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Psychological symptoms and self-image of patients with complaints attributed to dental restorative materials: Psychological symptoms in patients with environmental intolerance
Umeå University, Faculty of Medicine, Department of Odontology, School of Dentistry.
Umeå University, Faculty of Social Sciences, Department of Psychology.
Public Dental Health Competence Centre for Northern Norway, Tromsø, Norway.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives The aim was to study self-image the level of psychological symptoms in patients with symptoms attributed to their dental restorative materials, one group with local oral symptoms only (LSO) and one group with multi-symptoms (M-S).

Materials and methods A questionnaire was sent to the 257 participants, 189 women and 68 men, containing questions regarding their dental and medical history.The self-image was assessed with the Structural Analysis of Social Behavior (SASB. Psychological symptomssuch as somatization, depression and anxiety were assessedand the Global Severity Index (GSI) was computed by using the Symptom Check List 90 (SCL-90).

Results The SASB showed that the M-S group and the LSO-group scored significantly higher on the “spontaneous” and “positive self-image” than the reference group. In the SCL-90, the M-S group scored significantly higher than the LSO-group and the references on the somatization subscales. On depression, anxiety and the GSI scale, the M-S group scored significantly higher than the reference group.

Conclusions The two subgroups rated significantly higher on the SASB Spontaneous and Positive clusters which indicates that these patients have an excessively positive self-image, are very spontaneous and have an overconfidence in themselves compared to the reference group. In the M-S group  there was a clear tendency to somatization, depression and anxiety and they are more psychologically stressed than the reference group.

Clinical relevance Clinicians should be aware of that illness attributed to dental restorative materials seems to be multi-factorial and patient with multi-symptoms are more psychologically stressed than patient with local-symptoms only.

National Category
Biomaterials Science
Research subject
URN: urn:nbn:se:umu:diva-114092OAI: diva2:893640
Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2016-01-13
In thesis
1. A multidisciplinary study of patients with signs or symptoms attributed to dental restorative materials
Open this publication in new window or tab >>A multidisciplinary study of patients with signs or symptoms attributed to dental restorative materials
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anxiety for adverse health effects attributed to dental restorative materials especially dentalamalgam, have been discussed extensively off and on the last 30 years. The possible health effect ofamalgam and health effect of replacements of amalgam, have been extensively studied but theresults are inconclusive and the etiology of the reactions are not entirely elucidated. Furthermore,the question of psychological influence on symptoms attributed to dental restorative materials hasbeen raised and need further examination.

The aims of this thesis were to describe the change in health over time for patient with symptomsattributed to their dental materials and to determine whether replacement of their dentalrestorative materials had any impact on their perceived health. Furthermore, to determine anddescribe the personality, self-image, level of psychological symptoms and stress among thesepatients and compare the results with those of healthy controls. Finally, to evaluate regression ofLichenoid Contact Reactions and Oral lichen Planus after replacement of the dental materials.

A questionnaire was mailed to 614 patients that had been referred to the School of Dentistry, Umeå,Sweden with symptoms attributed to dental materials. Among these patients a subgroup with orallichen also underwent a clinical examination at follow-up.

The result showed that patients with complex symptoms had a more unfavorable long-termprognosis concerning persistent complaints than those with local symptoms only. The oralsymptoms had decreased between baseline and follow-up and the general symptoms had increased.The increase in general symptoms was contradictory since many patients experienced healthimprovement after removal of their dental restorative materials. Concerning personality thepatients was characterized mainly by high persistence and by high fatigability and asthenia as wellas psychosocially learned high self-acceptance. Regarding self-image, both patients with LocalSymptoms Only and patients with Multi Symptoms, scored significantly higher on "spontaneous"and "positive self-image" than the reference group. The Multi symptoms group scored significantlyhigher on psychological symptoms compared to the reference group. However, the Local symptomsgroup did not differ from the references. The remission of oral lesions was after an exchange ofdental materials was seen to a greater extent in patients with Lichenoid Contact Reaction than inpatients with Oral Lichen Planus. Regarding psychological parameters, there were no significantdifferences between the groups.

In conclusion symptoms related to dental restorative materials seem to be multi-factorial wheredental, medical, social, and psychological factors may be involved. Patient with complex symptomshave a more unfavorable prognosis than patient with local symptoms only. Patient with symptomsself-related to their dental materials may feel improvement in general health after an exchange ofdental materials. The group of patients seems to represent personalities that could be vulnerable inthe demanding modern society, and the various mental and somatic symptoms can be interpretedas attributed to dental fillings. Patients with Local Symptoms or Multi Symptoms are equalconcerning self-image, they are impulsive with an elevated positive self-image, that can result indifficulties in setting limits. Thus in combination with high demands may result in mental stress.The Multi Symptoms group was more psychologically stressed than the group with Local SymptomsOnly and the references. Therefore, before an exchange of dental materials is commenced inpatients with oral lichenoid lesions, a correct diagnosis is needed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. 73 p.
Umeå University odontological dissertations, ISSN 0345-7532 ; 135
Dental restorative materials, environmental intolerance, oral lichen, personality, self-image, psychological symptoms
National Category
Biomaterials Science
Research subject
urn:nbn:se:umu:diva-114096 (URN)978-91-7601-403-5 (ISBN)
Public defence
2016-02-05, Sal D 9 tr, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Available from: 2016-01-15 Created: 2016-01-13 Last updated: 2016-01-20Bibliographically approved

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School of DentistryDepartment of PsychologyDepartment of Public Health and Clinical MedicineDepartment of Odontology
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