Fears of the dental situation

Psychophysiological therapy vs. hypnotherapy in the treatment of patients with dental phobia

The aim of this study was to compare two different modes of behaviorally-oriented therapies for dental fear. The subjects were chosen consecutively from the waiting-list of a Dental Fears Research and Treatment Clinic. In addition, a control group was selected from patients treated under general anesthesia to compare levels of dental and general fear with the experimental groups. Twenty-two women, with a mean age of 31.8 yr, were included and randomly assigned to two groups. The median time of avoidance of dental care was 9.5 yr. One group received hypnotherapy (HT) and one group a behavioral treatment based on psychophysiological principles (PP). Both therapies included eight sessions followed by standardized conventional dental test treatments. Pre- and posttreatment measures were dental fear, general fear, mood, and patient behavior. Nine patients were not able to conclude the treatment sessions (6 HT and 3 PP); these patients did not differ significantly from the remaining patients before treatment. The PP group reported a statistically significant decrease in dental fear as well as a rise in mood during dental situations, as opposed to the HT group. General fear levels decreased but not significantly. Eleven patients completed conventional dental treatment according to a dentist's behavioral rating scale, indicating that they were relaxed, and no problems occurred during the treatments. These patients were referred to general practitioners within the community dental service. In conclusion, this small size study showed that a majority of the patients, who accomplished the behavioral therapy and the dental test treatments, became less fearful of dental care and were able to manage conventional dental care, including changing dentist.

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.

Alterations in blood pressure and pulse rate in exodontia patients

The measurement of blood pressure and pulse rate prior to, during and after exodontia was conducted on 60 healthy patients. The aims were to first, investigate the changes in blood pressure and pulse rate, and second, to observe the presence of any clinically significant change over time. Thirty patients attending an Oral Medicine Clinic were used as the control group to allow a comparison to be made between the effects of exodontia and non-invasive treatment. The results suggested that exodontia was the most stressful part of the procedure. Bradycardia during local analgesia was also noted. These changes in the cardiovascular parameters may represent a risk to patients with heart diseases especially those previously undiagnosed. Further, the results indicate the effect stress can have on the cardiovascular system and the importance of eliminating pain and minimizing patient anxiety.

Some problems of dental treatment. Part 2. Treatment avoidance: some differences between regular and irregular patients

Analysis of questionnaire data obtained from 54 irregular patients and 56 regular patients attending the Dental Department of the Lower Hutt Hospital and private practices in Lower Hutt and Wellington, New Zealand indicates that irregular patients are more anxious about dental treatment, value natural teeth less and find dental treatment more unpleasant than do regular patients. These and other survey findings on dental service utilization and dental anxiety suggest that the dental profession has a good deal of control over the way the public utilizes dental services. Most international surveys have found that less than 60 per cent of the population visits the dentist regularly, so there appears to be the potential for a substantial increase in regular use of dental services by the public. But, it is also likely that the longer an individual is remiss in regular dental care and the more teeth are lost, the more difficult conversion to regular visits will be.

Appraisal of dental anxiety and fear questionnaires: a review

This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents' Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. It is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.

Some problems of dental treatment. Part 1. Patient anxiety: some correlates and sex differences

An analysis of questionnaire data obtained from 110 adult patients attending the Dental Department of the Lower Hutt Hospital and four private dental practices in Lower Hutt and Wellington, New Zealand indicates that patient treatment anxiety is more severe in women than men and that it is correlated with patients' descriptions of dental treatment. Altogether, survey findings indicate that treatment anxiety has adverse effects and that, with few exceptions, it results directly or indirectly from unpleasant experiences during dental treatment. Two of the most common of such experiences are evidently pain arising from the stimulation of sensitive tissue and oral injections. The eradication of treatment anxiety is therefore heavily dependent on the unobtrusive induction of profound analgesia prior to painful procedures.

