Oral Health Psychology: Psychological Aspects Related to Dentistry (Textbooks in Contemporary Dentistry)

This textbook is exceptional in its coverage of modern theories on the patient-centered approach to communication, preventive dentistry, and dental anxiety. It provides the knowledge and tools required in order to implement a trauma-sensitive approach that will enhance the treatment experience for both the patient and the dental practitioner. General psychological aspects of dentistry and behavior management in patients who experience dental fear, anxiety, and pain are considered in detail. Extensive attention is devoted to the effective delivery of preventive care and dental treatment in a wide range of specific patient groups, including fearful and abused children and patients suffering from depression, personality disorders, psychosis, substance abuse disorders, and eating disorders. The importance of interdisciplinary cooperation and self-care in the dental clinic is also discussed. The book is an international collaborative effort between dentists and psychologists who draw on scientific research as well as their personal experiences in clinical practice. It is an excellent educational resource and will help readers to solve challenges in their own clinical settings. Foreword Preface Contents Contributors I: Basic Oral Health Psychology 1: Basic Oral Health-Related Psychology 1.1 Introduction 1.2 The Bio-psychosocial Model of Disease and Health 1.3 Self-Identity: Who Are We? 1.4 Relationship Between Behaviour, Thoughts, and Feelings 1.5 Thoughts: Fast and Slow Thinking Box 1.6 Basic Information Collection and Processing 1.7 Perception Box Box 1.8 Attention and Memory 1.9 Emotions 1.10 Emotions and Stress 1.11 Information Processing in the Clinical Context 1.12 Application of Psychological Theory in Oral Health Care 1.13 Practical Approaches Box 1.14 Development of Metacognitive Skills: Mindware 1.15 Emotional Competence References 2: The Importance of Trauma-Sensitive Care 2.1 Introduction 2.2 Why Is Trauma-Sensitive Dentistry Important? 2.3 Trauma-Sensitive Dentists Treat More Than Just Teeth 2.4 Trauma-Sensitive Approach: Responsiveness to an Unspoken Life Story 2.5 The Theoretical Basis for a Trauma-Sensitive Approach 2.5.1 Development of the Trauma Field: In Short 2.5.2 Comorbidity 2.6 What Is a Trauma? 2.7 How Does Dissociation Appear in the Dentist’s Office? 2.8 The Triune Brain and Reactions to Danger 2.9 Why “The Window of Tolerance” Is a Useful Model for Regulation of Emotions References 3: Pain 3.1 Introduction 3.2 Pain: A Complex Phenomenon Pain 3.2.1 Nociceptive, Neuropathic, and Nociplastic Pain 3.2.2 Acute vs. Persistent Pain 3.2.3 Chronic or Persistent Pain? 3.3 The Physiology of Pain 3.3.1 Basic Neurophysiology 3.3.2 Light Stimulation May Relieve Pain 3.3.3 Central Regulation of Pain 3.3.4 Referred Pain 3.4 Orofacial Pain 3.4.1 Pain from Teeth and Surrounding Tissues Case Study 3.4.2 Pain from Other Locations 3.4.3 Dental Treatment and Pain 3.5 Psychosocial Factors 3.5.1 Anamnestic Issues 3.5.2 Social Context 3.5.3 Interaction with Family 3.5.4 Pain and Cognitions 3.5.5 Emotional Factors, Psychological Problems, and Comorbidity 3.6 Treatment and Relief of Pain 3.7 Psychological Strategies for Relieving Pain 3.7.1 Expectations 3.7.2 Control vs. Catastrophizing 3.7.3 Relaxation 3.7.4 Distraction 3.8 Case Study 3.8.1 Overall Treatment Goals 3.8.2 Dental Treatment Box References 4: The Importance of a Safe Relationship with Dental Patients 4.1 What Is a Relationship? 4.2 The Importance of the Relationship in Patient Care 4.3 What Is a Good Relationship? 