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THE IMPORTANCE OF PSYCHOTHERAPY IN DENTAL PRACTICE AND ITS
EFFECTIVENESS ASSESSMENT OF DENTAL STATUS IN PATIENTS WITH
SCHIZOPHRENIA
1
Sultanov Shoxrux Xabibullayevich
2
Turayev Bobir Temirpulotovich
XIDIROV
3
Qodirbek Atamurod o‘g‘li
3
Xoljigitov Shohruh Bahodir o‘g‘li
1
Doctor of Science, SciencesDepartment of Therapeutic direction No.3, Tashkent State Dental
Institute, Tashkent, Uzbekistan
2
Assistant of the department of psychiatry, medical psychology and narcology, Samarkand State
Medical University, Samarkand, Republic of Uzbekistan
3
Student of group 409 of the dentistry faculty of Samarkand State Medical University,
Samarkand, Republic of Uzbekistan
https://doi.org/10.5281/zenodo.14647821
Abstract. In modern health care, the effective activities of providing medical care to
patients and preventive care to the healthy are properly associated with strategies of a
biopsychosocial approach, in which both the healthy and the patient are considered in the entire
complex of their biological, psychological and social manifestations and developmental
determinants. The innovative strategies we propose are also based on this approach, which aims
to maintain the health of the population of the country and each of its inhabitants.
Key words: dentistry, psychotherapy, medical care, preventive care, biopsychosocial
approach.
Introduction.
The biopsychosocial concept in dental practice directs the specialist to take
into account the psychological characteristics of the patient, as well as to introduce certain
psychotherapeutic methods into the arsenal of professional tools that have a therapeutic effect on
the patient. In fact, very often for the patient, acute toothache that suddenly appears at the most
inappropriate moment, the need to consult a dentist, the collapse of plans for the coming days,
meeting lines, bite prices, inevitable painful manipulations in the oral cavity, a long-term severe
discomfort in a wide-mouth chair, restriction of freedom of movement, blood type, the noise of
drilling machines This condition is often classified as dentophobia[1-3].
Unusual sensations of loss of sensitivity of the tongue and lips, psychotropic sedative effect
of anesthesia, swallowing disorders, impossibility of speech contact with the dentist, lack of
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information about what is happening and the future contributes to the emergence of derealization
and depersonalization. For many patients, these biological and psychological components of dental
disease are stress and are accompanied by mental disorders corresponding to the heading F43.0 on
ICD‐10 – an acute reaction to stress. Usually, in dental interventions it is mild, but all its structural
elements are identified: anxiety, fear, confusion, derealization, depersonalization, narrowing of
consciousness through the test that is taking place, muscle tension, inactivity, restriction of
freedom, unrepresentative emotional dissatisfaction, the need to sharpen the mechanisms of
control and restriction of emotions and actions, etc. [4-7]. During dental treatment, the patient's
behavior largely depends on his mental state. Due to intense fear (phobia), many patients leave
their dentist referral to the last level when pathophysiological and mental manifestations develop
to the maximum and the chances of effective treatment are reduced [8]. Researchers say predictors
of avoiding dental visits include smoking and brushing frequency, coping strategies, treating a
dental visit as an uncontrolled and unpredictable act, insomnia anxiety, lack of information about
what the dentist is going to do, and the cost of payment [9]. Depressive disorders also help reduce
motivation to treat and develop dental diseases [10].
The high prevalence and importance of stressful, phobic, anxious, depressive disorders, as
well as the possibility of hysterics, hypochondria, delusional and other mental disorders in dental
patients, requires certain training of dentists in psychiatry and psychotherapy [11-13]. Currently,
psychotherapy is becoming more and more common in dental practice [14], including patients who
have serious psychological problems in the appointment of a dentist can also [15].
Psychotherapy is often used in the complex treatment system of patients with various dental
diseases: Orofacial Pain [16], myofascial temporomandibular disorder [17], general periodontitis
[18], including when working with children [19].
This work provides recommendations for psychotherapeutic support of dental care, which
are described in the literature and summarize the clinical experience based on their practical
activities. The dentist does not have the time and special skills to undergo differentiated, qualified
psychotherapy, so we only define and explain methods that are organically combined with
manipulation and do not require time and special specialization for psychotherapy [20-24].
