by Ron Schefdore, DDS

and

Jack Maggiore, DDS

Many health care professionals are turning to blood screening test kits to quickly and accurately screen current and potential patients to help improve their health and possibly save their lives. These tests can be used at home by the patient or can be administered by a health care professional using only 1-4 drops of blood. Within the dental community, these tests have proven to improve treatment acceptance and increase quality referrals of patients by health care professionals (1). This is an example of a major paradigm shift occurring in a health care profession not accustomed to serving a leading role in systemic disease detection, whereby the outcome is the improved overall health of patients. While many dental offices have seen their incomes decrease over the past two years, offices that have implemented in-office blood screenings and follow the Healthy Heart Dentistry® program have realized sustained growth in revenues, patient base, and referrals. We describe below two such strategies for achieving this level of success.

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by V. Kim Kutsch, DMD., Carri Cady, RDH

Introduction
Medication-induced xerostomia (MIX disease, an acronym first introduced by Edwin Zinman) is becoming a more common problem for Americans. There are many potential causes of xerostomia, or dry mouth, and these causes include loss of saliva production as part of the natural aging process,¹ Sjogren's Syndrome,² radiation to the head and neck,³ and medication-induced xerostomia.⁴ There are now about 3000 prescription medications that list xerostomia as a possible side effect,⁵ but drug companies by-and-large have not included specific labeling to alert the consumer about xerostomia and its increased risk for dental caries.⁶ MIX disease affects people of all ages. The average person has no idea what xerostomia is, so the current drug labeling has little or no significance for them.

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Dental fears and phobias trouble patients with and without special needs, and they are a problem for dentists, as well. This article reviews current research and literature related to methods used to alleviate dental fear and concludes that while some important psychological methods are available, much work is left to be done in this area. It is clear that there is an important role for psychological and behavioral input to the dentist-patient interaction. While dental phobia represents a class of special needs itself, patients with other important disabilities (e.g., physical or cognitive impairments) are sometimes comorbidly phobic, a condition often missed or misdiagnosed by treating practitioners. Office-based techniques that focus on relaxation, breathing, imagery, hypnosis, and effective use of operatory language are described. The methods advocated here can be used with patients having mild or moderate cognitive impairments. Readings are recommended for the dentist or auxiliary practitioner interested in learning these techniques.

Spec Care Dentist. 2009 Jan;29(1):51-7. Peltier B. University of the Pacific, San Francisco, California, USA. bpeltier@pacific.edu

BACKGROUND: With regard to the management of dental anxiety in general dental practice, it has been considered that general dental practitioners (GDPs) are well placed to treat adults with mild forms of dental anxiety. However, little is known about the specific anxiety management techniques being used by GDPs in the UK.Aim To determine the views and experiences of dental practitioners in their current use of anxiety management techniques, their undergraduate and post-graduation training in these techniques and future training needs. METHODS: A postal questionnaire was sent to a sample of GDPs working in the Midlands region (n = 750) in the UK. Dentists were randomly selected using lists provided by the primary care trusts for each locality. RESULTS: The response rate was 73% (n = 550). Of these, 90 were not included in the final analysis due to exclusion criteria set prior to questionnaire release. This left 460 questionnaires for analysis. Eighty-five percent of respondents agreed that dentists had a responsibility to help dentally anxious patients (n = 391). Dentists were asked their reasons for not using anxiety management techniques in practice. Psychological techniques, sedation (oral, inhalation, or intravenous) and hypnosis were reported as not having been used due to the paucity of time available in practice, a shortage of confidence in using these techniques and the lack of fees available under the NHS regulations. Also, 91% reported feeling stressed when treating anxious patients. When asked about the quality of teaching they had received (undergraduate and postgraduate), 65% considered that the teaching was less than adequate in the use of psychological methods, whereas 44% indicated that they would be interested in further training in psychological methods if financial support was available. CONCLUSION: The need for further training in managing the dentally anxious patient is supported by dentists' lack of confidence and inadequate training in treating such patients, as determined from the results of a postal questionnaire to UK GDPs.