4.3.1 Authenticity 4.3.2 Unconditional Positive Acceptance 4.3.3 Empathy 4.3.4 “NURSE” 4.3.4.1 Name It 4.3.4.2 Understand It 4.3.4.3 Respect It 4.3.4.4 Support It 4.3.4.5 Explore It 4.4 Challenges in Relationship Building 4.5 The Attachment Perspective in Patient Treatment 4.5.1 Secure Attachment 4.5.2 Anxious-Ambivalent Attachment 4.5.3 Avoidant Attachment 4.5.4 Disorganized Attachment 4.6 Meeting Attachment Styles in Adult Dentistry 4.7 Transference and Countertransference 4.8 Developing Professionalism 4.9 Rupture and Repair: How to Repair When the Alliance Is Ruptured Case Study References 5: Oral Health Literacy 5.1 Oral Health Information 5.1.1 What Is Health Literacy? 5.1.2 The Prevalence of Low Health Literacy 5.1.3 Case Presentation: A Person with Low Oral Health Literacy 5.2 A Modern Oral Health Model Box (. Fig. 5.1) 5.2.1 Global Oral Health 5.2.2 Patient Participation 5.3 Oral Health Literacy Box 5.3.1 Factors Related to Low Health Literacy 5.3.2 Oral Health Literacy in a Clinical Context Box 5.3.3 What Can Oral Health Professionals Do? 5.3.4 Strategies Aimed at Low Oral Health Literacy Patients Box 5.3.5 A Model of Oral Health Literacy as a Risk References 6: Communication in Dentistry: The Four Habits Model 6.1 Why Is Learning Communication Skills Important? Box 6.1.1 Patient-Centred Communication 6.1.2 Basic Principles of Dentist-Patient Communication Box 6.1.3 Autonomy and Informed Consent 6.1.4 A Good Situation for History-Taking 6.1.5 Attentive Presence 6.1.6 The Professional Interview 6.2 Communication Skills 6.2.1 Verbal Communication Skills 6.2.2 Exploratory and Relationship-Building Skills 6.2.2.1 Open-Ended Questions 6.2.2.2 Active Listening 6.2.2.3 Reflecting 6.2.3 Giving the Patient Perception of Control 6.2.3.1 Start Control 6.2.3.2 Stop Control 6.2.4 Structuring Skills 6.2.4.1 Closed Questions 6.2.4.2 Transitions 6.3 “The Four Habits”: A Basic Toolbox of Communication Skills 6.3.1 Habit I: Invest in the Beginning 6.3.1.1 Create Rapport Quickly 6.3.1.2 Elicit the Patient’s Concerns 6.3.1.3 Plan the Visit with the Patient 6.3.2 Habit II: Elicit the Patient’s Perspective 6.3.2.1 Ask for the Patient’s Ideas 6.3.3 Habit III: Demonstrate Empathy 6.3.4 Habit IV: Invest in the End 6.4 Structuring the Dental Visit and Implementation of the Four Habits (Illustrated by Verbal Examples) 6.4.1 The Pre-clinical Interview Phase 6.4.2 Closing the Pre-clinical Interview and Transition to Clinical Phase 6.4.3 The Clinical Examination Phase 6.4.4 The Shared Decision-Making Phase 6.4.5 Clinical Treatment Phase 6.4.6 End of Visit Phase References 7: Behaviour Change for Oral Health 7.1 Introduction 7.2 Dental Health Care and Habits 7.3 Intentional Behaviour Change 7.3.1 Becoming Motivated Box 7.1 7.3.2 Decision-Making 7.3.2.1 Exploring Decision-Making in Dental Consultations 7.3.3 Implementing and Maintaining Behaviour 7.3.3.1 Knowing What to Do and Having the Skills 7.3.3.2 Carrying Out and Maintaining Healthy Behaviours 7.3.3.3 Put Dental Health on the Schedule of Daily Activities 7.3.3.4 Visual Reminders 7.3.3.5 Refresh Motivation 7.3.3.6 Renew One’s Decision and Use Self-Instructions 7.3.3.7 Positive Reinforcement: Crediting the Effort 7.3.3.8 Overcoming Dips in Motivation and Self-Sabotaging Thoughts 7.3.3.9 Mental Rehearsing: Using Visualisation and Imagery 7.4 Structuring Discussions About Oral Health 7.4.1 Balancing Expert Information and Eliciting the Patient’s Existing Resources 7.4.1.1 Increasing the Patient’s Active Participation in Dental Care 7.4.1.2 Cooperation and Avoiding Discord Between the Dental Health Professional and the Patient Box 7.2 7.4.1.3 Four Steps for Structuring Dental Consultations References Additional References 8: Self-Determination Theory – Autonomy Support and Improving Oral Health 8.1 Introduction to Self-Determination