MAXILLOFACIAL PROSTHETICS TEMPOROMANDIBULAR JOINT DENTAL IMPLANTS I. KENNETH
ADISMAN,
Psychological 1. W. Bailey,
Naval
Hospital
Section editor
considerations Ph.D.,
and
Darrel
and Naval Health
in
Edwards,
maxillofacial
prosthetics
Ph.D.
Research Center, San Diego, Calif.
1 mportant
psychological factors are involved when disease, injury, or treatment causes significant maxillofacial changes. The pioneering clinical research of MacGregor’ focused upon the psychosocial phenomena of the role of self-concept, the patients’ sensitivity to bodily impairment, responses of others to the disorder, and the ways in which maxillofacial problems influence social interactions. Some recent research investigated the effects of maxillofacial disorders and prosthetics upon the “quality of life” of patients (e.g., employment status, amount of social interaction, and health habits) .2, 3 The theoretical and empirical work of these various writers is instructive in specifying the variables with which the dentist must be concerned. However, there is no general framework which would integrate the sundry facets of psychological knowledge which are most applicable to patients involved in maxillofacial prosthetics. The purpose of this article is to present material from psychological theory and research that has implications for working with the maxillofacial patient. Consideration is given to the general importance of the sensory organs and body parts in the living experience, with particular attention given to the role of facial structures and their function. Problems which may occur in response to changes of the maxillofacial region are discussed. Such problems have implications for the dentist in terms of his treatment of each patient. Serious consideration of the psychological aspects of maxillofacial prosthetics will result in an increased understanding of the patient’s situation and in the effective implementation of the treatment plan. THE
ROLE
OF
THE
BODY
The physical structure of the body provides various tools which may be used to gain information from the world or provide information to the world. Information frotn the environment is perceived through sight, sound, touch, smell, and Presented Diego, Calif.
at the Conference
on Prosthetic
Dentistry,
Naval
Regional
Medical
Center,
San 533
534
Bailey
J. Prosthet. Novembel
and Edwards
Dent. , 1975
taste. In turn, the environment is affected by the use of the tonLgue, hands, or other body parts. Clearly, it is essentially impossible to separate human experience from the important role of these various physical tools. The sum of one’s experiences results in a sense of body inzagc which involves The significance of body image is rea wide range of attitudes and perceptions. flected by the fact that it is highly correlated with one’s general self-concept.4 Recause body image is so closely related to sense of adequacy and competence. Allport’ describes this variable as “the lifelong anchor for self-awareness.” As a function of one’s dependency upon these tools and the significant role of body image, strong emotions are affixed to the body parts. To the extent that a particular part of the body aids in receiving or expressing information, the person loves and needs that organ, Alteration, impairment, or loss of that part involves emotional turmoil. A strong sense of despair and depression typically accompanies the impairment or loss of a body part. OROFACIAL
MODES
AND
MEANINGS
The rnaxillofacial region is of crucial importance during one’s early development. It is involved in all interpersonal relationships and relates to some of our deepest needs. During the earliest stage of development, the most salient portion of the infant’s existence is oral. It is through the mouth that the infant receives life-maintaining substances. Mother and child invest a great deal of time and emotional involvement in satisfying the most basic needs of the child through the mouth. A child’s happiness and contentment are typically conveyed with a “coo,” whereas anger or frustration is likely to be expressed with biting or crying. Furthermore, infants and toddlers typically prefer a “mouth-check” of reality over the use of visual and tactile modes. Thus, novel stimuli are quickly assessed in terms of the potential for tasting, teething, or swallowing. It is because of the role of the mouth in earliest development that Freud and subsequent analysts ternred the first year of life the “oral stage.“” They have given much attention to the dependency of infants and their earliest expressions of “self” as they relate to basic personality style and development. Most important is the pivotal role of the maxillofacial region during this earliest stage of development: having one’s needs met: experiencing one’s earliest pleasures in relationship to oral sensations. It is with the mouth that “self” is first revealed to the environment. The crucial role of maxillofacial features in daily interpersonal relationships is readily appreciated. _2 high value is placed upon personal attractiveness in most societies, and most people are sensitive to the type of impact that they have upon meeting others. The cosmetic industries experience staggering profits from the concern most people have for the beauty of the maxillofacial region. Just as during the early stages of life, the maxillofacial region continues to be one of the primary modes of self-expression. It is difficult to imagine a person communicating delight or sadness or hope or anger without the use of maxillofacial tools. AS bonds of friendship develop, people tend to share in activities which are highly oral. For example, an invitation to friendship often involves sharing of a meal or a treat, as well as increased oral communication (e.g., discussions, “rapping”) . As relationships become even more intimate, consideration must be given to the sensual
Volumr Number
34 5
Psychology
and maxillofacial
prosthetics
535
component of the mouth, lips, and tongue. Thus, the maxillofacial region is important from the most superficial of interpersonal contacts to the most intimate of relationships. Because of the role of maxillofacial phenomena (features) in both early development and interpersonal relationships, these features are often thought to take on psychological meanings which undergird and shape personality structure and style.7-9 A personality style that is characterized by passivity and dependence on others is typically labeled the “oral-receptive” personality; whereas the hostile, selfish, verbally abusive person might be seen as “oral-aggressive.” Thus, BingeP concludes that the mouth is directly or symbolically related to major human instincts and passions : self-preservation, cognition, love and sexual mating, hate, and desire to kill.
