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Programs for the Treatment of Dental Disorders

Dental Anxiety and Temporomandibular Disorders

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Handbook of Clinical Psychology in Medical Settings

Abstract

Surveys indicate that 4%-10% of the adult population avoid dental treatment because of extreme fears, and probably an even larger percentage (up to 25%) avoid dental treatment except when they are symptomatic (Ayer & Corah, 1984). Extreme dental fears were reported in 23% of 14- to 21-year-olds, and there is a continuing reduction in fear with age. Dentists are generally inconsistent in their approach to dealing with anxious patients. Corah (1988) reported that three quarters of the dentists surveyed felt that patient anxiety was the greatest barrier to regular dental care. Very few dentists, however, ask the patient whether he or she is anxious. They are afraid that the question will suggest that there is something to be anxious about. Many dentists admit that they themselves become anxious if they deal with anxious patients. Dentists need to know both how to recognize patient anxiety and what to do about it. The first part of this chapter reviews the etiology of dental anxiety and indicates how it can be measured in child and adult patients. Strategies for reducing patient anxiety are provided in terms of the treatment of patients by psychologists and the education of dentists in behavior management strategies for preventing dental phobia. The second part of the chapter deals with temporomandibular disorder (TMD), a pain syndrome increasingly recognized as being influenced by psychological factors.

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References

  • Addelston, H. K. (1959). Child patient training. Fortnightly Review of the Chicago Dental Society, 38, 17.

    Google Scholar 

  • Adelson, D., & Goldfried, M. (1970). Modeling and the fearful child patient. Journal of Dentistry for Children, 37, 476–488.

    PubMed  Google Scholar 

  • Ayer, W. A., & Corah, N. L. (1984). Behavioral factors influencing dental treatment. In L. K. Cohen & P. S. Bryant (Eds.), Social sciences and dentistry: A clinical bibliography (Vol. 2, pp. 267–322). Kingston-upon-Thames, England: Quintessence Publishing Co. for Federation Dentaire Internationale.

    Google Scholar 

  • Ayer, W. A., & Levin, M. P. (1973). Elimination of tooth grinding habits by massed practice therapy. Journal of Periodontology, 44, 569.

    PubMed  Google Scholar 

  • Ayer, W. A., & Levin, M. P. (1975). Theoretical bases and application of massed practice exercises for the elimination of tooth grinding habits. Journal of Periodontology, 46, 306.

    PubMed  Google Scholar 

  • Bailey, J. S., & Reiss, M. L. (1979). Behavior technology advances in community dentistry. In D. J. Oborne, M. M. Grunelberg, & J. R. Eiser (Eds.), Research in psychology and medicine. New York: Academic Press.

    Google Scholar 

  • Barenie, J., & Ripa. L. (1977). The use of behavior modification techniques to successfully manage the child dental patient. Journal of the American Dental Association, 94, 329–334.

    PubMed  Google Scholar 

  • Baron, R. S., Logan, H., & Kao, C. F. (1990). Some variables affecting dentists’ assessment of patients’ distress. Health Psychology, 9, 143–153.

    Article  PubMed  Google Scholar 

  • Bernstein, D. A., Kleinknecht, R. A., & Alexander, L. D. (1979). Antecedents of dental fear. Journal of Public Health Dentistry, 39, 113–124.

    Article  PubMed  Google Scholar 

  • Brockhouse, R. T., & Pinkham, J. R. (1980). Assessment of nonverbal communication in children. Journal of Dentistry for Children, 42–45.

    Google Scholar 

  • Brooke, R. I., Stenn, R, & Mothersill, K. (1977). The diagnosis and conservative treatment of myofascial pain dysfunction syndrome. Oral Surgery, 44, 844–852.

    Article  Google Scholar 

  • Cassisi, J. E., McGlynn, E D., & Belles, D. R. (1987). EMGactivated feedback alarms for the treatment of nocturnal bruxism: Current status and future directions. Biofeedback and Self-Regulation, 12, 13–30.

