Reducing anxiety in new dental patients by means of leaflets

Fifty adults, consecutive attenders at a dentist who was new to them, were selected. They completed the Spielberger State Anxiety Inventory before and after they had read one of two different leaflets in the waiting room. One, the informative leaflet, included information about pain control and stop signals. A comparison leaflet did not include this information but acknowledged, sympathetically, that many people are nervous of dental treatment. The leaflet also provided some explanations for that fear. Both leaflets were designed, according to published evidence, to be easily read and understood. The layout drew attention to the most important points. State Anxiety decreased significantly only in the patients who read the informative leaflet (P < 0.01). This occurred before the patients met their new dentist. Those patients given the informative leaflet rated it as much more helpful than those given the comparison leaflet (P = 0.007).

Burning mouth syndrome: the relationship between the HAD scale and parafunctional habits

This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.

Assessment of anxiety in hospital patients

There has been research in North America to validate the nursing diagnosis of anxiety. As part of this work, Young used the defining characteristics and developed a tool to measure anxiety. The present research sought to extend that study in the United Kingdom, assess the anxiety-defining characteristics tool and identify key indicators of anxiety that might be useful in clinical practice. Four anxiety measurement tools, drawn from the literature, were used. These were the state trait anxiety inventory, the graphic anxiety scale, the hospital anxiety and depression scale, and the anxiety-defining characteristics tool. A random sample of 79 hospitalized patients were interviewed and their anxiety rated using all four measures. Calculation of Spearman's correlation co-efficients revealed convergent validity between the anxiety-defining characteristics tool and the state trait anxiety inventory and the anxiety score on the hospital anxiety and depression scale. Anxiety levels were found not to be affected by the age or sex of the respondent, or the length of stay or number of previous admissions. Discriminant analysis suggested that six characteristics adequately discriminated anxious subjects: sweating, faintness, tendency to blame others, continual review of things in their mind, focus on self and a lack of self-confidence. The study concluded that there is a scope for further research into these characteristics and their use in clinical practice.

Dutch students' dental anxiety and occurrence of thoughts related to treatment

The present study was intended to explore the relationship between individuals' level of dental anxiety and thoughts (both self-statements and mental images) related to dental treatment. Subjects were 210 psychology students (75 males, 135 females). The results showed that 98% of the subjects reported one or more negative or catastrophic thoughts. A significant positive relationship was found between reported severity of anxiety (S-DAI scores) and frequency of thoughts. The results indicate that dental anxiety is associated with the tendency to experience negative or threatening thoughts concerning treatment.

Smoking and trait anxiety

Smoking behavior was not associated with manifest anxiety scores for a sample of 91 college students.

An evaluation of four methods of assessing the behaviour of anxious child dental patients

The aim of this study was to evaluate four behavioural scales which have been used to assess anxious children during dental treatment: The Frankl (F), Houpt (H), Visual Analogue (VAS) and Global Rating (GR) scales. The study measured the agreement on three of the scales (F, H and VAS) between two judges expert in the management of anxious children and also between four other dentists. The operating dentists scored each visit using the fourth scale (GR). Twenty-nine anxious children aged 3-16 years who had been referred to a specialist clinic were included in the study, and 64 separate visits were recorded on videotape. The two-judge panel evaluated the children's behaviour on all 64 visits, and the four-judge panel evaluated a 12-visit segment. Comparisons within and between the two-judge and four-judge panels showed close agreement on the Visual Analogue and Houpt scales but not on the Frankl scale. There was significant correlation between the Global Rating scale and the Visual Analogue, Houpt and Frankl scales.

