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Kosenko K.N, Duryagina L.H.

Chair of Therapeutic Dentistry

SI “Crimea State Medical University named after S. I. Georgievsky”

Etiopathogenetical principals of clinical manifestations studying of the mouth cavity psychogenic diseases

The problem of psychogenic disorders is one of the most actual for modern practical and theoretical medicine. Psychogenic anxious, phobic, obsessive and somatoform disorders range to the most widely spread mental pathologies. According to the data from WHO to the beginning of XXI century the percentage of depressive and anxious disorders is about 40% of all the registered mental pathologies all over the world. In the same time 65% of those patients who get medical treatment have depressive symptoms.

We should notice that anxious disorders are more widely spread than mental impairments themselves. Social phobias have frequency not less than 3%, somatoform disorders – up to 4%, obsessive-compulsive – more than 5%. Not less than 10% of Earth population had panic disorders at least once in their life.

It should be assumed that the number of depressive patients who didn’t seek medical attention is much more than the number of registered patients. The affective disorders of these patients are the frequent reason for seeking of medical attention at the interns, including dentists.

In few last decades significant increase of psychosomatic morbidity took place in Ukraine. Only according to the data of official medical statistics from 1973 to 2000 years the number of registered somatoform disorders increased from 2,275 to 3,8% of all the population. Unrecognized psychogenic pathologies lead to incorrect symptomatic therapy which is usually ineffective. Such ineffective therapy of psychogenic disorders leads to their chronicity and the appearance of complications.

The target of our investigation is the studying of etiology, pathogenesis and clinical manifestations of mouth cavity psychosomatic diseases.

For the investigation we selected 282 persons, 115 of them were the patients of psychoneurological dispensaries and 167 were the patients of dental cares. The average age of patients was within 24-47 years, average duration of the disease was about 2,6 years.

Somatic manifestations of neurosis-like and phobic symptomatic had more expressed character and were manifested predominantly with changes of physiological reactions of heart, skin and respiratory system. Increase of sympatic nervous system tonus was marked, it was clinically manifested with corectasia, xerostomia, tachycardia and cold sweating. Most of the patients were inclined to increased impatience, tearfulness and syncope.

188 patients (66%) had neurosis and 179 (65%) patients had psycho-traumatic situations in anamnesis. Feeling of anxiety and stress before dental examination was present in 251 patients (89%), sharp increase of arterial blood pressure was marked in 46 patients (16,3%), impairment of cardiac rhythm was in 16 patients (5,67%). 89% of patients had changes of the most objective sympathoadrenal indexes. The most widely spread pathology in examined patients is the multiple caries fond in 176 (62,4%) patients. Paradentium diseases were found in 58 (20,5%) examined patients. The diseases of mouth’s mucous membrane were found in 84 patients (12,7%), among them soft leukoplasia in 39 patients (29,7%) and lichen acuminatus in 43 (15,2%) patients. It should be noticed that this dental pathology had erased clinical picture without significant complications pointing on this diseases.

The analyze of factors leading to oral cavity psychogenic diseases showed that the most widely spread socioeconomic factor was the factor of uncertainty about the future (70,5%), which was accompanied with the fear of socioeconomic condition’s deterioration in future. Factors of housing conditions’ and social status deterioration are met rare (22,5% and 38%). Unemployment (12,4%), conflicts with chiefs (9,6%) and change-over (7,4%) are the rarest psychogenic distresses.

The comparison of psychogenic factors leading to the development of mouth cavity psychogenic diseases said that main reasons of this pathology in males were mostly socioeconomic factors (uncertainty about the future and he fear of socioeconomic condition’s deterioration) and factors connected with their own diseases. However factors connected with family conflicts and diseases of kindred were met in examined males less than in females.

Preliminary results of the investigation say about the presence of correlative dependence between the expression degrees, features of the dental pathology course and psycho-traumatic factors. Interconnection in pathogenesis links of mouth cavity psychogenic diseases are estimated.

The received data will help to develop the system of dental diseases combined treatment in patients with depressive disorders, acting on the pathogenesis links of tooth hard tissues, paradentium and mucous membrane diseases development and to increase treatment and prophylactics efficiency in patients with psychogenic disorders. During the dental care of such patients we should remember about their generativity, inclination to doubts, fears, apprehensions and indecision. Also it’s necessary to explain such patients about the nature of their disease and to assure them in the benign outcome of the dental therapy.