SOME PROBLEMS IN MAXILLOFACIAL
CHANGES
In light of the role of the maxillofacial region in early development and continued normal functioning, and because of the meanings and emotions which may be involved, changes in facial features are likely to be accompanied by various types of difficulties. Some of the typical problems which are encountered are considered under seven broad categories. importance of loss. Through the disease process or traumatic experience, typical maxillofacial patients experience significant losses of body parts or tools which have had important roles in their life experience. In a very real sense, the patient has lost part of his self or being. Students of psychosomatic medicine are continually impressed with real or symbolic loss as a precipitating factor in a variety of psychiatric disorders, particularly those in which there is a component of depressi0n.l” To the extent that the deteriorating or lost body part has psychological meaning, the 10s~ factor and the accompanying depressive features are compounded. A new impact. Alterations in the maxillofacial region usually involve some changes in the person’s sense of attractiveness. There is the problem of uncertainty about how prosthetic treatment might affect the facial region, which is so intricately involved in first impressions. The impact changes not only relate to the way others view the person initially, but also involve alterations in modes of expressive behavior. The patient may have a crooked smile or a different tongue thrust when speaking. Concern about one’s new impact upon others would be expected to result in selfconsciousness and perhaps reduced social interaction.“, 4 New sensory experiences. The body is a processor of complex data from the environment. Alterations in the structure or function of the unit have an effect upon the acceptance and handling of input. The significance of new sensory experiences is readily understood when a patient is confronted with visual changes, yet there may be a failure to appreciate the extent to which sensory experiences are disrupted by other maxillofacial problems. There may be substantial changes in one or more The patient of the sensory modalities (e.g., taste, touch, and thermal sensitivity). may have very different and unique perceptions of his world. Unrealistic expectations. Since the maxillofacial region is implicated in so many interpersonal relationships, the problem of expectations complicates acceptance of every prosthesis.4 A patient may be somewhat socially inept and may perceive
536
Bailey
and Edwards
.I. Prosthet. Dent. November, 1975
correction as a promise for interpersonal effectiveness and a life without woes. On the other hand, some patients may exhibit unrealistically negative attitudes toward maxillofacial prostheses. Such patients may be able to focus only upon the potential disadvantagex in the treatment. Acc,eptance. .\nother aspect of change relates to the readiness with which the patient can accept the corrective procedures and incorporate them into his personality. During the process of treatment. the patient is asked to accept a foreign device as part of his body. There are vast differences among patients in ability to accept the prosthesis as a part of personal experience. Social status. Some recent work”, :l has demonstrated the decisive social effects of maxillofacial impairment and correction. Among the more than 100 patients in the study, substantial changes were observed in employment patterns, with associated downward fluctuations in economic status. Also, a significant reduction was found in the following activities of most patients during the time of impairment and treatment: entertaining in the home, going out regularly, meeting the public daily, and eating in the presence of others. Although there was some recovery of social most patients did not return to involvement subsequent to prosthetic treatment, premorbid levels of functioning. Perplexing paradox. The final problem involves phenomena cvhich are somewhat puzzling. Researchers and clinicians have repeatedly found that there is not a simple. positive relationship between actual severity of disfigurement and the degree of psychological distress experienced by the patient.“, ‘. 5 Patients with slightly disfigured maxillofacial regions often become more anxious or depressed than patients with a more marked impairment. MacGregor’ noted that, in general, the severely disfigured patient complains less bitterly than the mildly impaired person. More recent research with cancer patients reveals the lack of correlation between degree of visible disfigurement and the extent of social/vocational readjustment.” The patient’s self-perceptions, emotional stability, personality characteristics, and social circumstances appear to be the salient factors in dealing with maxillofacial disorders and the rehabilitation process. PRACTICAL