Differential diagnosis of odontophobic patients using the DSM-IV

Categories of extreme anxiety for dental treatment were derived using DSM-IV psychiatric criteria. A sample of 40 men and 40 women patients with extreme dental anxiety were initially evaluated with Dental Anxiety Scale (DAS), Trait Anxiety Inventory (STAI-T) and Geer Fear Scale (GFS). Patients all had DAS scores > or = 15 indicating extreme dental anxiety and were further evaluated with clinical interviews, Dental Fear Survey (DFS), Dental Beliefs Survey (DBS) and Mood Adjective Checklist (MACL). Results showed that 46% of 80 patients complained mainly of powerlessness and embarrassment about dental treatment while also having greater DBS scores than other categories, i.e. social phobia. Another 19% reported conditioned specific phobias (pain, drilling, injection, etc.) most often and lower DBS and GFS scores than other groups; while 35% had broader general anxiety complications, such as multiple phobias and agoraphobia with or without general anxiety symptoms (higher GFS and STAI-T compared to others). Symptoms of general anxiety disorder (GAD) were present in 30 of 80 patients, who had greater STAI-T and GFS and lower MACL scores than non-GAD patients. These results have implications for appropriate treatment strategies.

Validity of the Children's Dental Fear Picture test (CDFP)

The validity of the Children's Dental Fear Picture test (CDFP) was investigated in 146 Swedish children aged 5-12 yr. The CDFP was compared with dental fear scores on Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), selection criteria for testings (dentally fearful/not dentally fearful), and with level of general fear measured by the Short Form of Children's Fear Survey Schedule (CFSS-SF). Dental fear in the CDFP was closely related to high scores on CFSS-DS and CFSS-SF. The CDFP proved to be a valid instrument to diagnose dental fear in children with values of sensitivity up to 98.5%.

[Psychological profiles of patients with bronchial asthma. First report: analysis according to the difference in severity of asthma]

Although it is well known that asthma is influenced by psycho-social factors, the present medical system does not take any measures to deal with these underlying factors. Many physicians are unable to assist patients with psycho-social problems due to the lack of time they are allowed for each patient. We have employed a variety of psychological test scales to assist in screening patients. As a result, we found that many severe asthmatics lack enthusiasm for therapy, possess pessimistic feelings toward their prognosis. They also have personality traits of extroversion in combination with psychological instability, which may given them problems of compliance, while some manifest a tendency to flight to illness. These factors may lead to further difficulty in treatment, including steroid dependency and death from asthma. Early intervention must be contemplated to prevent such outcomes.

Anxiety reduction with nitrous oxide: a permanent solution?

Anxiety scores of highly fearful children were registered during a control period after their curative treatment. The average length of the control period was seventy-two weeks. The anxiety scores of the children who were treated curatively with the aid of nitrous oxide were significantly lower than those of children from a behavioral management group. All the semiannual check-ups were performed without the use of nitrous oxide. Anxiety scores of all the children during the control period correlated closely with the anxiety scores of the curative treatment before and after the control period. It was concluded that nitrous oxide helps children to lower their anxiety levels during a long period after treatment. Influencing anxiety in highly anxious children might be characterized as a long-term process.

Motivational effects of anxiety on psychomotor performance

The Hull-Spence theory of anxiety drive (A) was tested in a psychomotor learning situation in which both correct responses (R+) and competing responses (R-) were evoked by the task. Measures of A-Trait and A-State were obtained from 151 women and 52 men, all of whom were then exposed to a sequence of 16 trials on a mirror-tracking task presented either continuously or with 2-min. intertrial intervals. Analyses of the effects of A were then performed on samples of 68 women and 16 men drawn from the tails of the A distributions. Theoretical predictions about the effects of A on initial scores and performance trends of both R+ and R- were strongly supported, somewhat more so within the A-State classification than within the A-Trait classification owing to the larger amount of variance accounted for. Analyses involving intermediate levels of A showed that R+ was a monotonic and essentially linear function of A.

Dental fear in an urban Swedish child population: prevalence and concomitant factors

In order to establish normative data on the dental subscale of children's fear survey schedule (CFSS-DS), measuring child dental fear, and to study the influence of general fears, parental fears and socio-economic correlates on children's dental fear levels, a questionnaire was sent to parents of a representative sample of 4,505 children aged 4-6, and 9-11-years-old in Göteborg, Sweden. The questionnaire contained the CFSS-DS, a short form of the CFSS measuring general fears, Corah's dental anxiety scale (DAS) (measuring parents' dental fear) and specific questions on parents' employment and the native language in the family. A total of 3,204 responses was received. The overall mean score on CFSS-DS was 23.1, and 6.7 per cent of the children were found to be fearful. Dental fear decreased with increasing age and was positively correlated to general fears. Three variables: age, general fears and maternal dental fear, were found to have a significant impact on the variance of CFSS-DS.