Theory (SDT) Box Box 8.1.1 Ethical Considerations Using Autonomy Box 8.1.2 Autonomy and Self-Regulation 8.2 Basic Psychological Needs (BPN) Box 8.2.1 The Need for Autonomy and Self-Determination 8.2.2 The Need for Competence and Mastery 8.2.3 The Need for Relatedness and Belonging 8.2.4 Need Thwarting – Need Frustration Examples When Patients Feel Their Needs Thwarted 8.3 Guidelines for Autonomy Support 8.3.1 Autonomy Support 8.3.2 Autonomy – Guiding to Choice Rather Than Control Box Box Box 8.3.3 Competence – Providing Meaningful Rationales and Explaining Purposes Box 8.3.4 Relatedness – Acknowledging the Patient’s Feelings and Perspectives 8.4 Internalisation Process 8.4.1 Amotivation 8.4.2 Four Different Types of Extrinsic Motivation 8.4.2.1 External Regulation 8.4.2.2 Introjected Regulation 8.4.2.3 Identified Regulation 8.4.2.4 Integrated Regulation 8.4.3 Intrinsic Motivation 8.5 Self-Determination Theory and Dental Health Research References II: Children 9: Positive Encounters for Children to Prevent Dental Anxiety – Theory and Practice 9.1 Understanding Child Development 9.1.1 Overview 9.1.2 Social Development 9.1.2.1 Attachment Theory 9.1.3 Emotional Development 9.1.3.1 Circle of Security 9.1.3.2 Attachment in Action at the Dental Clinic Case Study 9.1.3.3 Temperament Case Studies 9.1.3.4 Developmental-Supported Treatment 9.2 Preparing for a “Successful” Dental Visit 9.2.1 Pre-school Children (2–5 Years) Case Study 9.3 Top Tips for Managing Pre-school Children Case Example of “Tell-Show-Do” 9.3.1 Primary School-Aged Children (6–12 Years) Case Scenario 9.4 Top Tips for Managing Primary School-Aged Children 9.4.1 Adolescents (13–18 Year-Olds) Case Study 9.5 Top Tips for Managing Teenagers 9.6 Dental Anxiety: Understanding the Anxious Child 9.6.1 Background to Child Dental Anxiety 9.6.2 Children’s Experiences of Dental Anxiety 9.7 Cognitive Behavioural Therapy 9.7.1 What Is It and How Does It Work? 9.7.2 CBT for Children in the Dental Setting Case Study 9.7.3 Using the “Your teeth, you are in control” Intervention References 10: Family Violence and Child Maltreatment 10.1 Child Maltreatment 10.1.1 Rights of the Child 10.1.2 Types of Child Maltreatment 10.1.3 Safeguarding and Protecting Children 10.1.4 Dental Professionals and Child Maltreatment 10.1.5 Communicating with the Child 10.1.6 How To Proceed When Worried that a Child Is Exposed to Maltreatment Box The Barnahus Model (Which Literally Means “Children’s House” or “Child Advocacy Center”) 10.2 Traumatized Children Grow Up to Be Adults 10.3 Domestic Violence – Adults 10.3.1 Categories of Intimate Partner Violence 10.3.2 The Dynamics of Domestic Violence 10.3.3 How to Explore Signs of Domestic Violence? Box Advises for Concerned Staff from the UN [28] 10.3.4 When a Dawning Concern Becomes a Severe Worry – What to Do? References Part II Voice of Children Box Reference III: Dental Anxiety 11: Understanding Development and Persistence of Dental Anxiety 11.1 Introduction 11.2 Dental Anxiety from an Evolutionary Biological Perspective 11.2.1 The Body’s Natural Reaction to Danger 11.3 When the Fear Reaction Becomes Dysfunctional Box 11.4 Biopsychosocial Understanding of Dental Anxiety 11.4.1 Biological Perspective 11.4.2 Psychosocial Perspective 11.5 Development of Dental Anxiety 11.5.1 Classical Conditioning 11.5.2 Operant Conditioning 11.5.3 Social/Model Learning 11.6 When Dental Treatment Feels Threatening 11.7 The Persistence Maintenance of Dental Anxiety 11.8 Safety-Seeking Strategies References 12: Psychological Prevention and Management of Dental Anxiety 12.1 Introduction 12.2 Part 1: Basic Elements in the Prevention and Management of Dental Anxiety Box 12.1 12.2.1 Providing the Patient with the Experience