|Year : 2018 | Volume
| Issue : 1 | Page : 10-15
Relevance of yoga in dental education
Padma Yog Sadhana, A Unit of Terna Public Charitable Trust, Navi Mumbai, Maharashtra, India
|Date of Web Publication||11-Jun-2018|
Padma Yog Sadhana, Above Auditorium, Terna Dental College, Sector 22, Plot 12, Opposite Nerul Railway Station, Nerul West, Navi Mumbai - 400 706, Maharashtra
Dental education is associated with a significant amount of stress and anxiety which may lead to depression and suicidal intent in few cases. Musculoskeletal disorder is also a prevalent occupational health problem in dental professionals. This alarming situation indicates a need to modify the current education system and provide timely interventions for physical and psychological health of our future dental professionals. There is a need to develop multidisciplinary team approach of integrating dental education with yoga to promote students' health and facilitate effective health-care services to the patients. This paper attempts to identify the application of yoga in dentistry and explores the possibility of incorporating yoga in dental education. Benefits of yoga greatly contribute to preventive dentistry and oral medicine as add-on therapy complementary to standard dental procedures. Yoga offers a promising, cost-effective, complementary, preventive, and therapeutic modality. Yogic practices are useful in quitting tobacco addiction. Yoga can be beneficial for comprehensive and sustained dental care and oral health. Dental professionals with knowledge of yoga can analyze, diagnose, and prescribe yoga for therapeutic benefits to their patients and help them reduce anxiety during dental treatment. Including yoga in dental curriculum will facilitate dental students to manage patients effectively, reduce occupational hazards, cope with stress, and improve academic performance. In future, more competent dental professionals with improved work efficiency will be produced. Incorporating yoga in dental education will facilitate positive health and well-being of future dental professionals, effective patient care, and improved health-care services to the community.
Keywords: Dental education, oral health, yoga
|How to cite this article:|
Deshpande A. Relevance of yoga in dental education. Yoga Mimamsa 2018;50:10-5
| Introduction|| |
Dental education is associated with a significant amount of stress, and this has increased along the years (Abu-Ghazaleh, Sonbol, & Rajab, 2016). Students are exposed to different stress factors in different stages of dental education which may have a negative impact not only on their physical and mental health (Deshpande & Chari, 2014; Al-Omari, 2005) but also on their academic performance (Westerman, Grandy, Ocanto, & Erskine, 1993). A study carried out in Chennai, India, concluded that, there was a corresponding increase in cases of depression with every increase in cases of stress among the students (Reddy, Naveenm, Prabhu, Preethi, & Ahmed, 2013). A study carried out in India (Bathla, Singh, Kulhara, Chandna, & Aneja, 2015) analyzed the anxiety, depression, and suicidal intent in undergraduate dental students and it was observed that the students of the first and final year reported higher anxiety and depression whereas suicidal intent was reported almost the same throughout the study sample.
Musculoskeletal disorder is also a significant occupational health problem in dental professionals. Shaik, Rao, Husain, & D'sa, (2011) described work-related musculoskeletal disorders among dental surgeons and reported that majority of the dental surgeons (73.3%) experienced stiffness in the back and 23.3% experienced severe pain in their neck. Majority of the dentists (87.2%) suffer from at least one symptom of musculoskeletal diseases at some point in their life (Valachi & Valachi, 2003). These symptoms are a product of many risk factors including prolonged static postures, static strains in the entire head and torso area (Ohlendorf et al., 2017), repetitive movements, and poor positioning (Karwouski, Marras, & Raton, 1999). If regularly occurring pain or discomfort is ignored, the cumulative physiological damage can lead to an injury (macro change) or a career-ending disability (Valachi & Valachi, 2003).
