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.