CC BY
31
Fattakhov Ravshan Abdurashidovich, Tashkent State dental institute Ph D., student in Department of intermediate dentistry E-mail: caudillo-dec@yandex.ru Khasanova Lola Emilyevna, Tashkent State dental institute professor, Dean of the professional development faculty
THE EFFECTIVENESS OF THE PSYCHOEMOTIONAL STRESS CORRECTION TECHNIQUE IN DENTAL PATIENTS
Abstract: Despite the indisputable significant positive changes in the provision of dental care to the public, dentists still pay little attention to the patient's psychoemotional status.
Psychological support rendered to the patient by the dentist, allows to conduct the process of treatment more efficiently, to organize interaction at the clinical reception and to form a positive attitude of the patient to dentistry.
All of the above has created the prerequisites for conducting a study ofpsychoemotional stress in patients, which results in delayed visits of patients to the dentist.
Keywords: dental phobia, fear and fright, delayed dental visits.
Despite of the high level of development of modern den- ing the safety of rendering dental care to the population. The
tistry, 93% of the population suffer from diseases of the dento-alveolar system [1, 2, 7, 10], therefore practically every person throughout life is forced to go through discomfort associated with a visit to a dentist.
Often they remain in memory for life, causing negative emotions and fear [3,4,6,8]. Basically, patients turn to the dentist for dental caries and its complications, periodontal diseases. In many respects, complications of caries are the result of delayed sanation [9, 11, 12, 13, 14, 15].
The emergence of dental phobia is associated with the expectation of imminent pain, i.e. patients associate a dentist with a person who can potentially hurt them [51]. Pain is not only unpleasant sensation, but also emotional experience arising in connection with the present or potential threat of tissue damage. Pain significantly worsens the quality of life [11].
Pain often leads to the emergence of anxiety and tension, which themselves increase the perception of pain. This explains the importance of psychotherapy in control of pain.
Psychoemotional tension of patients is expressed by their statements, some vegetative and behavioral signs. However, some patients can mask tension by effort of will. Therefore, the real picture of psychological experiences, in addition to analyzing the behavior of patients, allows supplementing the registration of the basic physiological functions of the body: heart rate, respiratory rate, blood pressure, etc. [3, 4, 11], as well as the use of psychological tests [7, 9].
To solve the set tasks, the development of methods for determining, affecting and correcting the emotional tension of patients on an outpatient dental appointment was conducted with the goal of creating psychological comfort and improv-
study was conducted on an outpatient dental reception in the dental clinic of Tashkent city "Chilonzor Denta Lyuks" in Tashkent in 2015-2016. The selection of the surveyed contingent was carried out in accordance with the recommendations ofWHO [5]. A total of 1,072 patients aged 18 to 65 years were examined. Of these, 398 were men, 674 were women.
Patients were divided into two groups — the main group (622 people) and the control group (450 people). In the main group, the number of men was 222, women 400. In the control group of men there were 176 women and 274 women.
In the control group, the psychoemotional tension was corrected, with the goal of creating psychological control. In the main group, no correction was performed.
Psychoemotional stress primarily causes a change in the activity of the nervous and cardiovascular systems.
In this regard, we proposed to study changes in heart rate and blood pressure in the process of dental treatment, which allow us to judge in general terms the activity of the autonomic nervous system in case of psychoemotional stress.
To obtain the initial data, the physiological parameters were recorded: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) three times before treatment, during and after treatment. After the measurements, the Kerdo index was calculated - an indicator of the activity of the autonomic nervous system.
To identify the level of psychoemotional stress during the study, patients were questioned using a questionnaire developed by Boyko. The questionnaire allows specialist to quickly assess the level of psychoemotional stress of a patient on an outpatient dental appointment. According to her results, the
doctor can predict the patient's behavior at the reception, which reduces the risk of possible complications.
Patients were questioned on the scale of dental anxiety by Corah. All patients of the control group underwent a correction of the psychoemotional state according to the revealed reaction.