The alarming rise in stress, anxiety, depression, suicidal intent in dental students, and occupational hazards of musculoskeletal disorders associated with the dental profession indicate a strong need to modify the current education system and provide timely interventions for physical and psychological health of future dental professionals. Several studies have suggested different ways of coping stress for dental students. Alzahem, Van der Molen, Alaujan, & De Boer, (2014) suggested the need for stress management programs in dental education to cope with the huge impact of stress on dental students. There is a need to develop multidisciplinary team approach of integrating dental education with yoga to promote students' health and facilitate effective health-care services to the patients and society.
In view of this, the present paper attempts to identify the application of yoga in dentistry and explores the possibility of incorporating yoga in dental education.
| Relevance of Yoga in Dental Profession|| |
Substantial scientific evidence proves yoga's efficacy in the management of musculoskeletal disorders (Allende, Anandan, Lauche, & Cramer, 2017), reducing pain and disability, and safety for practice (Chang, Holt, Sklar, & Groessl, 2016). It helps in maintaining physical, psychological health, and general wellbeing. Benefits of yoga greatly contribute to preventive dentistry and oral medicine as add-on therapy complimentary to standard dental procedures. Yogic practices are useful in quitting tobacco addiction. Integrated approach of including yoga in the dental curriculum will give the students a holistic approach of treating patients more effectively.
Although the evidence is sparse, few studies have analyzed the impact of yoga in the management of musculoskeletal disorders, stress, and anxiety in dental students. It has shown to benefit them at physical, psychological, social and spiritual levels.
Yoga for musculoskeletal disorders in dental professionals
Ramamoorthy et al., (2015) reported that occupational hazards such as musculoskeletal pain and stress are prevalent among dental practitioners, specifically in younger age groups. It was observed that, surprisingly, dentists were not well aware of the health benefits of yoga to treat these occupational hazards.
In a study by Monson, Chismark, Cooper, & Krenik-Matejcek, (2017), practice of biweekly yoga sessions was found beneficial in decreasing musculoskeletal pain in dental hygiene students. Koneru & Tanikonda (2015) observed that for work-related musculoskeletal disorders in dental professionals; yoga was more effective than other modes of physical activities such as aerobics, brisk walk, sports, etc., because of its more controlled nature and its positive effect on the psychological stress. Yoga can help to improve posture and condition the body to prevent injuries and reduce the risk of back, neck, and shoulder pain. The exercises can even be done between patients while waiting for a filling to set or during breaks. Bhavanani (2017) recommended a “yoga break” for dental professionals and suggested few energizing and loosening energizing practices of mudras, dynamic kriyas for psychosomatic harmony, pranayamas to overcome emotional and mental stress, meditation, and relaxation of the body and mind.
Therapeutic benefits of yoga for oral health problems
Yoga offers a synergistic effect through less invasive, natural approach to dentistry in promoting oral as well as systemic health. The holistic approach of yoga gives importance to maintain the hygiene of oral cavity, proper diet, and nutrition as well. Singh (2017) suggested the potential of yoga in the treatment and prevention of oral health problems such as chronic periodontal diseases, dental caries, dry mouth and salivary dysfunction, dental pain, neuralgia and oral complication of diabetes, such as dry mouth, dental caries, Candidiasis, and periodontal diseases. However, there is a need to evaluate these effects scientifically to get incorporated into existing treatment modalities.
Yoga for stress-related oral health conditions
The literature shows a positive relationship between psychological condition and oral health problems. Stress-related oral conditions include dental caries/erosion, gingivitis/periodontitits, bruxism/clenching of the jaw, myofascial pain dysfunction syndrome, aphthous ulcers, oral lichen planus, and burning mouth syndrome (Bhushan, Sandhu, Sandhu, 2014). There is substantial evidence supporting the use of yoga as a complementary or combination therapy for the management of stress, anxiety, and depression (Butterfield, Schultz, Rasmussen, & Proeve, 2017). Eliminating stress with yoga prevents pain and oral health problems. When stress levels fall, muscles relax, teeth clenching reduces, and there are fewer dental caries and oral diseases. Yoga intervention in patients with cervical myofascial pain syndrome resulted in significant improvement in the quality of health, physical capacity (strength), cervical range of motion, decrease in the disability, and pain in a study (Sharan, Manjula, Urmi, & Ajeesh, 2014). The awareness in mindfulness, meditation, relaxation, and yoga can help to release the tension areas in the body and relaxing these muscles can prevent severe complications that require extensive dental treatment.
