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Practical aspects of psychosomatic dentistry
Psychosomatic PRACTICAL JOHN
ASPECTS
Diseases
OF PSYCHOSOMATIC
PAUL rJ~~~~~~,
D.D.S.,” BAIKBRIDGE,
DENTISTRY &ID.
A
PPREHENSION and the fear of pain associated with the dental operation have done more to lower the percentage of dental treatment than any other one factor. With the advent of local and general chemical anesthetic agents, progress has been made to eliminate to a large degree in many patients the encounter of the dental operation. However, additional adjuncts are needed to support those patients who still maintain that the discomforts of dental operations are present, even with the chemical anesthetic agents. Whether those discomforts are due to the inadequacy of the anesthetic, by the lack of proper solution potential or the inaptitude of the anesthetist, or whether they are psychogenic factors, they still have to be met daily in the dental operator’s practice. It is with that thought in mind that it would benefit both the patient and the operator if all known and accepted available methods were on the shelf for his use and advantage. Countless papers and hours of work have purported to us the value of chemical agents as local and general anesthetics, for the successful use in the relief of anxiety, fear, pain, and apprehension. Other chemicals have demonstrated their effective preoperative value and postoperative success in reducing, and many times eliminating, those more mental habits that are associated with the thought and treatment of a dental operation. To those we must add the psychic adjunct of psychosomatic sleep. In psychosomatic dentistry, or “hypnosis in dentistry,” there is afforded to the dental profession, both military and civiliaq, an additional advantage for the success of dental operations in comfort. In allaying the elements of anxiety, fear, pain, and apprehension, there is an advantage which in its own procedures supports the success and comforts of a pleasant dental experience. We have relaxation which relieves anxiety ; sleep that reduces fear ; anesthesia which eliminates pain, and posthypnotic suggestion which counteracts apprehension. With hypnodontics, we have upon the shelf an adjunct which in its own very nature is an advantage that will confront those very basic psychic elements that have made dental treatments an orcleal with gross neglect to many. Those who have experienced psychic trauma by early dental experiences have to be retrained to accept dental treatment as a necessary phase in their -The opinions or assertions contained herein are the private ones of the author and are not to be construed as official or reflecting the views of the Navy Department or the Naval Service at large. Read before the gathering of the annual meeting presented by the Dental Department of the United States Naval Training Center, Bainbridge, Md. *Commander, Dental Corps. United States Navy, United States Naval Training Center, Bainbridge, Md. 425
lives. Also, those who attend to their dental cart grudgingly can IW taught that they too will enjoy a former drudge with comfort and relaxation. Then thoscl who are to experience their first tlrntal operatioll. to the third group, ~gardless of precious dental coaching received, they should IW CSJ)OSCX~ to aI 1 t,hr .I’actors available whereby they will have only pleasant thoughts anti memories of their dental esperiencae. There are no short ruts in the psychic The factors which will train l)aticnts to cn.jo:training for dental patients. dental treatment in comi’ort? relaxation. anesthesia. sleep, and anlnesia are to be utilized so that. treatment will no longer bear the brunt of being as one with anxiety, fear, pain, and apprehension. The training rests only within thv ScOpe of the dental operator, and his ability to apply those atljutlcts which are available for his use. Into one 0C the three eategorics mentioned will fall all servicemen who rcquire dental attent,ion. Therefore, it is for us to deterrnine how we are to outline the treatment for the service patient. It is for us to use judgment and care to leave our patients with psychic thoughts and memories of only comfort, pleasantness, and a desire to return for further treatment. I’redominantl~-. ncxarl!. all servicemen will bc able to continue t,heir dental treatment by the normal means of just plain oral assurance, by the application of preoperatirc sedatives, and by the use of local and grneral anesthetics. Yet, after these hart been applied some will need the additional psychic support in knowing that their dental treatment will be done in comfort. However, for those who cannot be classified into this group and who still need necessary attention, it behooves the operator to know and to understand what the anguish of the patinlt ma>- bc, and what satisfactory approacll he will have to use to suppress it. It is not suggested licrc or throughout the thought. of t,his papor that it is expected of the dental operator to be a clinical analyst, or psychologist, but it, is suggested that he become acquainted with t,he difficulty of a psychic emotional disturbance that may be engulfing the patient assigned to him for dental care, and what means he will use to console the emotion and to succeed in getting the Therefore, with the additional adjunct of necessary dental work completed. psychosomatic sleep for his USC,he will be able to carry out all aspects of dental treatment to a fuller degree of comfort and cooperation. He will be able to rcassure the patient by actual experience t,hat dental treatment can be done cornSo we must not delude ourselves in thinking that pletel>- without discomfort. the whole field of pain c*ontrol can be accomplished IQ- chemical anesthetics a1one.12 For the more practical application of psychosomatic sleep, WC must ask ourselves some basic questions. “How am I going to quiet that anxiety, fear, pain and apprehension in only a few minutes in the first sitting?” “Am I going to be able to re-train the pat,icnt’s psychic interpretation of dental treatment in Therefore, to answer t,hcse two basic questions, we must the first few minutes?” not hurry the first sitting. Ample time should be allotted to establish a satisfactorv “mind-set.“2, 3
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The “mind-set” is the first essential step in assuring the patient of what is to follow in the process of reducing his fear and apprehension for the treatment. When the proper “mind-set” has been established and the patient forms a receptive frame of mind to suggestion, the then accumulated time saved in successive sittings will compensate for the time taken at the first sitting. Confidence can be slowly started in such a manner as taking the patient’s case 1&oqr.3, 43lo, 11,29 For when questions are asked directly and for a definite purpose, the patient feels he is the one of interest at the time, and thereby eliminates the first troublesome stage of reception. Questions such as the following may be asked and listed: “How is your health today?” “Have YOU had any headaches, colds, sore throats, or any other physical complaints?” “HOW is your appetite?” “Have you any digestive disturbance?” ‘(DO you eat most of your meals every day?” “DO you grit your teeth during the day or night Y” . “Do you bite pencils, pipe stems, or finger nails?” “Which side do YOU favor in chewing?” “Are you embarrassed with bad breath?” “What dentifrice and tooth brush do you use?” “When do you brush your teeth?” “What, special fears or feeling do you have about bridges, dentures, anesthetics, drilling, prophylaxis, and others?” “Are you tense or relaxed during dental appointments?” “Would you like something to relieve the discomfort of your dental treatment ?” AS you go about getting the case history, you are establishing the first stage of relaxation. You are assuring the mind that it is capable of accepting ideas. Suggestion is only the implantation of an idea, or series of ideas, and is an in\-itation to action which is conveyed to the mind through any or all of the special senses.24,28,36 As we understand that suggestion is an invitation to action, we know that in every invitation to action there is not a suggestion. We see now that the first stages of retraining the mind have started. The mind as a result of education, heredity, environment, and training contributes to the development of the body as much as the body contributes to the development of the mind. Therefore, since we are to improve the growth and development of the hod- by supportive dental treatment, we must contribute to that growth by proper development of the mind.? As patients gain confidence in you they will believe in your knowledge, rely upon your skill, and trust in your words, deeds, and actions.F They in turn give you their confidence,31 which is a conscious act and is executed by the conscious mind. By this act they open t,o you the subconscious, the storehouse of the mind, which receives and records the suggestions you may place t,here. Your suggestions are then conveyed to the mind which influences the higher centers,‘3 both motor and sensory-motor in that the patient relaxes, and sensory in that the patient has no fear. The application of suggestion in psychosomatic sleep is practically unlimited in dealing with whatever dental treatment is essential. There appears to be no known contraindications”” for the usefulness of psychosomatic application in dental procedures. You have basically every essential that is required in good doctor-patient relationship. There is confidence, relaxation.
