Assessment of a dental anxiety scale

Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures

OBJECTIVE

To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents.

MATERIALS AND METHODS

We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15-18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah's DAS as a dichotomous dependent variable.

RESULTS

Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, 'external control belief', avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12).

CONCLUSIONS

Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.

Dentin hypersensitivity monitored by cold air quantitative sensory testing

BACKGROUND

Quantification of dentin hypersensitivity (DH) is challenging and requires standardised, graded stimulation by natural-like stimuli.

OBJECTIVE

The present study aimed at identifying DH subjects and longitudinally monitoring their pain thresholds by cold air quantitative sensory testing (QST).

METHODS

Subject recruitment started with an online DH questionnaire. Respondents were screened by dental air stimulation. Sensitising and habituating subjects were excluded. A recently developed stimulation device was employed for cold air QST. Single tooth DH was verified by applying an equi-intense stimulus to a control tooth. Descriptive statistics were applied for subject characteristics. Mean values were calculated for the stimulation parameters temperature and air flow. Reliability of temperatures for detecting pain and for evoking moderate pain over multiple time points within a 3-week period was analysed by two-way random single- and average-measure intra-class correlation coefficients.

RESULTS

A total of 353 persons completed the online DH questionnaire of which 117 were screened. Forty-four passed the screening, yet 15 were excluded for various reasons. Twenty-nine subjects were monitored by QST across 3 weeks. Results revealed a high intra-individual stability of the temperature inducing moderate to strong pain intensity (MPI) (single-measure ICC of T_MPI 0.83, P < 0.001). Mean T_MPI was -13.69°C, yet it highly varied among the 29 subjects (SD ± 10.04°C).

CONCLUSIONS

Using a novel approach, namely dental QST based on cold air stimuli, we present evidence for temporally stable DH perceptions over a 3-week period. The method fulfils international guideline requirements and is recommendable for obtaining valid results when testing various interventions for DH management.

Hemodynamic variations and anxiety during the surgical extraction of impacted lower third molars

Background

The surgical removal of an impacted third molar can cause patient anxiety. Such anxiety and the use of vasoconstrictor drugs and local anesthetics in turn can induce hemodynamic variations during the operation. A study is made of the variations in hemodynamic parameters (systolic and diastolic blood pressure and heart rate) and their correlation to patient gender and anxiety during surgical removal of an impacted lower third molar.

Material and Methods

A prospective study was carried out in the Oral Surgery Unit of a university clinic, with the inclusion of 125 patients (mean age 24.9 years). Anesthesia was administered in the form of 4% articaine and adrenalin 1:200,000 for surgical removal of the impacted lower third molars.

Results

Women experienced greater anxiety than men. Systolic blood pressure showed few changes - the maximum and minimum values being recorded at the time of incision and upon suturing, respectively. Diastolic blood pressure in turn showed maximum and minimum values before the start of surgery and during extraction, respectively, while heart rate proved maximum during incision and minimum upon suturing. The differences in systolic and diastolic blood pressure, and heart rate, between men and women, and between patients with and without anxiety, failed to reach statistical significance.

Conclusions

The fact that these were young patients could contribute to explain the absence of significant hemodynamic changes in our study. Key words:Anxiety, third molars, extraction, surgery.

Psychological distress and anxiety compared amongst dental patients- results of a cross-sectional study in 1549 adults

Background

This study aimed to identify anxiety in dental patients visiting a dental clinic using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and therefore identifying a correlation between these groups as well as their gender and age.

Methods

An adult sample of N = 1549 patients (865 females, 779 males) was examined over the course of three years using the Brief Symptom Inventory-18 to evaluate psychological distress and the Dental Anxiety Scale to determine anxiety before dental treatment. Evaluations were conducted according to age and gender.