Anxiety about dental hygienist treatment

Although dental anxiety is a well investigated phenomenon in dental health care, remarkably little is known about anxiety reactions related to treatment carried out by the dental hygienist. In the present study anxiety reactions were measured among 101 patients attending the dental hygienist. General level of anxiety was assessed through the PAQ (Photo Anxiety Questionnaire; STOUTHARD, DE JONGH & HOOGSTRATEN, 1991), whereas an additional questionnaire was used to obtain information about specific stimuli and situations that might provoke anxiety in the dental hygienist situation. The results indicated that during dental hygienist treatment only 15% of the patients experienced no feelings of anxiety. Another 15% of the patients reported that a visit to the dental hygienist was more distressing than dental treatment. The level of anxiety appeared to be strongly related to a number of stimuli and situations, with actual pain (78%) and expected pain (67%) major anxiety provoking factors. The relation between pain and anxiety was highly significant, with highly anxious patients having more fear for pain than their low anxious counterparts. Also feelings and sounds of instruments, patient's helplessness and perceived lack of control over what happens were identified as important contributors to anxiety for the dental hygienist treatment. The results of this study suggests that treatment by the dental hygienist is a distressing event for many patients.

The influence of social and ethnic factors on dental care habits and dental anxiety: a study in Israel

The purpose of the present study was to assess the influence of social and ethnic factors on dental care habits and dental anxiety in a group of children resident in Jerusalem, Israel. Four hundred and fifty-six children completed a questionnaire that included 21 questions: nine referred to socio-demographic variables, three concerned the children's dental care habits, and the remaining nine concerned dental anxiety. Social level was determined by the father's occupation and their area of residence. Ethnic background was established according to the mother's or grandmother's country of origin. Chi-squared tests revealed no significant differences between social class or ethnic origin and dental care habits or dental anxiety. Analysis of variance, however, revealed a significant difference between the anxiety reported by boys of the two ethnic groups studied. Dental care habits were good in the majority of the children of all backgrounds, and the level of dental anxiety was low in all groups. It was concluded that ethnic origin had an influence on dental anxiety only in boys, whereas ethnic origin and social class had no influence on dental care habits.

Delayed root canal therapy: an analysis of treatment over time

A retrospective study of 898 teeth receiving root canal therapy was performed to document the sequelae of delayed completion of root canal treatment. Teeth were categorized into a prompt treatment group and a delayed treatment group. Comparisons of prompt and delayed treatment groups were made with regard to preoperative pain, interappointment emergencies, postobturation pain, and final treatment. Findings from this study show that a palliative endodontic procedure is an extremely effective treatment. However, 56% of teeth with incomplete root canal therapy eventually were extracted compared with 2 to 3% for the root canal filling treatment groups. By emphasizing the potential loss of the tooth rather than the potential of interappointment emergencies, the clinician may be more effective in achieving compliance among patients receiving delayed treatment.

Assessment of dental fear. A comparison of two psychometric instruments

To analyze further dental fear and its presentation in dental patients, two psychometric instruments were distributed among 50 patients attending a dental emergency clinic (EMC) and 44 patients applying for treatment at a specialized dental fear clinic (FEC). The Dental Fear Survey (DFS) was compared with the Corah Dental Anxiety Scale (DAS). After separating the EMC patients into high- and low-fear individuals in accordance with DAS scores, analysis showed that DFS values also clearly distinguished between these groups and between the FEC group and EMC groups. The dental fear levels were in correspondence with previous results, and the correlation between the DAS and the DFS was high (r = 0.92). In contrast to the DFS avoidance and arousal dimensions, the difference between the mean item scores on the dental situation dimension was not significantly different between high-fear EMC and FEC individuals. This indicated that the evaluation and appraisal of the dental situation among high-fear EMC and FEC patients may have been corresponding, whereas the behavioral and physiologic effects were different. Thus, in spite of this similar appraisal of the dental situation, FEC patients were interpreted as showing a more phobic behavior, and this was better captured in the DFS than in the DAS.

Dentists evaluate their patients: an empirical investigation of preferences

Dental treatment is a dyadic encounter. Yet research on the dentist-patient dyad has tended to focus on patient perceptions of dentist, to the neglect of dentist perceptions of patient. Previous theoretic and qualitative work on caregiver perceptions of patients suggested three dimensions of evaluation. Dentists (N = 618) rated their patients on items taken from two prior studies. Dentists' responses were subjected to confirmatory factor analysis. The analysis substantiated the existence of three evaluative dimensions: compliance, tractability, and likability. Further analysis showed that the three dimensions formed a Guttman simplex, revealing a second-order factor of selectivity and allowing a classification of dentists on the basis of patient selectivity.