Stress can also lead to dry mouth, which occurs due to low amounts of saliva production. Dry mouth leads to halitosis (bad breath) and can eventually develop into dental caries and periodontal disease. A few yoga postures such as forward bends, twists, and inverted poses are believed to increase saliva production. The khechari mudra (placing the tip of the tongue along the roof of the mouth towards the back of the nostrils and holding it for some time) is thought to be an effective way to get the salivary glands activated (Carefree Dental, 2016). It is suggested that yoga helps in the prevention and management of lichen planus, a premalignant oral condition which is a psychosomatic disorder resulting from modern lifestyle (Vijender, Saurabh, & Raju, 2016).
Yoga for promoting oral health
Recent research has shown that yoga practices result in promoting oral health care and hygiene. Yoga intervention of rhythmic breathing exercise bhastrika (bellows breath), kapalbhati (passive inhalation and forceful exhalation), bahya pranayama (holding the breath after exhalation), anulom-vilom (alternate nostril breathing), bhramari pranayama (humming bee breath)and udgeet pranayama (deep inhalation followed by exhalation with chanting “Om') for 30 min daily were found to be clinically effective in terms of reduction of debris, calculus, and gingival index factor with improvement in maintenance of oral hygiene and reducing gingival ailments (Singh, 2017).
| Anti-Inflammatory Effect of Yoga|| |
Correlation of yoga and inflammatory markers has been evaluated in few studies, and has shown positive results. In a study by Rajbhoj, Shete, Verma, & Bhogal, (2015), 12 weeks of yoga postures and pranayama practice reduced pro-inflammatory cytokine and increased anti-inflammatory cytokine. Yoga enhances the systemic immunity which in turn enhances the oral defense mechanisms. Impact of yoga on oxidative stress level, pro-inflammatory cytokines and improving immune function can facilitate to reduce the chronic gingival inflammation and improve the health of gingiva (Singh, 2017). Psychological stress is known to affect wound healing. Evidence on psychosocial and relaxation interventions supports improved healing, particularly for surgical wounds (Robinson, Norton, Jarrett, & Broadbent, 2017). Yoga intervention facilitates wound healing and postoperative outcomes as evaluated in a study carried out by Rao et al., (2008) in early operable breast cancer patients undergoing surgery. This may be applicable to oral surgical procedures and needs to be explored through further research.
| Yoga-Based Myofunctional Therapy for Orofacial Development|| |
Yoga-based myofunctional therapy of facial and tongue exercises promote a proper tongue position, improved breathing, chewing, and swallowing. Studies substantiate that it helps in correction of orofacial muscle imbalance and abnormal swallowing patterns which are contributing factors to many kinds of malocclusion (Khemka, Thosar, & Baliga, 2015).
Yoga therapy is useful for the treatment of mouth-breathing habit, lip incompetence, tongue thrust habit, as well as in the correction of thumb-sucking habit and bruxism which have negative consequences, if not treated. Yogic practices such as shitali (cooling breath)and sheetkari pranayama (hissing breath) performed by children can produce correct alignment of teeth avoiding their irregular development (Vijender, Saurabh, & Raju, 2016).