Results

There was no correlation between different age groups of the sample the Dental Anxiety Scale. Anxiety, depression and GSI were more frequent in patients below the age of 46 than above. Women were more susceptible to signs of Anxiety and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index than male patients. There was a significant positive correlation between scores of the BSI-18 categories: Somatization, Anxiety and Depression and the DAS for dental patients.

Conclusions

This study showed that a relationship between dental anxiety and psychological distress exists. It would be an improvement to use a short questionnaire like the Dental Anxiety Scale to evaluate a patient before his first treatment so that more appropriate treatments can be pursued.

Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern State Medical University, Arkhangelsk, North-West Russia

The objective was to assess the prevalence of and factors associated with dental anxiety (DA) in medical and dental students in North-West Russia. This cross-sectional study included 422 medical and 285 dental undergraduate Russian students aged 18-25 years from the Northern State Medical University in Arkhangelsk. Corah's Dental Anxiety Scale (DAS) was applied to measure DA. Information on socio-demographic and socioeconomic factors, oral health behaviour and general and oral health was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess caries experience, Simplified Oral Hygiene Index, and Gingival Index. DAS score ≥13 was found in 13.7% and 2.2% of medical and dental students, respectively. Female sex (incidence rate ratio [IRR] = 1.11, p = 0.013), lower education of mother (IRR = 1.13, p = 0.001), and poor self-assessed oral health (IRR = 1.15, p < 0.001) were associated with DA in medical students. Corresponding factors in dental students were female sex (IRR = 1.16, p = 0.001), irregular dental visits (IRR = 1.19, p = 0.001), infrequent tooth-brushing (IRR = 1.17, p = 0.007), pain in mouth (IRR = 1.09, p = 0.031) and number of missing teeth (IRR = 1.13, p = 0.007). The prevalence of high DA was lower in dental students than in medical students. DA was associated with sex, mother's education, poor oral health behaviour and self-assessed and clinically assessed oral health.

Comparing oral health in patients with different levels of dental anxiety

Background

Dental Anxiety is still today one of the most common fears and is therefore a great challenge for every dental practitioner. The aim of this study was to identify patients with dental anxiety using the Dental Anxiety Scale and comparing different levels of dental anxiety with oral health using DMF-T and DMF-S index.

Methods

This study questioned 1549 patients over the course of three years (2002–2005). DAS questionnaires were handed out before treatment and the state of oral health was evaluated using DMF-T and DMF-S.

Results

There is no significant relation between high anxiety and the global DMF-T Score (p = 0.237), missing teeth (p = 0.034) and filled teeth (p = 0.237). There is however a significant increase in destroyed teeth, the higher the level of dental anxiety in the patient (p < 0.0001). There is as well a significant relationship between the global DMF-S Score (p = 0.042) and dental anxiety. No relationship was found comparing missing surfaces (p = 0.107) and filled surfaces (p = 0.516) with dental anxiety. Destroyed 16 surfaces are, however, significantly higher in patients with more dental anxiety (p < 0.0001). A higher dental anxiety therefore often causes minimalistic dentistry to fail due to more teeth being destroyed.

Conclusions

Patients with dental anxiety still have a worse oral hygiene than patients without dental anxiety. It is still necessary, in this time of caries prevention rather than over-treatment, to be educated so that patients suffering dental fear receive the right treatment.

INFLUENCE OF THE SEROTONERGIC SYSTEM POLYMORPHISM ON THE EXPRESSION OF DENTAL ANXIETY

- The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah's Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by ?χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.

Demographic profile, Oral Health Impact Profile and Dental Anxiety Scale in patients with chronic periodontitis: a case-control study

OBJECTIVES

To examine whether dental anxiety (DA) and oral health-related quality of life (OHRQoL) differ between persons with and those without chronic periodontitis.

