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Ms. Hemangi Narvekar
Clinical Psychologist
• Introduction
• Basic Anatomy of Mouth, Problems &
Treatment
• Etiology
• Consequences
• Assessments
• Intervention
• Conclusion
• References
INTRODUCTION
Anxiety is characterized as an uncertain, unpleasant feeling
accompanied by the premonition that something
undesirable is about to happen (Marya et al., 2012).
Dental anxiety is a widespread problem in populations of
different countries.
Previous studies reported 64% of individuals nervous of
dental treatment with a smaller but still significant number of adults (2.4 – 3.7%) classed as dental
phobics.
Dental anxiety, which is a psychological problem, is a serious condition that also influences patient’s
physical health.
BASIC ANATOMY OF THE
MOUTH
The mouth, or oral cavity, is made up of numerous components that work
together so that we can breathe, speak, eat and digest food.
• Lips and Cheeks
• Tongue
• Teeth, Gums and Alveolar Bone
• Salivary Glands
TYPES OF TEETH
Every tooth has a specific job or function
 Incisors - The sharp, chisel-shaped
front teeth (four upper, four lower)
used for cutting food.
 Canines - Sometimes called cuspids,
these teeth are shaped like points
(cusps) and are used for tearing food.
 Premolars - These teeth have two
pointed cusps on their biting surface
and are sometimes referred to as
bicuspids. The premolars are for
crushing and tearing.
 Molars - Used for grinding, these
teeth have several cusps on the biting
surface.
PARTS OF A TOOTH
• Crown - The top part of the tooth, and the only
part we can normally see.
• Gumline - Where the tooth and the gums meet.
• Root - The part of the tooth that is embedded in
bone.
• Enamel - The outermost layer of the tooth. It is
the hardest, most mineralized tissue in the body.
• Dentin - The layer of the tooth under the
enamel.
• Pulp - The soft tissue found in the center of all
teeth, where the nerve tissue and blood vessels
are.
DENTAL PROBLEMS
• Tooth decay
• Periodontitis
• Gingivitis
• Plaque
• Tartar
• Overbite
• Underbite
• Teeth grinding (bruxism)
• Tooth sensitivity
• Bad breath
• Dry mouth
• Wisdom Teeth
• Mouth sores & infections
• Temporomandibular Disorder
(TMD)
• Cracked Tooth Syndrome
• Hyperdontia
OTHER RELATED
COMPLICATIONS
• Because the mouth is a primary entryway into the body, poor oral health can have
negative consequences for the entire body.
• Because of the mouth’s proximity to the brain the infection does not have to travel
very far to affect one’s brain.
• 46 percent of the motor and sensory nerves of brain’s cerebral cortex are
interconnected to mouth and face.
• Headaches and toothaches all transmit through the trigeminal nerve, the largest
sensory nerve in the head that supplies the external face, scalp, jaw, teeth and much
of the intra-oral structures
• Pain in one branch of the nerve has the potential to activate other branches of the
nerve, and when that pain is chronic and sustained, it is more likely to trigger a
sequence of events that might lead to a headache.
OTHER RELATED
COMPLICATIONS
• Surrounding each tooth is a tight girdle of fibers
pulling the gums snugly around the neck of the
tooth. This tight seal is designed to keep
elements out.
• In a healthy mouth with no infection, the seal is
tight and the pathway between mouth bacteria
and the bloodstream is closed.
• When an infection is present in the gums, the
seal is weakened and elements from the outside
environment can get past the gums and into the
bloodstream.
OTHER RELATED
COMPLICATIONS
Cardiovascular Disease
Diabetes
Kidney Disease
Cancer
Dementia
Respiratory Infections
Erectile Dysfunction
Rheumatoid Arthritis
Infertility & Pregnancy complications
Stroke
TEETH ASSESSMENTS
Teeth X-ray films: X-ray pictures of
the teeth may detect cavities below
the gum line, or that are too small to
identify otherwise.
Teeth examination: By viewing and
gently manipulating the teeth, a
dentist can detect potential teeth
problems.