APPLICATION
TO the extent that the dentist gains an appreciation for the numerous psychological aspects of maxillofacial prosthetics. he will be increasingly effective in responding to the needs and potential problems of the patient. There are several specific treatment procedures which will facilitate the processes involved in therapy and rehabilitation. Evidence from both clinical experience and research attests to the importance of the doctor-patient relationship in prosthetic health services.f, I’ Rapport which is based upon mutual respect, honesty, and confidence must be established. Such rapport is developed when the doctor relates to the patient in a factual, supportive manner. Features of the treatment procedures which may be problematic should be discussed openly, with promises relating to prognosis held to a minimum. Realistic and clear communication concerning the prognosis of maxillofacial prosthetic therapy must occur in the context of a strong doctor-patient relationship. An understanding of patient dynamics is helpful in establishing clear communication.
Volume 34 Numbrr5
Psychology
and maxillofacial
prosthetics
537
As a function of the doctor-patient relationship, the doctor becomes more aware of the patient’s perspective of the problem. The doctor begins to learn the various meanings the patient has attached to his problem and to the treatment. The doctor is sensitive to the socioeconomic changes which the patient may undergo (e.g., increased dependency and reduced income), and he gains an appreciation of the patient’s feelings about himself (e.g., his sense of inner worth and his confidence in coping with changes). The doctor must be receptive and accepting of the patient so that the patient will feel comfortable in sharing his fears and conflicts. As the patient verbalizes his expectations, the doctor will sometimes find it necessary to help the patient clearify his anticipations and develop expectations which are realistic. During the entire diagnosis-treatment-rehabilitation sequence, special attention needs to be given to the emotional status of the patient. Of particular relevance are signs of depression, such as loss of appetite, dejection, withdrawal, and irritability. Rozen and associates” indicate that depression is the major impediment to the rehabilitation process. The role of emotional factors is readily appreciated in light of the sundry modes and meanings of the maxillofacial region and when considering the potential problems involved in changes of this part of the body. Finally, the doctor may be able to estimate the psychological progress of a particular patient by a comparison with the profile of the “successful patient” offered by MacGreg0r.l He found that progress by maxillofacial patients was accompanied by alterations on several dimensions: increased spontaneity, more social activity, improved self-esteem, greater confidence, reduced self-consciousness, and increased level of energy. To the extent that these attributes are not evident during the latter stages of treatment, one might suspect that psychologically based problems may be interfering with therapeutic progress. SUMMARY An attempt has been made to integrate information from psychological principles and clinical research which is relevant to maxillofacial prosthetics. Attention was given to the role of body parts in the human experience, with particular consideration of facial aspects. The importance of the maxillofacial region in early development, and day-to-day interpersonal relationships was reviewed personality dynamics, together with several specific problems which often accompany maxillofacial changes in structure or function. The dentist must be concerned with the patient’s expectations, personality characteristics, and ability to accept and integrate the prosthesis. Several implications for and utilization of clinical practice were presented. The dentist’s understanding psychological considerations should result in increased effectiveness in treatment and rehabilitation of maxillofacial patients. References 1. MacGregor, F. C.: Some Psycho-Social Problems Associated With Facial Deformities, Am. Social. Rev. 16: 629-638, 1951. 2. Rozen, R., Ordway, D. E., Curtis, T. A., and Cantor, R.: Psychosocial Aspects of Maxillofacial Rehabilitation. Part I. The Effect of Primary Cancer Treatment, J. PROSTHET. DENT. 28: 423-428, 1972. 3. Sykes, B. E., Curtis, T. A., and Cantor, R.: Psychosocial Aspects of Maxillofacial Re-