    Article  PubMed  Google Scholar 

  • Chambers, D. (1977). Behavioral management techniques for pediatric dentists; An embarrassment of riches. Journal of Dentistry for Children, 44, 30–35.

    PubMed  Google Scholar 

  • Chambers, W. L., Fields, H. W. & Machen, J. B. (1981). Measuring selected disruptive behaviors of the 36- to 60month-old patient: 1. Development and assessment of a rating scale. Pediatric Dentistry, 3, 25–56.

    Google Scholar 

  • Chertok, S. L., & Bornstein, P. H. (1979). Covert modeling treatment of children’s dental fears. Child Behavior Therapy, 1, 249–255.

    Article  Google Scholar 

  • Clarke, N. G. (1982). Occlusion and myofacial pain dysfunction: Is there a relationship? Journal of the American Dental Association, 115, 565–571.

    Google Scholar 

  • Corah, N. (1969). Development of a dental anxiety scale. Journal of Dental Research, 48, 596.

    Article  PubMed  Google Scholar 

  • Corah, N. (1988). Dental anxiety: Assessment, reduction and increasing patient satisfaction. The Dental Clinics of North America, 32(4), 779.

    Google Scholar 

  • Corah, N., Bissell, G. D., & Illig, S. (1978). Effects of perceived control in stress reduction in adult dental patients. Journal of Dental Research, 57, 74–76.

    Article  PubMed  Google Scholar 

  • Corah, N., Gale, E. N., & Illig, S. (1979). Psychological stress reduction during dental procedures. Journal of Dental Research, 58, 1347–1351.

    Article  PubMed  Google Scholar 

  • Cuthbert, M. I., & Melamed, B. G. (1982). A screening device: Children at risk for dental fears and management problems. Journal of Dentistry for Children, 49, 432–436.

    PubMed  Google Scholar 

  • Duperson, D. E, Burdick, J. A., Koltek, W. T., Chebib, E. S., & Goldberg, S. (1978, Spring). Cardiac activity of children in a dental situation. Journal of Pedodontics.

    Google Scholar 

  • Early, C., & Kleinknecht, R. (1978). The palmer sweat index as a function of repression sensitization and fear of dentistry. Journal of Consulting and Clinical Psychology, 46, 184–185.

    Article  PubMed  Google Scholar 

  • Fields, H., Machen, J. B., Chambers, W. L., & Pfefferle, J. C. (1981). Measuring selective disruptive behavior of the 36- to 60-month-old dental patient: 2. Quantification of observed behaviors. Pediatric Dentistry, 3, 257–266.

    PubMed  Google Scholar 

  • Filewich, R. J. (1988). Treatment of the agoraphobic dental patient. The Dental Clinics of North America, 32(4), 723.

    Google Scholar 

  • Fordyce, W. E. (1976). Behavioral methods for chronic pain and illness, St. Louis: Mosby.

    Google Scholar 

  • Forgione, A. G. (1988). Hypnosis in the treatment of dental fear and phobia. The Dental Clinics of North America, 32 (4), 745.

    Google Scholar 

  • Forgione, A., & Clark, E. (1975). Comments on an empirical study of the cause of dental fears. journal of Dental Research, 53, 496.

    Article  Google Scholar 

  • Frankel, R. I. (1980). The ticklish child and local anesthetic need. The Journal of Pedodontics, 139–144.

    Google Scholar 

  • Frankl, S., Shiere, E, & Fogels, H. (1962). Should the parent remain with the child in the dental operatory? Journal of Dentistry for Children, 29, 150–163.

    Google Scholar 

  • Friedson, E., & Feldman, J. J. (1958). The public looks at dental care. Journal of the American Dental Association 57, 325–335.

    Google Scholar 

  • Gale, E. (1972). Fears of the dental situation. Journal of Dental Research, 51, 964–966.

    Article  PubMed  Google Scholar 

  • Gatchel, R. J. (1986). Impact of a videotaped dental fear-reduction program on people who avoid dental treatment. Journal of American Dental Association, 112, 218–221.