| Yoga for Tobacco De-Addiction|| |
Apart from causing disease, disability and death, tobacco addiction also leads to social, environmental, and economic burdens. This demands timely interventions and implementation of economically viable treatment and prevention strategies for tobacco addictions. Some yogic purification techniques such as jala neti (nasal cleansing with warm water), postures such as bhujangasana (cobra pose), dhanurasana (bow pose), virabhadrasana (warrior pose), ushtrasana (camel pose), deep breathing techniques such as pranayam, sudarshan kriya, relaxation, and meditation are very much useful in quitting tobacco habit. According to recent studies, practicing alternate nostril breathing has immediate reductions in the strength of urges to smoke, reductions in craving, withdrawal symptoms of smoking, and increasing pulmonary function test (Jha & Li, 2017). Yoga cultivates determination and willpower in a smoker, which are the primary strengths needed to quit smoking. Yoga helps in maintaining psychological and emotional balance in the body. It creates awareness to lead a healthy life. The deep breathing in pranayama neutralizes the irresistible cravings for tobacco. Yoga helps quitting tobacco without any side effects. In particular, yoga may offer both behavioral and psychological benefits that may be especially valuable for smokers who are attempting to quit (McClernon, Westman, & Rose, 2004). In a trial of 88 smokers, eight sessions of mindfulness training resulted in greater reduction in cigarette use compared to the widely used American Lung Association Freedom From Smoking program, with a significantly better abstinence rate 17 week after the training ended (Brewer et al., 2011). Bock et al. (2014) investigated the effect of 12 weeks of Iyengar yoga for smoking cessation. This study explores the potential of yoga to improve smoking cessation through any of three mechanisms: (1) reduction of postcessation weight gain and/or concern about weight gain; (2) reducing stress-responsiveness that often leads to relapse; and (3) improving attention and deliberative planning by providing mindfulness training as part of yoga practice.
| Tooth Extraction With Jalandhara Bandha Yoga|| |
It is suggested that tooth extraction can be performed without anesthesia, by jalandhara bandha (throat lock), a unique, wonderful, magical, and cost-effective treatment based on Ayurveda and Yoga. It is associated with minimal bleeding, fast healing and no postextraction complications (Vivek, 2016). The pain (vedna) is decreased by increase of “vata dosha”. “Jalandhara bandha” controls the prana and when tooth is extracted, there is “no pain” because of controlled “vata” (Important Highlights of Benefits of Jalandhara Bandha for Tooth Extraction, n.d.). In this technique, pressure is exerted on trigeminal nerve which blocks pain impulse being passed to brain during extraction and results in successful extraction of tooth without pain. This holds promise for hypertensive and diabetic patients. However, there is little scientific evidence and more directed scientific work needs to be carried out in this area.
| Benefits of Yoga for Dental Patients in Management of Anxiety|| |
Dental treatment is known to evoke response of anxiety, fear, and nervousness in the patients. Yoga can prove to be effective to reduce these feelings of stress in dental patients. Deep breathing exercises alone can help patients relax and stay calm during treatment. Learning to cope with anxiety is almost certain have a positive impact on patients' oral health as they would be less likely to skip their appointments.
Kakodkar, Patil, & Santosh Kumar, (2016) evaluated the effect of a short 10-min chairside yoga session before extraction procedure and observed that it can reduce the anxiety levels and increase the comfort levels among the dental patients. Lovas & Lovas (2007) observed that rapid relaxation for 2–3 min before dental procedures of injecting local anesthetic and focusing on breathing during the dental procedure helps to reduce anxiety and the amount of anesthesia required. During anxiety, the tendency is to tighten up and hold the breath. When the body stays relaxed and breathing is smooth, the discomfort quickly fades away making dental treatment manageable or even surprisingly pleasant. A yoga-based relaxation method is advocated by Dr. Andrew Nette which lets the dental patients “melt” their shoulders just before, and during, the inferior alveolar nerve block, a technique used for local anesthetic injection. Higher rate of painless and successful mandibular blocks were observed with this technique. When the shoulders are relaxed, all pharyngeal and lower facial muscles become flaccid, and the needle can pass effortlessly (Brady, 2012).
