Teeth and psychoses, occlusal hypervigilance and psychosomatic disturbances

Psychosomatic disturbances in dental science

Psychosomatic disturbances in dental science

The number of patients to whom a definitive physical result cannot be allocated is continually on the increase.

Patients complain of burning, feeling of injury, taste problems, feeling of pressure, general mental state problems such as exhaustion, loss of energy, concentration problems, bad temper and loss of sleep. The problems are often connected to dental treatments or materials used in such treatments by the patients. In many cases such mental state problems without actual physical origins will be assigned to a mainly psychosomatic event. By psychosomatic in medicine we describe the tenet whereby the emotional capabilities and psychological ways of reacting of people in health and illness are viewed in their interdependence with bodily processes and behaviour.

According to the theory of psychosomatics, mental problems may be projected onto dental problems. Rarely, unsuccessful dental treatments result which on the one hand can increase mental problems and on the other could cause physical problems. The opposite of psychosomatics is somatopsychology, whereby the effects of physical ailments determine emotional and cognitive processes. Certainly it is not the dentist’s job to produce neurological or psychological diagnoses, nor indeed to carry out corresponding therapies, but the dentist should still be able to recognise psychosomatic disturbances and concur with the appropriate course of action. This requirement is becoming more necessary as a result of jurisprudence in liability cases.

Many patients complain about numbness or prickling sensations in the mouth after a dental intervention. Usually clinical results such as improperly fitting crowns’ edges are responsible but there are also many cases where despite correct dental work numbness or prickling still results. It’s not all due to psychosomatic disturbances, in many cases so-called occlusal hypervigilance, also called occlusal dysaesthia may exist. Our chewing apparatus reacts to the tiniest changes, so the tooth as a tactile organ is very sensitive. Minimal changes are observed – as you yourself are aware when a fibre of meat gets caught between your teeth for example. People usually feel that the teeth are being pushed far apart whilst in reality it is just a tiny fibre.

In some patients, above all those who have had many treatments over a short time and with which the patients were in all events rightly dissatisfied and which therefore had to be repeated this ‘tactile organ’ can become oversensitive. When the dentist doesn’t find any further clinical results in these cases then these diagnoses may be correct. It is best not to continue with further treatments. A thorough clarification of the patient with regard to occlusal hypervigilance can neutralize and/or alleviate the patient’s complaints.

It must be emphasized that the diagnosis of psychosomatic disturbance and/or hypervigilance is in no way to be used as an excuse for incorrect treatment or for the refusal to treat an uncomfortable patient.

Patients with actual psychological and neurological problems such as those with a clinical picture of depression or psychosis are to be distinguished from those with hypervigilance and psychomatic ones.

The dentist usually succeeds in establishing the difference in these clinical situations through extensive case history and consolidation of all the finds. Unfortunately this can take years. When there exists therefore a discrepancy between result and feelings, a change of the complaint or an inability to influence the complaint, through usually effective measures, or unusual participation of the patient’s personality then the difference between the presence of psychosomatic, occlusal hypervigilance or psychiatric problems should be determined. The patient and the dentist can thereby be saved from unintended embarrassing therapy and disastrous incorrect treatment.

This post is also available in: German

on No Comments Yet

Leave a Comment

You must be logged in to post a comment.