538
Bailey
and
J. Prosthet. Dent. No”ember. 197.5
kdwnrd.s
habilitation. Part II. .4 Long-Range Evaluation, J. PKOSTHBT. DEKT. 28: 540-545, 19i2. 4. Jourard, S. M., and Remy, R. M.: Perceived Parental Attitudes, the Self, and Security. J, Consult. Clin. Psycho]. 19: 364-366, 1955. 5. Allport, G. W.: Becoming: Basic Considerations for Becoming a Person, New Haven, Corm., 195j, Yale University Press. 6. Fenichel, 0.: The Psychoanalytic Theory of Neurosis, New York, 1945, W. W. Norton & Company, Inc. 7. Binger, C.: Personality and Oral Disease, Ann. Dent. 4: 173-l 82, 1946. 8. Weiss, E., and English, 0. S.: Psychosomatic Medicine, Philadelphia, 1957, W. B. Saunders Company, pp. 495-5 14. 9. Melvin, J. L., and Nagi, S. Z.: Factors in Behavioral Responses to Impairments, Arch. Phys. Med. Rehab. 51: 552-557, 1970. in Arieti, S.: American Hand10. Lidz, T.: General Concepts of Psychosomatic Medicine, book of Psychiatry, New York, 1969, Basic Books, Inc. DR. BAILEY UNITED STATES NAVAL HOSPITAL SAN DIEGO, CALIF. 92132 REPRINT REQUESTS TO : DR. EDWARDS NAVAL HEALTH RESEARCH CENTER SAN DIEGO, CALIF . 9”153 L -
ARTICLES TO APPEAR IN FUTURE ISSUES A method of measuring complete dentures
pressures
Charles C. Kelsey, B&E., MS.
D.D.S.,
American
of Prosthodontics
William
Board
MS.,
Fredrick
D. Reid,
tissues
supporting
B.S., MS.,
functioning
and Joel A. Coplowitz,
R. Laney, D.M.D.
Effects of artificial crown on gingival pocket depth Dominick
C. Larato,
A histologic Alfred
against
D.D.S.,
assessment
Schuchard,
D.D:S.
margin
extension
und tooth
brushing
frequency
cutting
-technique
M.S.D.
of low-torque,
ultrahigh-speed
ADISMAN,
Psychological 1. W. Bailey,
Naval
Hospital
Section editor
considerations Ph.D.,
and
Darrel
and Naval Health
in
Edwards,
maxillofacial
prosthetics
Ph.D.
Research Center, San Diego, Calif.
1 mportant
psychological factors are involved when disease, injury, or treatment causes significant maxillofacial changes. The pioneering clinical research of MacGregor’ focused upon the psychosocial phenomena of the role of self-concept, the patients’ sensitivity to bodily impairment, responses of others to the disorder, and the ways in which maxillofacial problems influence social interactions. Some recent research investigated the effects of maxillofacial disorders and prosthetics upon the “quality of life” of patients (e.g., employment status, amount of social interaction, and health habits) .2, 3 The theoretical and empirical work of these various writers is instructive in specifying the variables with which the dentist must be concerned. However, there is no general framework which would integrate the sundry facets of psychological knowledge which are most applicable to patients involved in maxillofacial prosthetics. The purpose of this article is to present material from psychological theory and research that has implications for working with the maxillofacial patient. Consideration is given to the general importance of the sensory organs and body parts in the living experience, with particular attention given to the role of facial structures and their function. Problems which may occur in response to changes of the maxillofacial region are discussed. Such problems have implications for the dentist in terms of his treatment of each patient. Serious consideration of the psychological aspects of maxillofacial prosthetics will result in an increased understanding of the patient’s situation and in the effective implementation of the treatment plan. THE
ROLE
OF
THE
BODY
The physical structure of the body provides various tools which may be used to gain information from the world or provide information to the world. Information frotn the environment is perceived through sight, sound, touch, smell, and Presented Diego, Calif.