comfort, anesthesia, amnesia when necessary, ant1 pleasantness. These fac4 (~1.5 apply to all the phases of dental treatment. The first and foremost, factor in tlentnl treat merit shoultl be complete IV laxation. Jn establishing complete relasation, i~ssurance should be c~o~lstatli izs the patient begins to rclas. the elitire with proper suggestions following. syndrome of apprehension diminishes. Breathing becomes more rhythmic. blood pressure becomes tllore normal. the l)ulsr ~IY~~M, and the feeling of release of nervous tension C'ILSUPS. l’he very tow of the voice in its suggestion is conducive to relaxing the entire body, and, as the body relaxes. there is also a relaxation of facial nmscles which allows For more fwdom of dental ol)eration. The constant combating of the oral musc*Ies is wtluwtl. \\‘ith relaxation also comes a more spiritetl c+ooperation by- the patient in responding to \vhiltcvrl‘ suggestions are ncedetl. As the l)atient relaxes ant1 sllggcstiolls are :I c*cdeptetl, he passes into a I)ath that is classified as a hylmoidal trance.‘. The ljatient shows signs of drowsiness, fluttering of the eyelids, closing of the eyes. mental relaxation, partial lethargy of the mind, irlltl heaviness ot’ limbs. As the trance continues from the hypnoidal to t,he light trance,‘” there is ill1 increase of the limb catalepsy and breathing becomes slower and deeper. Then comes a strong lassitude or disinclinat,ion to tnoye. speak. think, or act. a twitcdhing of the mouth and jaws, and establishment oI’ rapporP. x i b~tw-eell the subject itntl the operator. Simple 1)osthypnotic suggestion nlay Ilow be heeded. ant1 there is a partial feeling of detachment from the environmental surroundings (Fig. As the trance continues, there is an increase in nlnseL~l;lr inhibitions. I!. There is a tactical illusion, gustatory illusion. olfac+ory jlluxio~l. anal an establishment of arlesthesia. Also. we are now able to have the 1)ntient open his eyes without affecting the trance (F’ig. 2). which is il hell~f~l ilit when used in a worka.ble waking tranec ( Fig. :i). This trance stage is rotisidered deep somnambulistn. 21stage which is desired hy n~any hpl~notlontists. As it has the patient in anesthesia for what c\.er dental work is necessary. it ;11sohas a quality of posthypnotic: anesthesia to ~ducc pain ilftcr* operation. Herr also we have amnesia. \vhich is il qllality desiretl when it is best that the \\‘ith amnesia, the patient, remember nothin g of the a(!lual dental operation.‘. quality of happiness alIt surprise is introducctl as the l)atiellt looks into the mirror to see what actual dental work has hecn completed. some patients will enter a plellary trance. whitAh is it Occasionally, stuporous condition in which a,11spontaneous act,ivity is inhibited.“. I” The plenary trance is not, ik good practical depth to maintain c*otnl)let,e ral)l)ort. It could be compared to that of deep general anesthesia. However. it is not difficult to change from the plenary to the somnambulistic trance 1)~ a few suggestions. As the patient progresses from the relaxed state toward somnan~hulisn~, there is an induction of analgesia whereby minor exploratory work may he started. So also can start the suggestion that there be a reduction in th+ salivary flow into the mouth. The suggestion to the patient that the mouth
PRACTICAI,
ASPECTS
OF
PSYCHOSOMATIC
429
DESTISTRY
Fig.
Fig. tive tran, comfortat Fig. all surroc length of Fig. hension.
l.-Pal ces has ,le, and Z.-A Indings, desired 3.--Par He wil
Fig.
2.
Fig.
3.
th e stag ‘es of t1 in accepting the suggestions while passing through and is .ela xed, the feeling of detachment from environmental surrom Idings in a cooperafive state. ,:oopt !rating leln, ’ ;iew patient in a somnambulistic trance can haI re his eyes hc:sia for stain an open mouth, be free of excessive saliva, ar Id h&v ‘e am oper ation. tient in the desired depth of trance is free from anxiety, fear, pain, . ap llingl y cooperates for operative or surgical procedures.
:ient
430
JOHS
PAlrl,
JAKABAK
will become dry and that the flow of saliva will stop, does ior some unesl)laitlable reason retard the saliva and oftentimes stop it completely:” This f;lc*fot, alone has a practical aspect in that the dental operating fieltl is tlu longc~~~(‘otltaminated or saturated with saliva, and the constant interrul)tions assocGtt~(l with saliva are no longer present, expediting the time of the d(antal opcrntioll. In a similar relationship t.o the stoppage of saliva, thcrr is the ~ontrcll III’ stoppage of bleeding to the area indicated. Act,ual cessatioii (11’hcirlort*h:~~~ 0tI numerous occasions has been accomplished in deep cavity prt~paratioll whrreb~~ the gingivae were damaged in the preparation. Wit,h the stoppage ot’ blre(ling. it is easier to eontinuc cavity preparation and to expedite the ;~cll~~i~~ist~~atio~~ 01 restora,tions. In oral surgical procedures, the reducing of the flow of hemc~ rhage”’ keeps the field more visible and allows for frretlom of 1novement \vherc.by the operator is not constantly int,erfered with by the aspirator!.. Other practical factors which are to he considered with the application of psychosomatic sleep are that there is no interference by the patient with the Subjects are resting in a comfortable continual eruptions of conversation. st,ate while the doctor proceeds uninterrupted with the necessary dental l)rr)cedures (Fig. 4). As he continues uninterrupted. the time filctt)J' allows the operator to do more actual work or to expedite his work quickly, and therefore see more patients. Both factors are to be caonsidered. Also where the operator need not worry of extending proper cavity prcl)arations for fear 01‘ pain during the preparation, or that, of hurt,ing thr patient, during a prepar;~tion which necessitates being scat,etl below the giiigirac. hc WJI \vork JI~OI’V freely. Another very practical factor particularly associated with surgical procedures is that of the posthypnotic suggest,ion, whereby 6he area of operation will be in complete anesthesia and free from pain for the length of t,ime desired. Although, it is not possible to control completely the postoperative cellulitis, it is possible to keep the patient from having any feeling of pain that would normally accompany a surgical procedure. It is interesting to note that while the patient remarks that his face is swollen, he still c~laims no pain. Postoperative dressings may be changed in complete eolllfort in less time for patients who accept the trance. Localized alveolitis may be cdompletcl> made free of pain while healing is taking place. All discomforts may be I+ moved. The time expedited for such procedures far outlimits the same typt) of treatment if local or general chemical anesthetics were requiro(l. As an additional adjunct in maintaining close dental-medical relationship), it is possible to assist the medical officer in expediting traumatic injuries with comfort to the patient. A case history will be cited here to illustrate the A service patient who had been having all his necessary dental point further. work done under hypnoanesthesia. had his foot crushed when a heavy object fell from the overhead upon his foot. He was quickly brought to sick hay-. where anodynes were administered immediately. Before the orthopedic surgeon could estimate what, tramatic damage had been -done to the foot, it was necessary to take a series of x-rays. With the patient in such severe pain and with the immediate swelling of his foot, it was extremely difficult to