METHODS

One-hundred patients with chronic periodontitis and 50 age- and- sex-matched controls were included. Data were collected on the following: demographics; smoking habits; Numerical Rating Scale (NRS) for dental pain assessment; Corah's Dental Anxiety Scale (DAS); Oral Health Impact Profile 14 (OHIP-14); Decayed, Missing and Filled Teeth (DMFT) index; Plaque Index (PI); probing depth (PD); bleeding on probing (BOP); and radiographic bone loss.

RESULTS

Patients with chronic periodontitis exhibited a significantly higher percentage of high anxiety and phobia compared with subjects in the control group. Furthermore, patients with chronic periodontitis were statistically significantly more likely to consider themselves as suffering from dental anxiety (68.7% vs. 14.3%, P < 0.001) as well as more likely to have fear of receiving dental injections, hearing the dental drill noise and feeling a foreign object in the mouth. Patients with chronic periodontitis exhibited worse OHIP-14 global scores as well as worse scores in the following individual domains: functional limitation (P = 0.005); physical disability (P = 0.003); psychological disability (P = 0.010); social disability (P = 0.011); and handicap (P = 0.012).

CONCLUSIONS

Compared with controls, patients with chronic periodontitis had higher levels of dental anxiety and worse OHRQoL. It is important to consider dental anxiety and OHRQoL assessment as an integral component of the evaluation of patients with chronic periodontitis. Communication between dental and behavioral health professionals is needed to implement a multidisciplinary team approach involving behavioural and psychological interventions.

Dental pain and oral health-related quality of life in individuals with severe dental anxiety

OBJECTIVES

To analyze the prevalence and level of dental pain among adult individuals with severe dental anxiety (DA), and the association between dental pain and oral health-related quality of life (OHRQoL).

METHODS

The study was based on 170 adult individuals with DA referred to a specialized DA clinic. All patients answered a questionnaire including questions on DA (DAS, DFS), OHRQoL (OIDP) and dental pain. An adapted clinical examination and a panoramic radiograph revealed the present oral status.

RESULTS

The prevalence of dental pain was high (77.6%) and among those reporting pain the intensity was high (49.0-61.0 on a VAS). One or more problems during the last 6 months with the mouth or teeth affecting the individual's daily activities were reported in 85.3% of the participants. Individuals who reported dental pain had lower OHRQoL compared with those who did not report dental pain (p < .001). Dental pain and number of decayed teeth were associated with the probability of poor OHRQoL (OR = 8.2, p < .001, OR = 3.8, p = .008).

CONCLUSION

This study revealed a high prevalence and a high level of dental pain among adult individuals with severe DA. Having dental pain was associated with poor OHRQoL.

Dental Anxiety Among Israeli Postgraduate Pediatric Dental Students and their Instructors

OBJECTIVE

To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety.

STUDY DESIGN

Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on socio demographic information, dental anxiety scale (DAS) and dental fear survey (DFS).

RESULTS

The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentist's office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar.

CONCLUSIONS

Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.

Anxiety symptoms have a direct effect on oral health perception in young women

PURPOSE

Assess the influence of anxiety symptoms on oral health related-quality of life in young women from a cohort study in Southern Brazil.

METHODS

A sample of 535 young mothers were analyzed. Interviews and psychological evaluations were carried out by trained psychologists. The Brazilian version of the Corah's dental anxiety scale and the Beck anxiety inventory were used to evaluate dental anxiety and anxiety symptoms, respectively. The oral health-related quality of life (OHRQoL) was assessed by the Oral Impacts on Daily Performance instrument. Dental examinations were performed by trained dentists to assess oral health status (DMFT). The effect of anxiety symptoms on oral health-related quality of life was estimated using the parametric g-formula.

RESULTS

The prevalence of negative impact on OHRQoL was of 46.3 and 28% of the women presented anxiety symptoms. Unadjusted analysis showed that women with anxiety symptoms had 2.5 higher impact on OHRQoL (OR 2.55; CI 95% 1.72-3.79). The parametric g-formula revealed that anxiety had a direct effect on oral health perception (OR 1.16; CI 95% 1.04-1.30), not mediated by dental anxiety.

