Treatment modalities in a dental fear clinic and the relation with general psychopathology and oral health variables

OBJECTIVE

To assess differences among highly anxious dental patients assigned to different treatment modes (i.e. behavioural management (BM), nitrous oxide sedation (NOS), intravenous sedation (IVS). Patients were compared with regard to psychological and dental variables before treatment (e.g. number of decayed teeth), and dental variables after treatment (e.g. number of fillings made).

DESIGN

Dentists experienced in the treatment of highly anxious patients allocated patients to a treatment mode based upon their clinical judgement.

SETTING

Centre for Special Dental Care, Amsterdam, The Netherlands.

SUBJECTS

211 patients from this dental fear clinic.

MEASURES

General psychopathology, as measured by the Symptom Checklist 90 (SCL-90), and dental anxiety (DAS, S-DAI, 10-point scale) were measured prior to treatment. From the panoramic radiograph the following pre-treatment dental variables were assessed: number of teeth, number of decayed teeth, number of retained roots, and number of root-filled teeth. After treatment, number of fillings, extractions, endodontically treated elements, number of visits, and treatment duration, were determined from the patients' records.

RESULTS

Of the 144 patients who received dental treatment at the clinic, 46.5% was treated using a BM approach, 27.8% with NOS, 22.9% with IVS, and 2.8% under GA. No differences among the treatment groups were found with regard to SCL-90 and dental anxiety. The results showed that patients in the IVS group had statistically significant more decayed teeth than patients in the BM group. Furthermore, more fillings were made in the IVS group than in the BM group.

CONCLUSION

Since it appeared possible to treat a large proportion of patients by BM alone, training dentists in the application of psychological methods for the treatment of anxious patients should be stimulated. In addition, future research should seek for variables that, besides oral health, are better able to discriminate between groups of highly anxious patients than measures of dental anxiety and psychopathology.

Age of onset of dental anxiety

Little attention has been given to the issue of the age of onset of dental anxiety, even though it may have a bearing on the origins of this type of fear. This study aimed to identify the age of onset of dental anxiety and to identify differences by age of onset with respect to potential etiological factors, such as negative dental experiences, family history of dental anxiety, and general psychological states. Data were collected by means of two mail surveys of a random sample of the adult population. Of 1420 subjects returning questionnaires, 16.4% were dentally anxious. Half, 50.9%, reported onset in childhood, 22.0% in adolescence, and 27.1% in adulthood. Logistic regression analyses indicated that negative dental experiences were predictive of dental fear regardless of age of onset. A family history of dental anxiety was predictive of child onset only. Adolescent-onset subjects were characterized by trait anxiety and adult-onset subjects by multiple severe fears and symptoms indicative of psychiatric problems. The three groups were similar in terms of their physiological, cognitive, and behavioral responses to dental treatment. However, adolescent- and adult-onset subjects were more hostile toward and less trusting of dentists. These results indicate that child-onset subjects were more likely to fall into the exogenous etiological category suggested by Weiner and Sheehan (1990), while adult-onset subjects were more likely to fall into the endogenous category.

[Experience in the study of the effects of lead on the health status of children in Belovo]

Lead releases in Belovo town containing metallurgy enterprise had reached 120 tons/year earlier, but in recent years have decreased to 9 tons/year. Reduction of the production induced decrease of lead levels in the ambient air from 0.7-2.3 mg/m3 in 1994 to 0.001-0.24 mg/m3. Lead concentration in the soil ranges from 30 to 3000 mg/kg. Lead levels were measured in serum of 91 children, in hair of 67 ones and in teeth of 15 children. Serum lead levels in children aged 7-8 years varied from 0.5 to 39 mg/dl, with an average of 9.9 mg/dl (SD is 5.2 mg/dl), geometric mean is 8.5 mg/dl and error of geometric mean is 3.3. 46% of the children had serum lead levels exceeding the normal one (10 mg/dl). Average lead level in the hair equaled 4.5 mg/g (SD is 4.9 mg/g). The children living in towns with higher environmental lead levels demonstrated more frequent anxiety and changes in higher psychic functions. The major points influencing the serum lead level are proximity to highway, dietary load of goods grown near the residence, mother's smoking. Biokinetic model describing lead transfer into the blood helped to evaluate various modes of the enterprise functioning and efficiency of some environmental protection measures. The most efficient are measures aimed to lower dietary intake of lead, less efficiency is associated with measures reducing lead levels in air, dust and soil.