TREATMENTS
Brushing teeth Flossing teeth Rinsing teeth Teeth cleaning Tooth filling
Root canal Tooth
extraction
Braces Mouth guard Dental sealants
Teeth
whitening
Implants Dentures Veneers
DENTALANXIETY
• Dental anxiety is defined as a patient’s response to
stress that is specific to dental situation.
• It is ranked as the fourth among common fears and
ninth among intense fears.
• Dental anxiety can be observed at any age but onset is
usually seen in childhood, peak period in early
adulthood, and decline with increasing age.
• Dental anxiety can have a profound detrimental impact
on the quality of life of the sufferer.
• It may be also a source of professional stress, which
can decrease the surgeon’s performance in delicate
procedures and complex treatments.
RELATED BUT DIFFERENT
CONCEPTS
• A person with dental phobia may prefer to endure
pain rather than make a dental appointment and
may only choose to visit the dentist in extreme
circumstances.
DENTAL
PHOBIA
• Dental fear typically involves prior knowledge of the
dentist. With dental fear, however, the feelings of
distress are not as intense as those occurring with
dental phobia.
DENTAL
FEAR
• An individual who has never had a dental check-up
before may experience dental anxiety—feelings of
apprehension regarding what is not yet known about
the dentist or dental care in general.
DENTAL
ANXIETY
PSYCHOLOGICAL CYCLE OF
DENTAL ANXIETY
Anxiety
Avoidance
Deterioration
in dental
status
Feelings of
shame &
inferiority
Berggren & Meynert (1984)
ETIOLOGY
• The etiology of dental anxiety is a highly debated topic and many theories are put
forth.
• Nineteenth century literature paints a picture of what modern researchers delving
into dental anxiety have categorized as a feeling of “existential threat.”
• One theory states that there are two groups of dentally anxious individuals;
exogenous and endogenous.
• In the exogenous group, dental anxiety results from traumatic dental experiences
or even vicarious learning;
• In endogenous group, the individual has a constitutional vulnerability to the
anxiety disorders as evidenced by general anxiety states.
ETIOLOGICAL FACTORS
Age
Gender
Education
Relationship status
Congenital determinants
Trauma
Personality characteristics
Coping styles
Past unfavorable dental experiences
Learning of the bad experiences
Comorbid health issues
Dentist – Patient interactions
ETIOLOGICAL FACTORS
• Ray et al. found genetic component in dental fear/anxiety and the heritability was
shown to be higher in girls than in boys.
• In general women have more dental fear than men (Ragnarsson et al., 2003).
• Recent studies have shown that dental fear is more common among younger
adults than older individuals (Pekkan, Kilicoglu & Hatipoglu, 2011).
• However, other studies have indicated that younger individuals (15 to 25 years)
have less dental fear than older individuals (Lahti et al., 2007).
• Also, severe dental fear is more common among patients with lower educational
status or those who are single than among those with higher educational status
and/or in a relationship (Hagglin et al., 2000).
• Previous studies reported that there is a relationship between dental anxiety and
general fear and anxiety, as well as general psychological status and personality
characteristics (Fuentes, Gorenstein & Hu, 2009; Kesim et al., 2012).
• Blomqvist M, Ek U, Fernell E, et al found that children with a high verbal
intelligence suffer from less dental anxiety.
• Several environmental factors have been suggested, including congenital
determinants, trauma, and past unfavorable dental experiences (Tunc et al., 2005).
• Appukuttan, D. P., Cholan, P. K. , Tadepalli, A., & Subramanian, S. (2017) intended to
measure self-reported dental anxiety, recognize factors that possibly influence DA
and appraise the dental visiting pattern based on their severity of DA.
• A total of 1836 subjects aged 18-30 years participated and survey forms were
administered in both English and Tamil languages.
• The Modified Dental Anxiety Scale (MDAS) was used for assessment of DA.
• Subjects were students from an engineering college and an Arts, Science College also
the patients and their escorts, visiting the outpatient clinics of SRM Dental College.
Research Findings:
• History revealed that 50.8% never visited
a dentist and they were more anxious
(p<0.05). Irregular visiting pattern was
observed among those who visited a
dentist previously.