CONCLUSION

Oral health-related quality of life is influenced by anxiety symptoms, regardless of dental anxiety.

The Level of Dental Anxiety in Students of the First Year of Studies From Lublin Universities

Dental anxiety is a very important factor affecting the efficacy of prevention, diagnosis and treatment of dental diseases, both in patients in the developmental age and in young adults. Anxiety is considered an emotional state with negative connotations. The aim of the study was to determine the level of dental anxiety in first year university students, the intent being to help to develop an individual treatment plan in this group of patients. The study involved 280 students including 230 females and 50 males. Of these, 122 patients were from the Medical University of Lublin, 79 from University of Life Sciences and 79 from University of Maria Curie-Skłodowska. The mean age of the study subjects was 21 years and 8 months ± 3,9 months. No differences in the level of dental anxiety between women and men were observed. The highest level of dental anxiety was observed among students of University of Life Sciences, while the lowest level was observed among students of the Medical University

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.

Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.

Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].

Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.

Cardiovascular Changes Due to Dental Anxiety During Local Anesthesia Injection for Extraction

Aim of the Study

The present study evaluated the cardiovascular changes related to anxiety of the patient undergoing local anesthesia injection for extraction in Indian population.

Methodology

In total, 100 Indian male patients were enrolled in the prospective study. Anxiety was measured at 15 min before local anesthetic delivery using Corah's Dental Anxiety Scale (DAS). Cardiovascular response data including blood pressure, heart rate, oxygen saturation and electrocardiographic changes were measured at five time points from 5 min before to 15 min after the administration of anesthetic.

Results

The mean anxiety scale score before administration of anesthetic was 8.24 (± 3.55) with a range from 4 to 20. Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (DAS > 12) was associated with significantly increased heart rate and blood pressure during administration of anesthetic. Significant ECG change was present at the time and 5 min after local anesthesia administration. Pain on injection was also associated with increased heart rate and blood pressure during anesthetic administration.

Conclusion

The present study shows that significant cardiovascular changes do occur due to dental anxiety at the time of local anesthesia administration for tooth extraction in Indian population.

Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial

BACKGROUND

Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers.

METHODS

Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO_{2 max} (control) or 70% VO_{2 max} (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment.

RESULTS

In comparison to baseline, aerobic exercise within 70% VO_{2 max} significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order.

CONCLUSIONS

Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.

Dental anxiety and oral health-related quality of life in aggressive periodontitis patients

OBJECTIVES

To measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with aggressive periodontitis (AgP) compared to controls and analyze their association with various demographic and clinical parameters.

METHODS

Sixty consecutive patients with AgP were compared to 80 age- and sex-matched controls with no known history of periodontal disease. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah's Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss.

RESULTS

AgP patients exhibited statistically significant higher scores in the DAS total as well as sub-scores, except from DAS 1st question. Compared to the control group, AgP patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both AgP and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain.

CONCLUSIONS

AgP patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases.

STATEMENT OF CLINICAL RELEVANCE

Aggressive periodontitis (AgP) patients exhibited higher dental anxiety levels and worse oral health-related quality of life (OHRQoL) compared to controls. Professionals should design strategies that will cope with the dental anxiety associated with the treatment and prevent decreases in OHRQoL.

Assessment of patient’s anxiety and expectation associated with hemodynamic changes during surgical procedure under local anesthesia

