Antecedents of dental anxiety: learned responses versus personality traits.

The origins of dental fear and anxiety are numerous and complex. The purpose of the present study was to evaluate the relative effects of learned responses and subjective personality traits on the development of dental anxiety. The study was carried out in kibbutzim (closed homogeneous societies) in Israel where all subjects had received dental treatment from the same dentist since childhood with no choice of dentist. Subjects were requested to fill out questionnaires concerning their dental anxiety (DAS) in the past and at present, an evaluation of their dentist in the past and at present, and a psychopathologic symptom survey (SCL-90). The results show that dental anxiety at present correlates significantly with the evaluation of the present dentist; with dental anxiety as remembered from childhood; and with the following SCL-90 scales: interpersonal sensitivity, anxiety, phobic anxiety and Positive Symptom Distress Index. The best predictors of dental anxiety at present were the evaluation of the present dentist and past dental anxiety (as remembered from childhood). The results suggest that the level of the subject's dental anxiety is affected by environmental factors (evaluation of the present dentist, memories of anxiety from childhood), and by personality traits as evaluated by the SCL-90 questionnaire.

War-induced psychic trauma: an 18-year follow-up of Israeli veterans.

Eighteen years after their participation in the Yom Kippur War, the psychiatric status of two groups of Israeli veterans--112 combat stress reaction casualties and 189 comparable controls--was assessed. Casualties had higher rates and greater intensity of posttraumatic stress disorder than did controls, both initially and at 18-year follow-up. Similarly, intrusion and avoidance tendencies and psychiatric symptomatology were evidenced more often by combat stress reaction casualties than by controls. Clinical implications of the findings are discussed.

Detection of psychopathologic trends in glossodynia patients.

Glossodynia affects primarily middle-aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL-90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL-90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL-90 scores and duration of symptoms, prevalence of symptoms per day and patient's condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

Antecedents of burning mouth syndrome (glossodynia)--recent life events vs. psychopathologic aspects.

Burning mouth syndrome--BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)--primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry.

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.

Correlates of success and failure in behavior therapy for dental fear.

Extreme dental fear and avoidance are universal problems, with severe adverse effects on the patient's oral health. Although behavior modification techniques were shown to be effective in the treatment of this problem, their success is by no means absolute. In the present article, the SCL-90 questionnaire was used for development of possible predictive measures for success and failure of behavior modification as a treatment for dental fear. Patients who failed in treatment through behavior modification were found to score significantly higher on the global score of Positive Symptom Distress Index (p < 0.01) and on individual subscales of somatization (p < 0.02) and psychoticism (p < 0.05) than patients who were treated successfully. The predictive value of chosen SCL-90 scales was 71%. The results suggest that use of SCL-90 may be valuable for the prediction of success and failure of behavior modification as a treatment for dental fear and avoidance.

Hypnotic induction in dentistry--coping with the fear of losing control (autonomy): a brief communication.

A common cause of stress among dental patients is the patient's fear of losing control in face of the "helplessness provoking" dental situation. Although hypno-relaxation and hypnosis serve as efficient tools to aid in the administration of dental treatment to such patients, some of them may view hypnosis as a further relinquishing of control to the hypnotist and thus resist hypnotic induction, despite their willingness to try to use hypnosis for therapeutic reasons. To avoid this resistance, a "self-control" induction method is suggested that enables the patient to remain in control throughout the process. This technique minimizes the threat of losing one's autonomy and thus enables treatment of these patients.

Prolonged hypnosis with individualized therapy.

A therapeutic approach is presented which involves the use of prolonged hypnosis for the treatment of diverse medical and/or psychological conditions, including intractable pain. This approach may be indicated either as a complementary tool used in conjunction with other treatment approaches or as the only method of intervention. The technique is based on achieving a prolonged hypnotic response, during which hypno-relaxation serves as the foundation for the delivery of an individualized therapeutic plan which includes self-hypnosis, suggestive procedures, metaphors, and constructive imagery techniques. In debilitated patients, medical supervision and nursing care are essential, and hospitalization is recommended if necessary. Theoretical assumptions underlying this approach are presented, and clinical implications are discussed. The method is illustrated through case presentations.

Community intervention and mental health: a case study of a neighborhood in Jaffa.

Guiding principles of the Community Mental Health Center are comprehensiveness and continuity of care. The Community Mental Health Center in Jaffa, Israel, undertook a project in community intervention which, in effect, applied these principles on a community-wide basis. By helping to establish and sustain an inter-agency coordinating body, the CMHC increased the coordination and cooperation between caretaker agencies. This application of the principle of "continuity of care" on a wide scale had a snowball effect on the community with benefits far beyond the immediate mental health sphere.