A study of psychological stress created in dentists by children during pediatric dental treatment

Stresses on dental practitioners arising from pediatric examination and treatment can be broadly divided into those produced by the child and those produced by the child's guardian (usually the mother). The present study examined the psychological influence of the child. A series of questions regarding psychological stress caused by child patients was administered to a group of dentists and, by factor analysis, reduced to a 21-item scale. The effectiveness of this instrument was examined for reliability and validity. The following results were obtained: 1. The 21 items in the scale were selected for their association with three primary factors: stress from mild resistance behavior, stress from moderate resistance behavior, and stress from determined resistance behavior. 2. The scale demonstrated high internal consistency and, by test-retest, high stability over time. 3. High scores on a standardized scale for psychological stress in everyday life were found to correlate positively to scores on the scale created in the present study. The correlation was significant beyond the 5 percent level. Confirmatory factor analysis found factor loading for all items of 0.50 or greater, with no duplication of factors within items. Both tests confirmed the validity of the scale. The above results indicate that the scale created in the present study is an effective instrument for measuring psychological stress in dental practitioners created by children during pediatric dental treatment and examination.

Factors predictive of anxiety before oral surgery: efficacy of various subject screening measures

Recruiting anxious people for analgesic and anxiolytic studies allows greater opportunities to study the positive effects of anxiolytic medication. The purpose of this study is to describe a population recruited for a study of anxiolytic medication using the third molar model and to evaluate the relative efficacy of different measures of dental anxiety as recruitment tools. A concerted effort was made to recruit anxious subjects. The following measures were tested: Corah's Dental Anxiety Scale (DAS), Kleinknecht's Dental Fear Survey (DFS), Litt's Oral Surgery Confidence Questionnaire (OSCQ), and Spielberger's State-Trait Anxiety Inventory. The influence of prior experience with tooth extractions on anxiety was also assessed. Subjects who had previously experienced tooth extraction reported higher anxiety before oral surgery than did subjects without such experience. DAS, DFS and state anxiety scores correlated with anxiety reported before oral surgery. However, OSCQ scores and trait anxiety were not related to anxiety reported before surgery. Linear regression indicated that the DFS predicted anxiety before oral surgery best of all measures that were used. Kleinknecht's DFS is thus recommended for use as a tool for recruiting anxious patients.

Dentists' behavior in response to child dental fear

Dental fear is a multifactorial problem frequently encountered during dental treatment of children. Studies have indicated that, among others, the behavior of the dentist may play a part in the development of this dental fear. The present study was undertaken to examine the behavioral aspects of the dentist-patient relationship, and specific dentists' behavior that can reduce dental fear. The behavior of forty children referred to a center for special dental care and of two dentists was assessed during treatment. T-test results showed that the children's level of fear decreased after treatment (mean 3.2 vs. 2.1, t = -5.6, p = .000). In addition, it was found that the dentists behaved more directly and authoritatively during the treatment of highly fearful children than during the treatment of relatively less fearful children (p < or = .034). It seems that this direct approach had a positive, long-term effect on these children's fearful behavior during treatment.

Psychologic factors and oral lichen planus. A psychometric evaluation of 100 cases

OBJECTIVE

The purpose of this study was to analyze the importance of psychologic factors in patients with oral lichen planus, and attempts were made to identify possible personality features characteristic of patients with oral lichen planus.

STUDY DESIGN

The study involved 100 patients with oral lichen planus (group 1) and 50 control subjects (group 2). We applied the following psychometric tests to both groups: Spielberger State-Trait Anxiety Inventory, Cattell Personality Questionnaire 16PF, Hassanyeh Rating of Anxiety-Depression-Vulnerability, Beck Depression Inventory, Raskin Depression Screen, and Covi Anxiety Screen.