Abstract Introduction The dental patient’s anxiety and expectation may significantly alter their vital signs. The use of local anesthetics associated with a vasoconstrictor may also alter the vital signs of these patients, promoting hemodynamic changes that may result in emergency situations. Objective To evaluate the influence of anxiety of patients submitted to third molar extraction and the use of different anesthetic substances with adrenaline on their vital signs (oxygen saturation, heart rate, and systolic and diastolic blood pressure) in different moments. Material and method Forty patients answered the questionnaire of the Dental Anxiety Scale (Corah’s Scale) and fear (KleinKnecht’s Scale) and were submitted to third molar extraction in two surgical times for the use of articaine or mepivacaine, both associated with adrenaline. The results were analyzed by ANOVA followed by Tukey post hoc test, Student's t test, and Pearson's correlation coefficients (α=0.05). Result There was no significant differences in saturation or heart rate. The blood pressure showed significant variations during time for both anesthetics, however mepivacaine resulted in a longer postoperative time to restore blood pressure. Patients with high or moderate anxiety and high fear index were those who had positive correlations with the highest blood pressure values. Conclusion Anxiety and fear positively influence the increase in blood pressure. Mepivacaine promoted a greater resistance to the return of normal vital signs, especially blood pressure levels.

The Odyssey of Dental Anxiety: From Prehistory to the Present. A Narrative Review

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for medical emergencies in the dental office, so their prevention is an essential part of patient safety and overall quality of care. Being DA and its consequences closely related to the fight-or-flight reaction, it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. Archeological findings suggest that humans have been surprisingly skillful and knowledgeable since prehistory. Neanderthals used medicinal plants; and relics of dental tools bear witness to a kind of Neolithic proto-dentistry. In the two millennia BC, Egyptian and Greek physicians used both plants (such as papaver somniferum) and incubation (a forerunner of modern hypnosis, e.g., in the sleep temples dedicated to Asclepius) in the attempt to provide some form of therapy and painless surgery, whereas modern scientific medicine strongly understated the role of subjectivity and mind-body approaches until recently. DA has a wide range of causes and its management is far from being a matter of identifying the ideal sedative drug. A patient's proper management must include assessing his/her dental anxiety, ensuring good communications, and providing information (iatrosedation), effective local anesthesia, hypnosis, and/or a wise use of sedative drugs where necessary. Any weak link in this chain can cause avoidable suffering, mistrust, and emergencies, as well as having lifelong psychological consequences. Iatrosedation and hypnosis are no less relevant than drugs and should be considered as primary tools for the management of DA. Unlike pharmacological sedation, they allow to help patients cope with the dental procedure and also overcome their anxiety: achieving the latter may enable them to face future dental care autonomously, whereas pharmacological sedation can only afford a transient respite.

Cognitive behavioral therapy for psychosomatic problems in dental settings

Cognitive behavioral therapy (CBT) has been applied for various problems, including psychiatric diseases such as depression and anxiety, and for physical symptoms such as pain. It has also been applied for dental problems. Although the effect of CBTs on temporomandibular disorders and dental anxiety are well documented, its effectiveness on other types of oral symptoms remain unclear. Little information comparing the different types of CBTs in the dental setting is currently available. Because dental professionals are often expected to conduct CBTs in the dental setting, it is important to develop proper training programs for dental professionals.

In this review article, we demonstrate and discuss the application of CBTs for psychosomatic problems, including temporomandibular disorders, dental anxiety, burning mouth syndrome, and other oral complaints in dental settings.

The factor structure of dental fear

There is limited empirical information as to whether or how stimuli associated with dental fear can be classified into distinct subtypes. The purpose of the current study was to develop a descriptive framework for the classification of dental fear. Data were collected using a survey among Dutch twin families (n = 11,771). The sample was randomly divided into two subsamples of, respectively, 5,920 and 5,851 individuals. An exploratory factor analysis (EFA) was performed on the first subsample to delineate the multidimensional structure of a set of 28 dental-fear-provoking objects and situations. The second sample was used to confirm the newly derived model using confirmatory factor analysis (CFA). The EFA yielded a three-factor solution with 70.7% explained variance pertaining to: (i) invasive treatment or pain; (ii) losing control; and (iii) physical sensations. The CFA showed an acceptable fit to the data, thereby confirming the stability of the three-factor structure. There are at least three different subtypes of dental fear. As these subtypes require a different treatment approach in clinical practice, it could be important to assess the severity of patients' fear response along these three dimensions.

