Recognition and management of somatoform disorders

Alan H. Brodine, DMD,

a
and Mary A. Hartshorn, MD
b
University of Rochester, Eastman Dental Center, Rochester, NY
Many clinicians have encountered patients with a somatoform disorder without recognizing the clinical
presentation. Somatoformdisorders can confound a diagnosis, consume inordinate amounts of treatment
time, and may cause treatment failure. Recognition and management of somatoform disorders in
prosthodontic patients is discussed in this clinical report to assist practitioners in avoiding initiation of
prosthodontic treatment for patients with physical symptoms that are caused by a psychologic disorder
rather than organic disease. (J Prosthet Dent 2004;91:268-73.)
Somatoform disorders are psychological disorders
characterized by the presence of physical symptoms that
are not fully explained by a medical condition, the effects
of a substance, or by another mental disorder.
1
Fur-
thermore, the symptoms may cause signicant distress
or impaired social functioning and are not intentional.
1
Individuals with somatoform disorders express psycho-
logical and emotional distress as physical symptoms that
cannot be fully explained by an organic disease, whereas
psychosocial problems are denied.
2
Although the terms
psychosomatic illness and somatization are general syno-
nyms for somatoform disorders, the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-TR)
1
denes 7 distinct somatoform disorders as follows:
somatization disorder is a polysymptomatic disorder
characterized by a combination of pain, gastrointestinal,
sexual, and pseudoneurological symptoms; undifferen-
tiated somatoform disorder is consistent with unex-
plained physical complaints, lasting at least 6 months,
that are below the threshold for a diagnosis of
somatization disorder; conversion disorder is consistent
with unexplained symptoms or decits affecting volun-
tary motor or sensory function that suggest a neurologic
or other general medical condition; pain disorder occurs
when pain is the predominant focus of clinical attention,
and psychological factors have an important role in its
onset, severity, exacerbation, or maintenance; hypo-
chondriasis is preoccupation with the fear of having
a serious disease on the basis of the persons mis-
interpretation of bodily symptoms or bodily func-
tions; body dysmorphic disorder is the preoccupation
with an imagined or exaggerated defect in physical
appearance; somatoform disorder not otherwise specied
is a disorder with somatoform symptoms that do not
meet the criteria for any of the specic somatoform
disorders.
The cause of somatoform disorders is unknown,
but theories suggest aberrant neuronal pathways.
2
Goldberg and Bridges
3
argue that somatoform dis-
orders allow the patient to occupy the sick role while
psychologically unwell, to avoid responsibility for life
predicaments by occupying the position of the suffering
victim, and to suffer less depression by reducing self-
blame.
Prosthodontists may be most familiar with the
importance of psychological factors in the treatment of
denture patients. For example, Hartwell
4
attributed cer-
tain psychosomatic symptoms to menopause, whereas
Wakabayashi et al
5
found that psychological factors were
more important than clinical functional variables in
predicting patient satisfaction with removable partial
dentures. Similarly, Lindquist and Ettinger
6
stated that
patients who are not satised with the esthetics of
technicallyadequatecompletedentures mayexpress their
dissatisfaction as somatic symptoms such as a burning
mouth, excessive tightness of the dentures, inadequate
tongue space, or painful mucosa without ulceration.
Cunningham and Feinmann,
7
as well as several other
authors,
8-10
recommend psychological assessment of
patients requesting cosmetic dental or oral-facial
procedures because dentists, orthodontists, oral and
maxillofacial surgeons, and plastic surgeons are fre-
quently the rst clinicians to encounter patients with
body dysmorphic disorder (BDD). Table I may be used
by clinicians as a guide for determining which patients
requesting esthetic treatment should be referred for
evaluation to rule out BDD before initiation of
treatment. Complaints are usually very specic, and
many patients with BDD erroneously view cosmetic
procedures as a solution to problems.
7
One study found
that 86% of patients with BDD mentioned some aspect
of their face.
11
Other researchers found that burning mouth syn-
drome (BMS) is frequently (71.6%) a comorbid condi-
tion with other psychiatric disorders, and that Type II
nonpsychotic BMS is most appropriately considered
a particular type of somatoform pain disorder.
12
Not
surprisingly, the cost of somatoform disorders to the
health care system is high.
13
Presented at the American Prosthodontic Society Annual Meeting,
Chicago, Illinois, February 2002, and the American Academy of
Restorative Dentistry Annual Meeting, Chicago, Illinois, February
2004.
a
Assistant Clinical Professor, Prosthodontic Residency Program,
University of Rochester, Eastman Dental Center.
b
Private Practice, Clinical Psychiatry, Groton, New York.