RESULTS

The patients with oral lichen planus were found to exhibit greater anxiety, as reflected by statistically significant scores with the anxiety tests that were used (Spielberger State-Trait Anxiety Inventory, Cattell Personality Questionnaire 16PF, Hassanyeh Rating of Anxiety-Depression-Vulnerability, and Covi Anxiety Screen). The patients with oral lichen planus likewise exhibited greater depression than the controls in all 3 depression tests applied (Beck Depression Inventory, Hassanyeh Rating of Anxiety-Depression-Vulnerability, and Raskin Depression Screen) and were more vulnerable to psychic disorders on the basis of the PD subscales (vulnerability) of the Hassanyeh questionnaire. Three features (conformity to the group, astuteness, and rebelliousness) defined the personalities of our patients with oral lichen planus, according to the Cattell 16PF questionnaire. Finally, those patients with erosive lichen planus exhibited higher depression scores than patients with nonerosive lichen planus.

CONCLUSIONS

Despite the higher anxiety scores observed in patients with oral lichen planus, it was not established that the observed psychologic alterations constitute a direct etiologic factor of oral lichen planus; nor was it established that such alterations are a consequence of oral lichen planus and its lesions.

[Overattendance at primary care: a study of psychosocial factors]

OBJECTIVE

To determine the effect of various psychological and social factors--family function, social support, psychological malaise and social class--on frequency of attendance.

DESIGN

Study with cases and controls.

SETTING

Health Districts Girona-3 and La Bisbal.

PARTICIPANTS

Criteria for inclusion: being older than 14, being on a list as a user, and having been seen at least once during the study period. The person over-attending is defined as someone attending 7 or more times in a year. The normal attender attends less than 7 times. The sample was 441 patients (209 cases and 232 controls).

MEASUREMENTS AND MAIN RESULTS

The Smilkestein family Apgar and the DUKE-UNC social support questionnaires, and the Goldberg anxiety and depression scale, were administered. Social class was defined according to the job of the head of the family. Statistical analysis was undertaken in two steps: firstly, bivariate analysis; and second, multivariate. The social support and age variables were related to frequency of attendance: they explained 8.1% of it (through multiple regression). Depression increased by between 1.21 and 2.58 the risk of over-attending and explained 10.53% of the variability of over-attendance, in line with the logistical regression analysis.

CONCLUSIONS

The psychological and social variables studied fail to explain most of the variability. We should demystify the importance of psychological and social factors in the use of health resources.

Repressive and defensive coping styles predict resting plasma endorphin levels in the elderly

Jamner, L.D., Schwartz, G.E., 1986, Psychosom. Med. 48, 211-223, have proposed that repressive and defensive coping are associated with greater central endogenous opioid activity. They reasoned that high-defensive (HD) participants' attenuated distress, increased pain tolerances, attenuated somatic symptomatology, and accentuated reports of positive emotions are consistent with actions of centrally active opioid peptides. The present study assessed plasma beta-endorphin (END) levels, Marlowe Crowne Social Desirability Scale (MCSD), and Taylor Manifest Anxiety Scale (TMAS) scores in men (n = 6) and women (n = 20) between the ages of 59 and 79. Contrary to predictions, HD had lower plasma endorphin levels than did low-defensive (LD) participants. Raw MCSD scores correlated negatively with endorphin levels. Findings were significant for women only, which may have been due to the small sample of men. The results are discussed as they related to the hypothesis that defensiveness involves alteration of central opioid systems.

[Measurement of anxiety state in women: a short-form scale]

BACKGROUND

Clinical epidemiology and psychosocial studies often take into account the measurement of anxiety. Our objective was to develop and validate a short form scale of anxiety state from the Spielberger's State Trait Anxiety Inventory (STAI-Y), one of the most widely used scales.

METHODS

This study was carried out on French samples of women with different levels of anxiety. The first step was to select from the original 20-items scale, the items susceptible to compose two short forms scales: an 8-items (18-STAI) and a 5-items (15-STAI) one. It was carried out on patients attending cancer genetic clinics (n1 = 160, n2 = 41). The second step was carried out on 3 other samples of women (n3 = 150, n4 = 167, n5 = 105) and measured the psychometric characteristics of the short-form scales obtained previously.

RESULTS

The correlation coefficients between the short-forms and the complete 20-items form were very high (> 0.90) in particular for the 18-STAI (r > 0.95). Both short forms are sensitive to change. The internal consistency measured by Cronbach-alpha was comparable to the original scale. The results obtained with the 18 scale and another 10 items Spielberger's short-form scale are comparable and better than those with the 15 scale.