Usage of a Reward System for Dealing with Pediatric Dental Fear

Background:

Pediatric dental fear, if left unchecked, can persist for a lifetime and adversely impact the physical and psychological health of a patient. In this study, a feasible nonmedical method for relieving pediatric dental fear was investigated.

Methods:

A randomized, single-blind, controlled trial model was applied. The juvenile patients experiencing dental fear, whose parents or guardian had signed an informed consent form, were randomly divided into two groups. Group A (n = 50) was the control group, while Group B (n = 50) was the reward group. Participants in Group A accepted routine treatment. Participants in Group B were told that they would obtain a gift as a reward for their good behavior if they were compliant during their dental treatments. The Chinese version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was used to evaluate the level of dental fear of each patient both before and after each treatment. A contrast analysis and a correlation analysis of the results were used to assess the efficacy of the reward mechanism.

Results:

All participants in Group B, were obedient during the dental treatment, and they also successfully chose the present they wanted at the end of their dental treatment. Children at different ages showed different reward preferences. Significant difference in the fear scores of the participants in Group B before the treatment and after receiving the reward was found (independent samples t-test, t = 14.72, P < 0.001). In Group A, 86% children's fear score did not undergo a noticeable change.

Conclusions:

A reward system is proved feasible to relieve pediatric dental fear, and the form of reward should meet the demand of patients.

Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety?

Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors.Design Analysis of prospectively obtained data.Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children.Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data.Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale.Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P <0.001]).Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease.

Large Group Exposure Treatment: A Feasibility Study of Exposure Combined with Diaphragmatic Breathing in Highly Dental Fearful Individuals

A large-group one session treatment (LG-OST) combining exposure and diaphragmatic breathing as a bodily coping element was carried out to investigate its feasibility and effectiveness in a sample of 43 highly dental fearful individuals treated simultaneously. We assessed subjective dental fear, dysfunctional dental-related beliefs, and perceived control pre- and post-intervention and at four-month follow-up. Participants additionally performed a behavioural approach test (BAT) pre- and post-intervention. During the applied exposure exercises, four participants (9.3%) discontinued the program all reporting too high levels of distress. Regarding subjective dental fear and dysfunctional dental related beliefs post treatment effects, LG-OST showed medium to large effect sizes, ranging from Cohen's d = 0.51 to d = 0.84 in the Intention-to-Treat analysis. Subjective dental fear improved clinically significantly in about one fourth (25.6%) of therapy completers. All post-treatment effects remained stable over time. Concerning the behavioral fear dimension, we observed a strong ceiling effect. Already at pre-assessment, participants accomplished more than six out of seven BAT-steps. Thus, behavioral approach did not increase significantly following treatment. Overall, the LG-OST protocol proved feasible and efficient. Compared to other one-session individual and multi-session group treatments the observed LG-OST effects were smaller. However, if LG-OST could match the efficacy of highly intensive short treatments delivered in an individual setting in the future, for example, by applying a wider array of exposure exercises, it could be a very useful treatment option as an intermediate step within a stepped care approach.

Experimental protocol of dental procedures In patients with hereditary angioedema: the role of anxiety and the use of nitrogen oxide

Hereditary angioedema (HAE) is a rare disease, little known to the medical and dental community, but with a growing rate of hospitalization over the years. HAE is due to a deficit/dysfunction of C1 esterase inhibitor which leads to an increase in vascular permeability and the appearance of edemas widespread in all body areas. The airways are the most affected and laryngeal swelling, which can occur, it is dangerous for the patient's life, is also a sensitive spot in our daily practice, therefore, it is also important to be aware of all the signs of this disease. Episodes of HAE have no obvious cause, but it can be triggered by anxiety, invasive procedures and trauma. So this disease is a major problem in oral and maxillofacial surgery, ENT, endoscopy, emergency medicine and anesthesia because even simple procedures can cause laryngeal edema. The recommendations on the management of HAE include long- and short-term prophylaxis and treatment for acute attacks, however, the importance of anxiety control during the operating phases is undervalued. The present work suggests an experimental protocol for the surgery management of HAE patients with the help of nitrous oxide, with a brief review of the literature on this topic.

