Sir, the high transmissibility of the coronavirus and other contributing factors may cause psychological problems, including anxiety, depression, and stress. Patients who experience dental problems, especially such as acute pulpitis, oral haemorrhage, dental and maxillofacial trauma during the pandemic may also suffer tremendous psychosomatic problems.
Furthermore, isolation at home for a long period of time, suspension of dental services and high risk of dental treatment due to aerosolised respiratory secretions and close doctor-patient contact may exacerbate existing mental conditions and produce new oral psychosomatic disorders such as temporomandibular disorders (TMD), burning mouth syndrome (BMS), dental anxiety and other oral complaints.
Online psychological counselling services have been widely established in mainland China which provide free cognitive behavioural therapy (CBT) for depression, anxiety and insomnia for dental patients who suffer from psychosomatic problems. CBT has been proven effective for the treatment of psychiatric disorders, and has begun to be applied for psychosomatic problems in the dental patients. The prevalence of TMD in a community sample was almost 17.5% and the incidence even higher during the worldwide epidemic. Studies reported that CBT was more effective than no treatment.1 Although CBTs were mainly conducted by psychologists, those conducted by trained dental hygienists were also found to be effective in reducing TMD pain and pain-related interference.
BMS is characterised by a burning sensation of the oral mucosa, with a prevalence of 3.7-.9% and is frequently associated with stressful life events, anxiety, and depressive disorders.2 Various methods including psychological and pharmacological approaches have been applied for BMS with either long sessions of CBT or short duration of treatment improving the pain severity and discomfort of patients. Approximately 10-12% of the adult population suffer from dental anxiety.3
A significant reduction in subjective anxiety was achieved by patients with CBT when compared to those who received no treatment or anaesthesia/sedation. This study suggests more attention needs to be paid to patients with psychosomatic problems caused by acute dental pain and other urgent conditions; accessibility to online consulting service systems should be further strengthened and improved, particularly for confirmed cases who are in self-quarantine.
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Honda M, Iida T, Kamiyama H et al. Mechanical sensitivity and psychological factors in patients with burning mouth syndrome. Clin Oral Investig 2019; 23: 757-762.
Gordon D, Heimberg R G, Tellez M et al. A critical review of approaches to the treatment of dental anxiety in adults. J Anxiety Disord 2013; 27: 365-378.
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Mijiti, A., Huojia, M. Psychosomatic problems . Br Dent J 228, 738 (2020). https://doi.org/10.1038/s41415-020-1688-2