CONCLUSION

The 18 French short-form scale, balanced with positive and negative items, can be recommended for the measurement of state anxiety when the complete form cannot be used.

Reliability and validity of the short version of the Dental Anxiety Inventory

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patients filled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s=5.7) was somewhat higher than for men (mean=38.8, s=6.9) (t(306)=2.35; P=0.019). Cronbach's alpha for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS (P<0.001) and 0.69 (P<0.001) with the 10-point scale. The results indicated that the S-DAI has good reliability and construct validity. It was concluded that the S-DAI is easy to administer in general dental practices and dental fear clinics and has satisfactory psychometric qualities.

Catastrophizing, anxiety and pain during dental hygiene treatment

OBJECTIVES

This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment.

METHODS

Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale - Revised, and were asked to rate the degree of pain they experienced during the scaling procedure.

RESULTS

Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were significant predictors of pain, even when controlling for gender, and oral hygiene status.

CONCLUSIONS

The findings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.

Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence.

Choice of anaesthetic and healthcare facility for third molar surgery

A prospective investigation was carried out to find out which factors affected the choice of anaesthetic for 444 consecutive patients (153 male, 291 female, age range 15-85) listed for extraction of third molars. Two hundred and seventy-two were listed for treatment under general anaesthesia, 120 (44%) as inpatients and 152 (60%) as day cases. The remaining 144 (32%) patients were to be treated under local anaesthesia and 28 (6%) with additional intravenous sedation. Logistic regression analysis showed that difficulty of surgery, patients' anxiety, patients' preferences, medical history, and number of teeth to be removed were important predictors of choice of anaesthetic. From an anaesthetist's perspective, many more patients should have been treated under local anaesthesia with intravenous sedation and fewer should have been listed for inpatient extraction under general anaesthesia.

The Dental Subscale of the Children's Fear Survey Schedule: a factor analytic study in The Netherlands

The Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) is a well-known instrument for assessing dental fear in children. Previous studies have shown that the scale has acceptable reliability and validity. Factor analysis using scores of a group of Finnish schoolchildren resulted in three factors. No other data on the factor structure have been published. In order to report on the factor structure of the Dutch parental version of the CFSS-DS, the present study was undertaken. Factor analysis using scores from a group of Dutch children (n= 150) demonstrated a factor pattern fairly similar to the results found in the Finnish study. Three factors were found: 1) fear of highly invasive dental procedures, 2) fear of less invasive aspects of treatment and 3) fear of medical aspects. Considering that almost all items load substantially (> or =0.20) on more than one factor, it seems that one primary underlying dimension exists: fear of invasive treatment aspects. The CFSS-DS is proposed as a reliable, one-dimensional measure of dental fear.

[Changes in psychological features in patients for anesthesia and operation during perioperative period]

The purpose of this study was to assess perioperative changes in psychological features of patients receiving anesthesia and operation. Anxiety level and desire for obtaining information were evaluated in 37 patients using the Amsterdam preoperative anxiety and information scale (APAIS) at three points: before and after the preanesthetic examination, and 3 to 5 days after the operation. Anxiety scale (4-20) and information scale (2-10) scores decreased postoperatively from 9.8 +/- 3.8 to 7.3 +/- 3.4 and from 6.1 +/- 2.1 to 4.1 +/- 1.9, respectively. There was a significant but weak correlation (rs = 0.35) between the anxiety scale and information scale before the preanesthetic examination. The postoperative information scale score correlated well with preoperative anxiety scale score (rs = 0.61), and this correlation was higher than with preoperative information scale score (rs = 0.37). When patients were divided into two subgroups, namely patients with (U, n = 12) or without (non-U, n = 25) an increase in postoperative information scale score, anxiety scale score before the preanesthetic examination tended to be higher and the postoperative anxiety scale score was significantly higher in the U group than in the non-U group. We conclude that we should provide more information to the patients who have higher anxiety scale score before the preanesthetic examination regardless of their degree of desire for information.