Personality characteristics before and after treatment of different head pain syndromes

In order to examine whether, in patients with different types of headache and craniofacial pain, MMPI and STAI scores are significantly different before and after treatment, 114 patients with tension-type headache (n = 34), atypical facial pain (n = 20), temporomandibular joint dysfunction (n = 36), migraine (n = 16), cluster headache (n = 4), chronic paroxysmal hemicrania (n = 2), trigeminal neuralgia (n = 2) were examined. A pain index was calculated (0-10) which quantified pattern, duration and frequency of pain. The Italian MMPI (356 item abbreviated version) and the STAI tests were administered before and after treatment. A paired t-test was used to assess pre- and post-treatment differences, and multiple regression analysis was employed to examine whether such differences correlated with the improvement in the pain index. In the total group after treatment, there was a significant reduction of certain MMPI scores (Hs, D, Hy, Pa, Pt, Sc, Si) and of STAI 1 and 2 scores. Separate analysis confirmed this among women but not among men. No relation was found between MMPI and STAI changes and the degree of improvement as assessed through the pain index. Clinical improvement leads to normalization of MMPI profiles and STAI scores in women. The psychometric data before treatment were not predictive for treatment outcome.

[The effect of stressor experiences and optimism upon stress responses]

The present studies investigated whether or not optimism/pessimism is a cognitive mediator of future depression for people who have experienced many negative life events. Subjects were administered optimism scales, stress response scales at Time 1. They then completed the stressor scale and stress response scales at Time 2, about six weeks later. The results showed the interaction of stressor experiences and optimistic diathesis: Subjects who have higher stressor experiences and higher stable and global explanatory style for negative events showed higher depressive responses. Other indices of optimistic diathesis--Life Orientation, Cognitive Style, and Internality dimension of Attributional Style--did not produce this interaction effect. Moreover, this interaction did not appear in the psychological stress response other than depression. These results were consistent with diathesis-stress model of depression.

Updating a measure of dental anxiety: reliability, validity, and norms

PURPOSE

The Corah Dental Anxiety Scale was introduced in 1969. Since then, changes in dental practice and language usage have dated the scale. The purposes of this study were to (1) slightly modify the scale, (2) assess its reliability and validity, and (3) develop norms for the revised version. The scale modifications recognized the roles of dental hygienists and female dentists in the dental office. Two variations of the first item also were constructed. One asked about going to the dentist "for a checkup¿; the other asked about going "because of a toothache."

METHODS

The revised instrument was included in face-to-face interviews with 662 dentate adults living in the Detroit, Michigan, area. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the revised scale with another measure of dental anxiety and measures of conceptually related variables.

RESULTS

Cronbach's alpha coefficient was 0.82 for the checkup version of the scale, 0.79 for the toothache version, and 0.82 for a scale including both variations of the first item, indicating adequate reliability. Dental anxiety correlated positively with history of dental problems (r = .13, .09, and .10 for the checkup, toothache, and combined versions, respectively), negatively with frequency of preventive dental visits (r = -.28, -.22, and -.25), and positively with another measure of dental anxiety (r = .61, .59, and .62), supporting the validity of the scales.

CONCLUSIONS

The checkup version of the revised scale is recommended for future use. The Dental Anxiety Scale as modified continues to be a reliable and valid instrument 20 years after its introduction.

Dental anxiety, optimism-pessimism, and dental experience from childhood to adolescence

94 adolescents, 58% of the original study group, participated in a 5-yr follow-up questionnaire study to assess the predictive power of self-reported dental anxiety, optimism-pessimism dimension, and previous dental experience on dental anxiety level over the 5-yr period. The mean values on Corah's Dental Anxiety Scale (DAS) and Dental Anxiety Question (DAQ) had increased for the girls and remained stable for the boys. The predictive power of DAS and DAQ on anxiety levels as measured by these same scales 5 yr later was weak to moderate, although statistically significant. The optimism-pessimism dimension and dental treatment experiences did not have any effect on dental anxiety changes from childhood to adolescence. DAS had an independent, weak, but statistically significant negative effect on optimistic disposition over the period. The internal reliability of DAS was high and highly similar results using DAS and DAQ were found. Except for significantly more dental experience in the drop-out group (n = 69) than in the current study group in the first study, there were no statistically significant differences in mean scores between the groups with respect to self-reported and clinical dental anxiety, and optimism. Methodological complications are discussed.

