Psychological problems of the physically handicapped patient.

There is increasing concern about the difficulty encountered by handicapped patients in obtaining adequate dental health care. In addition to the problems of availability and accessibility of dental care there are social and psychological problems affecting the acceptability of dental health care. To overcome these difficulties the dentist must understand the bases of his own perceptions as well as those of his patients which interact in the dentist-patient treatment situation. Although many of the physical problems can be solved by such measures as wheel chair ramps, the major difficulty is the social acceptability of the handicapped. The same degree of handicap may cause different problems depending on the way in which the individual adjusts to it. Orofacial defects cause particular difficulties because they cannot be hidden in the same way as, for example, a missing or deformed limb. Often the relatively minor defects encountered in dental practice may cause greater problems than a more major deformity, since the near normal person strives harder to be considered as normal. Studies of babies' responses to normal and abnormal facial appearances have demonstrated the tremendous importance of the facial area in communication. Smiling responses were common with a normal face whereas grotesque faces induced anxiety in children. In later life facial abnormalities tend to evoke both aesthetic and sexual aversion so interfering with the process of social interaction. The dentist must become more aware of the psychological state of physically handicapped patients and of his own reaction to them.