at the Conference
on Prosthetic
Dentistry,
Naval
Regional
Medical
Center,
San 533
534
Bailey
J. Prosthet. Novembel
and Edwards
Dent. , 1975
taste. In turn, the environment is affected by the use of the tonLgue, hands, or other body parts. Clearly, it is essentially impossible to separate human experience from the important role of these various physical tools. The sum of one’s experiences results in a sense of body inzagc which involves The significance of body image is rea wide range of attitudes and perceptions. flected by the fact that it is highly correlated with one’s general self-concept.4 Recause body image is so closely related to sense of adequacy and competence. Allport’ describes this variable as “the lifelong anchor for self-awareness.” As a function of one’s dependency upon these tools and the significant role of body image, strong emotions are affixed to the body parts. To the extent that a particular part of the body aids in receiving or expressing information, the person loves and needs that organ, Alteration, impairment, or loss of that part involves emotional turmoil. A strong sense of despair and depression typically accompanies the impairment or loss of a body part. OROFACIAL
MODES
AND
MEANINGS
The rnaxillofacial region is of crucial importance during one’s early development. It is involved in all interpersonal relationships and relates to some of our deepest needs. During the earliest stage of development, the most salient portion of the infant’s existence is oral. It is through the mouth that the infant receives life-maintaining substances. Mother and child invest a great deal of time and emotional involvement in satisfying the most basic needs of the child through the mouth. A child’s happiness and contentment are typically conveyed with a “coo,” whereas anger or frustration is likely to be expressed with biting or crying. Furthermore, infants and toddlers typically prefer a “mouth-check” of reality over the use of visual and tactile modes. Thus, novel stimuli are quickly assessed in terms of the potential for tasting, teething, or swallowing. It is because of the role of the mouth in earliest development that Freud and subsequent analysts ternred the first year of life the “oral stage.“” They have given much attention to the dependency of infants and their earliest expressions of “self” as they relate to basic personality style and development. Most important is the pivotal role of the maxillofacial region during this earliest stage of development: having one’s needs met: experiencing one’s earliest pleasures in relationship to oral sensations. It is with the mouth that “self” is first revealed to the environment. The crucial role of maxillofacial features in daily interpersonal relationships is readily appreciated. _2 high value is placed upon personal attractiveness in most societies, and most people are sensitive to the type of impact that they have upon meeting others. The cosmetic industries experience staggering profits from the concern most people have for the beauty of the maxillofacial region. Just as during the early stages of life, the maxillofacial region continues to be one of the primary modes of self-expression. It is difficult to imagine a person communicating delight or sadness or hope or anger without the use of maxillofacial tools. AS bonds of friendship develop, people tend to share in activities which are highly oral. For example, an invitation to friendship often involves sharing of a meal or a treat, as well as increased oral communication (e.g., discussions, “rapping”) . As relationships become even more intimate, consideration must be given to the sensual
Volumr Number
34 5
Psychology
and maxillofacial
prosthetics
535
component of the mouth, lips, and tongue. Thus, the maxillofacial region is important from the most superficial of interpersonal contacts to the most intimate of relationships. Because of the role of maxillofacial phenomena (features) in both early development and interpersonal relationships, these features are often thought to take on psychological meanings which undergird and shape personality structure and style.7-9 A personality style that is characterized by passivity and dependence on others is typically labeled the “oral-receptive” personality; whereas the hostile, selfish, verbally abusive person might be seen as “oral-aggressive.” Thus, BingeP concludes that the mouth is directly or symbolically related to major human instincts and passions : self-preservation, cognition, love and sexual mating, hate, and desire to kill.