    Google Scholar 

  • Ghose, L., Giddon, D., Shiere, E, & Fogels, H. (1969). Evaluation of sibling support. Journal of Dentistry for Children, 36, 35–49.

    PubMed  Google Scholar 

  • Glaros, A. G., & Rao, S. M. (1977). Bruxism: A critical review. Psychological Bulletin, 84, 767–782.

    Article  PubMed  Google Scholar 

  • Glennon, B., & Weisz, J. R. (1978). An observational approach to the assessment of anxiety in young children. Journal of Consulting and Clinical Psychology, 46, 1246–1257

    Article  PubMed  Google Scholar 

  • Granger, E. R. (1958). Occlusion in temporomandibular joint pain. Journal of the American Dental Association, 56(5), 659–664.

    PubMed  Google Scholar 

  • Greene, C. S., Olson, R. E., & Laskin, D. M. (1982). Psychological factors in the etiology, progression, and treatment of MPD syndrome. Journal of the American Dental Association, 105, 443–448.

    Google Scholar 

  • Heller, R. E, & Strang, H. R. (1973). Controlling bruxism through automated aversive conditioning. Behavior Research and Therapy, 11, 327.

    Article  Google Scholar 

  • Herbertt, R. M., & Inns, J. M. (1979). Familiarization and preparatory information in the reduction of anxiety in child dental patients. Journal of Dentistry for Children.

    Google Scholar 

  • Hirschman, R., Young, D., & Nelson, C. (1979). Physiologically based techniques for stress reduction. In B. D. Ingersoll & W. R. McCutcheon (Eds.), Clinical research in behavioral dentistry. Morgantown, WV: University Foundation.

    Google Scholar 

  • Hodgson, R., & Rachman, S. J. (1974). Desynchrony in measures of fear. Behavior Research and Therapy, 12, 319–326.

    Article  Google Scholar 

  • Horowitz, L. G. (1987). Overcoming your fear of the dentist. Massachusetts Tetrahedron, Inc.

    Google Scholar 

  • Hutcherson, S. (1976). The occurrence of modeling in children viewing peer model and familiarization videotapes prior to undergoing dental treatment. Unpublished master’s thesis, Case Western Reserve University, Cleveland, Ohio.

    Google Scholar 

  • Kent, G. (1985). Memory of dental pain. Pain, 21, 187–194.

    Article  PubMed  Google Scholar 

  • Keys, J. (1978). Detecting and treatment dental phobic children: 1. Detection. Journal of Dentistry for Children, 4, 296–300.

    Google Scholar 

  • Kleinknecht, R. A., & Bernstein, D. A. (1979). Short term treatment of dental avoidance. Journal Behavior Therapy Exp. Psychiatry, 10, 311–315.

    Article  Google Scholar 

  • Kleinknecht, R., Klepac, R., & Alexander, L. (1973). Origins and characteristics of fear of dentistry. Journal of the American Dental Association, 86, 842–848.

    PubMed  Google Scholar 

  • Kleinknecht, R., Bernstein, D., & Alexander, L. (1977). Assessment of fear of dentistry. Paper presented at the annual meeting of the American Association for Dental Research, Las Vegas.

    Google Scholar 

  • Kleinknecht, R. A., Mahoney, E. R., & Alexander, L. D. (1987). Psychosocial and demographic correlates of temporomandibular disorders and related symptoms: An assessment of community and clinical findings. Pain, 29, 313–324.

    Article  PubMed  Google Scholar 

  • Klepac, R. (1975). Successful treatment of avoidance of dentistry by desensitization or by increasing pain tolerance. Journal of Behavior Therapy and Experimental Psychiatry, 6, 307–310.

    Article  Google Scholar 

  • Klepac, R. (1988). Behavioral treatment for adult dental avoidance: A stepped-care approach. The Dental Clinics of North America, 32(4), 507.

    Google Scholar 

  • Klinge, V. (1979). Facilitating oral hygiene in patients with chronic schizophrenia. Journal of the American Dental Association, 99, 644–645.