• DA predicted dental non-attendance and
avoidance behaviour in this study group.
• Bad experience at the dentist office was
associated with high anxiety scores
(p<0.001) and 3.34 times odds of
avoiding dental visit.
Receiving local anesthetic
injection
Drilling of the tooth
Sitting in the waiting
room
Visiting the dentist
Tooth cleaning and
polishing
OTHER FACTORS…
Fear of
injections
Expectations of post-
operative discomfort
Uncertainty
Invasion
Vulnerability and Loss of
Control
Isolation
Embarrassment
and Shame
Concern About Finances
Asphyxiation
Disfigurement from the
loss of a tooth, cut
tongue or lip
Dentist superiority or
patient inferiority Betrayal by past
assurances of painless
procedures that were
painful
Radiation exposure Mercury poisoning
CONSEQUENCES
One study by Cohen et al. has shown that the impact of dental anxiety
on people’s lives can be divided into the five categories outlined below:
Physiological
Disruption
E.g. dry mouth,
increased heart rate,
sweating
Cognitive
Changes
E. g. negative and even
catastrophic thoughts and
feelings, unhelpful beliefs
and fears
Behavioural
Changes
E.g. alteration of diet,
attention to oral
hygiene, avoidance of
dental environment,
crying, aggression
Health
Changes
E.g. sleep
disturbance,
acceptance of poor
oral health
Disruption of
Social Roles
E.g. reduced social
interactions and adverse
affects on performance at
work. Family and personal
relationships can also be
adversely affected
ASSESSMENTS
 Assessment of dental anxiety should be a prerequisite for any visit to the
dentist and can be routinely performed.
 The practitioner should not rely exclusively on clinical judgment in assessing
anxious patients, as studies indicate that there is disagreement between
patient self-reported anxiety status and clinician rating of dental anxiety.
 Objective measures involve assessment of blood pressure, pulse rate, pulse
oximetry, finger temperature, and galvanic skin response.
 Subjective assessment of anxious patients can also be done based on their
psychophysiological, behavioral, and emotional responses.
Author:
Norman Corah (1969)
Modified By:
Gerry M Humphris
Tom A Dyer
Peter G Robinson (1995)
Reliability:
The intraclass correlation
coefficient between test
and retest was 0.872.
Validity:
Spearman’s correlation
coefficient between the
total MDAS score and
VAS score was 0.838.
THE MODIFIED DENTAL
ANXIETY SCALE
Author:
J.H. Clarke
S. Rustvold (1993)
DENTAL CONCERNS
ASSESSMRENT
STRATEGIES
USED
BY
DENTISTS
Listening to soothing music
Watching television during the procedure
Setting early appointment times to decrease waiting time
Speaking to the dentist before procedure
Sedation for any dental procedure
Anxiety relieving medication
Relative analgesia (happy gas)
PSYCHOLOGY IN DENTISTRY
 Psychology can be applied to all dental specialties ranging from the general
practitioner to the experts in their respective fields and the dental surgeon itself.
 The Psychology applied to Dentistry should interact in the following areas:
Orthodontics and Pediatric Dentistry
Work and understand the poor habits (thumb sucking, nail
biting, fears, etc)
Interactions between patients and dental professionals
Coping with stress of dental pain
Compliance with recommended oral health practice
PSYCHOLOGICAL
INTERVENTIONS
Distraction
Modeling
Contingency
Management
Shaping
Visualization
Positive
Reinforcement
PSYCHOLOGICAL
INTERVENTIONS
Relaxation
Techniques
Systematic
Desensitization
EMDR
Biofeedback
Exposure
Therapy
Cognitive
Behavioural
Therapy
Hypnosis
CHILDREN AND ADULTS WITH
DISABILITIES
 Dental care also needs to be considered for children and adults with
disabilities.
 Cleft lip or palate, Down syndrome, neurological disorders, cerebral
palsy, and vision and hearing impairments are common medical
conditions requiring special dental care, as well as learning and
developmental disabilities.
 Dental problems of people with special needs are often associated with
mental abilities of the person.