The fear survey schedule for children-revised (FSSC-HI): ethnocultural variations in children's fearfulness

A revised Fear Survey Schedule for Children was used to examine the structure and developmental pattern of fearfulness in an ethnoculturally diverse sample of 385 Hawaii schoolchildren aged 7 to 16 years. The instrument's psychometric properties compared favorably with previous versions of the FSSC, and a 7-factor solution provided the best conceptual fit for the data. Six factors were similar to those described in previous versions of the FSSC, whereas the seventh was unique, reflecting children's social conformity fears. Between-group comparisons revealed significantly less fearfulness in children of Caucasian than of Asian, Filipino, and Hawaiian ethnocultural backgrounds. Gender and age differences were similar to previous reports in finding greater fearfulness in girl than boys, and in younger than older children on most factors. Results corroborate previous reports concerning gender and age trajectories of fearfulness and indicate that culture may mediate the expression of fears in culturally diverse populations.

Stress in elective dental treatment: epinephrine, norepinephrine, the VAS, and CDAS in four different procedures

This study focuses on progressive stress during defined, elective dental treatments, expressed in VAS, CDAS, and catecholamine excretion in urine. Fourteen male patients had avoided dental treatment for years; all were classified as ASA risk score I. The different dental sessions were: first visit after many years; check-up (nonpainful and nontraumatic); drilling and restoring under local anesthetics; drilling and restoring without local anesthesia; and extractions. Urine collection was performed directly before and after the sessions to measure epinephrine and norepinephrine concentrations. Anticipation stress was registered in the VAS, CDAS, and epinephrine excretion. Progressive stress was reflected in epinephrine increase, which discriminated between the different elective dental treatments.

Self-report measurements of dental anxiety and fear in children: a critical assessment

This article reviews self-report measurements frequently used to assess dental anxiety in children. The main focus is on their reliability and validity. For this purpose correlations between the reviewed measurements and other measurements of dental fear in children are considered, as well as their possible ambiguity with respect to scoring procedures and their ability to discriminate between fearful and non-fearful children. Results show that all three questionnaires discussed are open to criticism. It is concluded that of the self-report measurements, the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) is to be preferred to both Corah's Dental Anxiety Scale (DAS) and the Venham Picture Test (VPT). The reasons for this are the following: the CFSS-DS covers more aspects of the dental situation; it measures dental fear more precisely than the other scales; normative data are available on this scale; and it has slightly superior psychometric properties.

Oral midazolam for conscious sedation of children during minor procedures

OBJECTIVE

To compare the safety and efficacy of two doses of oral midazolam, and to assess the drug induced amnesia obtained, when used for conscious sedation of children undergoing minor procedures in the accident and emergency (A&E) setting.

METHODS

A two stage trial was completed: an initial prospective, double blinded, randomised trial comparing 0.2 mg/kg midazolam suspension with 0.5 mg/kg, followed by further data collection on the higher dose. Children whom staff and parents felt required sedation for accurate and humane completion of minor procedures were selected. Anxiety was measured using physiological parameters, a behavioural anxiety score, a parental visual analogue scale, and a telephone questionnaire at 2-7 days after the procedure.

RESULTS

Fifty patients in total were recruited. Randomisation between two doses ceased after 20 patients since staff, despite being "blinded", perceived there to be a wide variation in response to midazolam and attributed that to the difference in doses. On breaking the code these suspicions were partly supported. Due to reluctance to continue with the lower dose all children subsequently received 0.5 mg/kg. At this higher dose oral midazolam had an onset of action of 15 minutes and was effective in 76% of children (as measured by anxiety score and/or subsequent amnesia). Amnesia was reported in 66% of children. There were no adverse side effects except paradoxical hyperagitation in three (6%); this did not require any specific treatment. General anaesthesia was avoided in at least eight children in whom the procedure would not have been attempted without midazolam. Altogether 90% of parents said they would like it to be used again should similar circumstances arise.

CONCLUSIONS

At 0.5 mg/kg oral midazolam appears safe and is effective in sedating most children for minor procedures. Its use should be considered by all A&E departments dealing with children.

