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Psychogenic symptom of special sense organ — Clinical Guidelines

Overview

Psychogenic symptoms affecting special sense organs in patients with special needs often manifest as orofacial pain or dysfunction, challenging accurate assessment and management due to the complexity of underlying conditions and potential comorbid factors 2.

Diagnosis

Clinical Evaluation: Comprehensive assessment including history and physical examination to identify psychogenic origins 2.

Differential Diagnosis: Rule out organic causes through relevant diagnostic tests (e.g., imaging, blood tests) 2.

Behavioral Assessment: Evaluate for psychological factors and stressors contributing to symptoms 2.

Specialized Testing: Consider psychological evaluations and pain assessment tools tailored for special needs populations 2.

Management

Multidisciplinary Approach: Collaboration between dentists, psychologists, and other healthcare providers 2.

Behavioral Interventions: Cognitive-behavioral therapy and relaxation techniques to address psychological triggers 2.

Pharmacological Support: Use of minimal to moderate oral sedation (e.g., benzodiazepines, propofol) under strict supervision 8 16.

Environmental Modifications: Create a calming treatment environment to reduce anxiety and stress 19.

Special Populations

Pediatrics: Tailored sedation protocols and parental involvement crucial for managing anxiety and cooperation 8 19.

Elderly/Special Needs Adults: Consider medical comorbidities and cognitive impairments when selecting sedation methods 16 18.

Key Recommendations

Employ a multidisciplinary team including dental professionals, psychologists, and medical specialists for comprehensive care 2 (Evidence: Moderate).

Utilize behavioral interventions and psychological support alongside medical management to address psychogenic symptoms 2 (Evidence: Moderate).

Implement individualized sedation strategies based on patient's specific needs and medical history, ensuring close monitoring 8 16 (Evidence: Weak).

Adapt treatment environments to minimize anxiety and enhance patient comfort 19 (Evidence: Expert opinion).

References

1 Fuller AE, Duh-Leong C, Brown NM, Garg A, Oyeku SO, Gross RS. Material Hardship, Protective Factors, Children's Special Health Care Needs, and the Health of Mothers and Fathers. Academic pediatrics 2024. link 2 Lobbezoo F, Parisius KGH, Verhoeff MC. Orofacial pain and dysfunction in patients with special needs, with a focus on interdisciplinarity. Pain 2024. link 3 Whitmore KE, Johnson NL, Park J, Salama S, Sobiesk RJ. Improving Inclusion for Children With Special Health Care Needs in Childcare Settings: Results From a Statewide Survey of Childcare Professionals. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners 2023. link 4 Easterly C, Kim D, Steiner MJ, deJong NA. Childcare and Employment Disruptions in 2020 Among Caregivers of Children With and Without Special Health Care Needs. JAMA pediatrics 2022. link 5 Tuckerman J, Harper K, Sullivan TR, Fereday J, Couper J, Smith N et al.. Using provider-parent strategies to improve influenza vaccination in children and adolescents with special risk medical conditions: a randomised controlled trial protocol. BMJ open 2022. link 6 Stille CJ, Coller RJ, Shelton C, Wells N, Desmarais A, Berry JG. National Research Agenda on Health Systems for Children and Youth With Special Health Care Needs. Academic pediatrics 2022. link 7 Kenney MK, Chanlongbutra A, Fanflick PL, Ferrero A, Kim S, Novoa C. Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017. Disability and health journal 2022. link 8 Lin IH, Huang MS, Wang PY, Huang TS, Chong SY, Chen SL et al.. A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients. Medicine 2021. link 9 Piibe Q, Kane E, Melzer-Lange M, Beckmann K. Patient at Risk: Emergency medical service providers' opinions on improving an electronic emergency information form database for the medical care of children with special health care needs. Disability and health journal 2020. link 10 Warden C, Yun K, Semere W. Using the Children with Special Health Care Needs Screener with Immigrant Families: An Analysis of the National Survey of Children's Health. Journal of immigrant and minority health 2019. link 11 Costich MA, Peretz PJ, Davis JA, Stockwell MS, Matiz LA. Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health. Clinical pediatrics 2019. link 12 O'Connor M, O'Connor E, Quach J, Vashishtha R, Goldfeld S. Trends in the prevalence and distribution of teacher-identified special health-care needs across three successive population cohorts. Journal of paediatrics and child health 2019. link 13 Phillips CD, Truong C, Kum HC, Nwaiwu O, Ohsfeldt R. Post-acute care for children with special health care needs. Disability and health journal 2018. link 14 Campbell BH, Alderman SM. Planning for success: desired characteristics of special operations surgeons, a pilot study. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals 2012. link 15 Boynes SG, Moore PA, Lewis CL, Zovko J, Close JM. Complications associated with anesthesia administration for dental treatment in a special needs clinic. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2010. link 16 Coke JM, Edwards MD. Minimal and moderate oral sedation in the adult special needs patient. Dental clinics of North America 2009. link 17 Glassman P. A review of guidelines for sedation, anesthesia,and alternative interventions for people with special needs. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2009. link 18 Glassman P, Caputo A, Dougherty N, Lyons R, Messieha Z, Miller C et al.. Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry 2009. link 19 Lawton L. Providing dental care for special patients: tips for the general dentist. Journal of the American Dental Association (1939) 2002. link 20 Sneed RC, May WL, Stencel C. Physicians' reliance on specialists, therapists, and vendors when prescribing therapies and durable medical equipment for children with special health care needs. Pediatrics 2001. link 21 Colquhoun JP. The rarity--an acceptable stimulant. Australian family physician 1989. link

Psychogenic symptom of special sense organ