268 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 91 NUMBER 3
Many dentists may have encountered patients having
somatoform disorders without identifying the disorder.
Many practitioners have been unable to determine why
well-designed and executed treatment not only did not
improve, but also may have worsened, the patients
symptoms. Such outcomes have emotional, nancial,
and, potentially, legal consequences. Whereas somato-
form disorders cause symptoms that are real, the phy-
siological cause of those symptoms is not organic disease
but rather a psychiatric disorder.
1,2
The challenge is
to recognize somatoform disorders to avoid initiating
treatment for patients whose symptoms cannot be
helped by dental or oral-facial treatment. Although
patients with somatoform disorders having dental or
oral-facial symptoms are relatively uncommon, pro-
sthodontists and other specialists can expect to see
a higher percentage of somatoform disorder patients
than general practitioners, because patients are fre-
quently referred to specialists when the diagnosis is
unclear, the treatment plan is complex, or the patient is
dissatised with the treatment outcome.
Although Okeson and Bell
14
provide excellent in-
formation, there is a paucity of articles in the dental
literature on the topic of somatoform disorders. Votta
and Mandel
15
report that patients with somatoform
disorders frequently present in the Columbia University
Salivary Gland Center and have many salivary com-
plaints, some plausible and some bizarre, for which no
organic pathologic cause can be found. Coulthard et al
16
reported patients with development of symptoms of
seizures, facial pain, lingual paraesthesia, and unilateral
leg weakness after third molar removal. In each situation
organic disease could not account for the patients
symptoms, and, subsequently, a diagnosis of soma-
toform disorder was conrmed. Recognition and man-
agement of somatoform disorders in prosthodontic
patients are discussed to assist practitioners in avoiding
initiation of prosthodontic treatment for patients with
physical symptoms caused by a psychological disorder
rather than organic disease.
RECOGNITION OF PATIENTS WITH
SOMATOFORM DISORDERS
The rst step in recognizing somatoform disorders is
the exclusion of all general medical/dental conditions
that could fully account for the physical symptoms.
Substance-induced causes must also be discounted.
When pain is the chief complaint, all somatic and
neuropathic pain causes must be ruled out. For example,
it is important to differentiate somatoformpain disorder
fromneuropathic pains, such as atypical odontalgia, and
from heterotopic pains such as referred musculoskeletal
pain perceived as dental pain when a more common
cause for the pain cannot be found.
Next in the recognition process is identication of the
features common to most of the somatoform disorders.
When evaluating patients, objective ndings should be
evaluated without undue reliance on subjective com-
plaints.
1
Symptoms and ndings as a whole should be
examined to develop an impression of somatoform
disorder. In the authors experience, the most common
characteristics of prosthodontic patients with
somatoform disorders are as follows: plausible history,
but symptoms not consistent with ndings; history of
symptoms beginning with a single precipitating event;
physical symptoms not under patients conscious
control; history of anxiety/depressive mental illness;
history of lengthy visits, several prior doctors, no
improvement of symptoms; extremely anxious or
quietly despondent appearance; extended duration
(weeks, months, or years) of symptoms; symptoms
consume an inordinate amount of patients time and
attention; symptoms lead to avoidance or curtailment of
social function; the patient attempts to dictate diagnosis
and control treatment; patient cries easily out of
frustration; pain, when present, is poorly localized but
described with precision; pain, when present, varies in
intensity and is usually unilateral; pain when present is
the chief complaint yet the patient does not appear to be
suffering from pain. A precipitating event may be any
Table I. Initial assessment of patients requesting cosmetic
treatment
7
Assessment questions
Reasonable
treatment
request
Possible
BDD
The defect
Is there an actual deformity? Yes No
Is the defect minor? No Yes
The request
Is the request obscure? No Yes
Is the requested change feasible? Yes No
Is there a history of dissatisfaction with
previous treatment?
No Yes
Has the patient been doctor shopping? No Yes
The decision to seek help
Has there been long term planning? Yes No
Is the patient in acute crisis? No Yes
Is there pressure from others? No Yes
Is there support from friends/family? Yes No
The expectations
Are the expressed hopes reasonable? Yes No
The psychodynamics
Is there evidence of the complaint
reecting deeper conict? (such as
poor relationship with parent
who has the same feature)
No Yes
Previous history
Is there a history of past psychiatric
disturbances?