PRACTICAL
ASPECTS
OF PSYCHOSOMATIC
DENTISTRY
431
manipulate the foot in such a way as to get adequate radiographs. Being a patient who for dental operations accepted psychosomatic sleep, he was relaxed and in the stage of somnambulism almost instantaneously. In the somnambulistic trance, he was completely relaxed and apprehension was relieved and shock alleviated. He had complete anesthesia of his right foot, whereby it was not only possible to manipulate the broken fragments freely for x-ray, but also to have the broken bones set and the foot placed in a plaster cast. During the entire operation, he was completely at rest with pleasant hallucinations. The total operating time took forty-seven minutes during which time the patient felt no pain or discomfort. This example is just another phase of the practical aspects of psychosomatic sleep as it can be utilized in an emergency. Psychosomatic sleep is not a new thing. It had its periods of ups and downs through the centuries. Literature is full of the various developments of suggestive therapy and hypnosis. Various authorP, 20~21p32,33 ha.ve indicated, by their experience, that the use of psychosomatic sleep in competent trained hands has its place in the fields of medicine. With the recent trend of successful dental operations2p lo, I7926 under the influence of psychosomatic sleep, an increased desire of practitioners to become acquainted with this additional adjunct has shown that the psychic position of the dental patient is being more understood and as so successfully handled. We may ask, “Who then, will be our patients for the successful use of psychosomatic sleep?” To this we can answer, “Every normal person from the age of 3ys to old age can be successful in accepting the trance”lO, Z; either extreme presents a more dif6cult problem for the lack of mental concentration. The best subjects are those of higher I. Q., teachers, students, professional people. 2l 3l 25,31 Thus in the service we are not concerned or limited to the type of normal patients used. Again we ask, “Are there any subjects other than the previously mentioned who may be considered poor patients for psychosomatic sleep?” We can answer, “Yes”; there are those who are psychotic, suffering with various psychoses, and who should be under psychiatric care.8p I8 There are also those who will under no circumstances cooperate toward a successful trance. Time here would only be wasted. “For what length of time should a subject remain in a trance during dental treatment P” Literature has mentioned cases that have remained for days. However, there is no earthly need to keep a dental patient in a trance any longer than is essentially necessary to carry out what dental work is contemplated. Occasionally while a patient is completely relaxed and comfortable, a tendency to do more work than routine has been evidenced. “Are any other surroundings needed other than the average dental operating chair?” Conditions here will vary a lot with the expectant subject. However, some trances have occurred under the most trying surrounding disturbances. Some of the most successful and most rapid trances have been experienced by the author on board ship while riveting was going on in the
432
JOHN
P.11’1.
J.iRhBAK
adjoining ship’s compartment. Jt is, however, recommended that normality be the policy. Prior to the initial trance surgical instruments and dental armamentarium should be retained in the background and direct convcrsatio]I in the same office spaces should be restricted, for quietness in itself is conducive to relaxa.tion and then sleep. Occasionally a patient would like to cooperate but persists with the old notion of mind dominance. This patient ea.11be reassured that he will be awake at all times.“?, ?; ant1 thus, while in the trance, be capable of answering questions and viewing all surroundings and maintaining limited conversation. It, however. has been noted that patients while undergoing dental treatment prefer. through hallucinations, their favorite music, beautiful scenery, or perhaps to rc-enjoy a recent movie they have seen’” (Fig. 5). In the author’s experience of numerous service personnel of different rates and ranks in short establishments and shipboard, psychosomatic sleep has been induced anywhere from thirty seconds at the initial setting to an accumulated time of two hours. However, after the initial trance is accepted and the patient was left, with the posthypnotic suggestion, the average time for sleep was from instaittaneousl” to t,wo minutes. The third and successive trances were practical1.v instantaneous, surpassing the time necessary for any chemical anesthetic. Among the many case histories on file there is almost every conceivable dental treatment known. In oral surgery, upper and lower third molar impact,ions were accomplished with and without supporting procaine for comparison of depth of anesthesia. In a lower third molar impaction, the mouth remained constantly open for thirty-six minutes--hemorrhage and saliva were reduced to where only once was the aspirator required and with no accompanying postoperative pain for seventy-two hours. In periodontia, full mouth gingivectomies were performed. both surgically and ele&onecdle with the insertion of packs and with complete postoperative anesthesia for forty-eight hours. The quaclrant where hemorrhage was rchartled for compnrativc purposes a.ppeared to show evidence of quicker healing. In endodontia, necrotic and newly exposed pulps were removed in complete patient comfort. Bilateral apicocctomies were performed, one during a trance and the other under local anesthet,ic. The latter took longer and, during this time. the patient, exhibited physical signs of uneasiness, perspiration, and postoperative t’atiguc. In operative dentistry, a11 type cavity classifications were prepared and Subgingival hemorrhage was stopped and conciseness and speed in filled. operation prevailed. During many operative procedures, anesthesia just to the tooth being worked on was adapted during a waking trance, with the daily conversation evidenced. In prost,hodontia, upper and lower immediate dentures with surgery, constructions, and insertions were accomplished while the patient remained in Postoperative pain was retarded with no complete relaxation and comfort. soreness for limited periods, twelve, twenty-four, seventy-two hours.
PRACTICAL
ASPECTS
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DENTISTRY
Fvig.
Fig. interrupted Fig. comfortably F’ig. treated by
Fig.
5.
k ‘ig.
(I.
4.-Patient is resting in a workable waking trance while the operator proceeds unwith necessary examination and treatment. S.-During the period of the dental operation the unapprehensive patient is resting and enjoying a beautiful scene with his favorite music. B.-Patient is in a cooperating somnambulistic trance with his eyes open and being another operator in full response to only suggestions of that second operator.