Optimism-pessimism dimension and dental anxiety in children aged 10-12 years

This study explored the relationships between Previous Dental Experience (PDE), Corah's Dental Anxiety Scale (DAS), the Dental Anxiety Question (DAQ), dispositional optimism as measured by the Life Orientation Test (LOT), and Clinical Behavioral Rating (CBR). The main purpose of the study reported here was to investigate the possible usefulness of the optimism-pessimism dimension in predicting clinical dental anxiety. 163 children aged 10-12 yr participated in the investigation. The results indicate that both self-reported dental anxiety and optimism-pessimism were unique contributers to prediction of behavioral ratings of dental anxiety.

A comparison of anxiety levels associated with root canal therapy and oral surgery treatment

Questionnaires regarding experience, hearsay, and perceptions of anxiety toward eight dental treatments were distributed to a general patient population. Data revealed that among 349 respondents 35% heard that root canal therapy was the most unpleasant dental treatment, whereas 29% listed oral surgery treatment as having the worst reputation. However, 53% of those experiencing oral surgery treatment stated that an oral surgery treatment was the most unpleasant treatment whereas only 17% experiencing root canal therapy stated the same for root canal therapy. On the basis of anxiety scores, root canal therapy and oral surgery treatment were categorized in the high-anxiety category, crowns, dentures, and fillings in the moderate-anxiety category, and cleaning, sick call, and examination in the low-anxiety category. The anxiety levels of root canal therapy and oral surgery treatment were then analyzed as they related to different experience groups (combinations of root canal therapy and oral surgery and experience), hearsay experience, and most unpleasant experience with root canal therapy and oral surgery. Patients having experience with root canal therapy or oral surgery treatment had lower anxiety levels toward these respective treatments than did those who had no such experience. Patients who have heard negative stories (hearsay) of root canal therapy and oral surgery showed higher levels of anxiety toward these respective treatments than did those who have not heard such stories. But former endodontic patients who had heard negative stories about root canal therapy actually recorded lower anxiety levels toward root canal therapy than those patients with no negative hearsay experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)

Exploratory factor analysis of a sixty-item questionnaire concerned with fear of dental treatment

701 dental-school outpatients rated the degree of fear occasioned by each of 60 events that occur routinely during dental treatment. The 4,206 ratings then were subjected to principal components factor analysis with oblique rotation. Four meaningful factors were deduced: fear of pain and its antecedents, anticipatory fear, fear of negative evaluation, and fear due to perceived absence of control over the dentist. This outcome is compared and contrasted with results of other attempts to delineate the components of dental fear.

A cross-cultural cross validation of the Dental Fear Survey in South East Asia

This study was designed as a cross-cultural replication and cross validation of the Dental Fear Survey (DFS) in two groups of Singapore adults: university students and military conscripts. Factor analysis of the DFS in each of these dissimilar samples revealed factor structures that were highly comparable to one another as well as to those obtained in the U.S.A. Behavioral and physiological fear assessment during exposure to simulated dental treatment also showed results comparable to those found in Western cultures. Self report measures were more likely to correlate with other self reports than with physiologic or behavioral measures. Among university students, those who had visited a dentist within the past year had significantly lower DFS scores than those who had avoided dentistry. The fear-avoidance relationship did not hold for military subjects who reported less dental fear overall. It was concluded that the DFS was factorially stable; and therefore, generalizable to this South East Asia culture.

Pre-school children with uncooperative behavior in the dental situation. Some characteristics and background factors

One hundred and eighty-six generally healthy pre-school children referred to a pedodontic clinic because of uncooperativeness in the dental situation were surveyed with regard to some characteristics and background factors considered of importance as possible origins of the uncooperative behavior. Information was gained from interviews with the referring dentists and the parents, from a developmental test of the child, and from dental records. In spite of a high prevalence of caries, dental treatment before referral was characterized by few restorative measures. The results also showed that the children constituted a heterogeneous group with regard to the variables studied. Further, the referring dentists represented various resources in terms of self-reported knowledge and time for treating this category of children. The data provide a basis for comparisons with a reference group, to be presented in a subsequent study.