No Yes
Is there a history of severe
maladjustment in life situations?
No Yes
THE JOURNAL OF PROSTHETIC DENTISTRY BRODINE AND HARTSHORN
MARCH 2004 269
dental procedure, such as dental prophylaxis, restoration
placement, difculty removing an impression tray, or
extraction.
The initial interview of typical patients with
somatoform disorders may begin with comments such as
I never had any problem with my mouth until (pre-
cipitating event.) Now I just want to nd someone who
understands this problem(or who can get it right) so I can
go on with my life. Im here because everyone says youre
the best The patients mood may elevate signicantly if
hope of successful treatment is offered, and at the end of
the rst treatment visit, the patient may state feeling
essentially symptom free and be extremely happy with the
treatment provided. At the next visit, or perhaps weeks or
months later, the patient will state that the symptoms are
either unchanged or worse than ever. Symptoms then
often worsen with each successive treatment.
The hallmarks of somatoform disorders are 3-fold:
organic symptoms that are inconsistent with physical
ndings, history of a precipitating event after which the
symptoms began, and unintentional symptoms.
2
Dental
patients may take antidepressant and antianxiety
medications, and these patients may raise suspicion with
regard to what type of reaction may manifest during
dental treatment. However, a history of taking antide-
pressant or antianxiety medications or a history of
another mental disorder when symptoms are consistent
with physical ndings, should not contribute to an
impression of somatoform disorder. It is important to
avoid automatically attributing the patients symptoms
to an existing mental disorder.
In contrast, patients with somatoform disorders
usually deny a history of psychiatric treatment when, in
fact, they may have changed psychiatrists several times in
recent years.
2
Also, these patients are often not
compliant with counseling or medication.
2
An added
complication is that some patients with somatoform
disorders may be treated by several physicians and
dentists at the same time but do not admit to such
concurrent therapies. The patients primary care physi-
cian may be aware of the patients somatoformdisorder,
because the patient may have previously presented
symptoms of nonorganic cause related to other somatic
structures.
To recognize patients with somatoform disorders,
the authors advise completing a thorough clinical
examination, including any appropriate ancillary studies,
without undue reliance on symptoms. Next, determine
whether the physical ndings explain the symptoms.
Have condence in objective ndings or lack of
abnormal ndings. Listen carefully and thoughtfully
assess both the details and overall presentation. Be aware
of the characteristics of somatoformdisorders previously
described. Contact the patients physician and previous
dentists for historical information that the patient may
not have remembered, realized, or revealed. When in
doubt of physical ndings, refer to another dental
specialist for a second opinion. Speak with the dentist to
whom the referral is made, communicating the un-
certainty of ndings and the suspicion of somatoform
disorders.
Some patients present with symptoms of organic
disease concurrent with symptoms of nonorganic origin.
The best approach for this type of presentation may be
to rst provide appropriate treatment for all symptom-
atic organic disease. If symptoms persist, then somato-
formdisorder should be part of the differential diagnosis
and the patient referred for further dental or psychiatric
evaluation.
In addition, patients who have a history of facial
trauma from physical abuse can present with or develop
somatoform disorders and have lower pain thresholds.
2
Patients with such histories may therefore be referred for
psychiatric evaluation before initiating irreversible pro-
sthodontic treatment, and the patient should be in-
formed that performing dental treatment could trigger
a somatoform disorder or another psychiatric disorder,
prompting the patient to make irrational treatment
demands in response to bizarre physical symptoms that
are inconsistent with physical ndings.
Finally, clinicians may nd it helpful to use an
organized psychological assessment (Table I) to evalu-
ate the need to refer patients requesting esthetic
procedures for psychiatric evaluation to rule out BDD
before initiating esthetic treatment.
7
CLINICAL SCENARIOS
A 57-year-old woman presented with a history of
hypothyroidism and was taking ibuprofen for dental
pain. She complained of burning sensations in the left
tongue and oor of the mouth, as well as pressure in the
bone associated with the roots of the mandibular left
second molar and second premolar. The mandibular left
rst molar had been missing for many years. The
symptoms began after her general dentist had difculty
removing the impression tray during fabrication of
a xed partial denture (FPD), spanning from the
mandibular left second molar to second premolar. The
patient presented with individual provisional crowns on
the mandibular left second molar and second premolar.
