Giving Teeth to Psychological Science

“The NIH Dental Institute has a psychological science program?”

We’re accustomed to hearing that question from our behavioral science colleagues when we describe the behavioral science programs we oversee at the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health. The answer is an enthusiastic “Yes!” NIDCR’s mission is to improve oral, dental, and craniofacial health through research, research training, and the dissemination of health information. As many of the conditions of interest to the institute have strong behavioral and social components, psychological research is essential to achieving our mission. The NIDCR Strategic Plan of 2009-2013 states this explicitly and highlights our objective to increase “the Institute’s commitment to basic and applied research in the behavioral and social sciences.” This short introduction to the NIDCR is intended as an invitation to members of the psychological science community to apply our behavioral and social expertise to the challenges faced in the oral health field.

The most common oral diseases are dental caries (i.e., “cavities”) and periodontal disease (i.e., “gum disease”). The etiologies of these diseases are largely known, with health behaviors playing an essential role. Dental caries is caused by the build-up of acid-producing bacteria that erode protective tooth enamel and underlying tissue. Except in rare cases, dental caries is preventable by removing bacteria via regular tooth brushing and proper flossing, fortifying enamel with fluoride, and minimizing the extent to which the teeth are bathed in carbohydrate-rich foods that feed caries-causing bacteria (Featherstone, 2000). Additional factors contribute to dental caries as we age, including use of medications that reduce protective salivary flow; abuse of tobacco, alcohol, and some other drugs; and an increased reliance on caregivers for maintaining oral hygiene. The role of behavior in dental caries is so widely recognized that a recent international task force convened by the World Dental Federation suggested that caries be redefined as “an example of a behavioural disease with a bacterial component…” (p. 231).

Although oral care providers are well-equipped with clinical approaches to restore cavitated teeth, most providers do not have extensive training in behavior change. As psychological scientists focus on behavior and behavior change, the tools of psychological science have the potential to dramatically advance oral health care. Below are a few illustrative examples:

• Understanding how children learn and maintain healthy habits could lead to new approaches to coaching parents and caregivers and to enhancing school curricula about oral health.
• New applications of behavioral economic findings to oral health could lead to creative ways of “making the healthy choice the easy choice,” where the choice involves diet, oral hygiene, accessing care, and others.
• Research advances in message framing, risk perception, and emotional processing might provide specific guidance in ensuring effective provider-patient communication in the dental clinic and in developing effective public health campaigns.
• The dental setting may provide an opportunity to study how and why providers make practice changes and to test contemporary approaches to screening, brief intervention, and referral to treatment for oral-health relevant conditions (HIV, diabetes, tobacco use, drug abuse, eating disorders, safe sports participation, interpersonal violence, etc.).

Dental caries is only one of many oral, dental, and craniofacial disorders of interest to the NIDCR. Among the others are periodontal disease (i.e., “gum disease”); craniofacial anomalies (e.g., cleft lip and palate, craniosynostosis); craniofacial injuries (e.g., from sports, vehicular accidents, interpersonal violence, etc.); oral and pharyngeal cancers; salivary disorders, such as Sjogren’s syndrome; oral infections (e.g., candidiasis, human papillomavirus, apthous ulcers); and orofacial pain, such as temporomandibular disorders. Each of these disorders has a unique set of behavioral and social correlates, and each calls out for the contributions of psychological science. We at the NIDCR hope that you will hear this call and consider applying your expertise to the challenges of oral health.

References

Featherstone, J. D. B. (2000). The science and practice of caries prevention. Journal of the American Dental Association, 131, 887–899.

Frencken, J. E., Peters, M. C., Manton, D. J., Leal, S. C., Gordan, V. V., & Eden, E. (2012). Minimal intervention dentistry for managing dental caries: A review. International Dental Journal, 62, 223–243.

National Institute of Dental and Craniofacial Research. (2009, May). NIDCR Strategic Plan 2009-2013 (NIH Publication No. 09-7362). Retrieved from http://www.nidcr.nih.gov/Research/ResearchPriorities/StrategicPlan/