General method for analysing dentist-patient interaction

The interaction between dentist and patient during dental treatment may influence the frequency of dental visits in the future because this interaction may increase the dental fear of the patient. To find the characteristics of the dentist's behavior that increase or decrease dental fear a statistical analysis of the interaction may be used. Data of such interactions are known as time series. Because it is highly probable that the behavior of an individual at two different points in time is autocorrelated a correct statistical analysis of the interaction between dentist and patient must take this possibility into account. A general statistical method is proposed that can take autocorrelations into account. The method is compared with a simpler method that may not deal adequately with autocorrelations.

Components of dental fear in adults?

The functional relatedness between dental fear and multiple other fears was studied in a normative sample of 285 undergraduates. Rachman and Lopatka's work on the inter-dependence of multiple fears within individuals, as well as Lang's bioinformational theory of emotion, provided a theoretical background for this investigation. Fears about social contact, pain, mutilation (e.g. injury, blood, disfigurement), and being closed-in were assessed within the realm of verbal report; they were studied as possible components and/or concomitants of the dental fear construct. Multiple regression analyses with these variables utilized the Dental Fear Survey total score as a criterion variable. Fear of pain was found to be the most significant predictor of dental fear in both males and females. For females only, mutilation fear was the next strongest determinant. Fear of being closed-in was an additional significant dental fear predictor for both sexes. The possible role of social fears in the manifestation of dental fear was not confirmed and awaits further investigation. Results were consistent with the idea that there may often be a moderate degree of functional dependence between dental fear and the other fears identified here.

Effect of systematized "behavior shaping" on acceptance of dental treatment in children

The aim of this study was to compare the acceptance level of children treated by dentists who had participated in a training program of psychologic care and systematized "behavior shaping", with the acceptance level of children treated to a large extent by the same dentists before their training program. The material consisted of 2400 children treated by 149 dentists, to be compared with the material of 2773 children treated by 161 dentists in the "before training" study; 127 dentists took part in both studies. The training program included a video film, a manual, and a case form. Of the children treated before the dentists underwent the training program, 79% showed positive acceptance of all treatment steps encountered during dental visits, 13% reluctant acceptance, and 8% negative or no acceptance. The corresponding figures for children treated after the training program were 92, 6, and 2%. The distributions of overall positive acceptance in the two studies were compared by means of a logistic regression model. The level of overall positive acceptance was significantly increased after the dentists had participated in the training program. The improvement was most pronounced among the youngest children and children in need of restorative treatment or extraction. Of all the background variables studied, age, present need of treatment, and the before/after training variable had the greatest influence. The study shows that dentists can be trained to obtain significantly increased positive acceptance of dental treatment in children, and that the method does not require extra time in the dental chair.

Interactions between dentists and anxious child patients: a behavioral analysis

The aim of this investigation was to study the effect of dentists' behavior on the (anxious) behavior of child patients. Twelve high-anxious and a matched group of 12 low-anxious children from 6 to 12 yr of age were selected and randomly assigned to one of six dentists: three with experience in treating fearful children and three without such experience. Each child was treated twice. The first treatment was prophylactic, the second, 2 wks later, consisted of preparation and restoration of a cavity (Class 1) under local anesthesia. While both treatment sessions were videotaped, only the latter one was used in this study. Data analysis which did not control for autocorrelations revealed 22 (out of 28) significant effects. Data analysis with a control for autocorrelations showed only two significant effects: 'working contact', which decreased fear-related behavior and 'no physical contact', which increased fear-related behavior.