Dental anxiety among patients undergoing endodontic treatment

The purpose of this study was to evaluate the dental anxiety expressed among patients undergoing endodontic treatment with respect to some social and dental parameters. The dental records of 98 patients, 42 men and 56 women who were referred for root canal treatment to an endodontist, were examined. Patients completed a Dental Anxiety Scale (DAS). Dental experience, time of last visit to the dentist, and symptoms of tooth were recorded. The mean DAS scores were higher than scores reported in other countries (9.4 +/- 3.3). Women demonstrated higher dental anxiety than men. Patients with higher education demonstrated lower dental anxiety. No difference was found between patients experienced in endodontic treatment and those who were not, patients who suffered previous pain in the treated tooth and patients who did not. Women in their mid-thirties to mid-forties and men in their twenties expressed the highest DAS scores.

The ability of Corah's Dental Anxiety Scale and Spielberger's State Anxiety Inventory to distinguish between fearful and regular Norwegian dental patients

The purpose of this study was to test the ability of Corah's Dental Anxiety Scale (DAS) and Spielberger's State Anxiety Inventory (STAI-S) to distinguish between fearful (n = 145) and regularly attending (n = 156) Norwegian dental patients. The reliability of both instruments was high (Cronbach's alpha indices > 0.95). With DAS, 90% of the fearful patients and 85% of the reference patients were correctly assigned to their appropriate group. Thus it may be concluded that, when used on a Norwegian population, DAS is a valid instrument for distinguishing fearful patients from those regularly attending dental treatment. The corresponding figures for STAI-S were 80% for the fearful patients and 79% for the reference patients. Although not developed specifically for this purpose, this instrument may therefore still validly be used to distinguish between the groups. The correlation between the instruments was 0.76, indicating that to some extent they measure the same phenomenon.

Dental fear and anxiety in an adult Icelandic population

This study was carried out on a random sample drawn from participants in a population-based survey in Reykjavík, Iceland. The sample consisted of 1548 people, men and women, born in 1914-63 (age range, 25-74 years) who lived in and around Reykjavík and a rural area in southern Iceland. The results from a single, modified Dental Anxiety Question (DAQ), designed to classify fear or anxiety into five different levels or categories, were compared with respect to age, oral status, extent of edentulousness, and education level. Of the whole sample 10% admitted to having considerable or more than considerable fear, while 5% classified their fear as extensive or more than extensive. Only 0.3%, however, said that it prevented dental visits. Fear was influenced by sex, as significantly more women experienced some level of fear (P < 0.001) and described their fear as considerable or extensive (P < 0.001). Fear was more common in the younger age groups among both sexes. A significant correlation was found between the number of decayed teeth and anxiety among the men, and patients of both sexes who admitted to fear had significantly fewer fillings. Fear was significantly more common in the rural than the urban population (P < 0.001). Edentulousness, or number of remaining teeth, did not seem to be significantly reflected in the extent of dental fear. People with higher education levels reported less dental fear.

Propofol and fentanyl compared with midazolam and fentanyl during third molar surgery

PURPOSE

The purpose of this study was to measure the safety and efficacy of propofol combined with fentanyl as sedative agents during third molar outpatient surgery.

PATIENTS AND METHODS

A double-blind, prospective, randomized clinical trial involving 57 patients undergoing removal of third molars under intravenous sedation between November 1994 and December 1995 was performed. Patients randomly received either propofol and fentanyl (P + F, th = 24) or midazolam and fentanyl (M + F, M = 33). Patient demographics, Corah anxiety scores, and physiologic parameters were determined preoperatively. All medications were titrated to the same clinical end point for sedation. Intraoperative physiologic parameters, cooperation, alertness, and pain scores were assessed. Postoperative recovery and degree of amnesia also were determined.

RESULTS

There were no significant differences in either patient demographics or surgical characteristics between groups. The P + F group was significantly less cooperative than the M + F group. Pain during injection of propofol was a significant adverse side effect. Both groups experienced a small percentage of apneic episodes, but mechanical ventilation was never required. There were no differences in recovery between groups as measured by the Treiger dot test and psychomotor recovery scores. The degree of anterograde amnesia was greater for the M + F group, although the difference was not statistically significant. Sedation was rated good to excellent by the patient, surgeon, and observer, and there were no statistically significant differences between groups.

CONCLUSION

Propofol appears to be a safe and efficacious drug for use during outpatient oral surgical procedures.