Clinical and radiographic evaluation revealed no abnor-
mal ndings. The patients symptoms were unchanged
by local provocation, local anesthesia testing, temporo-
mandibular joint (TMJ) loading, and head and neck
muscle palpation. The patients symptoms were also
unchanged after endodontic treatment of the mandib-
ular left second molar and premolar. The patient initially
denied history of psychiatric treatment and history of
treatment by other dentists. However, discussions with
the patients physician and subsequently with her
psychiatrist revealed that the patient had seen at least 6
THE JOURNAL OF PROSTHETIC DENTISTRY BRODINE AND HARTSHORN
270 VOLUME 91 NUMBER 3
other dentists and 4 psychiatrists within the past year. It
was also found that the patient had been hospitalized the
previous year for depression and somatoform disorder
for which the patients symptoms revolved around
perceived hair loss. While hospitalized, the patient
received electric shock therapy, which resolved the
symptoms related to depression and perceived hair loss,
but the patient refused to comply with counseling and
medications. At the time the patient presented for
prosthodontic treatment, there was complete lack of
insight into the somatoform disorder and poor motiva-
tion toward the necessary psychiatric therapy that could
have treated depression and managed the somatoform
disorder. The diagnosis was undifferentiated somato-
form disorder and prior psychotic depressive episode
with somatic delusions. Although it would have been
best to delay nonurgent dental treatment until adequate
psychiatric management was obtained, the mandibular
left second molar and premolar provisional crowns were
replaced with individual complete gold crowns that
completely resolved the patients symptoms for 1 week.
After 1 week the symptoms returned with greater
intensity. Later the patient had the gold crowns
removed by another dentist and was scheduled with
a neurologist for a stellate ganglion block to rule out
atypical odontalgia. No further follow-up could be
obtained. It was apparent that most of the subsequent
dental and medical practitioners involved with this
patients treatment did not recognize the patients
somatoform disorder presentation, nor was there
communication with previous practitioners who could
have provided information related to the patients
disorder. Recognition of this somatoform disorder
would have been facilitated had the treating physicians
and dentists insisted on obtaining the previous medical
and dental records.
A 68-year-old woman presented with a medical
history of mitral-valve prolapse, hypertension, past psy-
chiatric treatment for anxiety disorder, and taking no
medications. She complained of pain in the edentulous
gingiva under the Kennedy Class II precision attach-
ment maxillary removable partial denture replacing the
maxillary left premolars and molars and pain in the
maxillary left canine abutment tooth. The patients
symptoms began after completion of the prosthodontic
treatment 1 year earlier by another prosthodontist.
Clinical and radiographic ndings were within normal
limits. The patients symptoms were unchanged after
discontinued use of the removable partial denture and
after occlusal adjustment of the maxillary left canine
crown. The patients symptoms were also unchanged
during TMJ loading, head and neck muscle palpation,
local provocation, and local anesthesia testing. The
patient accepted the recommendation for re-evaluation
by her psychologist to rule out somatoform disorder.
The patients psychologist conrmed the diagnosis of
generalized anxiety disorder, and the patient became
symptom free with counseling. It was found in the
course of further prosthodontic treatment that the
patients pain returned when her anxiety increased, and
the pain remitted when the anxiety was controlled. The
patient managed her anxiety by repeatedly listening to
audiotapes of consultation and treatment planning
visits. Ultimately, the patient chose to replace the
missing maxillary left premolars and rst molar with
a xed implant-supported prosthesis. She therefore
received left maxillary sinus elevation bone grafting,
placement of 3 root-form implants, and fabrication of
a screw-retained implant-supported prosthesis replacing
the maxillary left premolars and rst molar. The
maxillary left canine required no further treatment,
and the patient has remained symptom free for 3 years
after completion of this prosthodontic treatment.
A 58-year-old man presented with a history of heart
murmur, gastroesophageal reux disorder, and osteo-
arthritis and was taking rofecoxib, terazosin, lan-
soprazole, and diazepam. The patient complained of
such a poor occlusion that he could only eat a liquid diet
and suffered fromexhaustion of the masticatory muscles
bilaterally after masticating any type of food. The patient
also complained that his teeth were generally migrating
away from a normal position and that he suffered from
painful lip chewing, and cheek sucking habits.