Ratings of fears associated with twelve dental situations

Ratings of fear aroused by 12 dental situations were obtained by the method of paired comparisons. The dental situations concerned one of four categories: (a) preparations for the dental visit, (b) preparations for dental treatment, (c) comments by the dentist on oral state, and (d) actual dental treatment. The situations originated from Gale's ranking questionnaire. It was hypothesized that the amount of fear elicited would increase in the order a, b, c, and d. Results indicated that subjects were capable of ranking dental situations according to the amount of anxiety they aroused. Overall ratings show reasonably good agreement with the results of Gale's study. The hypothesis concerning the rank order of the situations was partly confirmed. Two situations deviated strongly from the expected order. The categories (c) and (d) were rated highest in the hierarchy of fear arousal, but their rank order couldn't be established. This finding suggests that dental fear contains a component of physical danger as well as a component of threat to a person's self-esteem.

Dental anxiety--the development of a measurement model

A more detailed measurement instrument for dental anxiety has been developed. To investigate the dimensionability of the response, two instruments were administered to 452 persons. The first set of items (33) concerned stimuli which might prove fearsome to patients. Some of these were dental specific, others were not. A second instrument (20 items) elicited the anxiety symptoms experienced. By comparing separate Kaiser-Caffrey Alpha Factor Analyses two factors were identified within each instrument. These were labelled "generalized" phobias and "dental specific" phobias; and "endogenous" and "exogenous" (anticipatory) anxiety symptoms. Four scales were constructed using simple summations of highly loaded variables. The scales are quite reliable. Although correlations among the scales proved to be significant they are all quite low, indicating that the four scales give more or less non-redundant information about the patient. The scale had discriminating validity in differentiating between patients who acknowledge experiencing spontaneous panic/anxiety attacks and those who did not. The data confirm that dental fears are relatively independent of other generalized anticipatory fears. The results cast doubt on previously held assumptions regarding the unidimensionality of anxiety. They are consistent with a new classification of anxiety and phobic disorders presented elsewhere. The implications for research and patient management are discussed.

Psychophysiological responses to dental injections

Dentists frequently change local anesthetic formulations on the basis of a patient's experience of adverse effects. Frequently, less effective anesthetics are selected because a lack of understanding exists regarding the nature of untoward events. This may exacerbate the problem. Allergic reactions are overreported, whereas fear responses frequently are unrecognized. This article outlines the clinical problem of adverse reactions to local anesthetics in dental practice. Clinical recommendations based on proper diagnosis are provided to prevent recurrence of the problem.

Dentists' management of patients' fear and anxiety

Dentists participating in a health screening at the 1983 ADA annual session were asked to complete a brief questionnaire concerning their attitudes and methods of managing anxious patients. Most dentists see patient fear as an extremely important dimension of their practice and believe it to be the most important impediment to patient satisfaction. Behavioral methods such as "talking" appear to be the most frequently used methods of dealing with fearful patients. Finally, most dentists appear to learn their behavioral management methods through informal means.

Usefulness of two psychometric scales in Swedish patients with severe dental fear

Dental fears and other fears were assessed in 67 patients with dental fear with the Corah Dental Anxiety Scale (CDAS), the Geer Fear Scale (GFS), and a behavioral dentist's rating scale (DR). Patients were selected because of extreme initial dental fear (n = 20), favorable response to treatment for dental fear (n = 23). CDAS change paralleled behavioral change (DR), supporting the usefulness of CDAS in assessing dental fear. GFS scores did not change in either group but were higher among patients who did not respond to treatment for dental fear; these findings are discussed in terms of treatment outcome prediction and treatment specificity.

Multivariate, non linear analysis of the preference for preservation of the teeth

Application of classical, linear approaches to analyze data of a categorical or discrete nature might bring about false results, because the data are forced to fit inappropriate models. The present paper describes a non linear, multivariate approach which might be considered a principal component analysis of data collected in a survey. The computer algorithm HOMALS is used to detect which dimensions are to be found in the data. Searched for are factors associated with the variable preference for preservation of the teeth. The analysis enabled the description of one subgroup: those who do not care about retaining their teeth are characterized, in a descending order of importance, by irregular dental attendance, a (self-assessed) very poor oral health condition, being equally afraid of extraction and cavity preparation, dissatisfaction with dental treatment in the past, and lowest level of education. It appeared that the categories of the variables are not linear. It is concluded that the combination of characteristics, describing a subgroup in the sample, does not imply the description of another subgroup with opposite characteristics.