It was also possible to control and stop the gagging rcfles during thtl trance and after the sccontl posthypnotic suggestiou eliminate the gagging Wflex completely, eve’11to the point whrrr t,he length of the mouth mirror did not affect the reflex. It helped trrmentlously in ~~elasing for taking centric. occlusion. On other occasions through posfhyl)notic suggestions, other phases of oral disturbances”, I”, 35 such as glossotlynia, pulatotlpnia, bruxism, traumatic occlusion, denture estheticas, condylan* clicking, an(l mandibular subluxat,ion were relieved or eliminntetl. ,1 noted point. which contributed inlmensurably to the expediting ot dental procedures wr?s that once the patient was in psychosomatic sleep, it was possible to have another operator or technician (L’ig. 6) proceed with t,he operation or prophylaxis while the patient enjoyed relaxed comfort. Definite rules were followed hero wherchy only snpplcnlt~ntn~y suggestions needed for the necessary treatment were used. and the patient was always aroused in the itlentical surroundings in which he was in (luring the incluction period for t,hat. setting. Kow the question arises, “What moral misuse of psychosomatic sleep can he transcended while the patient is in n trance?” The fact that psychosomatic sleep can be misused by unprincipled individuals should not be interpreted as Identical criticism arises from a legitimate objection to its use in dcntist,ry. For principled practitioners of indiscriminate use of chemical anesthetics. dentistry there can be no moral misuse of this therapeutic adjunct. For what other joviality or showmanship it may he utilized removes it from the realm ot’ therapy and as such cannot be considered an adjunct to dental therapeutics. &4 summary of the following ad\-alltages of psychosomatic sleep are to be considered : 1. In trained hands it is without danger or aftereffect. 2. It reduces anxiety, fear, pain, and apprehension in dental patients, permitting better cooperation. 3, Extremely nervous patients can be comfortably treated. 3. It is easy to evoke relaxation, thus enabling patients to feel rested and A feeling of freshness prevails. not fatigued after treatment. 5. No premeditation is necessa.ry and postoperat,ive sedatives need not be administered. 6. Speed of anesthesia enhances for greater production of work. 7. Anesthesia can be localized, maintained, and terminated, leaving no aftereffects as with drug anesthesia. 8. There is no sickness or nausea during the operation. 9. All phases of dental operations can be accomplished. 10. Disturbing factors such as saliva, hemorrhage, and gagging, ran he eliminated. 11. Postoperative pain can be eontrolled by posthypnotic suggestion. 12. Patients will remember and will look forward with pleasure to the next dental appointment..
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DEXTISTRY
435
Conclusion Since the psychic factors of anxiety, fear, pain, and apprehension cannot be entirely controlled by chemical agents and now that there is a recognized therapeutic adjunct available for the use of the dental practitioner, it is for him to take advantage of what psychosomatic dentistry has to offer. Psychic trauma by previous unhappy dental experience, and the mental physical anguish associated with dental treatment, can now be met, understood, and suppressed by proper mental conditioning. The comfort and relaxation associated with psychosomatic sleep in dentistry are conducive to a more relaxing and happier patient-doctor relationship. Not only will essential dental work be completed but, if patients no longer are afraid, preventative procedures can be more easily accomplished. What could be more gratifying to a fearful patient than to awaken from the dental treatment relaxed, fresh, comfortable, and with a happy smile.
References Almonsi, Renato J. : Psychosomaticsin Dentistry, Dent. Med. 98: 103, 1949. 4: Ament, Philip: Relaxation of Excitable Patients With Hypnosis, J. Dent. Med. vol. 3, July, 1948. Philip: Psychotherapy in Patient Relaxation, J. Dent. Med. 5: 3-7, 1950. Ament, Philip: Illuminating Facts of Psychosomatic Dentistry, Northwest Dent. 29: 107-110, 1950. American Psychiatry, New York, 1944, Columbia University Press, p. 39. A. P. Report, Having Faith in Drug Helps Relieve Pain-Science Finds, July, 1950. Bisch, Louis E.: Psychotherapy, INT.J.ORTHODONTIA~~: 547~549,1925. Brady, Raymond S.: Psychosomatic Sleep-An Aid to Pain Control, D. Survey 27: 487-491, 1951. Brenman! ‘M., and McGill, M.: Hypnotherapy, Psychosom. Med. vol. 8, no. 2, March,
3. Ament, 4. 5. 6. x’: 9.
April, 1946.
10. Burgess, Thomas 0.: Hypnodontia-Hypnosis as Applied to Dentistry, Cal Magazine, Februarv. March. Anril. 1951. 11. Clarke, George A.: Da&s Study Club, Boston, Mass., personal communication. John W.: Hypnotic Therapeutics and Modern Dentistry, Dental Cosmos, vol. 12. Dorland, 63, August, 1949. 13. Editor’s page, Dental Digest, vol. 49, March, 1943. 14. Ewen, S. J.: Psychosomatic Aspects of Oral Medicine, J. Dent. Med., pp. 117-120, October, 1949. Hawkes, L. A.: Hypnotism as an Anesthetic, Oral Hygiene 19: 1948, 1929. ii: Hensie and Shatzky: Psychiatric Dictionary, New York, 1940, Oxford University Press. Heron, W. T.: Hypnosis and Dentistry, Northwest Dent., vol. 28, no. 3, p. 2, July, 1949. 1’:: Heron, W. T.: Clinical Applications of Suggestions and Hypnosis, Springfield, Ill., 1950, Charles C Thomas, Publisher, pp. 8-20. Hollander, Bernard: Hypnosis and Anesthesia, D. Surgeon 24: 234-244, 1932. Hypnotism Today, New York, 1947, Grune and 2: LeCron, L. M., and Bordeau, J.: Stratton, Inc. Unconsciousness, New York, John Wiley and Sons, Inc.; London, James Crier: 21. Miller, Chaoman and Hall. Ltd. Waking Hypnotic Suggestions, D. Survey, vol. 25, June, 1949. 22. Moss, Aaron A.: Neurof. Irving: Patients Attitude, Dental Cosmos, vol. 67. Anril. 1925. M.: Suggestive Therapy and the’ Nervous Patient, ORAL SURG., ORAL 22:: Owen, ‘Melvin MED. AND ORAL PATH.~: 298,1949. Psychosomatic Sleep in Dentistry (A Society of Psychosomatic Dentistry: 25. American Preliminary Report), Northwest Dent. 28: 94-98, 1949. Suggestion as an Aid to Anesthesia, Anesthesiology Bernard B. : Mental 26. Raginsky, 9: 472-480, 1948. Aspects of General Anesthesia, AnesthesiBernard B. : Some Psychosomatic 27. Raginsky, ology, 11: 391.408, 1950.
2X. Robertson, \V.: Suggestive Therapeutics, J. I)ent. Assoc. South Africa 3: .ill-.Tli, l!Nil. 29. Staples, Lawrence M.: 1)avia Study Club, Boston, NRYS., personal c’omltllnli~atioll. 30. Stien, M. R.: Anesthesia by Mental IXsassociation, Dental Items .Lnterest 52: 941-91Tl 1930. 31. Staw, lrwin 8.: Treatment for Relaxation, Tic, E’cl,~mr~-, 1949. 32. Weiss, Edoardo: Principles of Psychodyxunics, Sew York, Grune hr StrnttoIl, Inc. Kew 170rk. Grnne & Stratton, Inc. 33. Wolberg, Lewis R.: Hypnoanalysis, 34. Your Health, Parade Magazine. Oct. 23. 1950. 35. Ziskin, D. Et, and Moulton, R:: Glossbdpnia: A St,udy of Idiopathic Orolingual Pain, J. Am. Dent. A. 33: 1422, 1946. 36. Zulauf, A. Frank: Suggestion as a Factor of Success in the Practice of Dentistry, I)ental Items Interest 45: 841-858, 1923.