Symptoms began 2 years prior. At that time, a large
mesial-occlusal-distal amalgam was replaced in the
maxillary right rst molar. The patient had previously
consulted with an orthodontist and an oral surgeon,
each of whom presented treatment plans involving
aligning crowded teeth and orthognathic surgery to
change the vertical dimension of occlusion as a method
for resolving the patients symptoms. Clinical and
radiographic ndings were within normal limits except
for traumatic lip and cheek lesions, and the patients
symptoms were unchanged with TMJ loading, local
provocation, and head and neck muscle palpation. The
patient also presented with an occlusal guard made 5
years earlier that showed that no change in tooth
position had occurred. The diagnostic impression was
that of severe anxiety disorder with oral focus, under-
lying depressive disorder, and secondary undifferenti-
ated somatoformdisorder. The patient accepted referral
to his primary care physician to rule out somatoform
disorders. Subsequent conversations with the patients
physician revealed that the patient suffered from de-
pression, refused antidepressant medications, and at
subsequent medical visits, no longer complained of oral
symptoms.
MANAGEMENT OF PATIENTS WITH
SOMATOFORM DISORDERS
In managing patients with somatoform disorders,
clinicians should avoid thinking that the patients
THE JOURNAL OF PROSTHETIC DENTISTRY BRODINE AND HARTSHORN
MARCH 2004 271
symptoms can be resolved by retreatment at a higher
level of expertise if the clinical ndings are not obviously
and completely consistent with the symptoms. If there is
doubt, the patient should be referred for a second
opinion. The patient should be informed of other
existing dental problems such as caries or periodontitis.
However, it may be best to recommend monitoring
while delaying treatment of the nonurgent conditions
for which the patient is symptom free until after the
patients presenting symptoms are resolved, because the
patient may perceive such treatment as contributing to
the presenting symptoms.
No curative or ameliorative treatment has been found
for any of the somatoform disorders except conversion
disorder symptoms, which often remit spontaneously or
in response to a variety of accepted treatment methods.
2
Psychiatrists manage the balance of the somatoform
disorders by focusing on coping rather than curing;
however, the depression and anxiety associated with
many of the somatoform disorders may be decreased
considerably by psychiatric therapy.
2
Hamilton et al
17
found in a retrospective case study that anxiety and
depression were documented as contributing to
symptoms in 33% of patients with symptoms un-
explained by organic disease. The authors rec-
ommended referral of such patients for psychiatric
evaluation, because anxiety and depression may be
successfully treated. Patients for whom anxiety and
depression are successfully treated may have resolution
of symptoms without dental or oral-facial treatment
and, subsequently, can be treated as usual for dental or
oral-facial disease that does have an identiable organic
cause.
The clinician should explain to the patient that
a dental or oral-facial cause for the symptoms cannot be
found, but that stress can cause somatoform disorders
that may manifest symptoms of altered and enhanced
pain perception or perception of outward appearance.
Patients often accept an explanation that provides
a tangible mechanism for the cause of somatoform
disorders.
18
For example, the clinician may explain that
somatoform disorders are believed to arise from stress-
induced alteration of neuronal pathways.
19
The clinician
may also nd it helpful to provide an explanatory model
of the symptom process to demonstrate how closely
mind and body are linked. For example, stress can cause
tension headache, increased heart rate, hyperventilation,
or even butteries in the stomach.
19
Somatoform disorders should be ruled out before
initiation of dental treatment. If treatment has already
begun when signs of a possible somatoform disorder
manifest, then treatment may be temporarily suspended
while referral is made to evaluate for somatoform
disorders. This course of action is no different than the
need to refer for evaluation of any other medical
condition that may manifest during dental treatment.
For example, if signs of a possible stroke, uncontrolled
diabetes, or malignant carcinoma manifested during the
course of dental treatment, then temporary suspension
of dental treatment would be warranted until appropri-
ate medical management was accomplished. Evaluation
for somatoform disorders as the cause for symptoms is
part of comprehensive, thorough diagnosis and treat-
ment. The patient may be referred to a primary care
physician or psychiatrist/psychologist for evaluation to
rule out somatoformdisorders. The physician should be
sent a letter detailing the reasons for referral, followed by
a phone call to discuss ndings. The patients symptoms
and history, as well as ndings and recommendations,
should be documented as part of the patients record.
The patients acceptance or rejection of the clinicians
recommendations should be noted.
The clinician may provide patients who do not have
a psychiatrist or psychologist a list of psychiatrists who
treat somatoform disorders. Such specialists are trained
to assist with stress management. Bass and Benjamin
19
have suggested useful responses for patients objections
to psychiatric referral. Some patients will refer to this list
later when reconsidering the clinicians recommenda-
tions, as well as the inability of the previous practitioners
to provide treatment that could resolve symptoms. Alist
of psychiatrists who treat somatoform disorders can be
compiled by contacting primary care physicians and
psychiatric services in local hospitals.