Table 1. - Results of the study of blood pressure values in patient groups (in mm Hg)
Indicators Main group Control group
SBP before admission 130.1 ± 0.46* 110.6 ± 0.48
SBP during admission 128.5 ± 0.43* 110.4 ± 0.46
SBP after admission 127.5 ± 0.46* 109.6 ± 0.59
DBP before admission 86.7 ± 0.31* 71.7 ± 0.31
DBP during admission 83.3 ± 0.31* 71.6 ± 0.31
DBP after admission 82.7 ± 0.27* 71.5 ± 0.31
* - (p < 0.05)
Analyzing the table it can be seen that statistically significant differences in blood pressure values are observed in patients before, during and after dental treatment. After administration, mean blood pressure values in all groups were reduced to normal numbers, however, in the patients of the main group were significantly higher than in the control group.
It was established that the values of arterial parameters were statistically higher in the main group than in the control group. Analysis of blood pressure values has shown that in all patients before dental treatment the pressure is higher than after administration.
The Kerdo index in the main group indicates a stress reaction and its numerical value indicates that almost all patients have a pronounced effect of the parasympathetic nervous system.
When the reactions of the parasympathetic nervous system are dominated, syncope states, bradycardia, lowering blood pressure, reducing respiratory rate and muscle tone may occur. Hypersalivation is observed, sweating, peristalsis of the intestine is increasing, peripheral blood vessels are expanding, there is confusion and excitation of salivation.
In the control group, the sympathetic nervous system predominates over the parasympathetic nervous system. But by the end of the reception there is a gradual decrease in the excitation and sympathetic nervous system, i.e. Gradually equilibrium is established in the components of the autonomic nervous system. The main function of the sympathetic depart-
Table 2. - Results of the study of values of heart rate in groups of patients (in bpm)
Indicators Main group Control group
Heart rate before admission 89.7 ± 0.18* 74.5 ± 0.24
Heart rate during admission 86.6 ± 0.16* 73.2 ± 0.22
Heart rate after admission 79.2 ± 0.14* 72.9 ± 0.20
* - (p < 0.05)
According to the table, it is seen that in the main group of heart rate is statistically significantly higher than in the control group, regardless of the time of measurement. In our opinion, this is due to the fact that patients who have not undergone a correction of their psychoemotional state are in a state of excitement and stress, so the psychoemotional tension before dental intervention is more pronounced.
The work determined the Kerdo index as an indicator of the functions of the autonomic nervous system, the functioning of which is inextricably linked to the cardiovascular system.
If the value of this index is greater than zero, then the predominance of sympathetic influences in the activity of the autonomic nervous system is indicated, if less than zero, then the prevalence of parasympathetic influences, if zero, indicates functional equilibrium.
ment of the autonomic nervous system is to regulate internal vegetative functions, in connection with external activity, especially in extreme situations. In other words, the sympathetic nervous system affects the vegetative processes so that they are most useful in an extreme situation.
But by the end of the reception there is a gradual decrease in the excitation and sympathetic nervous system (a twofold decrease in the indicator), i. e. Gradually equilibrium is established in the components of the autonomic nervous system. Summarizing the results of the study of the indices of physiological indicators, it should be noted that their change at the dental reception was revealed. Prior to dental surgery, patients are more excited than during and after taking. It was found that the values of blood pressure and heart rate were statistically higher in the main group than in the control group.
Table 3. - The results of calculating the Kerdo index
Main group (before admission) Main group (during admission) Main group (after admission) Control group (before admission) Control group (during admission) Control group (after admission)
-4.8 ± 0.37 -3.3 ± 0.38 -7.2 ± 0.37 3.5 ± 0.43 1.99 ± 0.45 1.73 ± 0.4
Also, the analysis of physiological parameters (blood pressure, heart rate and IR), as indicators of the functions of the autonomic nervous system, allows us to state that the application of the method of correction of the psychoemotional state at the dental appointment significantly reduces the level of psychoemotional stress in patients.
