March 2003
Volume 16, Number 3
Teaching Dentists to Treat People, Not Teeth
 Marita Rohr Ingehart is an associate professor at the University of Michigan school of dentistry and an adjunct associate professor in the department of psychology. She was educated at the University of Mannheim, Germany, and came to the University of Michigan as a visiting professor in the 1980s. Her research focuses on the role of psychosocial factors in oral health and oral health care. |
Why would a dean in one of the 52 dental schools in the United States hire a psychologist as a full time faculty member? The short, if not cynical, answer to this question is that US dental schools have to get accredited every five years and need to demonstrate that behavioral science is one part of their curriculum. Additionally, behavioral science is also one area in the National Board exams for all graduating students. This means that even if a dean is not aware of the potential contributions a psychologist could make to the dental school community, pragmatically it may seem wise to cover all bases and have a psychologist on board.
Why would psychologists want to work in a dental school? Unless they had been trained as dentists before getting a degree in psychology, the answer to this question is difficult, and may lie in pragmatic reasons such as the availability of jobs for dual-career families. However, independent of the reasons a psychologist ended up in a dental school, a description of the ways in which psychologists can contribute to teaching, research, and service in this setting is interesting.
Usually psychologists in dental schools teach one to three courses to dental and dental hygiene students per year and give guest lectures in other courses. At the University of Michigan School of Dentistry the students have a behavioral science course in their first term, which covers dental fear and pain, communication with the patient, and oral health promotion. In the second term of their first year, they have two behavioral science courses. The first class focuses on communicating with patients from different social groups such as children, older adults, persons from different ethnic/racial backgrounds, with different sexual orientations, different disabilities, or diseases.
The second course is a Behavioral Science Practicum in which each of approximately 100 students is videotaped three times in interactions with patients. The first interaction is with a typical patient while the student takes a medical/dental history. The second interaction is with a peer as a patient during a dental cleaning, and the third interaction is with a regularly scheduled patient in the health education section of a dental exam. These videotaped interactions are self-evaluated, peer-evaluated, and instructor-evaluated. They are also discussed in small group settings. Guest lectures are given to undergraduate dental students as well as to dentists in the graduate specialty programs. Orthodontic graduate students learn, for example, about patient cooperation with orthodontic treatment and communication, and the pediatric graduate students learn about child development, the role of the family, and communication with children and parents. All teaching is only truly successful if the knowledge base of psychology is applied clearly to the professional situation - which means that psychologists need to be motivated to self-educate about dentistry.
Research activities are a function of the faculty member's own interests and the fit of these interests with important research questions in the dental setting. In 1991, I published a book entitled Reactions to Critical Life Events - A Social Psychological Analysis, which served as a starting point to explore the role of stress in oral health. This interest developed into a focus on the outcomes of oral health care and how oral health affects a person's quality of life (Inglehart & Bagramian, 2002). Oral health-related quality of life is a truly psychological topic that can alert dentists to the fact that they treat patients and not teeth. It is at the core of every patient's interest in oral health promotion and the utilization of oral health care services. Patients want to have a good quality of life, which includes the abilities to chew and bite, speak and smile. They do not want to live with acute or chronic oral-facial pain, andthey want to feel good about the way they look. Dentists need to be aware of these facts and to act accordingly. This concept of oral health-related quality of life is also important in light of the findings in the first U.S. Surgeon General's Report on Oral Health from the year 2000. This report pointed to tremendous oral health disparities and the lack of access to oral care for large segments of the U.S. population. Psychologists are well equipped to conduct research that documents the personal suffering, for example, of young children who cannot sleep through the night and cannot pay attention in school because of dental pain that is due to poor oral health and a lack of access to care. In this sense, psychologists can contribute to connecting the technical aspects of dentistry with the bigger picture that oral health plays in a person's life. Interdisciplinary collaborations on research projects are of course crucial in this context.
Service to the dental school community is a function of a psychologist's own interests and the needs perceived in an organization. The services can include being a research mentor for clinicians and students who want to study psychosocial outcomes of dental care, serving on committees, or providing insights from one's own discipline. A specific example of service as it played out in one university is that the perceived need for better education about treating patients with different disabilities led not only to the creation of a committee on treating such patients, but also to the provision of monthly, free continuing education programs on this topic for students, staff, and faculty members. These service activities offer a great opportunity to find common interests with other members of the dental school community and to work collaboratively in interdisciplinary teams.
The life of a psychologist in a dental school is interesting, but it can lack discipline-specific intellectual stimulation at times. Reaching out to colleagues in a psychology department and working collaboratively is therefore crucial. An adjunct appointment in a psychology department also opens the door for faculty to teach students who self-select into courses, rather than only students who are required to take the courses.
On the whole, there are benefits to working in this nontraditional setting. In many instances, a psychologist can be a patient advocate. Sometimes it feels like exploring an uncharted domain. The challenges are those that all psychologists face when they enter a nontraditional field. There are dangers of being seen as second-class citizens, and as less scientific than other faculty members, because "everybody knows about psychology." The major challenge is to ensure that cross-discipline communication is successful and does not break down. Whenever the challenges seem to outweigh the benefits, I find it useful to think of Moscovici's work on minority influence. He tells us to be persistent, consistent, and to have a positive self-esteem. He points out that in the end, history shows that progress and change are brought not by the majority, but by minority members who persist. The change in dentists' perspectives from treating teeth to treating patients might be slow, but psychologists can definitely contribute to it.
REFERENCES
Inglehart, M.R. (1991). Reactions to Critical Life Events: A Social Psychological Analysis. New York: Praeger Publishers.
Inglehart, M.R., & Bagramian, R.A. (Eds.). (2002). Oral Health-Related Quality of Life. Quintessence Publishing Company.