Psychometric measures of dental fear

Four psychometric scales: Corah Dental Anxiety Scale (CDAS), a modified version of the Geer Fear Scale (GFS), the Health Locus of Control Scale (HLCS), and a Mood Adjective Check List (MACL), were studied with regard to their implications for dental fear. Swedish versions given to groups of fearful and non-fearful dental patients as well as non-patients showed satisfactory metric properties. Mean scores obtained were in most cases similar to those reported for original American versions, even though some indications of cultural differences were observed. The scales seem to reflect important aspects of dental fear, and they represent a valuable methodology in research on etiology and treatment of dental fear.

Effects of dentists' behavior on patients' attitudes

A group of 16 patients received Class II restorations at two different sessions. During one session a dentist interacted positively with the patient. During another session, the dentist had little interaction with the patients. Patients' ratings indicated that both dentists were perceived as equally competent but that the dentist who interacted with the patients was rated significantly better. It is possible that dentists will gain more satisfaction from their patients as they increase their interaction.

Dental fear and avoidance: causes, symptoms, and consequences

A specialized community dental unit for dental fear treatment was used to investigate 160 adult patients. The patients, predominantly women 20 to 40 years old, had avoided regular dental care for an average of 16 years. Psychosocial and psychosomatic conditions were common. Dental fear generally had started in childhood (85%) and the dominating causative factor was previous traumatic dental experiences. For fear of early origin, the dentist's professional behavior was most important, whereas for fear acquired in adult years, pain was important. The most feared events in dentistry ranked by the patients were drilling, having an anesthetic, and extraction. The most desired dentist attributes were understanding and trying to avoid pain, whereas the most undesired were being heavy-handed, critical, and remote and distant. The dental status was strongly affected by fear and avoidance, and the deterioration was significantly more pronounced in men.

Factor analysis of the dental fear survey with cross-validation

Factor analysis of the Dental Fear Survey disclosed three stable and reliable factors. The first factor related to patterns of dental avoidance and anticipatory anxiety. The second factor related to fear associated with specific dental stimuli and procedures. Factor three concerned felt physiologic arousal during dental treatment. Cross validation showed these three factors to be consistent across four demographically and geographically diverse groups.

Historical antecedents of dental anxiety

Our data are based on retrospective self-reported answers of college students. To what extent do these answers accurately reflect the feelings of an actual clinical sample of dental patients? Although there is little direct evidence, a number of observations suggest that in the area of dental anxiety, college populations closely approximate the self-reported answers of the general population. The average level of dental anxiety in an actual clinical sample also appears to be remarkably similar to the average level of dental anxiety among a sample of college students. Kleinknecht and Bernstein found that, on a 1 to 5 scale, dental patients reported a mean level of dental anxiety of 2.31, and that when the identical question was used in a college population, the average level of dental anxiety was 2.47. In our sample, the mean level of dental anxiety was a similar 2.4 on a 0 to 6 scale. Obviously, self-reported answers are subject to distortions. However, it is important that these perceptions can still have a powerful bearing on the behaviors and feelings of patients. A number of observations and hypotheses about the historical origins of dental anxiety were confirmed. Some of these findings have direct clinical implications for the prevention of dental anxiety by dentists or treatment by psychologists. For example, high dentally anxious subjects are more concerned with and feel more ashamed about telling their dentist that they are dentally anxious. It may be helpful for dentists to provide an open forum about the patient's concern.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of continuous patient information in the dental environment

The effects of varying knowledge of an information system and belief in the effects of this information on discomfort during dental treatment were measured. The information system consisted of patient-operated buttons connected to a series of lights which provided continuous information to the dentist concerning the relative comfort of the patient. Actual information, false information, and knowledge of the information system were combined to form experimental groups. The results showed that those individuals with the ability to provide information to the dentist reported less discomfort than those without this ability during a scaling procedure. During the polishing procedure, the belief of the effect of information resulted in a decrease of reported discomfort.

Stress in dental patients undergoing routine procedures

A method was devised to record graphically the stress that patients experience during routine dental procedures. Heart rate was used as the indicator and the variations in it showed which parts of the treatment provoked the maximum stress reactions. This pilot study indicated that by using this method it is possible to study specific dental problems and methods for treating them.