Spring 2013 - Tufts University School of Dental Medicine

word of mouth
Why Do We Avoid Health Care
Brain science may offer answers by Gail Bambrick
ear 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.
Kelly Kimiko Leong,
D14, wants a career that
melds her interests in
psychology, neuroscience
and dental research.
6 tufts dental medicine spring 2013 Photo: chrIs hartlove