of Predictability and Control 12.2.2 Checking Out the Alliance 12.2.3 Psychoeducation 12.2.3.1 Bodily Reactions 12.2.3.2 Catastrophic Interpretations and Thoughts 12.2.3.3 The Anxiety Hierarchy 12.2.3.4 The Habituation Model of Anxiety 12.3 Part 2: Coping Strategies 12.3.1 Giving Positive Reinforcements 12.3.2 Distraction 12.3.3 Assessing Catastrophic Thoughts 12.3.4 Using the Window of Tolerance 12.3.4.1 Decreasing Activation When the Patient Is at the Higher End of the Window of Tolerance 12.3.4.2 Increasing Activation When the Patient Is at the Lower End of the Window of Tolerance 12.3.4.3 Observing Patients’ Presence in the Present 12.4 Part 3: Daily Practice 12.4.1 Emergency Treatment 12.4.2 Elective Treatment 12.4.2.1 The Preclinical Phase 12.4.2.2 Assessment of Dental Anxiety 12.4.2.3 Devising a Coping Plan with the Patient 12.4.2.4 The Clinical Examination Phase 12.4.2.5 The Clinical Phase of Dental Treatment 12.4.3 Psychological Management in Combination with Pharmacological Sedation 12.4.4 Cooperation with the Patient’s Doctor/Psychologist Box 12.2 12.4.5 Common Reactions in Scared Patients References 13: Dentist-Administered CBT for Dental Anxiety 13.1 An Evidence-Based Treatment Method for Dental Anxiety 13.1.1 Cognitive Behavioral Therapy (CBT) 13.1.2 CBT in the Treatment of Dental Anxiety 13.1.3 What Is New in D-CBT? 13.2 Treatment Requirements 13.2.1 Manualized Treatment 13.2.2 Dentist Requirements 13.2.3 Practical Training 13.2.4 A Clear Definition of the Role of the Dentist 13.3 When Is D-CBT Applicable? 13.4 Practical Arrangements 13.5 Step-by-Step Use of the D-CBT Manual 13.5.1 Before the First Treatment Session 13.5.2 The First Treatment Session (60 Minutes) 13.5.2.1 Establishing a Good Relationship 13.5.2.2 Background, the Patient’s Problem, and Motivation 13.5.2.3 Psychoeducation 13.5.2.4 Cognitive Restructuring 13.5.2.5 Method and Coping Techniques 13.5.3 End of the First Session: Evaluation, Alliance Check, Home Lessons, and Further Plans 13.5.4 The Second, Third, and Fourth Appointments 13.5.4.1 Start of the Sessions: Psychoeducation and Cognitive Restructuring, Continued 13.5.4.2 Exposure Training 13.5.4.3 End of the Sessions 13.5.5 The Fifth and Last Session 13.5.5.1 Coping Plan References 14: Blood–Injury–Injection Phobia 14.1 Introduction 14.2 Possible Causes of Blood–Injury–Injection Phobia Box 14.1: The diphasic activation of the autonomic nerves system when a fearful patient experiences fainting 14.3 Two-Phase Change in Blood Pressure in BII Phobia 14.4 Model/Social/Vicarious Learning 14.5 Congenital Vulnerability 14.6 Overlap Between BII Phobia and Odontophobia 14.6.1 What Do BII Phobics Fear? 14.6.2 Negative and Catastrophic Thoughts About Getting Anesthesia 14.6.2.1 Thoughts About Bodily Consequences 14.6.2.2 Thoughts About Psychological Consequences 14.6.2.3 Thoughts About the Consequences of Not Being Able to Trust the Dentist 14.6.2.4 Thoughts About Pain 14.6.2.5 Thoughts About the Effect of the Syringe and the Anesthetic 14.7 Cognitive Restructuring 14.8 Applied Tension (AT): To Prevent Fainting 14.9 How to Treat BII Phobia? Case Study: Peter 33 Years Old References Part III The Voice of Dentally Anxious Patients IV: Patients with Complex Reactions and Co-morbidity 15: People with Mental Disorders in the Dental Clinic 15.1 Preface 15.2 Oral Health and Mental Health 15.3 Clinical Encounters 15.4 Patients, Actions, and Explanations 15.4.1 Storytelling as a Method of Learning 15.4.2 Stories 15.4.2.1 Story #1 Mrs. Hansen What Do You Do? Why? 15.4.2.2 Story #2 Mr. Peterson What Do You Do? Why? 15.4.2.3 Story #3 Mrs. Dale What Do You Do? Why? 15.4.2.4 Story #4 Miss Aftani What Do You Do? Why? 15.4.2.5 Story #5 Miss Potter What Do You Do? Why? 15.4.2.6 Story #6 Young Mr. Jameson What Do You Do? Why? 15.4.2.7 Story #7 Mr. Duffy What Do You Do? Why? 15.4.2.8 Story #8 Mr. Rourke What Do You Do? Why? 15.4.2.9 Story #9 Mrs. Johnsen What Do You Do? Why? 15.4.2.10 Story #10 Mr. Bashir What Do You Do? Why? 15.4.2.11 Story #11 Mrs. Gideon What Do You Do? Why? References 16: How to Deal with Gagging 16.1 Who Are the Patients? 