SOME PROBLEMS IN MAXILLOFACIAL
CHANGES
In light of the role of the maxillofacial region in early development and continued normal functioning, and because of the meanings and emotions which may be involved, changes in facial features are likely to be accompanied by various types of difficulties. Some of the typical problems which are encountered are considered under seven broad categories. importance of loss. Through the disease process or traumatic experience, typical maxillofacial patients experience significant losses of body parts or tools which have had important roles in their life experience. In a very real sense, the patient has lost part of his self or being. Students of psychosomatic medicine are continually impressed with real or symbolic loss as a precipitating factor in a variety of psychiatric disorders, particularly those in which there is a component of depressi0n.l” To the extent that the deteriorating or lost body part has psychological meaning, the 10s~ factor and the accompanying depressive features are compounded. A new impact. Alterations in the maxillofacial region usually involve some changes in the person’s sense of attractiveness. There is the problem of uncertainty about how prosthetic treatment might affect the facial region, which is so intricately involved in first impressions. The impact changes not only relate to the way others view the person initially, but also involve alterations in modes of expressive behavior. The patient may have a crooked smile or a different tongue thrust when speaking. Concern about one’s new impact upon others would be expected to result in selfconsciousness and perhaps reduced social interaction.“, 4 New sensory experiences. The body is a processor of complex data from the environment. Alterations in the structure or function of the unit have an effect upon the acceptance and handling of input. The significance of new sensory experiences is readily understood when a patient is confronted with visual changes, yet there may be a failure to appreciate the extent to which sensory experiences are disrupted by other maxillofacial problems. There may be substantial changes in one or more The patient of the sensory modalities (e.g., taste, touch, and thermal sensitivity). may have very different and unique perceptions of his world. Unrealistic expectations. Since the maxillofacial region is implicated in so many interpersonal relationships, the problem of expectations complicates acceptance of every prosthesis.4 A patient may be somewhat socially inept and may perceive
536
Bailey
and Edwards
.I. Prosthet. Dent. November, 1975
correction as a promise for interpersonal effectiveness and a life without woes. On the other hand, some patients may exhibit unrealistically negative attitudes toward maxillofacial prostheses. Such patients may be able to focus only upon the potential disadvantagex in the treatment. Acc,eptance. .\nother aspect of change relates to the readiness with which the patient can accept the corrective procedures and incorporate them into his personality. During the process of treatment. the patient is asked to accept a foreign device as part of his body. There are vast differences among patients in ability to accept the prosthesis as a part of personal experience. Social status. Some recent work”, :l has demonstrated the decisive social effects of maxillofacial impairment and correction. Among the more than 100 patients in the study, substantial changes were observed in employment patterns, with associated downward fluctuations in economic status. Also, a significant reduction was found in the following activities of most patients during the time of impairment and treatment: entertaining in the home, going out regularly, meeting the public daily, and eating in the presence of others. Although there was some recovery of social most patients did not return to involvement subsequent to prosthetic treatment, premorbid levels of functioning. Perplexing paradox. The final problem involves phenomena cvhich are somewhat puzzling. Researchers and clinicians have repeatedly found that there is not a simple. positive relationship between actual severity of disfigurement and the degree of psychological distress experienced by the patient.“, ‘. 5 Patients with slightly disfigured maxillofacial regions often become more anxious or depressed than patients with a more marked impairment. MacGregor’ noted that, in general, the severely disfigured patient complains less bitterly than the mildly impaired person. More recent research with cancer patients reveals the lack of correlation between degree of visible disfigurement and the extent of social/vocational readjustment.” The patient’s self-perceptions, emotional stability, personality characteristics, and social circumstances appear to be the salient factors in dealing with maxillofacial disorders and the rehabilitation process. PRACTICAL
APPLICATION
TO the extent that the dentist gains an appreciation for the numerous psychological aspects of maxillofacial prosthetics. he will be increasingly effective in responding to the needs and potential problems of the patient. There are several specific treatment procedures which will facilitate the processes involved in therapy and rehabilitation. Evidence from both clinical experience and research attests to the importance of the doctor-patient relationship in prosthetic health services.f, I’ Rapport which is based upon mutual respect, honesty, and confidence must be established. Such rapport is developed when the doctor relates to the patient in a factual, supportive manner. Features of the treatment procedures which may be problematic should be discussed openly, with promises relating to prognosis held to a minimum. Realistic and clear communication concerning the prognosis of maxillofacial prosthetic therapy must occur in the context of a strong doctor-patient relationship. An understanding of patient dynamics is helpful in establishing clear communication.
