19. • Psychosomatic disorders may affect almost any part of the
body, though they are usually found in systems not under
voluntary control.
20. Factors affecting periodontal
diseases
• age, sex, and genetic enhancement
• physiological factors, such as raised blood pressure
• smoking, alcohol consumption
• drugs
• psychological and social factors
21. • Dentist should be able to recognise various psychological and
pathopsychological conditions and develop new and
interdisciplinary approaches to dental management
22. Parafunctional habits that leads to
periodontal diseases
• Bruxism : tooth to tooth grinding, it may be intermittent or
continuous
• The patient may be completely unaware of these repeated
and sustained forced contacts of the teeth
• Emotional tension, anxiety and deep-seated aggression could
cause or aggravate bruxism, clenching and tapping.
•
23. • Digit sucking :
Contributes arch displacements and malocclusion, thus
compromising the periodontium.
• Fingernail biting: cause injury to the periodontium
• Objects( as pencil) biting: cause injury to the periodontium
24. • Mouth breathing
Gingivitis is often seen associated with mouth breathing. The
gingival changes include erythema, edema, enlargement and a
diffuse surface shineness in the exposed areas. Maxillary anterior
region is the commonest site of involvement. Its harmful effect is
generally attributed to irritation from surface dehydration.
25. • Cigarette Smoking
Smoking potentially acts by affecting tissue moisture or
temperature that has been related to the etiology for NUG and
other oral diseases as well.
delayed wound healing after implant surgery is expected in
smoking patient, as smoking upregulates the expression of pro-
inflammatory cytokines such as interleukin-1, which contributes
to increased tissue damage and alveolar bone resorption.
Nicotine may have an effect on cellular protein synthesis and
impairs the gingival fibroblast's ability to adhere, thus interfering
with wound healing and/or exacerbating periodontal disease.
26. PSYCHOSOMATICDISORDERSANDFACTORS
There are two ways, in which psychosomatic disorder may be
induced in the oral cavity:
- Through the development of habits that are injurious to the
periodontium
- By the direct effect of the autonomic nervous system on the
physiologic tissue balance
27. • Stress:
Psychosocial stress has been found to influence host defenses
exerting an immunosuppressive effect and affecting one’s
vulnerability to periodontal disease.
28. Stress and necrotizing ulcerative
gingivitis
• NUG is usually occurs in presence of stress and emotional
disturbances, as increased adrenocortical secretion are
common.
• It can be concluded that opportunistic bacteria are the
primary etiologic agents of NUG in patients that demonstrate
immunosuppression. Stress, smoking and pre-existing
gingivitis are common predisposing factors.
29.
30. • Oral hygiene
Oral hygiene may be neglected during depression and deep
anxiety
Dependent individuals may exhibit chronic neglect as if they were
expecting such care to be the responsibility of others. The
dentist’s instructions concerning oral hygiene may be ignored as
a form of “parental defiance”
31. Anxiety
Oral health problems associated with anxiety disorders include
canker sores, dry mouth, lichen planus (lacy white lines, mouth
ulcers, burning mouth syndrome, and temporomandibular joint
disorders (TMD)). People with anxiety disorders may disregard
their oral health altogether and are at an increased risk
for periodontal disease and bruxism. Being anxious of a needle
can also complicate periodontal procedure.
32. • Diet and appetite:
Psychologic factors affect the choice of foods, the physical
consistency of diet, and the consumption of excessive quantities
of refined carbohydrates and softer diets, requiring less vigorous
mastication and therefore predisposing to plaque accumulation
at the proximal risk sites. These factors may have a direct or
indirect influence on the periodontium.
33. • other harmful habits as alcohol consumption:
• Studies that have evaluated the effects of alcoholism on oral
tissues suggest that it may be associated with a greater risk for
development of periodontal problems due to poor oral
hygiene
34. • Gingival circulation:
The tonus of smooth muscle of blood vessels may be altered by
the emotions by way of the autonomic nervous system, e.g.
prolonged contraction could alter the supply of oxygen and
nutrients to the tissues. Smoking and stress have been implicated
in reducing gingival blood flow which in turn could increase the
possibility of necrosis of tissues, with subsequent reduced
resistance to plaque.
35. • Saliva:
stress or emotional disturbances produce a transient reduction of
salivary flow and changes in the salivary enzyme count, making
the individual more susceptible to oral diseases and disorders.
36. • Lowered host resistance:
Under stress, the release of adrenaline and nor-adrenaline may
not only induce a decrease in blood flow, but possibly also those
blood elements necessary for maintaining resistance to disease
related microbes.
38. • tricyclic antidepressants (TCAs) as well as selective serotonin
reuptake inhibitors (SSRIs) are causing xerostomia which is a
common predisposing factor in periodontal disease
39. Management
•Interview
• Rapport:
The interview gives the dentist an opportunity to establish
rapport, to introduce patient education, and to make the patient
familiar with the way in which the practice is conducted.
During the interview the chief complaint, the medical history and
the dental history are obtained.
40. • Observation:
A good share of observation consist
of being attentive to the patient’s manner of reponse. Patient’s
choice of words; voice tone, pitch, tempo; facial expression and
movements during the time of interview. These reactions tend to
be heightened in the dental office, since a visit to a dental clinic
represents a stressful situation to many patients.
41. Questioning
• Questioning :
When the patient asks questions concerning dentistry, he/she
may be expressing anxiety rather than an interest in dentistry.
The more experienced practitioner will sense this anxiety and
reassure the patient. Do not deliver long details on dentistry that
does not satisfy the patient’s need, leaving the patient with a
feeling of frustration
42. PsychiatricManifestationsDuring Therapy
• Value judgments:
The dentist should treat the patient with friendliness and respect,
not with criticism or condemnation.
Referral:
When the situation appears to be unmanageable, the patient
should be referred to another dentist or physician. The dentist
feels less angry when there is no compulsion to comply with
impossible demands.
43. References
• Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism
physiology and pathology: an overview for clinicians. J Oral
Rehabil. 2008;35:476–494.
• Shamim T. A simple working type classification proposed for
the psychosomatic disorders of the oral cavity. J Coll Physicians
Surg Pak. 2012;22:612.
• 1. Aksoy N. Psychosomatic diseases and dentistry (report of
two psychoneurotic cases) Ankara Univ Hekim Fak
Derg. 1990;17:141–143.
• 2. Yoshikawa T, Toyofuku A. Psychopharmacology and oral
psychosomatic disorder. Nihon Rinsho. 2012;70:122–125.
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