16.2 Prevalence and Severity 16.3 The Biopsychosocial Model 16.3.1 The Biological Aspects of Gagging (. Fig. 16.2) 16.3.1.1 The Basal Gag Reflex 16.3.1.2 Systemic Factors 16.3.1.3 Local Factors 16.3.2 The Psychological Aspects of Gagging 16.3.2.1 Gagging as a Train of Thought 16.3.2.2 Losing Control 16.3.2.3 Gagging as a Coping Strategy to Control Dental Treatment 16.3.3 The Social Aspects of Gagging 16.3.3.1 Previous Traumatic Events Related to Dentistry 16.3.3.2 Gagging and Sexual Abuse 16.4 How to Manage a Severe Gag Reflex in the Dental Setting 16.4.1 What Are the Treatment Goals? 16.4.2 Exploring the Gagging Problem Clinically 16.4.3 Relationship Building/Communication 16.4.4 How to Enhance Communication with the Patient During Dental Treatment 16.4.5 Behavior Modification/Cognitive Behavioral Therapy (CBT) 16.4.6 Methods Addressing Reflective Muscular Contractions During Gagging 16.4.6.1 Habit Reversal 16.4.7 Unlearning the Gag Response by Systematic Desensitization 16.4.8 Distraction 16.4.9 Adjustments/Facilitations 16.4.10 Pharmacological/Technical Interventions References 17: Child Sexual Abuse and Oral Health Challenges 17.1 Introduction 17.2 Possible Trauma Reactions Before, During and After Treatment 17.2.1 Consciousness Level – Dissociation A No Win Situation – The CSA Patients’ Possible Dilemma 17.2.2 Triggers 17.2.3 How CSA Survivors Experience Dental Treatment 17.3 Oral Health-Related Problems Invade Deeply into the Lives of CSA Survivors 17.3.1 Causing Serious Oral Health Symptoms 17.3.2 Triggering Trauma Reactions in Everyday Life 17.3.3 Increasing Emotional Distress 17.3.4 Shaping the Understanding of Self 17.3.5 Intruding Daily Life Practices 17.3.6 Restraining Social Interactions 17.3.7 Generating Financial Difficulties 17.4 Trauma-Sensitive Dental Treatment of CSA Survivors Box 17.4.1 Offering a Good Start 17.4.2 Being Competent 17.4.3 Being Aware of the Influence of Staff Behaviour 17.4.4 Building a Safe Relationship 17.4.5 Exploring and Coping with Individual Triggers 17.4.6 Reducing Possible Perceptions of Being Trapped 17.4.7 Strategies to Regulate Trauma-Driven Anxiety in CSA Survivors References 18: Providing Dental Care to Torture Survivors 18.1 What Is Torture? United Nations Torture Convention Article 1.1 18.2 Investigation and Documentation of Torture Injuries 18.2.1 Where Does Torture Occur? 18.2.2 Who Are the Torture Survivors? 18.2.3 Trauma Following War and Refuge 18.3 Torture Against Teeth and Facial Area 18.3.1 Oral Consequences of Torture 18.4 Late Effects of Torture 18.4.1 Psychological Consequences 18.4.2 Pain as a Consequence of Torture 18.5 Torture and Dental Anxiety 18.5.1 Adapting the Dental Treatment 18.5.1.1 Identifying Triggers 18.5.1.2 Use of Interpreters 18.5.1.3 Cultural Understanding and Culture-Sensitive Approach 18.5.1.4 Building Trust and Sense of Control Box 18.6 Choice of Dental Treatment References 19: The Psychosocial Impacts of Orofacial Features: With Examples from Orthognathic Surgery 19.1 The Psychosocial Relevance of Orofacial Features Box 19.2 Body Dysmorphic Disorder (BDD) 19.3 Orthognathic Surgery Box 19.3.1 Prevalence 19.3.2 Treatment Strategies 19.3.3 Indications for Surgery 19.3.4 Evaluation of the Facial Morphology 19.3.5 Orthognathic Surgery Osteotomies 19.3.5.1 Vertical Ramus Osteotomy 19.3.5.2 Bilateral Sagittal