek treatment from someone they will ultimately reject. A self-fulfilling prophecy develops as a cycle leading to failure. Due to lack of trust and a desire to feel important, the patient creates an atmosphere that leads to discord, hostility, anger, and frustration. Resultant discord leads to the establishment of a relationship that demands much time and energy from the helper. The helper is ultimately manipulated into a no-win situation that ends with the helper dismissing the patient, thereby completing the patient's self-fulfilling prophecy. Recurrent stress in the patient's life recycles the drive force and the need for treatment and attention starts all over again. With greater understanding of the DDP's problems, management solutions could be formulated. Management techniques might include an initial interview with trust-building strategies, the reassurance to the patient of the uniqueness of his situation to neutralize the need to create a crisis for his own identity; and challenges to point out the hopelessness of their position to activate the patient's need to prove the helper wrong. Finally, in addition to management of the patient, techniques can be developed to identify the DDP with HRC tendencies. Proper recognition and diagnosis before treatment begins can prevent many problems associated with these patients and prevent stress and discord for both dentist and patients.