 These include: considerably poor oral hygiene, significant presence of
soft and hard deposits on teeth, presence of periodontal disease, high
percentage of untreated carious teeth, a small number of filled teeth,
large number of extracted teeth compared to the healthy population,
trauma and damage to the teeth and mouth are much more prevalent
(due to falls), and considerably more common prevalence of
malocclusions of different degrees of difficulty.
ISSUES OF CULTURAL
DIVERSITY IN DENTAL
TREATMENT
 It is important to recognise the cultural beliefs relating to dental disease and
treatment, e.g. in many cultures treatment is only sought if or when symptoms
occur as opposed to a more preventative dental care approach.
 Some of the chronic dental diseases have their etiologies embedded in cultural
habits; the classical example being oral cancer which has an increased risk in Asian
populations particularly from the Indian subcontinent due to the high rate of paan
consumption.
 Another interesting example comes from China where the appearance of teeth is
psychosocially important.
 Use of folk remedies - the use of cotton balls soaked in aspirin solution, alcohol or
salt water is a well-known home remedy for pain.
TO CONCLUDE..
• Fear of dentistry and associated
psychological difficulties, is a widespread
problem.
• Dental anxiety – a joint interest for dentists
and psychologists.
• The need for psychological interventions in
dentistry is now supported, as is the
importance of providing the necessary
psychological guidance and expertise in
terms of treatment planning and clinical
decision-making (General Dental Council,
1990; British Psychological Society, 1996).
REFERENCES
• Appukuttan, D. P., et al. (2017). Evaluation of Dental Anxiety and its Influence on
Dental Visiting Pattern among Young Adults in India: A Multicentre Cross Sectional
Study. Annals of Medical & Health Science Research, 7,393-400.
• Carteret, M. (2013). How culture affects oral health beliefs and behaviors.
Retrieved from http://www.dimensionsofculture.com/2013/01/how-culture-
affects-oral-health-beliefs-and-behaviors/
• Dental Fear Central: Psychological Approaches. Retrieved from
https://www.dentalfearcentral.org/help/psychology/
• Humphris, G., Spyt, J., Herbison, A. G., & Kelsey, T. (2015). Adult dental anxiety:
Recent assessment approaches and psychological management in a dental practice
setting.
• Longman, L. P., & Ireland, R. S. (2010). Management of dental anxiety.
• Srivastava & Anuradha. (2013). Psychology in dentistry—“An emerging field of
dentistry in India’’. Global journal of medicine and public health, 2(5).
• Wide Boman, U., Carlsson, V., Westin, M., & Hakeberg, M. (2013). Psychological
treatment of dental anxiety among adults: a systematic review. European Journal
of Oral Science, 121, 225–234.
Dental Anxiety

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Dental Anxiety

  • 2. • Introduction • Basic Anatomy of Mouth, Problems & Treatment • Etiology • Consequences • Assessments • Intervention • Conclusion • References
  • 3. INTRODUCTION Anxiety is characterized as an uncertain, unpleasant feeling accompanied by the premonition that something undesirable is about to happen (Marya et al., 2012). Dental anxiety is a widespread problem in populations of different countries. Previous studies reported 64% of individuals nervous of dental treatment with a smaller but still significant number of adults (2.4 – 3.7%) classed as dental phobics. Dental anxiety, which is a psychological problem, is a serious condition that also influences patient’s physical health.
  • 4. BASIC ANATOMY OF THE MOUTH The mouth, or oral cavity, is made up of numerous components that work together so that we can breathe, speak, eat and digest food. • Lips and Cheeks • Tongue • Teeth, Gums and Alveolar Bone • Salivary Glands
  • 5. TYPES OF TEETH Every tooth has a specific job or function  Incisors - The sharp, chisel-shaped front teeth (four upper, four lower) used for cutting food.  Canines - Sometimes called cuspids, these teeth are shaped like points (cusps) and are used for tearing food.  Premolars - These teeth have two pointed cusps on their biting surface and are sometimes referred to as bicuspids. The premolars are for crushing and tearing.  Molars - Used for grinding, these teeth have several cusps on the biting surface.