Br Dent J. 2008 Apr 26;204(8):E13; discussion 442-3. Epub 2008 Apr 18. Hill KB, Hainsworth JM, Burke FJ, Fairbrother KJ. University of Birmingham, School of Dentistry, St Chad's Queensway, Birmingham, B4 6NN. K.B.Hill@bham.ac.uk

BACKGROUND: With regard to the management of dental anxiety in general dental practice, it has been considered that general dental practitioners (GDPs) are well placed to treat adults with mild forms of dental anxiety. However, little is known about the specific anxiety management techniques being used by GDPs in the UK.Aim To determine the views and experiences of dental practitioners in their current use of anxiety management techniques, their undergraduate and post-graduation training in these techniques and future training needs. METHODS: A postal questionnaire was sent to a sample of GDPs working in the Midlands region (n = 750) in the UK. Dentists were randomly selected using lists provided by the primary care trusts for each locality. RESULTS: The response rate was 73% (n = 550). Of these, 90 were not included in the final analysis due to exclusion criteria set prior to questionnaire release. This left 460 questionnaires for analysis. Eighty-five percent of respondents agreed that dentists had a responsibility to help dentally anxious patients (n = 391). Dentists were asked their reasons for not using anxiety management techniques in practice. Psychological techniques, sedation (oral, inhalation, or intravenous) and hypnosis were reported as not having been used due to the paucity of time available in practice, a shortage of confidence in using these techniques and the lack of fees available under the NHS regulations. Also, 91% reported feeling stressed when treating anxious patients. When asked about the quality of teaching they had received (undergraduate and postgraduate), 65% considered that the teaching was less than adequate in the use of psychological methods, whereas 44% indicated that they would be interested in further training in psychological methods if financial support was available. CONCLUSION: The need for further training in managing the dentally anxious patient is supported by dentists' lack of confidence and inadequate training in treating such patients, as determined from the results of a postal questionnaire to UK GDPs.

Br Dent J. 2008 Apr 26;204(8):E13; discussion 442-3. Hill KB, Hainsworth JM, Burke FJ, Fairbrother KJ. University of Birmingham, School of Dentistry, St Chad's Queensway, Birmingham, B4 6NN. K.B.Hill@bham.ac.uk

Temporomandibular disorders (TMDs) involve a heterogeneous group of clinical conditions affecting the stomatognathic system and its related structures. Because the etiology of these disorders is still unclear, a wide range of therapeutic solutions has been proposed in the literature, including occlusal appliances, physical therapies, drugs, and biobehavioral modalities. Biobehavioral therapy could have a beneficial effect in the treatment of TMDs because of the reportedly high prevalence of psychological dysfunction in TMD patients. The authors reviewed the biobehavioral modalities used to achieve pain relief in patients affected by such disorders, with the aim of synthesizing data on the effectiveness these therapeutic approaches. Literature data suggest that the inclusion of biobehavioral interventions in the management of TMDs may be reasonable, even if no conclusions can be drawn about their long-term effectiveness.

Behav Med. 2007 Fall;33(3):101-18. Orlando B, Manfredini D, Salvetti G, Bosco M. The Department of Neuroscience, Section of Prosthetic Dentistry, University of Pisa, Italy.

Complementary and alternative medicine in dentistry includes various treatment modalities. Many procedures are under scientific investigation to determine effectiveness. Dental patients request CAM therapy in an attempt to save money and to prevent invasive procedures. The Alternative Medical Systems are methods of alternative therapy different from Conventional/Western medicine. Mind-Body Interventions are methods of affecting body functions using prayer, meditation, mental imagery and creativity. Biologically-Based Therapy is the use of substances found in nature to promote healing and wellness. Manipulative and Body-Based Methods are based on the manipulation and/or movement of the body to treat for pain and wellness. Energy Therapy is based on manipulating energy fields of body. CAM procedures may eventually become standard practice after scientific verification of efficacy.

Dent Assist. 2007 Jul-Aug;76(4):34-6, 38, 40-3 Andrews EK.

The Department of Maxillofacial Surgery of the University Hospital Schleswig-Holstein/Campus Lübeck offers intraoperative hypnosis since 2002. Besides clinical evaluation by controlled studies, patients attitudes should be included in the judgement on such adjuvant procedure not established in general.70 patients of the department treated under combined local anaesthesia/hypnosis rated their individual postoperative patient satisfaction by standardised questionnaires. A control group of equal size and demographic/surgical features consisted of patients that were treated without hypnosis in the same interval.Results of the inquiry indicate that intraoperative hypnosis increases significantly postoperative satisfaction of oral and maxillofacial patients. Satisfaction is attributed decisively on the adjuvant procedure.

