Objectives. This review documents published obsessive-compulsive disorder (OCD) cases with dental and oral conditions with potential impact on the dental procedure. The research question was, what are the psychiatric and behavioral features of people with OCD that might affect dental sessions? Methods. This review followed the PRISMA guidelines (PROSPERO registration No. CRD42020212371). Six databases (PubMed, Scopus, Web of Science, LILACS, Cochrane Library, and PsycINFO) were screened for published clinical studies that report dental patients with obsessions or compulsions behaviors as identified by National Institute of Mental Health (NIMH). Inclusion of the studies was performed according to the eligibility criteria. The quality evaluation was carried out using the Joanna Briggs Institute’s (JBI) Critical Appraisal Checklist. The results were qualitatively assessed for synthesis. Results. After elimination of duplication, 530 articles were screened, and 35 articles were evaluated for eligibility. 17 studies met the inclusion criteria (8 case reports, 5 cross-sectional studies, 1 longitudinal cohort study, and 3 case-control studies) and were included in the review. All case reports demonstrated symptoms of obsessions or compulsions such as fear of germs and contamination, aggressive thoughts, having things symmetric in perfect order, excessive cleaning or handwashing, repeatedly checking things, and compulsive counting. OCD-related behavior was assessed in the included clinical investigations using standardized protocols such as Florida Obsessive-Compulsive Inventory, Symptom Checklist-90-Revised, 4-item Corah Dental Anxiety Scale, Diagnostic and Statistical Manual of Mental Disorders, and the Crown Crisp Experimental Index. Quality assessment of the 17 included articles revealed 14 articles with low risk of bias and 3 articles with moderate risk of bias. Conclusion. The reported OCD symptoms may implement psychological difficulties during dental procedures without affecting the outcome. Although there was no contraindication for planning or performing dental treatments for a patient with OCD, dental-related procedures and protocols might be modified for successful dental appointments.
1. Introduction
Obsessive-compulsive disorder (OCD) is a severe psychological disorder, with global prevalence of 2-3% [1]. The major characteristics of OCD include obsessional debilitating inner thoughts associated with repetitive behaviors [1]. OCD can be presented in four types of obsessive symptoms as identified by the National Institute of Mental Health (NIMH) including (1) fear of infection, germs diseases, and contamination; (2) aggressive thoughts against self or others; (3) impious thoughts; and (4) worries about symmetry and perfectionism [2]. According to these intrusive thoughts, obsessive patients feel the urge toward some behaviors as frequent washing and cleaning, checking things repetitively, and compulsive counting. OCD always shows two modes of onset. By approaching 11 years of age, the first peak starts and then in the early adulthood the second peak begins. Almost by 10 years of age, symptoms appear in around 20% of the affected population [3].
Several psychological symptoms might hinder the success of dental procedures and can give the dentist hard time during treatment periods. Due to fear of infection, patients with OCD may be distrusted about the disinfection and cleanliness of the materials, tools, table, and dental chair, which may irritate the dentist. Therefore, taking a complete medical history, including psychiatric, along with consulting the patient’s psychiatric physician is a vital step to avoid dental problems or oral conditions. Moreover, dentists should be aware of OCD diagnostic criteria as they might be the first ones to suspect that their patients may be diagnosed with OCD by correlating patient’s behavior with OCD diagnostic criteria. In this context, this review aims to familiarize dentists with OCD behavioral characteristics that were reported in dental clinics, which could be helpful to complete dental treatment sessions of patients with OCD successfully.
2. Materials and Methods
2.1. Protocol and Registration
The protocol of this review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [4]. Registration of the protocol was done in International Prospective Register of Systematic Reviews (PROSPERO) platform with the Centre for Reviews and Dissemination at the University of York under code CRD42020212371.
2.2. Review Question
The focus question in this review was, “what are behavioral characteristics of individuals with OCD in dental clinics?”
2.3. Search Strategy
A structure online database search was conducted independently by the two reviewers the till the 24th of December 2020. Searches were performed on six different electronic databases: PubMed, Scopus, Web of science (WoS), Latin American & Caribbean Health Sciences Literature (LILACS), Cochrane Library, and PsycINFO. The organization and duplicated articles exclusion were carried out by EndNote online (Thomson Reuters, Philadelphia, USA). For each database, numerous words’ combinations were done including “Obsessive compulsive disorder” AND “Dental” OR “Dentistry” OR “Periodontal” OR “Periodontitis” OR “Gingiva” OR “Orthodontic” OR “Dental implant” OR “Maxillofacial” OR “Teeth” OR “Tooth” OR “Tooth Extraction” OR “Pediatric dentistry” OR “Dental prosthesis” OR “Denture” OR “Bleaching” OR “Caries” OR “Amalgam” OR “Composite” OR “Oral lesion” OR “Tongue” OR “Edentulous” OR “Endodontic” OR “Pulp.”
2.4. Eligibility Criteria
Articles of this review were chosen based on the PICOS elements (Table 1), where population (P) = dental patients diagnosed with OCD, intervention (I) = different dental procedures, comparison (C) = dental patients free from OCD, outcome (O) = clinical difficulties during dental treatment sessions, and study design (S) = published case reports, case series, cohort, cross-sectional, case-control, or randomized clinical studies. Only articles that were published in English language were considered.
PICOS
Inclusion criteria
Exclusion criteria
Population
Patients having dental or oral condition and diagnosed with OCD.
Patients with or without psychological disorder other than OCD.
Intervention
All dental procedures including preventative, conservative, or maxillofacial surgeries.
Medical interventions without dental contribution.
Comparison
Mental and psychologically normal dental patients.
Dental patients with psychiatric disorder other than OCD.
Outcome
Practicing difficulties associated with patients with OCD in dental clinics.
Clinical practicing complications related to people with OCD in nondental clinics.
Study design
Published case reports, case series, cohort, cross-sectional, case-control, or randomized clinical studies.
Conference abstract, editorial correspondence, book chapters, studies not involving human subjects, or review articles