  • 6. PARTS OF A TOOTH • Crown - The top part of the tooth, and the only part we can normally see. • Gumline - Where the tooth and the gums meet. • Root - The part of the tooth that is embedded in bone. • Enamel - The outermost layer of the tooth. It is the hardest, most mineralized tissue in the body. • Dentin - The layer of the tooth under the enamel. • Pulp - The soft tissue found in the center of all teeth, where the nerve tissue and blood vessels are.
  • 7. DENTAL PROBLEMS • Tooth decay • Periodontitis • Gingivitis • Plaque • Tartar • Overbite • Underbite • Teeth grinding (bruxism) • Tooth sensitivity • Bad breath • Dry mouth • Wisdom Teeth • Mouth sores & infections • Temporomandibular Disorder (TMD) • Cracked Tooth Syndrome • Hyperdontia
  • 8. OTHER RELATED COMPLICATIONS • Because the mouth is a primary entryway into the body, poor oral health can have negative consequences for the entire body. • Because of the mouth’s proximity to the brain the infection does not have to travel very far to affect one’s brain. • 46 percent of the motor and sensory nerves of brain’s cerebral cortex are interconnected to mouth and face. • Headaches and toothaches all transmit through the trigeminal nerve, the largest sensory nerve in the head that supplies the external face, scalp, jaw, teeth and much of the intra-oral structures • Pain in one branch of the nerve has the potential to activate other branches of the nerve, and when that pain is chronic and sustained, it is more likely to trigger a sequence of events that might lead to a headache.
  • 9. OTHER RELATED COMPLICATIONS • Surrounding each tooth is a tight girdle of fibers pulling the gums snugly around the neck of the tooth. This tight seal is designed to keep elements out. • In a healthy mouth with no infection, the seal is tight and the pathway between mouth bacteria and the bloodstream is closed. • When an infection is present in the gums, the seal is weakened and elements from the outside environment can get past the gums and into the bloodstream.
  • 10. OTHER RELATED COMPLICATIONS Cardiovascular Disease Diabetes Kidney Disease Cancer Dementia Respiratory Infections Erectile Dysfunction Rheumatoid Arthritis Infertility & Pregnancy complications Stroke
  • 11. TEETH ASSESSMENTS Teeth X-ray films: X-ray pictures of the teeth may detect cavities below the gum line, or that are too small to identify otherwise. Teeth examination: By viewing and gently manipulating the teeth, a dentist can detect potential teeth problems.
  • 12. TREATMENTS Brushing teeth Flossing teeth Rinsing teeth Teeth cleaning Tooth filling Root canal Tooth extraction Braces Mouth guard Dental sealants Teeth whitening Implants Dentures Veneers
  • 13. DENTALANXIETY • Dental anxiety is defined as a patient’s response to stress that is specific to dental situation. • It is ranked as the fourth among common fears and ninth among intense fears. • Dental anxiety can be observed at any age but onset is usually seen in childhood, peak period in early adulthood, and decline with increasing age. • Dental anxiety can have a profound detrimental impact on the quality of life of the sufferer. • It may be also a source of professional stress, which can decrease the surgeon’s performance in delicate procedures and complex treatments.
  • 14. RELATED BUT DIFFERENT CONCEPTS • A person with dental phobia may prefer to endure pain rather than make a dental appointment and may only choose to visit the dentist in extreme circumstances. DENTAL PHOBIA • Dental fear typically involves prior knowledge of the dentist. With dental fear, however, the feelings of distress are not as intense as those occurring with dental phobia. DENTAL FEAR • An individual who has never had a dental check-up before may experience dental anxiety—feelings of apprehension regarding what is not yet known about the dentist or dental care in general. DENTAL ANXIETY
  • 15. PSYCHOLOGICAL CYCLE OF DENTAL ANXIETY Anxiety Avoidance Deterioration in dental status Feelings of shame & inferiority Berggren & Meynert (1984)
  • 16. ETIOLOGY • The etiology of dental anxiety is a highly debated topic and many theories are put forth. • Nineteenth century literature paints a picture of what modern researchers delving into dental anxiety have categorized as a feeling of “existential threat.” • One theory states that there are two groups of dentally anxious individuals; exogenous and endogenous. • In the exogenous group, dental anxiety results from traumatic dental experiences or even vicarious learning; • In endogenous group, the individual has a constitutional vulnerability to the anxiety disorders as evidenced by general anxiety states.