The Dental Anxiety Scale and Effects of Dental Fear on Salivary Cortisol

Only a few studies have investigated use of the Dental Anxiety Scale in dental fear-induced neuroendocrine changes. The present study examined 19 female patients, each at two timepoints across an educational and a treatment session within a periodontitis therapy. Subjective measures included a visual analogue scale, the STAI State scale, and the Dental Anxiety Scale. Salivary cortisol was measured in parallel across all four timepoints. Although patients were significantly more aroused and anxious prior to the treatment session, salivary cortisol remained unchanged. However, patients with high Dental Anxiety were significantly more aroused and anxious and showed significantly higher salivary cortisol during the educational session than those with low scores on Dental Anxiety. In conclusion, the Dental Anxiety Scale differentiated mean neuroendocrine change between patients scoring low and high for Dental Anxiety and its use as an accurate tool to identify patients with high dental anxiety should be further studied predictively.

Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis

Accumulating evidence has revealed that dental anxiety (DA), as a dispositional factor toward the dental situation, is associated with the state anxiety (SA) and pain related to dental procedures. However, conclusions from individual studies may be limited by the treatment procedures that patients received, the tools used to assess DA, or the treatment stages when anxiety or pain was assessed. It is unclear whether DA, at the study level, accounts for the variance in pretreatment SA. The impact of DA and SA on pain at different treatment stages has not been systematically investigated. To address these questions, we present novel meta-analytical evidence from 35 articles (encompassing 47 clinical groups) that investigated DA in a clinical group. Subgroup analyses revealed that the studies of surgical and nonsurgical procedures did not significantly differ in either DA or pretreatment SA. Furthermore, metaregressions revealed DA as a significant predictor that explained the variance in SA assessed before and during treatment but not after treatment. The findings suggest that patient DA has a significant impact on patient SA. Metaregressions revealed DA as a significant predictor that explained the variance in expected pain, pain during treatment and posttreatment pain. In contrast, pretreatment SA was a significant predictor that explained the variance in expected pain. The findings reveal that DA has a consistent impact on pain through the entire period of dental treatment. Altogether, the findings highlight the role of DA as an overall indicator for anxiety and pain, across different types of dental procedures or treatment stages. We conclude that anxiety should be assessed as a critical step not only in anxiety management for high-DA patients, but also in pain control for all dental patients.

Dental anxiety in patients with borderline intellectual functioning and patients with intellectual disabilities

Background

This study was aimed to investigate the prevalence of dental anxiety in a population of patients with Borderline Intellectual Functioning (BIF) and patients with mild and moderate intellectual disability (ID), and how dental anxiety correlated with their age and gender.

Methods

The sample was made of 700 patients, 287 females and 413 males, 6-to-47 years old, either with borderline intellectual functioning or mild/moderate intellectual disabilities. All patients were administered the Dental Anxiety Scale to assess their level of dental anxiety.

Results

Moderate Anxiety was the most prevalent dental anxiety category for patients with intellectual borderline functioning (15.56 %) and mild intellectual disabilities(18.79 %), while Severe Anxiety was the most prevalent category for patients with moderate intellectual disabilities(21 %). Overall, a statistically significant difference (p < 0.001) between the three groups (BIF, Mild-ID and Moderate-ID) was found. Also, the correlation analysis between participants’ age and dental anxiety was statistically significant (p < 0.001); indeed, dental anxiety turned out to decrease with the increasing of the age. Moreover, the analysis between gender and dental anxiety was found to be significant as well (p < 0.001), where higher prevalence of dental anxiety was found in females.