Table 4. - Indicators of the intensity of psychoemotional stress at the dental appointment:
The average indices of ps dental ac ychoemotional stress on mission
Main group Control group
144.5 ± 8.55 points 74.9 ± 4.18 points
The average degree of psychoemotional stress An easy degree of psychoemotional stress
The average value of the sum of points in the main group was 144.5 ± 8.55 points, which corresponds to the average degree of psychoemotional stress (for a sum above 133 points it is necessary to correct the psychoemotional state). In the control group, the mean score was 74.9 ± 4.18, which corresponds to an easy degree of psychoemotional stress (from 0 to 100 points). Thus, it can be stated from
Based on the foregoing, we consider it possible and necessary, to recommend a method for correcting the psychoemotional state of patients on an outpatient dental appointment for practical public health.
Using the technique of correction of psychoemotional stress in outpatient dental reception, taking into account the differentiated approach to the type of psychoemotional reaction detected in dental patients, allows to reduce the prevalence of negative dental experience and dentofobia among the population, increase the motivation of the population for timely prevention and dental treatment. That, ultimately, leads to an increase in the effectiveness of therapeutic and prophylactic measures in the field of dentistry by optimizing the interaction of the dentist with patients, taking into account their psychoemotional state.
the table that there are statistically significant differences in the level of emotional state between the control group and the main group. The obtained data confirm the data on the presence of emotional stress in patients on dental admission.
Table 5. - Results of studies on the scale of dental anxiety by Corah:
Main group Control group
17.52 ± 0.98 points 8.24 ± 0.37 points
Dental phobia is expressed Dental phobia is not expressed
The lower limit of pronounced dental phobia is 17 points, which at the result of 17.52 ± 0.98 indicates its presence in the main group.
For the purpose of approbation of the results of the method of correction of psychoemotional stress (application 1), 450 patients were examined, who applied for caries, its complications and periodontal diseases. These patients made up a control group. In the course of the examination and conversation among the control group, the following types of psy-choemotional reactions were identified:
Application 1.
The sequence of actions of the dentist, aimed at determining the type of psychoemotional reaction of the patient at the reception.
1. Episodic anxiety
The patient's condition is characterized by signs: a relaxed, calm state of the patient is replaced by unexpectedly alertness, zazhatosty. In this case, the patient more actively controls the situation. This state is replaced by a state of relative calm and relaxation.
Such conditions of the patient are correlated with the reasons, among which the insufficient level of preparation by the patient's doctor for the expectation of specific unpleasant sensations; The patient's attention was attracted by a source of unpleasant sensations; There can be a situation classified
Table 6.
Type of psychoemotional reaction Men (years) Women (years)
16-21 21-35 35-65 16-21 21-35 35-65
Episodic anxiety 2 4 18 1 7 43
Excitement 3 20 20 4 28 33
Mobilization 1 5 11 3 6 19
Fright 6 23 42 5 38 73
Fear 1 8 12 1 3 10
Total 13 60 103 14 82 178
by the patient as supernumerary, associated with a threat to his health.
2. Excitement
The patient's condition is characterized by signs associated with an increase in the number of micro-motions of the body - an increase in the frequency of blinking, the strain of the fingers of the limbs, excessive twitching of the shoulders, excessive head movements to find a more comfortable position; The increase in verbal activity, the appearance or increase in the number of critical comments on the environment - the actions of the doctor, the situation in the room, the state of technical support, the quality of materials, personnel qualifications, etc.
Such conditions of the patient are correlated with the reasons, among which the level of the patient's preparedness for specific influences and his sensations is not sufficient; Sufficient level of preparedness of the patient, but the duration of the procedure was delayed; Discomfort from immobility and long open mouth; excessive physical impact on the oral cavity of the patient, etc .; Insufficiently qualified actions of the doctor, insufficiently intelligible explanations on manipulations.
3. Mobilization:
The patient's condition is characterized by signs associated with long periods of time, with a strain of the muscles of the body, fixation of the limbs, heads, fixation of the sight, low-level verbal contact, monosyllabic, delayed response.
Such conditions and signs correlate with such reasons as the insufficient level of preparation of the patient for the forthcoming manipulations and the sensations associated with them; Also negative experience associated with past effects on the patient by dentists (past experience).