  • 17. ETIOLOGICAL FACTORS Age Gender Education Relationship status Congenital determinants Trauma Personality characteristics Coping styles Past unfavorable dental experiences Learning of the bad experiences Comorbid health issues Dentist – Patient interactions
  • 18. ETIOLOGICAL FACTORS • Ray et al. found genetic component in dental fear/anxiety and the heritability was shown to be higher in girls than in boys. • In general women have more dental fear than men (Ragnarsson et al., 2003). • Recent studies have shown that dental fear is more common among younger adults than older individuals (Pekkan, Kilicoglu & Hatipoglu, 2011). • However, other studies have indicated that younger individuals (15 to 25 years) have less dental fear than older individuals (Lahti et al., 2007). • Also, severe dental fear is more common among patients with lower educational status or those who are single than among those with higher educational status and/or in a relationship (Hagglin et al., 2000). • Previous studies reported that there is a relationship between dental anxiety and general fear and anxiety, as well as general psychological status and personality characteristics (Fuentes, Gorenstein & Hu, 2009; Kesim et al., 2012). • Blomqvist M, Ek U, Fernell E, et al found that children with a high verbal intelligence suffer from less dental anxiety. • Several environmental factors have been suggested, including congenital determinants, trauma, and past unfavorable dental experiences (Tunc et al., 2005).
  • 19. • Appukuttan, D. P., Cholan, P. K. , Tadepalli, A., & Subramanian, S. (2017) intended to measure self-reported dental anxiety, recognize factors that possibly influence DA and appraise the dental visiting pattern based on their severity of DA. • A total of 1836 subjects aged 18-30 years participated and survey forms were administered in both English and Tamil languages. • The Modified Dental Anxiety Scale (MDAS) was used for assessment of DA. • Subjects were students from an engineering college and an Arts, Science College also the patients and their escorts, visiting the outpatient clinics of SRM Dental College.
  • 20. Research Findings: • History revealed that 50.8% never visited a dentist and they were more anxious (p<0.05). Irregular visiting pattern was observed among those who visited a dentist previously. • DA predicted dental non-attendance and avoidance behaviour in this study group. • Bad experience at the dentist office was associated with high anxiety scores (p<0.001) and 3.34 times odds of avoiding dental visit. Receiving local anesthetic injection Drilling of the tooth Sitting in the waiting room Visiting the dentist Tooth cleaning and polishing
  • 21. OTHER FACTORS… Fear of injections Expectations of post- operative discomfort Uncertainty Invasion Vulnerability and Loss of Control Isolation Embarrassment and Shame Concern About Finances Asphyxiation Disfigurement from the loss of a tooth, cut tongue or lip Dentist superiority or patient inferiority Betrayal by past assurances of painless procedures that were painful Radiation exposure Mercury poisoning
  • 22. CONSEQUENCES One study by Cohen et al. has shown that the impact of dental anxiety on people’s lives can be divided into the five categories outlined below: Physiological Disruption E.g. dry mouth, increased heart rate, sweating Cognitive Changes E. g. negative and even catastrophic thoughts and feelings, unhelpful beliefs and fears Behavioural Changes E.g. alteration of diet, attention to oral hygiene, avoidance of dental environment, crying, aggression Health Changes E.g. sleep disturbance, acceptance of poor oral health Disruption of Social Roles E.g. reduced social interactions and adverse affects on performance at work. Family and personal relationships can also be adversely affected
  • 23. ASSESSMENTS  Assessment of dental anxiety should be a prerequisite for any visit to the dentist and can be routinely performed.  The practitioner should not rely exclusively on clinical judgment in assessing anxious patients, as studies indicate that there is disagreement between patient self-reported anxiety status and clinician rating of dental anxiety.  Objective measures involve assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response.  Subjective assessment of anxious patients can also be done based on their psychophysiological, behavioral, and emotional responses.
