The study of the psychological status at patients with teeth discoloration

Abstract

Resume. At modern dentistry, the issue of tooth color is extremely important, as a beautiful smile is an indicator ofhealth and well-being. The increase in the number of patients who seek dental care with a request to improve their appearance, forced dentists to pay more attention to aesthetics, as well as the importance of a smile for the aesthetics of the face is widely known in a society. A beautiful smile is an extremely important element for perception and communication with other people, it reflects a certain way and style of life, health, and a state of mental balance. Today, in aesthetic dentistry there are many methods of improving the color of teeth among which tooth whitening is one of them.

The purpose of the research: to study the specifics of the effect of tooth color change on the psychological state of patients before and after whitening procedure.

Materials and methods. In the course of the study, we have examined 140 patients with discoloration of the teeth hard tissues, including those one with color changes after previous endodontic treatment, aged from 18 to 49 years (76 women and 64 men) and who were divided into 5 groups. The first group – patients with discoloration of the hard tissues of the teeth, who will be treated only with the help of the professional oral hygiene (30 people). The second group – patients with discoloration of the teeth hard tissues, who will undergo this with the help of removing dental deposits, using the home whitening system “Opalescence” which is based on hydrogen peroxide (30 people).

The third group – patients with a change in the color of the hard tissues of the teeth, who will undergo color correction using the removal of dental deposits and the method of teeth whitening which is based on application of the sodium chloride products (Rapid white whitening system) (30 people). The fourth group – patients with discoloration of the hard dental tissues, who will undergo color correction by removing dental deposits, with the usage of an Air Flow technique and professional whitening system «Beyond» that is supplemented with remineralization therapy (30 people). The fifth group – patients with a change in the color of the teeth hard tissues, who are motivated by failure and who refused the teeth whitening procedure (20 people). Special attention is being paid to psychological tests at our research. We assessed the correspondence between the patients’ desire for aesthetic treatment and the indications for its implementation, using the developed by us card “Assessment of the patient's dental status by the doctor and the patient.” The essence of this technique arises from the fact that there are two questionnaires, one of which is filled out by the patient and the other one by the dentist. In order to determine motivation for success or fear of failure, a special questionnaire was used, which consists of 20 questions according to which every patient must answer “yes” or “no.” The results are processed according to the survey key. If the result is from 1 to 10 points, failure motivation prevails, 11–20 points – success motivation. Also, to assess the truthfulness of patients’ statements in the questionnaires, we have included the so-called scales of lying or the desire for approval according to D. Marlow and D. Crown. This test allows you to assess the desire to receive the approval of others regarding your words and actions, and in our study, the approval of the people around you regarding the aesthetics of a smile. High approval motivation indicates a high need for communication and vice versa. We performed the examination and diagnosis of tooth discoloration according to the following protocol. Firstly, a psychological test was conducted, then an anamnesis was collected, determining the cause of the teeth discoloration. Indications and contraindications for whitening were also determined. All our patients underwent general clinical examination methods, X-ray examination, assessment of the state of individual oral hygiene: determination of the oral hygiene index (OHI-S), determination of the simplified plaque index on the contact (proximal) surfaces of the teeth (API) and the periodontal index (PI). We have also used statistical methods.

Results. As a result, we have found that 14 patients were motivated to succeed in effective teeth whitening among patients of the 1st group who only underwent professional oral hygiene. However, there was a tendency towards successful motivation at 5 patients, and a tendency towards unsuccessful bleaching was found at 8 patients. It should be noted that motivation for failure was established at 3 patients. At patients of the II group, for whom was performed whitening at home, motivation for success was established at 21 patients and was significantly higher than this indicator among patients of the first group. A tendency towards successful motivation was revealed at 7 patients and at 2 patients – a tendency towards failure motivation. In the III group, we found motivation for successful teeth whitening at 20 patients, motivation for success at 7 patients and motivation for failure at 3 patients. At the IV group of patients, we did not establish a motivational tendency for unsuccessful teeth whitening, 25 patients had motivation for success and 5 patients had a motivational tendency for successful whitening. Hence, the best results were obtained by us in the group of patients who underwent whitening procedure according to the proposed method. Also, unsatisfactory oral hygiene was noted at patients of all groups during the initial clinical examination. This is also confirmed by the data of the index assessment: the ONIS hygienic index was unsatisfactory and averaged – 2.1±0.20 points. In particular, at the I group of patients it was 1.9±0.3 points, at the II group – 2.15±0.4, at the III group – 2.23±0.4 and at the IV group – 2.1±0.4 points. However, after treatment, the ONI-S hygienic index improved significantly at all groups and amounted to 0.5±0.06 points at the first group, 0.4±0.09 points at the second group, 0.55±0.08 points at the third group and at the fourth group it was the best one and amounted to – 0.3±0.05 points. The obtained data of the clinical study at our patients after teeth whitening procedure revealed stable level of achievement motivation and approval indicators. The distribution of patients by type of motivation remained the same as before the teeth whitening procedure.

Conclusions. We have established that the primary task of the dentist will be to pay attention and tell our patients in detail about the tooth whitening procedure and possible side effects during and after this procedure. Patients who have an approval motivation need to be encouraged and emphasize their personal significance.

The highest rates of motivation for successful teeth whitening (100 %) were obtained among patients of the fourth group for whom professional treatment was performed, including the removal of dental deposits, application of the Air Flow technique and professional teeth whitening with the help of the «Beyond» system supplemented with the remineralization therapy. However, as expected, the lowest indicators of motivation for teeth whitening were obtained at the 1st group of patients (63.4 %) and at the same time the highest indicators of motivation for failure –  10 %.