ASPECTS
Diseases
OF PSYCHOSOMATIC
PAUL rJ~~~~~~,
D.D.S.,” BAIKBRIDGE,
DENTISTRY &ID.
A
PPREHENSION and the fear of pain associated with the dental operation have done more to lower the percentage of dental treatment than any other one factor. With the advent of local and general chemical anesthetic agents, progress has been made to eliminate to a large degree in many patients the encounter of the dental operation. However, additional adjuncts are needed to support those patients who still maintain that the discomforts of dental operations are present, even with the chemical anesthetic agents. Whether those discomforts are due to the inadequacy of the anesthetic, by the lack of proper solution potential or the inaptitude of the anesthetist, or whether they are psychogenic factors, they still have to be met daily in the dental operator’s practice. It is with that thought in mind that it would benefit both the patient and the operator if all known and accepted available methods were on the shelf for his use and advantage. Countless papers and hours of work have purported to us the value of chemical agents as local and general anesthetics, for the successful use in the relief of anxiety, fear, pain, and apprehension. Other chemicals have demonstrated their effective preoperative value and postoperative success in reducing, and many times eliminating, those more mental habits that are associated with the thought and treatment of a dental operation. To those we must add the psychic adjunct of psychosomatic sleep. In psychosomatic dentistry, or “hypnosis in dentistry,” there is afforded to the dental profession, both military and civiliaq, an additional advantage for the success of dental operations in comfort. In allaying the elements of anxiety, fear, pain, and apprehension, there is an advantage which in its own procedures supports the success and comforts of a pleasant dental experience. We have relaxation which relieves anxiety ; sleep that reduces fear ; anesthesia which eliminates pain, and posthypnotic suggestion which counteracts apprehension. With hypnodontics, we have upon the shelf an adjunct which in its own very nature is an advantage that will confront those very basic psychic elements that have made dental treatments an orcleal with gross neglect to many. Those who have experienced psychic trauma by early dental experiences have to be retrained to accept dental treatment as a necessary phase in their -The opinions or assertions contained herein are the private ones of the author and are not to be construed as official or reflecting the views of the Navy Department or the Naval Service at large. Read before the gathering of the annual meeting presented by the Dental Department of the United States Naval Training Center, Bainbridge, Md. *Commander, Dental Corps. United States Navy, United States Naval Training Center, Bainbridge, Md. 425
lives. Also, those who attend to their dental cart grudgingly can IW taught that they too will enjoy a former drudge with comfort and relaxation. Then thoscl who are to experience their first tlrntal operatioll. to the third group, ~gardless of precious dental coaching received, they should IW CSJ)OSCX~ to aI 1 t,hr .I’actors available whereby they will have only pleasant thoughts anti memories of their dental esperiencae. There are no short ruts in the psychic The factors which will train l)aticnts to cn.jo:training for dental patients. dental treatment in comi’ort? relaxation. anesthesia. sleep, and anlnesia are to be utilized so that. treatment will no longer bear the brunt of being as one with anxiety, fear, pain, and apprehension. The training rests only within thv ScOpe of the dental operator, and his ability to apply those atljutlcts which are available for his use. Into one 0C the three eategorics mentioned will fall all servicemen who rcquire dental attent,ion. Therefore, it is for us to deterrnine how we are to outline the treatment for the service patient. It is for us to use judgment and care to leave our patients with psychic thoughts and memories of only comfort, pleasantness, and a desire to return for further treatment. I’redominantl~-. ncxarl!. all servicemen will bc able to continue t,heir dental treatment by the normal means of just plain oral assurance, by the application of preoperatirc sedatives, and by the use of local and grneral anesthetics. Yet, after these hart been applied some will need the additional psychic support in knowing that their dental treatment will be done in comfort. However, for those who cannot be classified into this group and who still need necessary attention, it behooves the operator to know and to understand what the anguish of the patinlt ma>- bc, and what satisfactory approacll he will have to use to suppress it. It is not suggested licrc or throughout the thought. of t,his papor that it is expected of the dental operator to be a clinical analyst, or psychologist, but it, is suggested that he become acquainted with t,he difficulty of a psychic emotional disturbance that may be engulfing the patient assigned to him for dental care, and what means he will use to console the emotion and to succeed in getting the Therefore, with the additional adjunct of necessary dental work completed. psychosomatic sleep for his USC,he will be able to carry out all aspects of dental treatment to a fuller degree of comfort and cooperation. He will be able to rcassure the patient by actual experience t,hat dental treatment can be done cornSo we must not delude ourselves in thinking that pletel>- without discomfort. the whole field of pain c*ontrol can be accomplished IQ- chemical anesthetics a1one.12 For the more practical application of psychosomatic sleep, WC must ask ourselves some basic questions. “How am I going to quiet that anxiety, fear, pain and apprehension in only a few minutes in the first sitting?” “Am I going to be able to re-train the pat,icnt’s psychic interpretation of dental treatment in Therefore, to answer t,hcse two basic questions, we must the first few minutes?” not hurry the first sitting. Ample time should be allotted to establish a satisfactorv “mind-set.“2, 3
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The “mind-set” is the first essential step in assuring the patient of what is to follow in the process of reducing his fear and apprehension for the treatment. When the proper “mind-set” has been established and the patient forms a receptive frame of mind to suggestion, the then accumulated time saved in successive sittings will compensate for the time taken at the first sitting. Confidence can be slowly started in such a manner as taking the patient’s case 1&oqr.3, 43lo, 11,29 For when questions are asked directly and for a definite purpose, the patient feels he is the one of interest at the time, and thereby eliminates the first troublesome stage of reception. Questions such as the following may be asked and listed: “How is your health today?” “Have YOU had any headaches, colds, sore throats, or any other physical complaints?” “HOW is your appetite?” “Have you any digestive disturbance?” ‘(DO you eat most of your meals every day?” “DO you grit your teeth during the day or night Y” . “Do you bite pencils, pipe stems, or finger nails?” “Which side do YOU favor in chewing?” “Are you embarrassed with bad breath?” “What dentifrice and tooth brush do you use?” “When do you brush your teeth?” “What, special fears or feeling do you have about bridges, dentures, anesthetics, drilling, prophylaxis, and others?” “Are you tense or relaxed during dental appointments?” “Would you like something to relieve the discomfort of your dental treatment ?” AS you go about getting the case history, you are establishing the first stage of relaxation. You are assuring the mind that it is capable of accepting ideas. Suggestion is only the implantation of an idea, or series of ideas, and is an in\-itation to action which is conveyed to the mind through any or all of the special senses.24,28,36 As we understand that suggestion is an invitation to action, we know that in every invitation to action there is not a suggestion. We see now that the first stages of retraining the mind have started. The mind as a result of education, heredity, environment, and training contributes to the development of the body as much as the body contributes to the development of the mind. Therefore, since we are to improve the growth and development of the hod- by supportive dental treatment, we must contribute to that growth by proper development of the mind.? As patients gain confidence in you they will believe in your knowledge, rely upon your skill, and trust in your words, deeds, and actions.F They in turn give you their confidence,31 which is a conscious act and is executed by the conscious mind. By this act they open t,o you the subconscious, the storehouse of the mind, which receives and records the suggestions you may place t,here. Your suggestions are then conveyed to the mind which influences the higher centers,‘3 both motor and sensory-motor in that the patient relaxes, and sensory in that the patient has no fear. The application of suggestion in psychosomatic sleep is practically unlimited in dealing with whatever dental treatment is essential. There appears to be no known contraindications”” for the usefulness of psychosomatic application in dental procedures. You have basically every essential that is required in good doctor-patient relationship. There is confidence, relaxation.