  • 24. Author: Norman Corah (1969) Modified By: Gerry M Humphris Tom A Dyer Peter G Robinson (1995) Reliability: The intraclass correlation coefficient between test and retest was 0.872. Validity: Spearman’s correlation coefficient between the total MDAS score and VAS score was 0.838. THE MODIFIED DENTAL ANXIETY SCALE
  • 25. Author: J.H. Clarke S. Rustvold (1993) DENTAL CONCERNS ASSESSMRENT
  • 26. STRATEGIES USED BY DENTISTS Listening to soothing music Watching television during the procedure Setting early appointment times to decrease waiting time Speaking to the dentist before procedure Sedation for any dental procedure Anxiety relieving medication Relative analgesia (happy gas)
  • 27. PSYCHOLOGY IN DENTISTRY  Psychology can be applied to all dental specialties ranging from the general practitioner to the experts in their respective fields and the dental surgeon itself.  The Psychology applied to Dentistry should interact in the following areas: Orthodontics and Pediatric Dentistry Work and understand the poor habits (thumb sucking, nail biting, fears, etc) Interactions between patients and dental professionals Coping with stress of dental pain Compliance with recommended oral health practice
  • 30. CHILDREN AND ADULTS WITH DISABILITIES  Dental care also needs to be considered for children and adults with disabilities.  Cleft lip or palate, Down syndrome, neurological disorders, cerebral palsy, and vision and hearing impairments are common medical conditions requiring special dental care, as well as learning and developmental disabilities.  Dental problems of people with special needs are often associated with mental abilities of the person.  These include: considerably poor oral hygiene, significant presence of soft and hard deposits on teeth, presence of periodontal disease, high percentage of untreated carious teeth, a small number of filled teeth, large number of extracted teeth compared to the healthy population, trauma and damage to the teeth and mouth are much more prevalent (due to falls), and considerably more common prevalence of malocclusions of different degrees of difficulty.
  • 31. ISSUES OF CULTURAL DIVERSITY IN DENTAL TREATMENT  It is important to recognise the cultural beliefs relating to dental disease and treatment, e.g. in many cultures treatment is only sought if or when symptoms occur as opposed to a more preventative dental care approach.  Some of the chronic dental diseases have their etiologies embedded in cultural habits; the classical example being oral cancer which has an increased risk in Asian populations particularly from the Indian subcontinent due to the high rate of paan consumption.  Another interesting example comes from China where the appearance of teeth is psychosocially important.  Use of folk remedies - the use of cotton balls soaked in aspirin solution, alcohol or salt water is a well-known home remedy for pain.
  • 32. TO CONCLUDE.. • Fear of dentistry and associated psychological difficulties, is a widespread problem. • Dental anxiety – a joint interest for dentists and psychologists. • The need for psychological interventions in dentistry is now supported, as is the importance of providing the necessary psychological guidance and expertise in terms of treatment planning and clinical decision-making (General Dental Council, 1990; British Psychological Society, 1996).
  • 33. REFERENCES • Appukuttan, D. P., et al. (2017). Evaluation of Dental Anxiety and its Influence on Dental Visiting Pattern among Young Adults in India: A Multicentre Cross Sectional Study. Annals of Medical & Health Science Research, 7,393-400. • Carteret, M. (2013). How culture affects oral health beliefs and behaviors. Retrieved from http://www.dimensionsofculture.com/2013/01/how-culture- affects-oral-health-beliefs-and-behaviors/ • Dental Fear Central: Psychological Approaches. Retrieved from https://www.dentalfearcentral.org/help/psychology/ • Humphris, G., Spyt, J., Herbison, A. G., & Kelsey, T. (2015). Adult dental anxiety: Recent assessment approaches and psychological management in a dental practice setting. • Longman, L. P., & Ireland, R. S. (2010). Management of dental anxiety. • Srivastava & Anuradha. (2013). Psychology in dentistry—“An emerging field of dentistry in India’’. Global journal of medicine and public health, 2(5). • Wide Boman, U., Carlsson, V., Westin, M., & Hakeberg, M. (2013). Psychological treatment of dental anxiety among adults: a systematic review. European Journal of Oral Science, 121, 225–234.