Volume 34 Numbrr5
Psychology
and maxillofacial
prosthetics
537
As a function of the doctor-patient relationship, the doctor becomes more aware of the patient’s perspective of the problem. The doctor begins to learn the various meanings the patient has attached to his problem and to the treatment. The doctor is sensitive to the socioeconomic changes which the patient may undergo (e.g., increased dependency and reduced income), and he gains an appreciation of the patient’s feelings about himself (e.g., his sense of inner worth and his confidence in coping with changes). The doctor must be receptive and accepting of the patient so that the patient will feel comfortable in sharing his fears and conflicts. As the patient verbalizes his expectations, the doctor will sometimes find it necessary to help the patient clearify his anticipations and develop expectations which are realistic. During the entire diagnosis-treatment-rehabilitation sequence, special attention needs to be given to the emotional status of the patient. Of particular relevance are signs of depression, such as loss of appetite, dejection, withdrawal, and irritability. Rozen and associates” indicate that depression is the major impediment to the rehabilitation process. The role of emotional factors is readily appreciated in light of the sundry modes and meanings of the maxillofacial region and when considering the potential problems involved in changes of this part of the body. Finally, the doctor may be able to estimate the psychological progress of a particular patient by a comparison with the profile of the “successful patient” offered by MacGreg0r.l He found that progress by maxillofacial patients was accompanied by alterations on several dimensions: increased spontaneity, more social activity, improved self-esteem, greater confidence, reduced self-consciousness, and increased level of energy. To the extent that these attributes are not evident during the latter stages of treatment, one might suspect that psychologically based problems may be interfering with therapeutic progress. SUMMARY An attempt has been made to integrate information from psychological principles and clinical research which is relevant to maxillofacial prosthetics. Attention was given to the role of body parts in the human experience, with particular consideration of facial aspects. The importance of the maxillofacial region in early development, and day-to-day interpersonal relationships was reviewed personality dynamics, together with several specific problems which often accompany maxillofacial changes in structure or function. The dentist must be concerned with the patient’s expectations, personality characteristics, and ability to accept and integrate the prosthesis. Several implications for and utilization of clinical practice were presented. The dentist’s understanding psychological considerations should result in increased effectiveness in treatment and rehabilitation of maxillofacial patients. References 1. MacGregor, F. C.: Some Psycho-Social Problems Associated With Facial Deformities, Am. Social. Rev. 16: 629-638, 1951. 2. Rozen, R., Ordway, D. E., Curtis, T. A., and Cantor, R.: Psychosocial Aspects of Maxillofacial Rehabilitation. Part I. The Effect of Primary Cancer Treatment, J. PROSTHET. DENT. 28: 423-428, 1972. 3. Sykes, B. E., Curtis, T. A., and Cantor, R.: Psychosocial Aspects of Maxillofacial Re-
538
Bailey
and
J. Prosthet. Dent. No”ember. 197.5
kdwnrd.s
habilitation. Part II. .4 Long-Range Evaluation, J. PKOSTHBT. DEKT. 28: 540-545, 19i2. 4. Jourard, S. M., and Remy, R. M.: Perceived Parental Attitudes, the Self, and Security. J, Consult. Clin. Psycho]. 19: 364-366, 1955. 5. Allport, G. W.: Becoming: Basic Considerations for Becoming a Person, New Haven, Corm., 195j, Yale University Press. 6. Fenichel, 0.: The Psychoanalytic Theory of Neurosis, New York, 1945, W. W. Norton & Company, Inc. 7. Binger, C.: Personality and Oral Disease, Ann. Dent. 4: 173-l 82, 1946. 8. Weiss, E., and English, 0. S.: Psychosomatic Medicine, Philadelphia, 1957, W. B. Saunders Company, pp. 495-5 14. 9. Melvin, J. L., and Nagi, S. Z.: Factors in Behavioral Responses to Impairments, Arch. Phys. Med. Rehab. 51: 552-557, 1970. in Arieti, S.: American Hand10. Lidz, T.: General Concepts of Psychosomatic Medicine, book of Psychiatry, New York, 1969, Basic Books, Inc. DR. BAILEY UNITED STATES NAVAL HOSPITAL SAN DIEGO, CALIF. 92132 REPRINT REQUESTS TO : DR. EDWARDS NAVAL HEALTH RESEARCH CENTER SAN DIEGO, CALIF . 9”153 L -
ARTICLES TO APPEAR IN FUTURE ISSUES A method of measuring complete dentures
pressures
Charles C. Kelsey, B&E., MS.
D.D.S.,
American
of Prosthodontics
William
Board
MS.,
Fredrick
D. Reid,
tissues
supporting
B.S., MS.,
functioning
and Joel A. Coplowitz,
R. Laney, D.M.D.
Effects of artificial crown on gingival pocket depth Dominick
C. Larato,
A histologic Alfred
against
D.D.S.,
assessment
Schuchard,
D.D:S.
margin
extension
und tooth
brushing
frequency
cutting
-technique
M.S.D.
of low-torque,
ultrahigh-speed