comfort, anesthesia, amnesia when necessary, ant1 pleasantness. These fac4 (~1.5 apply to all the phases of dental treatment. The first and foremost, factor in tlentnl treat merit shoultl be complete IV laxation. Jn establishing complete relasation, i~ssurance should be c~o~lstatli izs the patient begins to rclas. the elitire with proper suggestions following. syndrome of apprehension diminishes. Breathing becomes more rhythmic. blood pressure becomes tllore normal. the l)ulsr ~IY~~M, and the feeling of release of nervous tension C'ILSUPS. l’he very tow of the voice in its suggestion is conducive to relaxing the entire body, and, as the body relaxes. there is also a relaxation of facial nmscles which allows For more fwdom of dental ol)eration. The constant combating of the oral musc*Ies is wtluwtl. \\‘ith relaxation also comes a more spiritetl c+ooperation by- the patient in responding to \vhiltcvrl‘ suggestions are ncedetl. As the l)atient relaxes ant1 sllggcstiolls are :I c*cdeptetl, he passes into a I)ath that is classified as a hylmoidal trance.‘. The ljatient shows signs of drowsiness, fluttering of the eyelids, closing of the eyes. mental relaxation, partial lethargy of the mind, irlltl heaviness ot’ limbs. As the trance continues from the hypnoidal to t,he light trance,‘” there is ill1 increase of the limb catalepsy and breathing becomes slower and deeper. Then comes a strong lassitude or disinclinat,ion to tnoye. speak. think, or act. a twitcdhing of the mouth and jaws, and establishment oI’ rapporP. x i b~tw-eell the subject itntl the operator. Simple 1)osthypnotic suggestion nlay Ilow be heeded. ant1 there is a partial feeling of detachment from the environmental surroundings (Fig. As the trance continues, there is an increase in nlnseL~l;lr inhibitions. I!. There is a tactical illusion, gustatory illusion. olfac+ory jlluxio~l. anal an establishment of arlesthesia. Also. we are now able to have the 1)ntient open his eyes without affecting the trance (F’ig. 2). which is il hell~f~l ilit when used in a worka.ble waking tranec ( Fig. :i). This trance stage is rotisidered deep somnambulistn. 21stage which is desired hy n~any hpl~notlontists. As it has the patient in anesthesia for what c\.er dental work is necessary. it ;11sohas a quality of posthypnotic: anesthesia to ~ducc pain ilftcr* operation. Herr also we have amnesia. \vhich is il qllality desiretl when it is best that the \\‘ith amnesia, the patient, remember nothin g of the a(!lual dental operation.‘. quality of happiness alIt surprise is introducctl as the l)atiellt looks into the mirror to see what actual dental work has hecn completed. some patients will enter a plellary trance. whitAh is it Occasionally, stuporous condition in which a,11spontaneous act,ivity is inhibited.“. I” The plenary trance is not, ik good practical depth to maintain c*otnl)let,e ral)l)ort. It could be compared to that of deep general anesthesia. However. it is not difficult to change from the plenary to the somnambulistic trance 1)~ a few suggestions. As the patient progresses from the relaxed state toward somnan~hulisn~, there is an induction of analgesia whereby minor exploratory work may he started. So also can start the suggestion that there be a reduction in th+ salivary flow into the mouth. The suggestion to the patient that the mouth
PRACTICAI,
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DESTISTRY
Fig.
Fig. tive tran, comfortat Fig. all surroc length of Fig. hension.
l.-Pal ces has ,le, and Z.-A Indings, desired 3.--Par He wil
Fig.
2.
Fig.
3.
th e stag ‘es of t1 in accepting the suggestions while passing through and is .ela xed, the feeling of detachment from environmental surrom Idings in a cooperafive state. ,:oopt !rating leln, ’ ;iew patient in a somnambulistic trance can haI re his eyes hc:sia for stain an open mouth, be free of excessive saliva, ar Id h&v ‘e am oper ation. tient in the desired depth of trance is free from anxiety, fear, pain, . ap llingl y cooperates for operative or surgical procedures.
:ient
430
JOHS
PAlrl,
JAKABAK
will become dry and that the flow of saliva will stop, does ior some unesl)laitlable reason retard the saliva and oftentimes stop it completely:” This f;lc*fot, alone has a practical aspect in that the dental operating fieltl is tlu longc~~~(‘otltaminated or saturated with saliva, and the constant interrul)tions assocGtt~(l with saliva are no longer present, expediting the time of the d(antal opcrntioll. In a similar relationship t.o the stoppage of saliva, thcrr is the ~ontrcll III’ stoppage of bleeding to the area indicated. Act,ual cessatioii (11’hcirlort*h:~~~ 0tI numerous occasions has been accomplished in deep cavity prt~paratioll whrreb~~ the gingivae were damaged in the preparation. Wit,h the stoppage ot’ blre(ling. it is easier to eontinuc cavity preparation and to expedite the ;~cll~~i~~ist~~atio~~ 01 restora,tions. In oral surgical procedures, the reducing of the flow of hemc~ rhage”’ keeps the field more visible and allows for frretlom of 1novement \vherc.by the operator is not constantly int,erfered with by the aspirator!.. Other practical factors which are to he considered with the application of psychosomatic sleep are that there is no interference by the patient with the Subjects are resting in a comfortable continual eruptions of conversation. st,ate while the doctor proceeds uninterrupted with the necessary dental l)rr)cedures (Fig. 4). As he continues uninterrupted. the time filctt)J' allows the operator to do more actual work or to expedite his work quickly, and therefore see more patients. Both factors are to be caonsidered. Also where the operator need not worry of extending proper cavity prcl)arations for fear 01‘ pain during the preparation, or that, of hurt,ing thr patient, during a prepar;~tion which necessitates being scat,etl below the giiigirac. hc WJI \vork JI~OI’V freely. Another very practical factor particularly associated with surgical procedures is that of the posthypnotic suggest,ion, whereby 6he area of operation will be in complete anesthesia and free from pain for the length of t,ime desired. Although, it is not possible to control completely the postoperative cellulitis, it is possible to keep the patient from having any feeling of pain that would normally accompany a surgical procedure. It is interesting to note that while the patient remarks that his face is swollen, he still c~laims no pain. Postoperative dressings may be changed in complete eolllfort in less time for patients who accept the trance. Localized alveolitis may be cdompletcl> made free of pain while healing is taking place. All discomforts may be I+ moved. The time expedited for such procedures far outlimits the same typt) of treatment if local or general chemical anesthetics were requiro(l. As an additional adjunct in maintaining close dental-medical relationship), it is possible to assist the medical officer in expediting traumatic injuries with comfort to the patient. A case history will be cited here to illustrate the A service patient who had been having all his necessary dental point further. work done under hypnoanesthesia. had his foot crushed when a heavy object fell from the overhead upon his foot. He was quickly brought to sick hay-. where anodynes were administered immediately. Before the orthopedic surgeon could estimate what, tramatic damage had been -done to the foot, it was necessary to take a series of x-rays. With the patient in such severe pain and with the immediate swelling of his foot, it was extremely difficult to
