Ulf Berggren

Pain in orthodontics

This literature review focuses on previous studies of pain and pain perception in dentistry with special emphasis on orthodontic treatment. The prevalence of pain and background factors such as age, gender and culture/society, in addition to pain physiology and the influence of concomitant emotional and cognitive factors, is examined. Pain during orthodontic tooth movement is reported from the point of view of its physiology and character and different assessment methods. These aspects are described both generally and specifically in relation to the type of orthodontic forces and to the experience of discomfort other than pain. Since the orthodontic treatment may cause some degree of suffering for the patients, it is important for orthodontists to handle this situation in the best possible way. Some ideas about the possibilities of avoiding, reducing or alleviating pain in orthodontics are discussed.ZusammenfassungDieser Literaturüberblick beruht auf vorangegangenen Untersuchungen des Schmerzes und der Schmerzempfindung mit besonderer Berücksichtigung der kieferorthopädischen Behandlung. Dabei werden die Häufigkeit des Schmerzes und die Hintergrundfaktoren, wie zum Beispiel Alter, Geschlecht und kulturelle/gesellschaftliche Verhältnisse, sowie die Physiologie des Schmerzes und dessen Einfluß auf begleitende emotionale und kognitive Faktoren dargestellt. Es wird über den Schmerz und dessen Charakter während der orthodontischen Zahnbewegung aus physiologischer Sicht und über verschiedene Bewertungsmethoden berichtet. Diese Gesichtspunkte werden sowohl allgemein als auch speziell abhängig von der Art der angewandten orthodontischen Kräfte und der Erfahrung des Unbehagens wie des Schmerzes beschrieben. Da die kieferorthopädische Behandlung dem Patienten bis zu einem gewissen Grad Leiden verursacht, sollte der Kieferorthopäde mit dieser Situation bestmöglich umgehen. Einige Ansätze zur möglichen Schmerzvermeidung, Schmerzverminderung und Schmerzlinderung in der Kieferorthopädie werden diskutiert.

Relaxation vs. Cognitively Oriented Therapies for Dental Fear

Cognitive therapy has been reported for the treatment of dental phobia, but comparisons with other behavioral treatments are scarce. This study investigated the outcome of two modes of treatment for phobic dental fear. Relaxation and cognitively oriented therapy were compared in a sample of 112 adult fearful dental patients. The patient made questionnaire assessments of background and outcome variables, and the specialist dentist rated successful/non-successful outcome. It was shown that a higher number of patients who received cognitively oriented therapy completed the treatment program, while anxiety was more reduced among patients who received relaxation-oriented therapy. Dropout during the initial phobia therapy with a psychologist was related to lower motivation (willingness to engage in treatment), while failures during dental treatment after the completion of therapy were related to higher levels of general fear and anxiety. A multiple logistic regression model explaining 67% of the variance revealed that the risk of failure was only slightly increased by general fears, while patients with low (below median) motivation ran a 3.6-times-higher risk of dropping out. In conclusion, it was shown that the two treatment methods were both effective in reducing dental phobic reactions. However, while cognitively oriented therapy resulted in a higher number of patients completing therapy, relaxation-oriented treatment generally resulted in a more significant reduction in dental fear as well as in general anxiety and fear. Motivation was found to be a significant predictor of successful treatment outcome.

Phobic avoidance and regular dental care in fearful dental patients : a comparative study.

The present investigation was a comparative study of 169 highly fearful dental patients, some of whom received regular dental care (n = 28) and some who never, or only when absolutely necessary, utilized dental care (n = 141). It was hypothesized that phobic avoidance is related to anticipatory stress and anxiety reactions, negative oral health effects, psychological distress, and negative social consequences. Background factors (sex, age, education, and dental attendance pattern), dental anxiety, general fears, general state and trait anxiety, mood states, depression, and quality of life effects were studied. Data were analyzed with descriptive statistics and with exploratory factor and multiple logistic regression analysis. It was shown that dental anxiety is significantly higher among the avoiders and this is in particular evident for anticipatory dental anxiety. Oral health differed between the groups, and it was shown that avoiders had significantly more missing teeth, whereas regular attenders had significantly more filled teeth. The avoiders reported a stronger negative impact on their daily life, whereas there were no significant differences between the groups with regard to general emotions. The logistic regression analysis showed that phobic avoidance was predicted only by anticipated dental anxiety and missing teeth. It was concluded that differences between high dental fear patients with regular dental care and phobic avoidance were mainly related to anticipated fear and anxiety, oral health effects, and concomitant negative life consequences. These results are discussed in terms of subjective stress, negative cognitions, social support, and coping-strategies.

The Effect of Catecholamine Receptor Antagonists on Ethanol-Induced Locomotor Stimulation

The effect of various catecholamine receptor antagonists, which differ in their potency to block central dopamine and noradrenaline receptors, respectively, on ethanol-induced locomotor stimulation was investigated. It was shown that small doses of both specific dopamine (pimozide, haloperidol) and noradrenaline (phenoxybenzamine, yohimbine) receptor blocking agents statistically significantly suppressed the ethanol-induced locomotor stimulation. Of special interest in this study was the observation that remarkably small doses of clozapine completely antagonized the ethanol-induced locomotor stimulation. The possibility that this effect of clozapine is mediated via its interference with the activity of central noradrenaline and/or GABA neurons is discussed.