The acute stress relief algorithm is implemented in two directions. The first is the
elimination of real and perceived trauma, threat, danger. To do this, it is necessary to remove pain,
inflammation, bleeding, etc.if emotional manifestations are expressed very strongly – fear, anxiety,
tension, confusion, they should be stopped with tranquilizers-mebikar, phenazepam, grandaxin,
phenibut. Special studies have shown that under the influence of mebicar, not only the limit of
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pain sensitivity of hard dental tissues increases, but also the limit of pain resistance [25-27]. In
patients, the fear of tooth manipulation decreases, tolerance to painful procedures improves. That
is, there are scientifically based recommendations for taking mebikar 0,3‐0,6 g or its counterpart
adaptol 0,5 g before visiting the dentist.it relieves stress, fear, anxiety and pain, improves patient
adaptation and behavior during treatment.
Hypnosis techniques can be used to relieve fear and anxiety and overcome the Gag reflex
[28], cognitive behavioral therapy [29], music therapy [30], relaxation [33], which significantly
reduces the doses of pharmacological agents used for analgesia or sedation [31].
The second area of stress relief is to eliminate the lack of information about what is
happening and about disruptions in experiences and behaviors. This is achieved as a result of
explaining the causes of the disease, methods of its treatment and Prevention, life-saving and
guarantees of social adaptation. The patient must restore psychological, social and behavioral
structures that are suddenly disturbed by the disease. Give understandable, acceptable and
executable recommendations for treatment and encourage them to follow, i.e.conduct a
motivational interview [32-35]. The literature describes a somewhat unusual direction of
psychotherapeutic influence in dental practice-resorting to suggestive effects to reduce salivation
in the patient during treatment [36].
The practical implementation of these principles begins with the establishment of
psychotherapeutic contact with the patient, the use of psychological techniques for joining him. At
first glance at the patient entering the office, the dentist understands his feelings, desires and hopes.
It is necessary to show this understanding and partnership and willingness to help. A friendly look,
a greeting, an invitation to a chair, asking a few questions to clarify the task. You need to accept
the role of a kind, empathetic, strong, calm, literate, experienced, reliable doctor. To do this, name
the symptoms that the patient has not yet named, show interest in him and show his
professionalism. Maintain calm, confidence and optimism in intonations, poses, gestures [37-42].
Since the patient suffers more from his ideas about the disease, it is necessary to carry out
a rational‐psychotherapeutic correction of the "inner picture of the disease". Speak, explain,
eliminate the lack of information to create adequate, optimistic structures from the patient's
motives for dismantling and restoring subjective, frightening psychological structures about the
disease, returning to normal life and their implementation [43-45].
To exclude unexpected traumatic and frightening effects for the patient, you need to be
maximally careful. Let him know when he will hurt and how quickly this feeling will pass. The
doctor is advised to explain all your logical and physical actions to the patient.
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For this, it is in great demand. In addition, with his mouth open, he himself does not ask
for anything and cannot say. He must understand everything and be a partner, partner of the
therapeutic process responsible for its outcome. It distracts from the disease, keeps thinking busy
and creates a positive attitude [46-49].
Informational and emotional psychotherapeutic support of the patient is carried out taking
into account the mental and somatic state, age, temperament, personal qualities, behavioral
characteristics, mood. Most people who are in a state of acute stress remain "stupid", do not
understand the instructions well, do them incorrectly, do not remember anything. The doctor
should be prepared for this. Repeat the instructions and recommendations several times and write
them down. A stressed patient can forget, mix, do everything in his own way, out of fear and under
the influence of anesthetics [50-52].
Conclusion.
After completing the reception, you need to draw conclusions. Explain what
tasks the patient came with, what therapeutic manipulations the doctor performed, how the patient
should behave. When to spit out a tampon, how long not to eat and drink, how to wash the oral
cavity, what toothpaste and brush to use, what medications to take, when to come to a control
meeting, work schedule, phones. It is difficult for the patient to concentrate, understand and
remember even the simplest recommendations. Therefore, they must be written down in advance
or prepared a note, and put into the hands of the patient as a material guarantee of his safety. Most
importantly, a stressed person needs information about a topic relevant to him.
In conclusion, we note that these issues should be included in the curriculum for students
and dentists. International experience shows that role-playing games can be used to train dental
students in the pre-clinical phase. On the other hand, an increase in the psychological literacy and
psychotherapeutic competence of a doctor is positively associated with his health, well-being,
originality.
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