Spring 2013

Why Do We Avoid Health Care?

Brain science may offer answers

By Gail Bambrick

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Photo: Chris Hartlove

Fear of pain and general anxiety about the dentist cause many patients to neglect their oral health. Kelly Kimiko Leong, D14, is conducting basic research at the National Institutes of Health to identify what parts of the brain are activated when we make such decisions—science that could lead to a better understanding of the issues that prompt patients to avoid seeing a dentist or physician.

“I have always been interested in what motivates or prevents people from taking care of their health,” Leong says. “In dentistry, we often focus on maintenance, or correcting a problem, such as filling the cavity. But if you’re scared to come to the dentist because you have anxiety, how can we alleviate these worries so you will want to take care of yourself?”

Leong, one of only four dental students in the country selected for the inaugural class of the National Institutes of Health (NIH) Medical Research Scholars Program, is spending this year at the NIH campus in Bethesda, Md.

She’s working at the National Institute of Mental Health, in the lab of cognitive neuroscientist James Blair, where researchers are using functional magnetic resonance imaging (fMRI) to determine which neural pathways are activated when we face a decision involving a moral component

While an MRI produces images of internal body structures, such as bones or organs, an fMRI measures brain activity by detecting changes in blood flow. When an area of the brain is active, blood flow to that region also increases.

Blair’s lab focuses on understanding children with psychological disorders and behavioral problems. While this may seem a far cry from dental anxiety in adults, the basics of how the brain functions when we make decisions could have implications for many kinds of human behavior.

Leong’s assignment is to establish a baseline range of responses of mentally healthy adult subjects confronted with a series of moral issues. She presents them with scenarios that illustrate “care-based” morality (someone inflicting harm on another person) as well as “social convention” morality (a boy going into a girl’s bathroom). While undergoing an fMRI, study subjects are asked to decide, on a scale of 1 to 4, if an action is acceptable or unacceptable.

These kinds of decisions usually prompt activity within the limbic system and temporal cortex regions of the brain. Leong and her colleagues use the fMRI to look even more closely to identify the specific neural pathways that show increased blood flow and oxygen, a signal known as the BOLD (Blood Oxygen Level Dependent) response.

Once these adult baselines have been established, researchers can compare them with the responses of children with psychological and behavior problems who will undergo similar tests.

Leong says she’s always been equally intrigued by research and human behavior (she did her undergraduate work in psychology and molecular and cell biology at the University of California, Berkeley). Before coming to Tufts School of Dental Medicine, she was a student researcher at the University of California, San Francisco’s Marshall Laboratory, where she investigated dental implant materials that promote maximum bone healing around the implant.

She is hoping to find a niche in the dental profession that will allow her to meld her interests in psychology, neuroscience and dental research. Her mentors at NIH have advised her to let her career evolve in line with her passions. She sees research as key to eliminating the emotional and technological barriers that can hamper the delivery of accessible, state-of-the-art dental care.

“To make a mark on how we work, to change the way we look at procedures and to innovate dental technology is really something very special,” Leong says. “I think if we can encourage dental students in their research pursuits, it could have a great impact on the whole profession.”

Gail Bambrick, a senior writer in Tufts’ Office of Publications, can be reached at gail.bambrick@tufts.edu.

 

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