A psychophysiological therapy for dental fear

Abstract A partly automated method for treating dental fear and avoidance is outlined. The method combines a desensitization procedure with EMG biofeedback and cognitive reattribution. After therapy, 21 out of 24 patients suffering from severe dental fear were able to complete dental rehabilitation. The therapy process is discussed in terms of reconditioning, cognitive reorientation and coping training.

Assessment of Patients with Phobic Dental Anxiety

This study investigated a screening procedure for psychologic distress in adult patients with dental phobia before treatment of dental fear. The screening procedure was performed among 191 individuals in consecutive steps and included a medical/dental history, psychologic interviewing, and testing. Data collected during this process were analyzed and compared with SCL-90(R) data. The screening process was successful in selecting individuals without major psychologic distress problems. Among the excluded patients 91% had general symptoms scores on the SCL-90(R) exceeding a normative population mean, and 95% of included patients had a mean lower than an average for psychiatric outpatients. There were statistically significant differences between included and excluded patients on all subdimensions of the SCL-90. Thus, excluded patients had higher levels of psychologic distress, poorer psychosocial background, and more psychosomatic symptoms. This was accompanied by higher levels of negative attitudes toward dentists and their performance of dentistry, whereas no significant differences were found among the dental fear measures used.

Further neuroendocrine evidence for reduced D2 dopamine receptor function in alcoholism

D2 dopamine receptor function, as assessed by growth hormone (GH) responses to apomorphine (APO; 0.18-0.24 mg i.v.), was investigated in 15 male alcoholics with reported long-term abstinence. Results from only nine subjects could be evaluated. These subjects had been heavy alcohol consumers for a mean of 15 +/- 10 years and had thereafter been abstinent for a mean of 7 +/- 6 years prior to the investigation. Eight male healthy subjects, all of whom were light social drinkers, were selected as controls. The maximum GH responses to APO were significantly lower in the alcoholics (5.8 +/- 5.8 mU/l) than in the controls (22.1 +/- 19.2 mU/l). This finding gives neuroendocrine evidence for reduced D2 dopamine receptor function in alcoholics with long-term abstinence.

Research in clinical process and outcome methodology: Psychophysiology, systematic desensitization and dental fear

Eleven dental phobics were treated with a modified systematic desensitization procedure which included EMG biofeedback and videotaped scene presentations. During treatment, multiple psychophysiological recordings as well as subjective and psychometric assessments of mood were made. Intraindividual correlations between process variables were, to a large extent, idiosyncratic. Variance in treatment outcome could be accounted for by change-over treatment sessions of psychometrically assessed mood (R2 = .76) alone or in combination with change-over treatment sessions of minimum heart rate (R2 = .84). The process variable correlation patterns indicate a need for much more multivariate methodological research.

Psychosocial aspects of dental and general fears in dental phobic patients.

Phobic reactions can often be a significant health problem for fearful dental patients. This is true in particular for individuals with long-time avoidance and elevated general psychological distress. The aim of this study was to investigate the expression of dental fear among 67 dental phobic individuals with a low versus high degree of general fear. Reported etiologic background factors, avoidance time, general psychological distress and psychosocial manifestations and consequences of dental phobia were studied. No significant difference in dental anxiety level between individuals with low versus high general fear was found, and both groups reported high frequencies of negative dental experiences. The low-fear group reported a longer (though not statistically significant) average avoidance time than the high-fear group. However, patients with a high level of general fear showed a significantly higher degree of psychological distress, and also reported stronger negative social consequences from their dental anxiety. These results indicate that the character of dental fear might be different between different groups of fearful patients, which makes the condition psychologically handicapping. Such aspects should be assessed in the diagnostic analysis of patients with severe dental anxiety. In particular, assessments of signs of general psychological distress are warranted.

The effect of lithium on amphetamine-induced locomotor stimulation

A behavioural study was performed to investigate how lithium interacts with monoamine mechanisms. Acute lithium pretreatment partially antagonized amphetamine-induced locomotor stimulation in mice. A rather small dose of l-dopa, which had no stimulant effect on locomotor activity of its own, caused a dose-dependent antagonism of the lithium-induced suppression of the amphetamine-induced locomotor stimulation. Additionally, acute lithium pretreatment had no effect on the apomorphine-clonidine-induced locomotor stimulation after elimination of presynaptic activity by means of pretreatment with reserpine and α-MT.Our interpretation of these results is that the inhibitory effect on amphetamine-induced locomotor stimulation is likely to be mediated via presynaptic mechanisms (i.e., decreased release of catecholamines or inhibition of catecholamine synthesis or a combination of both mechanisms) and, further, lithium seems to have no effect at or beyond the catecholamine receptors. However, the possibility that lithium may increase the activity in neuronal systems antagonizing the catecholamine neurons cannot be excluded.