    PubMed  Google Scholar 

  • Klingman, A., Melamed, B. G., Cuthbert, M. I. & Hermecz, D. A. (1984). Effects of participant modeling on information acquisition and skill utilization. Journal of Consulting and Clinical Psychology, 52, 414–422.

    Article  PubMed  Google Scholar 

  • Klorman, R., Ratner, J., Arata, C., King, J., & Sveen, D. (1978). Predicting the child’s uncooperativeness in dental treatment from maternal trait, state, and dental anxiety. Journal of Dentistry for Children, 45, 62–67.

    PubMed  Google Scholar 

  • Klorman, R., Hilpert, P., Michael, R., LaGana, C., & Sveen, D. (1980). Effects of coping and mastery modeling on experienced and inexperienced pedodontic patients’ disruptiveness. Behavior Therapy, 11, 156–168.

    Article  Google Scholar 

  • Koenigsberg, S. R., & Johnson, R. (1975). Child behavior during three dental visits. Journal of Dentistry for Children, 42, 195–196.

    Google Scholar 

  • Kohlenberg, R., Greenberg, D., Reymore, L., & Mass, G. (1972). Behavior modification and management of mentally retarded dental patients. Journal of Dentistry for Children, 39, 61–67.

    PubMed  Google Scholar 

  • Kreisburg, M. K. (1982, March-April). Alternative view of the bruxism phenomenon. General Dentistry, 121–123.

    Google Scholar 

  • Kroeger, R. F. (1988). How to overcome fear of dentistry. Cincinnati: Heritage Communications.

    Google Scholar 

  • Lamb, D., & Plant, R. (1972). Patient anxiety in the dentist’s office. Journal of Dental Research, 51, 986–989.

    Article  PubMed  Google Scholar 

  • Lautch, H. (1971). Dental phobia. British Journal of Psychiatry, 229, 151–158.

    Article  Google Scholar 

  • Levy, R. L., & Domoto, P. K. (1979). Current techniques for behavior management: A survey. Pediatric Dentistry, 1, 160–164.

    PubMed  Google Scholar 

  • Lewis, T. M., & Law, D. B. (1958). Investigation of certain autonomic responses of children to specific dental stress. Journal of the American Dental Association, 57, 769–777.

    PubMed  Google Scholar 

  • Lund, A. K., & Kegeles, S. (1979). Cognitive and behavioral strategies for children’s preventive dental behavior. Journal of Dental Research, 58, 132.

    Google Scholar 

  • Marciani, R. D., Haley, J. V., Moody, P. M., & Roth, G. I. (1987). Identification of patients at risk for unnecessary or excessive TMJ surgery. Oral Surgery, Oral Medicine and Oral Pathology, 64, 533–535.

    Article  Google Scholar 

  • Martens, L., Frazier, P., Hirt, K., Meskin, L., & Proshek, J. (1973). Developing brushing performance in second graders through behavior modification. Health Services Report, 88, 818–823.

    Article  Google Scholar 

  • Meichenbaum, D. (1977). Cognitive behavior modification: An integrative approach. New York: Plenum Press.

    Google Scholar 

  • Melamed, B. G. (1979). Behavioral approaches to fear in dental settings. In M. Hersen, R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior modification (Vol. 7). New York: Academic Press.

    Google Scholar 

  • Melamed, B. G. (1982). Reduction of medical fears: An information processing analysis. In J. Boulougouris (Ed.), Learning theory approaches to psychiatry. New York: Wiley.

    Google Scholar 

  • Melamed, B. G., Hawes, R., Heiby, E., & Glick, J. (1975a). The use of film modeling to reduce uncooperative behavior of children during dental treatment. Journal of Dental Research, 54, 797–801.

    Article  Google Scholar 

  • Melamed, B. G., Weinstein, D., Hawes, R., & Katin-Borland, M. (1975b). Reduction of fear-related dental management using filming modeling. Journal of the American Dental Association, 90, 822–826.