Group therapy compared with individual desensitization for dental anxiety

Effects of group therapy (GT) on extreme dental anxiety were compared with individual treatment (IT). Results by scales of dental anxiety, beliefs or trust in dentists, and fear of the next dentist after specialist treatment showed reduced dental anxiety and improved dental beliefs compared with a static control group of 45 patients. The 30 GT patients showed no significant difference in dropouts during training compared with the 68 IT patients, but for patients who completed treatment, GT (n = 24) had greater dental anxiety reduction than IT subjects (n = 60). GT patients required fewer therapist hours per patients than did either of the two IT methods, but time saved in GT did not reach significance over clinical rehearsal IT. Results at 1-yr follow-up after specialist treatment indicated that dropouts were significantly greater in group therapy. Rehearsal IT performed best for sustained dental care behavior. Group dynamics are discussed and suggestions made for effective and efficient group therapy as well as decision making about choice of treatment.

Predictors of dental anxiety in six-year-old children: findings from a pilot study

The pilot study reported here is based on interviews with sixty, 6-year-old children randomly selected from a school population (and their mothers), to investigate predictors of dental anxiety in this age-group. The results demonstrated that child dental anxiety status was significantly related to dental factors, psychological developmental factors, and maternal factors. When all sixty data sets were entered into a regression analysis, 92 percent of the variance of the relationship of child dental anxiety could be predicted by eight factors in the three categories (F = 7.39, P < 0.001). The study demonstrated that the child's ability to cope with dental treatment (as reflected in reported disruptive behaviors) was based upon his/her degree of psychological development together with the mother's fear of dental treatment. It seems that an interaction exists, in which the role of the mother plays a central part influencing on the one hand the child's degree of psychological development and on the other the child's ability to cope with dental treatment. The findings from this preliminary study suggest that factors such as these should be considered by dentists when assessing their child patients, in order to identify and help the anxious child cope with dental care.

Dental anxiety of parents in an Israeli kibbutz population

The purpose of the present study was to compare the levels of dental anxiety in both parents of children in a kibbutz in Israel. Sixty pairs of parents between 22 and 56 years of age with children aged 1-14 years comprised the study population. The parents were divided into three age groups: 22-34 years, 35-44 years, and 45-56 years. Dental anxiety was assessed by using Corah's Dental Anxiety Scale and Kleinknecht's Dental Fear Survey. The mothers showed significantly higher levels of dental anxiety than the fathers. Within the families dental anxiety of husbands and wives were poorly correlated. Mothers in the 35-44-year age group displayed the highest scores of dental anxiety. Among the fathers, dental anxiety was highest in the youngest age group (22-34 years). The mean Corah score for the combined group was much higher than those reported for patients in private clinics in Sweden and in the USA. The results suggest that mothers in their mid-thirties to mid-forties merit special support with regard to the dental situation.

The anxiolytic effects of intravenous sedation using midazolam alone or in multiple drug techniques

This study examines four drug combinations (midazolam, midazolam-midazolam, fentanyl-midazolam, and fentanyl-midazolam-methohexital) in a placebo-controlled double-blind clinical trial of intravenous sedation. It tests the hypothesis that there is no difference between the anxiolytic effect of the four combinations when compared with a saline placebo. Subjects were 207 mildly anxious young adults having their third molars removed. Cognitive measures of anxiety increased from preoperative levels in the placebo and both midazolam groups (P < .05). The anxiety response remained the same in the fentanyl-midazolam and fentanyl-midazolam-methohexital groups (P > .05). The level of successful anxiolysis ranged from 24% in the placebo group to 74% in the barbiturate group. Using the log likelihood method, comparisons suggest that the drug groups (from midazolam alone to the methohexital combination) have increasingly positive anxiolytic effects even when controlling for the effects of dental fear and intraoperative pain. The fentanyl-midazolam group is 8.1 and the methohexital group is 9.0 times more likely to have had a favorable outcome than the placebo group. Additional analyses of behavioral measures of anxiety yielded parallel results. Global evaluations after surgery were related to the success of anxiolysis for subjects in the active drug conditions (P < .05).