Mund Kiefer Gesichtschir. 2007 Oct 19 Hermes D, Trübger D, Hakim SG. Klinik für Kiefer- und Gesichtschirurgie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany, mail@dirkhermes.de.

The authors conducted two pilot studies that investigated the roles of hypnotizability, absorption (defined as the ability to maintain focused attention on a task or stimulus) and state versus trait anxiety as predictors of dental anxiety. One of the studies also examined the effectiveness of hypnosis in managing dental anxiety. METHODS: Participants in study 1 completed measures of hypnotizability and anxiety, viewed a video of a dental procedure either under hypnosis or not, and completed dental anxiety questionnaires. Participants in study 2 were told either that the video showed major dental work or a routine polishing. All subjects watched the video and then completed measures assessing their perceptions of the video and their anxiety. RESULTS: The authors found a positive relationship between hypnotizability and scores on the Dental Anxiety Scale (DAS) (F(1,290) = 3.45, P = .06), as well as an interaction between hypnotizability and hypnosis (F(1,290) = 6.55, P = .01). An analysis of covariance found a relationship between trait and dental anxiety (F(1,290) = 11.50; P = .001). A two-way analysis of variance found a main effect for hypnosis (F(1,290) = 3.20, P = .07). The authors found an effect for group on the DAS (F(1,228) = 3.67, P = .057), such that subjects in the negative-cognition group scored higher on the DAS. The authors found an interaction between absorption and cognition in perceptions of pain experienced by the patient in the video (F(1,228) = 3.70, P = .05) and in ratings of one's own pain level if in the same situation (F(1,228) = 4.38, P < .05). CONCLUSIONS: Hypnotizability or absorption, pre-existing anxiety and cognitions about dental procedures predict dental anxiety, and hypnosis may be helpful for some, but not all, patients. CLINICAL IMPLICATIONS: Characteristics such as hypnotizability, trait anxiety and negative cognitions predict which people develop dental anxiety and who will be more responsive to hypnosis. The authors provide suggestions for dentists treating anxious patients.

J Am Dent Assoc. 2007 Sep;138(9):1242-50.

Diclementi JD, Deffenbaugh J, Jackson D.

Fear of the dentist is a common phenomenon. There are many ways of dealing with anxious patients and this review aims to present the most common methods available to general dental practitioners. Clinical Relevance: An ability to deal with anxious patients successfully is undoubtedly a practice builder. Anxious patients can be stressful to manage but they often become the most vocal advocates of dentists that they trust.

School of Dentistry, Higher Cambridge Street, Manchester M15 6FH.

Dent Update. 2007 Mar;34(2):108-10, 113-4.

Surveys indicate that the adolescent, in particular, suffers from acute anxiety in relation to dentistry. This anxiety is promoted by the general opinion they form of dentists and dentistry through portrayal by their peers and the media.

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"Hypnopuncture," a combination treatment of hypnosis and acupuncture, provides a therapeutic treatment plan for long-term therapy for patients with a distinctive gag reflex. The treatment is applied independently of the cause. In cases of emergency treatment in dentistry, the immediate compliance of a patient is of utmost importance. The long-term goal of any therapeutic measure is control of the gag reflex.

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It was hypothesized that dental anxiety, which leads to neurophysiologic alterations in heart rate, respiratory rate and blood pressure prior, during and subsequent to dental treatment, can be influenced by medical hypnosis. We report the positive impact from non-invasive hypno-sedation during dental implant surgery on a 54-year-old female patient who experienced neurophysiologic reactions as a result of the psychosomatic process of dental anxiety (dental anxiety scale value = 13). The neurophysiologic changes during dental surgery performed with and without hypnosis were compared after the patient underwent the same surgical treatment protocol. This case report was part of a study designed to evaluate hypnosis as a non-invasive therapy for dental-anxious patients over six sessions using subjective experience and objective parameters, which included electroencephalogram, electrocardiogram, heart rate, blood pressure, oxygen saturation of the blood, respiration rate, salivary cortisol concentration and body temperature.

Department of Prosthodontics, Maxillofacial Surgery and Neurology and Psychiatry, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. seitner@prothetik-erlangen.de

In this article, the nature of hypnosis will be discussed, together with its therapeutic/facilitator role in the control of the potential problems that occur in everyday dental practice. It is the vital relationship between a patient and therapist which produces the desired results of hypnotherapy. CLINICAL RELEVANCE: A holistic approach, in patient care, emphasizes the treatment of an individual who has a dental problem.