    Google Scholar 

  • Melamed, B. G., Yurcheson, R., Hawes, R., Hutcherson, S., & Fleece, E. L. (1978). Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in level of previous experience in the stress situation. Journal of Consulting and Clinical Psychology, 46, 1357–1367.

    Article  PubMed  Google Scholar 

  • Melamed, B. G., & Mealiea, W. L., Jr. (1980). Behavioral intervention in pain-related problems in dentistry. In J. M. Ferguson & C. B. Taylor (Eds.), A comprehensive handbook of behavioral medicine. Jamaica, NY: Spectrum.

    Google Scholar 

  • Melamed, B. G., Bennett, C. G., Jerrell, G., Ross, S. L., Bush, J. P., Courts, E, & Ronk, S. (1983a). Dentists’ behavior management as it affects compliance and fear in pediatric patients. Journal of the American Dental Association, 106(3), 323–330.

    Google Scholar 

  • Melamed, B. G., Dearborn, M., & Hermecz, D. A. (1983b). Necessary considerations for surgery preparation: Age and previous experience with the stressors. Psychosomatic Medicine, 45, 517–525.

    Google Scholar 

  • Messer, J. G. (1977). Stress in dental patients undergoing routine procedures. Journal of Dental Research, 56, 362–367.

    Article  PubMed  Google Scholar 

  • Milgrom, P., Weinstein, P., Kleinknecht, R., & Getz, T. (1985). Treating fearful dental patients: A patient management handbook. Virginia: Reston.

    Google Scholar 

  • Miller, M. P., Murphy, P. J., & Miller, T. P. (1978). Comparison of electromyographic feedback and progressive relaxation training in treating circumscribed anxiety stress reduction. Journal of Consulting and Clinical Psychology, 46, 1291–1298.

    Article  PubMed  Google Scholar 

  • Moulten, R. E. (1955). Psychiatric consideration in maxillofacial pain. Journal of the American Dental Association, 51(4), 408–416.

    Google Scholar 

  • Murphy, L. (1952). The widening world of childhood. New York: Basic Books.

    Google Scholar 

  • Pillemer, E. G., Masek, B. J., & Kaban, L. B. (1987). Temporomandibular joint dysfunction and facial pain in children: An approach to diagnosis and treatment. Pediatrics, 80(4), 565–570.

    PubMed  Google Scholar 

  • Pinkham, J. R., & Fields, H. W. (1976). The effects of pre-appointment procedures on maternal manifest anxiety. Journal of Dentistry for Children, 43, 180–183.

    PubMed  Google Scholar 

  • Reiss, M. L., Piotrowski, W. D., & Bailey, J. S. (1976). Behavioral community psychology: Encouraging low-income parents to seek dental care for their children. Journal of Applied Behavior Analysis, 9, 387–397.

    Article  PubMed  Google Scholar 

  • Rugh, J. D., & Solberg, W. K. (1976). Psychological implications in temporamandibular pain and dysfunction. Oral Sciences Review, 7, 3–30.

    Google Scholar 

  • Salter, M. W, Brooke, R. I., & Merskey, H. (1986). Temporomandibular pain and dysfunction syndrome: The relationship of clinical and psychological data to outcome. Journal of Behavioral Medicine, 9(1), 97–109.

    Article  PubMed  Google Scholar 

  • Satoh, T., & Harada, Y. (1973). Electrophysiological study on tooth grinding during sleep. Electroencephalography and Clinical Neurophysiology, 35, 267–275.

    Article  PubMed  Google Scholar 

  • Sawtell, R., Simon, J., & Simeonsson, R. (1974). The effects of five preparatory methods upon child behavior during the first dental visit. Journal of Dentistry for Children, 41, 367–375.

    PubMed  Google Scholar 

  • Sermet, O. (1975). Emotional and medical factors in child dental anxiety. Journal of Child Psychology and Psychiatric and Allied Disciplines, 15, 313–321.

