First published in 1992. Oral Psychophysiology: Stress, Pain, and Behavior in Dental Care presents the many different behavioral aspects of dental treatment, including specific dento-related behavioral dysfunctions (fear, anxiety and phobia, excessive gagging reflex, orofacial pain). Special attention is given to the specific problems of elderly dental patients, including possible problems in adapting to dentures. The effects of stress on physiological conditions in the oral cavity and stress-related behavior, such as syncope or inability to achieve local anesthesia, are discussed. The book also summarizes possible treatment modalities for patients who find it difficult to cope with the various aspects of dental care, such as behavior modification, hypnosis, and pharmaceutical approaches.
Oral Psychophysiology: Stress, Pain, and Behavior in Dental Care is an indispensable resource for dentists and dental students who occasionally encounter "problematic" patients. The handling of such patients requires more than the usual, familiar, manual skills and is often a source of stress and frustration to the dentist. By developing an understanding of the underlying principles of the behavior of these patients, a clinician will be able to create a better interpersonal relationship with his/her patients, prevent some of the potential problems, and solve others.
Table of Contents
PREFACE. ACKNOWLEDGMENTS. STRESS AND PAIN IN DENTAL CARE. WHAT IS STRESS. The Stress Response. The Concept of Threat. Variables of Threat Appraisal. Coping with Stress. STRESS AND THE DENTAL SITUATION. Conflict and Dental Treatment. The Oral Cavity and Personality Development. The Complex Role of the Oral Cavity. The Complex Nature of the Dental Situation. Learned Responses. Cognitive Processes. Dentist-Patient Interpersonal Relationship. Environmental Factors. The Dentist's View. THE EXPERIENCE OF PAIN-PSYCHOLOGICAL ASPECTS. Definition of Pain. Gate-Control Theory of Pain. Acute vs. Chronic Pain. BEHAVIORAL ASPECTS OF DENTAL TREATMENT. DENTAL FEAR, ANXIETY AND PHOBIA. Definitions. Prevalence. Influence on Oral Health. Antecedents of Dental Fear/Anxiety/Phobia. Components of Dental Fear/Anxiety/Phobia. Assessment of Dental Fear. Treatment. THE EXCESSIVE GAGGING REFLEX. Definitions. Physiology of Swallowing, Gagging, and Vomiting. Cognitive Aspects of Gagging. Gag (Retch) Patients with Dentures. Gag Patients without Dentures. Patient Management with Excessive Gagging Reflex. PSYCHOGENIC FACTORS IN BENIGN CHRONIC OROFACIAL PAIN. Classification. Pain with Known Pathophysiological Mechanisms. Temporomandibular Pain and Dysfunction Syndrome (TMPDS). Tension Headache. Pain with No Pathophysiological Mechanisms (Nondelusional and Nonhallucinatory). Atypical Odontalgia. Glossodynia. Oral "Galvanism". Pain with No Known Pathophysiological Mechanisms (Delusional or Hallucinatory). Treatment. THE ELDERLY DENTAL PATIENT. Demographic Considerations. Need and Utilization of Dental Services. Psychiatric Factors Affecting Dental Care. Oral Physical Senses. Pain. Preventive Care. PSYCHOSOCIAL FACTORS IN ADAPTATION TO DENTURES. The Edentulous Patient. The Dentist-Patient Relationship. Habituation. Prediction of Patient's Adaptation. EFFECTS OF STRESS ON PHYSIOLOGICAL CONDITIONS IN THE ORAL CAVITY. Effect of Stress on Saliva. Stress and Soft Tissues in the Oral Cavity. Stress and Caries Susceptibility. Effect of Stress on Local Anesthesia. Syncope in the Dental Chair. Fatigue and Associated Symptoms and Their Possible Relation to the Oral Cavity. The Multi-Allergic Patient. TREATMENT MODALITIES. BEHAVIOR MODIFICATION. Theoretical Background. The Role of Cognitions. Getting to Know the Patient-The Interview. Treatment Approaches Based on Respondent Conditioning (Extinction and Counterconditioning). Treatment Approaches Based on Operant Conditioning. Treatment Approaches Based on Social Learning. Treatment Approaches Based on Cognitions. HYPNOSIS. Common Phenomena in Hypnosis. Use of Hypnosis in Dentistry. Caution in the Use of Hypnosis. PHARMACEUTICAL APPROACHES. Conscious Sedation. General Anesthesia. MULTIDISCIPLINARY COOPERATION. Specialized, Multidisciplinary Dental Clinics. Psychiatric/Psychological Referral.