4. Fear
The patient's condition is characterized by signs associated with a sufficient level of the patient's readiness to explain the cause and time of the onset of the disease, there is no isolation, a sufficiently high level of interest in communication with personnel, information, readiness for detailed explanation of the circumstances of the disease, readiness for contact and assistance to medical personnel in Elimination of a painful condition.
The verbal manifestation of fear is associated with the questions asked by the patient, remarks about the treatment situation, remarks about the fears in the treatment situation.
Nonverbal manifestation of fear is characterized by a state of mimicry, gaze, movement of limbs and body movements, the patient is emotionally stable, sufficient level of trust in the personnel.
Such conditions and signs are correlated with such signs as insufficient level of positive attitude towards treatment, absence or lack thereof in relation to modern methods of
anesthesia, reaction of the trace cause, level of expectation of unpleasant sensations. The role of infantility in the patient's behavior plays a role and plays a role, which is manifested in the fact that the patient needs custody, wants to shift the decision-making process to others; The patient's condition is affected by past experience, including children's from visiting the dentist and the experience of adults, in particular parents. There are also various social misconceptions and prejudices associated with the idea of the nature of dental treatment, i. e. Level of dental literacy.
5. Fear
The patient's condition is characterized by signs associated with verbal (speech) manifestations, when the fear is expressed verbally, the patient does not cope with emotions, there is also a blocking of thinking, this leads to the fact that the patient is unable to take into account his arguments, arguments surrounding him, confirming the inadequacy of his experiences The existing causal series.
Also, non-verbal (nonverbal) manifestations of fear are associated with behavioral peculiarities, such as pallor of the skin, decreased speed of movement, increased size of pupils of the eyes; Tension of limbs, slurred speech, semantically less adequate than usual; Can be mimic manifestations.
In addition to the above, the manifestations of fear can be in a less pronounced, disguised form, which is manifested in the denial of the dental treatment itself, the refusal to visit the dentist; Choice of goals of a higher level than treatment. It can be anosognosia; Avoiding visits to the dentist, also in the behavior of the patient in such a state there is an excessive, unreasonable level of optimism; Reevaluation of impressions; Can be criticism of dentistry in general, as a branch of medicine; Insufficiently high level of the patient's culture can determine the manifestations of anger, rudeness, aggression towards the medical staff.
The sequence of measures to reduce the level of psy-choemotional stress at the dental reception (depending on the type of psychoemotional reaction).
Regardless of the type of psychoemotional reaction, patients need to carry out activities for psychotherapeutic de-sensitization:
1. The patient needs to clarify the preliminary treatment plan.
2. The patient mentally represents the alarm scale (the phenomena that cause him psychoemotional reaction).
3. To relax as much as possible (unobtrusive lighting is necessary, soft, relaxing music is permissible), breathe deeply and rarely.
4. After relaxation, repeatedly imagine the original scale.
The order of performing actions in general to reduce the
level of psychoemotional stress:
1) Recognize the reaction that is dominant, identify and understand the characteristic features of this reaction; Understand the psychological need, which determines this reaction.
2) To show the patient an understanding of his features -to show by his actions the acceptance of the characteristics of his response, to carry out actions that encourage the characteristics of the patient's response.
3) To conduct an adequate impact: for rationally thinking patients it is necessary to give specific facts; Irrationally thinking patients require the use of appropriate forms of influence, i.e. It is necessary to adjust to them.
The procedure for dealing with a patient in a state of episodic anxiety, agitation, mobilization: the treatment process requires prior agreement with the patient on a signal corresponding to the state of anxiety.
1) It is necessary to work with patients on the basis of understanding that his feelings, experiences are understood and taken into account.
2) In the work with the patient, pauses are necessary 3) In cases where interruptions in the actions are not possible, the patient needs to explain the routine of the situation, give an explanation of the nature and duration of the procedure.
The procedure for dealing with a patient in the event of a fear reaction.
1. It is necessary to confirm the naturalness of the experience of fear, to show sympathy to him, while it is appropriate to show him an understanding of discomfort, due to the presence of a state of fear; Also explain the positive side of fear, which mobilizes the body.