As stated previously, patients with somatoform
disorders other than conversion disorder cannot be
cured and must be assisted by the psychiatrist or
psychologist in coping with the disorder. Prostho-
dontic treatment that is absolutely necessary must be
approached with detailed informed consent that in-
volves the spouse or other close family members.
Informed consent should stress that the necessary dental
treatment is not intended to resolve the patients
symptoms and may result in worsening of the current
symptoms or in occurrence of additional symptoms. The
patient must also be informed that their symptoms are
not related to the necessary treatment, but rather are
caused by a somatoform disorder as conrmed by their
psychiatrist or psychologist.
SUMMARY
Recognition of somatoform disorders may prevent
initiation of dental or oral-facial treatment for patients
whose symptoms are not caused by physical disorders
and can facilitate referral of patients to appropriate
medical practitioners who can diagnose and treat
somatoform disorders.
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Reprint requests to:
DR ALAN H. BRODINE
220 LINDEN OAKS, SUITE 340
ROCHESTER, NY 14625
FAX: 585-248-8643
E-MAIL: abrodine@rochester.rr.com
0022-3913/$30.00
Copyright 2004 by the Editorial Council of The Journal of Prosthetic
Dentistry
doi:10.1016/j.prosdent.2003.12.025
Terminology for implant prostheses
Simon H, Yanase RT. Int J Oral Maxillofac Implants 2003;18:539-43.
The use of systematic terminology for implant prostheses can simplify communication within the scientic
community. However, a reviewof the current literature demonstrates the lack of uniformity in this eld. It is the
purpose of this manuscript to suggest uniform terminology based on conventional prosthodontic terms that
will simplify communication in the profession.Reprinted with permission of Quintessence Publishing.
Noteworthy Abstracts
of the
Current Literature
THE JOURNAL OF PROSTHETIC DENTISTRY BRODINE AND HARTSHORN
MARCH 2004 273
2. Sadock B, Sadock V. Kaplan & Sadocks Comprehensive textbook of
psychiatry. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.
p. 1504-32, 1556.
3. Goldberg DP, Bridges K. Somatic presentations of psychiatric illness in
primary care setting. J Psychosom Res 1988;32:137-44.
4. Hartwell CM. Psychologic considerations in complete denture prostho-
dontics. J Prosthet Dent 1970;24:5-10.
5. Wakabayashi N, Yatabe M, Ai M, Sato M, Nakamura K. The inuence of
some demographic and clinical variables on psychosomatic traits of
patients requesting replacement of removable partial dentures. J Oral
Rehabil 1998;25:507-12.
6. Lindquist TJ, Ettinger RL. Patient management and decision making in
complete denture fabrication using a duplicate denture procedure:
a clinical report. J Prosthet Dent 1999;82:499-503.
7. Cunningham SJ, Feinmann C. Psychological assessment of patients
requesting orthognathic surgery and the relevance of body dysmorphic
disorder. Br J Orthod 1998;25:293-8.
8. Grossbart TA, Sarwer DB. Cosmetic surgery: surgical tools-psychosocial
goals. Seminars in Cutaneous Med and Surg 1999;18:101-11.
9. Edgerton MT Jr, Knorr NJ. Motivational patterns of patients seeking
cosmetic (aesthetic) surgery. Plastic Reconstr Surg 1971;48:551-7.
10. Peterson LJ, Topazian RG. Psychological considerations in corrective
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Reprint requests to:
DR ALAN H. BRODINE
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Copyright 2004 by the Editorial Council of The Journal of Prosthetic
Dentistry
doi:10.1016/j.prosdent.2003.12.025
Terminology for implant prostheses
Simon H, Yanase RT. Int J Oral Maxillofac Implants 2003;18:539-43.
The use of systematic terminology for implant prostheses can simplify communication within the scientic
community. However, a reviewof the current literature demonstrates the lack of uniformity in this eld. It is the
purpose of this manuscript to suggest uniform terminology based on conventional prosthodontic terms that
will simplify communication in the profession.Reprinted with permission of Quintessence Publishing.
Noteworthy Abstracts
of the
Current Literature
THE JOURNAL OF PROSTHETIC DENTISTRY BRODINE AND HARTSHORN
MARCH 2004 273