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manipulate the foot in such a way as to get adequate radiographs. Being a patient who for dental operations accepted psychosomatic sleep, he was relaxed and in the stage of somnambulism almost instantaneously. In the somnambulistic trance, he was completely relaxed and apprehension was relieved and shock alleviated. He had complete anesthesia of his right foot, whereby it was not only possible to manipulate the broken fragments freely for x-ray, but also to have the broken bones set and the foot placed in a plaster cast. During the entire operation, he was completely at rest with pleasant hallucinations. The total operating time took forty-seven minutes during which time the patient felt no pain or discomfort. This example is just another phase of the practical aspects of psychosomatic sleep as it can be utilized in an emergency. Psychosomatic sleep is not a new thing. It had its periods of ups and downs through the centuries. Literature is full of the various developments of suggestive therapy and hypnosis. Various authorP, 20~21p32,33 ha.ve indicated, by their experience, that the use of psychosomatic sleep in competent trained hands has its place in the fields of medicine. With the recent trend of successful dental operations2p lo, I7926 under the influence of psychosomatic sleep, an increased desire of practitioners to become acquainted with this additional adjunct has shown that the psychic position of the dental patient is being more understood and as so successfully handled. We may ask, “Who then, will be our patients for the successful use of psychosomatic sleep?” To this we can answer, “Every normal person from the age of 3ys to old age can be successful in accepting the trance”lO, Z; either extreme presents a more dif6cult problem for the lack of mental concentration. The best subjects are those of higher I. Q., teachers, students, professional people. 2l 3l 25,31 Thus in the service we are not concerned or limited to the type of normal patients used. Again we ask, “Are there any subjects other than the previously mentioned who may be considered poor patients for psychosomatic sleep?” We can answer, “Yes”; there are those who are psychotic, suffering with various psychoses, and who should be under psychiatric care.8p I8 There are also those who will under no circumstances cooperate toward a successful trance. Time here would only be wasted. “For what length of time should a subject remain in a trance during dental treatment P” Literature has mentioned cases that have remained for days. However, there is no earthly need to keep a dental patient in a trance any longer than is essentially necessary to carry out what dental work is contemplated. Occasionally while a patient is completely relaxed and comfortable, a tendency to do more work than routine has been evidenced. “Are any other surroundings needed other than the average dental operating chair?” Conditions here will vary a lot with the expectant subject. However, some trances have occurred under the most trying surrounding disturbances. Some of the most successful and most rapid trances have been experienced by the author on board ship while riveting was going on in the
432
JOHN
P.11’1.
J.iRhBAK
adjoining ship’s compartment. Jt is, however, recommended that normality be the policy. Prior to the initial trance surgical instruments and dental armamentarium should be retained in the background and direct convcrsatio]I in the same office spaces should be restricted, for quietness in itself is conducive to relaxa.tion and then sleep. Occasionally a patient would like to cooperate but persists with the old notion of mind dominance. This patient ea.11be reassured that he will be awake at all times.“?, ?; ant1 thus, while in the trance, be capable of answering questions and viewing all surroundings and maintaining limited conversation. It, however. has been noted that patients while undergoing dental treatment prefer. through hallucinations, their favorite music, beautiful scenery, or perhaps to rc-enjoy a recent movie they have seen’” (Fig. 5). In the author’s experience of numerous service personnel of different rates and ranks in short establishments and shipboard, psychosomatic sleep has been induced anywhere from thirty seconds at the initial setting to an accumulated time of two hours. However, after the initial trance is accepted and the patient was left, with the posthypnotic suggestion, the average time for sleep was from instaittaneousl” to t,wo minutes. The third and successive trances were practical1.v instantaneous, surpassing the time necessary for any chemical anesthetic. Among the many case histories on file there is almost every conceivable dental treatment known. In oral surgery, upper and lower third molar impact,ions were accomplished with and without supporting procaine for comparison of depth of anesthesia. In a lower third molar impaction, the mouth remained constantly open for thirty-six minutes--hemorrhage and saliva were reduced to where only once was the aspirator required and with no accompanying postoperative pain for seventy-two hours. In periodontia, full mouth gingivectomies were performed. both surgically and ele&onecdle with the insertion of packs and with complete postoperative anesthesia for forty-eight hours. The quaclrant where hemorrhage was rchartled for compnrativc purposes a.ppeared to show evidence of quicker healing. In endodontia, necrotic and newly exposed pulps were removed in complete patient comfort. Bilateral apicocctomies were performed, one during a trance and the other under local anesthet,ic. The latter took longer and, during this time. the patient, exhibited physical signs of uneasiness, perspiration, and postoperative t’atiguc. In operative dentistry, a11 type cavity classifications were prepared and Subgingival hemorrhage was stopped and conciseness and speed in filled. operation prevailed. During many operative procedures, anesthesia just to the tooth being worked on was adapted during a waking trance, with the daily conversation evidenced. In prost,hodontia, upper and lower immediate dentures with surgery, constructions, and insertions were accomplished while the patient remained in Postoperative pain was retarded with no complete relaxation and comfort. soreness for limited periods, twelve, twenty-four, seventy-two hours.
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DENTISTRY
Fvig.
Fig. interrupted Fig. comfortably F’ig. treated by
Fig.
5.
k ‘ig.
(I.
4.-Patient is resting in a workable waking trance while the operator proceeds unwith necessary examination and treatment. S.-During the period of the dental operation the unapprehensive patient is resting and enjoying a beautiful scene with his favorite music. B.-Patient is in a cooperating somnambulistic trance with his eyes open and being another operator in full response to only suggestions of that second operator.