| Yoga and Dental Education|| |
Few studies have analyzed the impact of yoga in the management of musculoskeletal disorders, stress, and anxiety in dental students. It has shown to benefit them at physical, psychological, social, and spiritual levels. A study carried out in India on dental students performing their first periodontal surgery found a significant reduction in anxiety following 1 h yoga session for 1 week (Shankarapillai, Nair, & George, 2012). Lovas, Lovas, & Lovas, (2008) proposed introducing a mindfulness practice into the dental curriculum to improve the effectiveness of teaching professionalism. The qualities cultivated through mindfulness meditation practice closely resemble the global attitudes of professionalism. It was suggested that mindfulness practice should help improve attentiveness, self-awareness, acceptance, wisdom, and self-care in dentistry.
Some researchers have suggested including physical fitness course, yoga into health science education. Peros, Vodanovic, Mestrovic, Rosin-Grget, & Valic, (2011) advocated that a physical fitness course included in the dental school's curriculum should offer regular physical fitness workout.
| Students' Perception About Yoga in Health Science Education|| |
In a study on health science, students' perception about yoga the author observed that 96.8% students believe that yoga will help in keeping optimum fitness with balanced physical, mental, and spiritual health. The health science students had overall positive attitude toward yoga, and health. Nearly 89.9% students believed that yoga will help to improve their academic performance. Nearly 88.7% students believed that yoga should be included in health science education curriculum (Deshpande, 2015, p. 68).
| Need for Integrating Yoga in Dental Education|| |
The major drawback of current dental education system is that there is no stress management module in regular training. Yoga offers a promising, cost-effective, well-tolerated complementary preventive and therapeutic modality which can be easily integrated into present dental education. The Government of India through the Ministry of AYUSH is strongly promoting Yoga for the health professional education. Few universities in India have taken initiative to start impletrial of 88 smokersmenting the integration of yoga with modern medicine (Bhavanani, 2017). A holistic health module should be included in the dental curriculum that will be based on the specific needs of dental professionals and feasible to implement. Yoga professionals may be appointed at dental educational institutions to carry out training programs for the students on a regular basis. Dental professionals with knowledge of yoga can analyze, diagnose, and prescribe yoga for therapeutic benefits to their patients and help them reduce anxiety during dental treatment. Including yoga in dental education will facilitate inculcating healthy habits in dental students at early stage of professional career which can be beneficial for them throughout their life. This will help to improve the capability of the students to cope with day-to-day stress, improve physical, and mental health with a more focused approach resulting in better academic performance. In the long term, the effectiveness of these measures is expected to help the students to be more competent in their professional life with better clinical skills and improved work efficiency. Ultimately better dental professionals will be produced which will improve the health-care services in the community, region, and country.
The regulations on graduate medical education, 2012 released by the Medical Council of India allot nearly 4% of the total teaching hours in the first 2 years of MBBS to sports and extracurricular activities including yoga. It is mandatory for students to undergo a 2-month foundation course, which will include yoga and sports, at the beginning of the academic year.
Similarly, the regulating bodies of dental education should consider including yoga in the dental curriculum.
| Conclusion|| |
The alarming rise in stress, anxiety, depression, suicidal intent in dental students, and occupational hazards of musculoskeletal disorders associated with the dental profession indicate a strong need to modify current education system, reform the curriculum and provide timely interventions for physical and psychological health of our future dental professionals. Yoga, being a science and philosophy covering physical, psychological, and spiritual dimensions of health certainly complements with dental education. Dental professionals with knowledge of yoga can analyze, diagnose, and prescribe yoga for therapeutic benefits to their patients and help them reduce anxiety during dental treatment. Incorporating yoga in dental education will facilitate positive health and well-being of future dental professionals, effective patient care, and improved health-care services to the community. Combination of modern dental education and ancient wisdom of yoga with spirituality will give us a holistic healthcare which will prove to be effective for preventive and therapeutic requirements of the community.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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