    Article  Google Scholar 

  • Shaw, D., & Thoreson, C. (1974). Dental anxiety in children. British Dental Journal, 139, 134–139.

    Article  Google Scholar 

  • Shoben, E., & Borland, L. (1954). An empirical study of the etiology of dental fears. Journal of Clinical Psychology, 10, 171–174.

    Article  PubMed  Google Scholar 

  • Siegel, L. J., & Peterson, L. (1980). Stress reduction in young dental patients through coping skills and sensory information. Journal of Consulting and Clinical Psychology, 48, 785–787.

    Article  PubMed  Google Scholar 

  • Simpson, W. J., Ruzicka, R. L., & Thomas, N. R. (1974). Physiologic responses of children to initial dental experience. Journal of Dentistry for Children, 465–470.

    Google Scholar 

  • Solberg, W. K., &Rugh, J. D. (1972). The use of biofeedback devices in the treatment of bruxism. Journal of the Southern California Dental Association, 40, 852–853.

    PubMed  Google Scholar 

  • Spielberger, C., Gorsuch, R., & Lushene, R. (1970). The State-Trait Anxiety Inventory (STAI) Manual. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Srp, L., & Kominek, J. (1963). The reaction of children to dental treatment: An experimental study. Odontological Review,14, 178–186.

    Google Scholar 

  • Stoffelmayr, B. (1970). The treatment of retching responses to dentures by counteractive reading aloud. Journal of Behavior Therapy and Experimental Psychiatry, 1, 163–164.

    Article  Google Scholar 

  • Thrash, W. J., Marr, J. N., & Box, T. G. (1982). Effects of continuous patient information in the dental environment. Journal of Dental Research, 61, 1063–1065.

    Article  PubMed  Google Scholar 

  • Venham, L. L., & Quatrocelli, S. (1977). The young child’s response to repeated dental procedures. Journal of Dental Research, 7, 734–738.

    Article  Google Scholar 

  • Venham, L., Bengston, D., & Cipes, M. (1977). Children’s response to sequential dental visits. Journal of Dental Research, 56, 454–459.

    Article  PubMed  Google Scholar 

  • Venham, L., Bengston, D., & Cipes, M. (1978). Parents’ presence and the child’s response to dental stress. Journal of Dentistry in Children.

    Google Scholar 

  • Venham, L. L., Murray, P., & Gaulin-Kremer, E. (1979). Personality factors affecting the preschool child’s response to dental stress. Journal of Dental Research, 58, 2046–2051.

    Article  PubMed  Google Scholar 

  • Von Korff, M. R., Howard, J. A., Truelove, E. L., Sommers, E., Wagner, E. H., & Dworkin, S. (1988). Temporomandibular disorders: Variation in clinical practice. Medical Care,63(3), 1–8.

    Google Scholar 

  • Weinstein, P., & Getz, T. (1978). Preclinical laboratory course in dental behavioral science: Changing human behavior. Journal of Dental Education, 42, 147–149.

    PubMed  Google Scholar 

  • Weinstein, P., & Nathan, J. E. (1988). The challenge of fearful and phobic children. The Dental Clinics of North America, 32, 667.

    Google Scholar 

  • Weinstein, P., et al. (1982). The effects of dentists’ behaviors on fear-related behaviors in children. Journal of American Dental Association, 104, 32–38.

    Google Scholar 

  • Weinstein, P., Domoto, P, & Holleman, E. (1986). The use of nitrous oxide in the treatment of children: Results of a controlled study. Journal of American Dental Association, 112 325–331.

    Google Scholar 

  • Wright, G. Z., Alpern, G. P., & Leake, J. L. (1973). The modifiability of maternal anxiety as it relates to children’s cooperative dental behavior. Journal of Dentistry for Children.

    Google Scholar 

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Melamed, B.G., Williamson, D.J. (1991). Programs for the Treatment of Dental Disorders. In: Sweet, J.J., Rozensky, R.H., Tovian, S.M. (eds) Handbook of Clinical Psychology in Medical Settings. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3792-2_29

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