2. To designate a measure of fear, i. e. A sense of fear should not be harmful.
3. Determine the cause of fear. In most cases, the patient himself indicates a specific cause. If this does not happen, then help in establishing the cause of the questions, about what could have caused the appearance of fear of dental intervention.
4. The reason to formulate the patient. 5. Show the patient an unreasonable level of the significance of the cause: to show the groundlessness of the reason, to give arguments. The arguments presented can be divided into two main types -the behavioral actions of patients received from communication with a person, the impressions received by oneself or colleagues; Received from sources of information - scientific data from publications, existing historical information.
The procedure for acting on the patient in case of a reaction of fear.
Overcoming fear involves the implementation of a number of actions related to the solution of the main task - encouraging the patient to possibly spend the emotional charge before treatment.
1. To associate oneself with the patient, to point out the manifestation of fear as a natural property of a person, to show the level of sympathy for the patient, the positivity of the manifestation of fear in life situations.
2. To give a correct understanding in the evaluation of fear management: to point out such moments that fear should not be a hindrance in the process of treatment, should not interfere with the communication of the doctor and the patient.
3. At this stage it is necessary to pay attention to specific methods of psychotherapeutic influence associated with the choice of breathing mode, switching attention, switching fear, confrontation, catharsis.
References:
1. Alyamovskaya E. H. Psychoprophylaxis in stomatology // New in stomatology.- 2002.- No. 6.- P. 12-13.
2. Anisimova N. Y. Patients with dental phobia at the dental reception // Bulletin of TSPU.- 2014.- No. 5.- C. 123-128.
3. Collado V., Nicolas E., Hennequin M. Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety // Odontostomatol Trop.- 2008.- No. 124.- P. 35-42.
4. Daini S., Errico A., Quinti E., Manicone P. F., Raffaelli L., Rossi G. Dental anxiety in adolescent people // Minerva Sto-matol.- 2005.- No. 54.- P. 647-659.
5. Dental examinations: Basic methods.- 5th ed.- WHO,- 2013.- 135 p.
6. Ershov K. A. Psychoemotional status as the basis for successful prosthetics of toothless jaws in gerontopatsientov // International Scientific and Research Journal.- 2016.- No. 49.- P. 60-62.
7. Grositskaya I. K. Delayed visits to the dentist and their connection with the patient's personal characteristics: author's abstract. dis. ... cand. medical science.- Moscow.- 2002.- 21 p.
8. Hofer D., Thoma M. V., Schmidlin P. R., Attin T., Ehlert U., Nater U. M. Pre-treatment anxiety in a dental hygiene recall population: a cross-sectional pilot study // BMC Oral Health.- 2016.- No. 16.- P. 43-47.
9. Lukhanina T. V. Assessment of psychoemotional and dental status in mentally ill patients in connection with the tasks of therapy: Author's abstract. dis. ... cand. medical science.- M.- 2009.- P. 35-38.
10. McGrath C., Bedi R. The association between dental anxiety and oral health-related quality of life in Britain // Community Dent Oral Epidemiol.-2004.- No. 32.- P. 67-72.
11. Paul S. Dental phobia ... How to overcome it // Todays FDA.- 2014.- No. 26.- P. 16-19.
12. Sharova T. N., Antonova A. A. Predicting the emotional state of patients at the dental reception of modern dentistry.-2014.- No. 1.- P. 94-96.
13. Vasyanina A. A. Treatment of teeth in children with a negative attitude to dental manipulation: Dis. Cand. honey. sciences.-St. Petersburg.- 2008.- 176.
14. Volokhonsky V. L. Psychological factors of adherence to treatment: a comparative analysis of patients who perform and do not follow the recommendations of a dentist // Meditsinskaya psikhologiya v Rossii.- 2017.- No. 42.- P. 1-16.
15. Yerilin E. A., Anisimova E. N., Anisimova N. Yu. Methods for assessing the psychoemotional state of patients in outpatient dental reception // Bulletin of New Medical Technologies - 2016 - No. 2.- P. 124-130. doi: 10.12737 / 18754.