It was also possible to control and stop the gagging rcfles during thtl trance and after the sccontl posthypnotic suggestiou eliminate the gagging Wflex completely, eve’11to the point whrrr t,he length of the mouth mirror did not affect the reflex. It helped trrmentlously in ~~elasing for taking centric. occlusion. On other occasions through posfhyl)notic suggestions, other phases of oral disturbances”, I”, 35 such as glossotlynia, pulatotlpnia, bruxism, traumatic occlusion, denture estheticas, condylan* clicking, an(l mandibular subluxat,ion were relieved or eliminntetl. ,1 noted point. which contributed inlmensurably to the expediting ot dental procedures wr?s that once the patient was in psychosomatic sleep, it was possible to have another operator or technician (L’ig. 6) proceed with t,he operation or prophylaxis while the patient enjoyed relaxed comfort. Definite rules were followed hero wherchy only snpplcnlt~ntn~y suggestions needed for the necessary treatment were used. and the patient was always aroused in the itlentical surroundings in which he was in (luring the incluction period for t,hat. setting. Kow the question arises, “What moral misuse of psychosomatic sleep can he transcended while the patient is in n trance?” The fact that psychosomatic sleep can be misused by unprincipled individuals should not be interpreted as Identical criticism arises from a legitimate objection to its use in dcntist,ry. For principled practitioners of indiscriminate use of chemical anesthetics. dentistry there can be no moral misuse of this therapeutic adjunct. For what other joviality or showmanship it may he utilized removes it from the realm ot’ therapy and as such cannot be considered an adjunct to dental therapeutics. &4 summary of the following ad\-alltages of psychosomatic sleep are to be considered : 1. In trained hands it is without danger or aftereffect. 2. It reduces anxiety, fear, pain, and apprehension in dental patients, permitting better cooperation. 3, Extremely nervous patients can be comfortably treated. 3. It is easy to evoke relaxation, thus enabling patients to feel rested and A feeling of freshness prevails. not fatigued after treatment. 5. No premeditation is necessa.ry and postoperat,ive sedatives need not be administered. 6. Speed of anesthesia enhances for greater production of work. 7. Anesthesia can be localized, maintained, and terminated, leaving no aftereffects as with drug anesthesia. 8. There is no sickness or nausea during the operation. 9. All phases of dental operations can be accomplished. 10. Disturbing factors such as saliva, hemorrhage, and gagging, ran he eliminated. 11. Postoperative pain can be eontrolled by posthypnotic suggestion. 12. Patients will remember and will look forward with pleasure to the next dental appointment..
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435
Conclusion Since the psychic factors of anxiety, fear, pain, and apprehension cannot be entirely controlled by chemical agents and now that there is a recognized therapeutic adjunct available for the use of the dental practitioner, it is for him to take advantage of what psychosomatic dentistry has to offer. Psychic trauma by previous unhappy dental experience, and the mental physical anguish associated with dental treatment, can now be met, understood, and suppressed by proper mental conditioning. The comfort and relaxation associated with psychosomatic sleep in dentistry are conducive to a more relaxing and happier patient-doctor relationship. Not only will essential dental work be completed but, if patients no longer are afraid, preventative procedures can be more easily accomplished. What could be more gratifying to a fearful patient than to awaken from the dental treatment relaxed, fresh, comfortable, and with a happy smile.
References Almonsi, Renato J. : Psychosomaticsin Dentistry, Dent. Med. 98: 103, 1949. 4: Ament, Philip: Relaxation of Excitable Patients With Hypnosis, J. Dent. Med. vol. 3, July, 1948. Philip: Psychotherapy in Patient Relaxation, J. Dent. Med. 5: 3-7, 1950. Ament, Philip: Illuminating Facts of Psychosomatic Dentistry, Northwest Dent. 29: 107-110, 1950. American Psychiatry, New York, 1944, Columbia University Press, p. 39. A. P. Report, Having Faith in Drug Helps Relieve Pain-Science Finds, July, 1950. Bisch, Louis E.: Psychotherapy, INT.J.ORTHODONTIA~~: 547~549,1925. Brady, Raymond S.: Psychosomatic Sleep-An Aid to Pain Control, D. Survey 27: 487-491, 1951. Brenman! ‘M., and McGill, M.: Hypnotherapy, Psychosom. Med. vol. 8, no. 2, March,
3. Ament, 4. 5. 6. x’: 9.
April, 1946.
10. Burgess, Thomas 0.: Hypnodontia-Hypnosis as Applied to Dentistry, Cal Magazine, Februarv. March. Anril. 1951. 11. Clarke, George A.: Da&s Study Club, Boston, Mass., personal communication. John W.: Hypnotic Therapeutics and Modern Dentistry, Dental Cosmos, vol. 12. Dorland, 63, August, 1949. 13. Editor’s page, Dental Digest, vol. 49, March, 1943. 14. Ewen, S. J.: Psychosomatic Aspects of Oral Medicine, J. Dent. Med., pp. 117-120, October, 1949. Hawkes, L. A.: Hypnotism as an Anesthetic, Oral Hygiene 19: 1948, 1929. ii: Hensie and Shatzky: Psychiatric Dictionary, New York, 1940, Oxford University Press. Heron, W. T.: Hypnosis and Dentistry, Northwest Dent., vol. 28, no. 3, p. 2, July, 1949. 1’:: Heron, W. T.: Clinical Applications of Suggestions and Hypnosis, Springfield, Ill., 1950, Charles C Thomas, Publisher, pp. 8-20. Hollander, Bernard: Hypnosis and Anesthesia, D. Surgeon 24: 234-244, 1932. Hypnotism Today, New York, 1947, Grune and 2: LeCron, L. M., and Bordeau, J.: Stratton, Inc. Unconsciousness, New York, John Wiley and Sons, Inc.; London, James Crier: 21. Miller, Chaoman and Hall. Ltd. Waking Hypnotic Suggestions, D. Survey, vol. 25, June, 1949. 22. Moss, Aaron A.: Neurof. Irving: Patients Attitude, Dental Cosmos, vol. 67. Anril. 1925. M.: Suggestive Therapy and the’ Nervous Patient, ORAL SURG., ORAL 22:: Owen, ‘Melvin MED. AND ORAL PATH.~: 298,1949. Psychosomatic Sleep in Dentistry (A Society of Psychosomatic Dentistry: 25. American Preliminary Report), Northwest Dent. 28: 94-98, 1949. Suggestion as an Aid to Anesthesia, Anesthesiology Bernard B. : Mental 26. Raginsky, 9: 472-480, 1948. Aspects of General Anesthesia, AnesthesiBernard B. : Some Psychosomatic 27. Raginsky, ology, 11: 391.408, 1950.
2X. Robertson, \V.: Suggestive Therapeutics, J. I)ent. Assoc. South Africa 3: .ill-.Tli, l!Nil. 29. Staples, Lawrence M.: 1)avia Study Club, Boston, NRYS., personal c’omltllnli~atioll. 30. Stien, M. R.: Anesthesia by Mental IXsassociation, Dental Items .Lnterest 52: 941-91Tl 1930. 31. Staw, lrwin 8.: Treatment for Relaxation, Tic, E’cl,~mr~-, 1949. 32. Weiss, Edoardo: Principles of Psychodyxunics, Sew York, Grune hr StrnttoIl, Inc. Kew 170rk. Grnne & Stratton, Inc. 33. Wolberg, Lewis R.: Hypnoanalysis, 34. Your Health, Parade Magazine. Oct. 23. 1950. 35. Ziskin, D. Et, and Moulton, R:: Glossbdpnia: A St,udy of Idiopathic Orolingual Pain, J. Am. Dent. A. 33: 1422, 1946. 36. Zulauf, A. Frank: Suggestion as a Factor of Success in the Practice of Dentistry, I)ental Items Interest 45: 841-858, 1923.