Split Osteotomy 19.3.5.3 Le Fort I Osteotomy 19.3.5.4 Genioplasty 19.3.5.5 Bimaxillary Orthognathic Surgery 19.3.5.6 Distraction Osteogenesis Box 19.3.6 Terminology 19.3.7 Case Report Box 19.4 Psychosocial Outcomes of Orthognathic Surgery Psychological Implications of Complex Dentistry Affecting Appearance References Part IV The Voice of CSA Survivors About Dental Treatment About the Communication Between Dentist and Patient About Facilitations During Dental Treatment After Treatment V: Professionalism 20: Dental Professionalism and Professional Behaviour in Practice and Education 20.1 General Features of Professionalism 20.2 Importance of Professionalism to Health Care and Dentistry 20.3 Dentistry as a Profession 20.4 Themes Within Dental Professionalism Box. Themes Within Dental Professionalism Box. Comparison of Traditional and Contemporary Professionalism [51] 20.5 Empirical Research and Dental Professionalism 20.6 Professionalism in Context 20.7 Professionalism as a Personal Quality 20.8 Reflection as a Core Component 20.9 A Word on Teaching and Assessment of Professionalism 20.10 Remediation 20.11 Conclusion References 21: Living in a Golden Cage? Work Stress, Burnout Risk, and Engagement in Dental Practice: Background and Prevention 21.1 Introduction 21.2 Part I: Background 21.2.1 Stress and Work 21.2.2 The Job Demands–Resources Model 21.2.3 Burnout 21.2.4 Positive Engagement 21.2.5 How Do These Processes Appear Among Dentists? 21.2.6 Burnout Profiles 21.2.7 Demanding Work Aspects in Dentistry 21.2.8 Burnout and Health Complaints 21.2.9 Job Resources 21.2.10 The Job Demands–Resources Model Among Dentists 21.2.11 Person Environment Fit 21.2.12 Dental Students and Stress 21.3 Part II: Prevention 21.3.1 Warning Signs of Exhaustion 21.3.2 How to Take Care of Yourself as a Dental Professional 21.3.2.1 Putting Words on Thoughts and Feelings 21.3.2.2 Seeking Guidance 21.3.2.3 Increasing Your Knowledge 21.3.2.4 Sources to Gain Powers 21.3.2.5 Reducing Exposure 21.3.3 Enrichment and Traumatic Growth: Implications References 22: Working in Partnership for Better Oral Health Care 22.1 Introduction 22.2 The Biopsychosocial Approach 22.3 Benefits of Collaboration 22.3.1 Communication 22.3.2 Psychological Illnesses 22.3.2.1 Dental Phobia Screening/Intake Treatment 22.3.2.2 Other Mental Health Problems 22.3.2.3 Working with Specific Patient Groups 22.3.2.4 Temporomandibular Disorders, Adaptation to Dental Prosthetics, and Gagging Reflexes 22.3.2.5 Orthognathic Surgery 22.3.2.6 Children 22.3.3 Understanding Patient Behaviour 22.3.4 Ripple Effect 22.3.5 Economy 22.3.6 Increasing Dental Team Resilience 22.4 Challenges 22.4.1 Identifying the Members of the Team 22.4.2 Perspectives 22.4.3 The Lack of a Common Culture and a Shared “Language” 22.4.4 Time Pressures 22.4.5 Availability of Psychologists 22.5 Future Perspectives 22.6 Descriptions from Interdisciplinary Work 22.6.1 Psychology and Oral Health Psychology in the United Kingdom 22.6.1.1 History 22.6.1.2 Education 22.6.1.3 Research 22.6.1.4 Healthcare Services 22.6.1.5 Policy Development and Influence on Health Service Provision 22.6.2 Psychology and Oral Health Psychology in The Netherlands 22.6.2.1 History 22.6.2.2 Dental Phobia 22.6.2.3 Psychiatric Disorders, Intellectual Disabilities, and Gerodontology 22.6.2.4 Maxillofacial Prosthetics and Temporomandibular Disorders 22.6.3 Psychology and Oral Health Psychology in Norway 22.6.3.1 History 22.6.3.2 Clinical Work Innovation Research and Innovation 22.6.4 Psychology and Oral Health Psychology in Sweden 22.6.4.1 History 22.6.4.2 Clinical Work Severe Dental Anxiety/Phobia in Adults Other Clinical Areas 22.6.4.3 Professional Development, Research, and Innovation References Index