The effect of children's dental anxiety on the behaviour of a dentist

Two groups of children were given the Child Manifest Anxiety Scale to measure their general anxiety and the Venham Picture Scale to assess their dental anxiety. The experimental group consisted of children who had been referred with a specific problem of anxiety. The control group had been referred for dental problems other than anxiety. The two groups of children did not differ with respect to general anxiety but the experimental group showed significantly higher scores on the scale of dental anxiety, indicating that dentally anxious children are not always anxious in other situations. The children were treated by one dentist and, during treatment, the behaviour of the dentist was observed and measured using the Weinstein Dentist Behaviour Scale. It was found that the dentist changed his behaviour when dealing with anxious children and adopted some, but not all, of the anxiety management techniques that have been found in previous studies to reduce stress of dentally anxious children.

[Assessment of QOL in cancer drug therapy using 22-item questionnaire]

In order to integrate quality of life as the end point in the cancer drug therapy, a questionnaire form has been developed over the past four years by a Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare, Japan. Fifty-one items generated by questionnaires were forwarded to oncologists, nurses, psychologists and 121 patients. Then questionnaires were scaled down to 36 items based upon factor analysis considering correlation to State-Trait Anxiety Inventory (STAI) and Self-rating Depression Scale (SDS). These 36 items were administered to 536 patients. Finally, a 22-item questionnaire was completed by rechecking correlations with PS, STAI, SDS and Cronbach's alpha. It includes such components as physical activities (6 items), psychological (5 items) and social variables (5 items), symptoms (5 items) and global well-being (1 item: face scale). In our treatment of G. I. cancer by chemotherapy, NC patients showed improvement (+1.56 score), especially in physical functions (+2.43 score), but with slight deterioration (-0.25 score).

Cognitive correlates of dental anxiety

This study examined cognitive correlates of dental anxiety among 24 highly anxious patients and 17 low-anxious patients. In both groups, anxiety expectations, dental trait anxiety, and state anxiety (in the waiting room and in the dental chair) were rated. Negative cognitions and cognitive control were also assessed. It was found that dentally high-anxious patients claimed to experience more negative thoughts than those with low anxiety (p < 0.001). None of the highly anxious patients reported relatively few negative cognitions, and none of the patients in the low-anxiety group reported relatively numerous negative cognitions. While patients from both groups reported that cognitive control declined with the imminence of treatment, highly anxious patients were found to have less control over their negative thoughts (p < 0.001). A series of stepwise regression analyses revealed that both the number of negative cognitions and perceived cognitive control accounted for 75% of the variance in dental trait anxiety. The results of the present study suggest that cognitive activities, such as negative thinking (catastrophizing) and cognitive control, are important moderators of dental anxiety.

Psychological distress in patients attending an oncology clinic after definitive treatment for maxillofacial malignant neoplasia

Although management of malignant tumours of the mouth and salivary glands generally involves joint consultation with radiotherapists in dedicated oncology clinics, patients' preferences or psychological needs in this environment have not been investigated prospectively, particularly for those on long-term review after treatment. In this prospective study, therefore, psychometric data were collected from a series of 40 consecutive review patients by questionnaires completed on the day of consultation. The following established psychometric tests were used: the Hospital Anxiety and Depression Scale and the General Health Questionnaire. Patients' reactions to duration of consultation, advice given, opportunity to ask questions, and number of staff present were also investigated by a standard structured questionnaire. Forty-seven per cent of patients exhibited symptoms of psychiatric disturbance; 33% were anxious, and 15% were depressed, preoccupation with physical symptoms being the most frequent problem. Explanations of continuing physical symptoms were particularly highly valued because these were often wrongly interpreted by the patients as evidence of recurrence. No patient objected to the presence of students and only one to the presence of more than 10 members of staff. However, 18% requested one-to-one discussion in addition.