Conclusions

To our knowledge, this is the first study on dental anxiety carried out in the field of intellectual disability. Results show that the higher the level of intellectual disability – and consequently the lower the cognitive functioning – the higher the percentage and the severity of dental anxiety.

The Level of Anxiety and Pain Perception of Endodontic Patients

OBJECTIVES

to compare the level of anxiety reported by patients and assessed by dentists. Also, the expected and actual pain during the treatment perceived by the patient and dentist were assessed.

METHODS

sixty six endodontic patients filled in two questionnaires, prior to and after the treatment, so did their therapists. The first set of questions for patients was regarding demographics, the frequency of dental visits, the level of anxiety and expectations about the level of pain. Before the treatment, dentists estimated the level of patients' anxiety and the expected intensity of pain. After the treatment, the patients evaluated the level of experienced pain and dentists' empathy during the treatment, while dentists reassessed the intensity of patients' pain.The data were statistically analysed by t-test for paired samples and by Spearmans's Rho correlation coefficient at level of significance set at 0.05.

RESULTS

Patients' expectation of pain intensity was higher than the actual pain during the treatment (t-test=3.540, p=0.001). There was no difference in the level of pain which dentists expected and their perception of pain during the procedure. There was a statistically significant correlation between the patients' level of anxiety and recognition of it by dentists (Spearman Rho=0.460, p<0.001). A higher level of anxiety increased the expected intensity of pain (Spearman Rho=0.401, p=0.001). Actual intensity of pain was not significantly associated with dental anxiety (Spearman Rho=0.080, p=0.524).

CONCLUSION

Since the level of dental anxiety was associated with the increased intensity of expected pain, a vicious cycle of pain and anxiety may be terminated by giving positive information to the patient before and during endodontic procedures.

Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: Randomized controlled trial

Introduction:

In teeth with irreversible pulpitis, successful local anesthesia is hard to achieve irrespective of the amount of local anesthesia and technique used. Such cases can be managed by concoction of pre-medications like anxiolytics, analgesics and effective local anesthesia. This double-blind, placebo-controlled study was planned to evaluate the effect of oral administration of alprazolam and diclofenac potassium on the success rate of inferior alveolar nerve block (IANB), Gow-Gates (GG) and Vazirani-Akinosi (VA) techniques for the root canal treatment of mandibular molars with irreversible pulpitis.

Method:

198 emergency patients with symptomatic irreversible pulpitis were randomly divided into three groups as – A, B and C receiving IANB, GG or V-A respectively using 2% lidocaine with 1: 100,000 epinephrine. These groups were sub-divided into sub-groups I and II as control and pre-medication groups. Patients who did not react to the stimulus made by an explorer between the canine and first premolar and showing subjective lip and tongue numbness were included in the study.

Result:

All sub-groups showed statistically significant reduction in VAS score. However sub-groups V and VI (that is GG with and without pre-medication respectively) showed best improvement in initial severe pain in mandibular molars with irreversible pulpitis. Moreover, all pre-medication sub-groups showed better pain control compared to respective control groups.

Conclusion:

It was concluded that use of pre-medications in the form of combination of anxiolytics and analgesics improves the success rate of local anesthesia in teeth with irreversible pulpitis. Use of anxiolytics eases the patient in endodontic emergencies. Also use of GG along with pre-medication is the best method for effective pain management of acute pain in irreversible pulpitis.

The burden of disease of dental anxiety: generic and disease-specific quality of life in patients with and without extreme levels of dental anxiety

The aim of this study was to compare disease-specific (oral health-related) quality of life (OHRQoL), assessed using the Oral Health Impact Profile-14 (OHIP-14), and generic (health-related) quality of life (HRQoL), assessed using the EuroQol5D (EQ-5D-5L), in patients with severe dental anxiety (who were visiting a centre for special care dentistry) with a control group from the general population. Seventy-six patients with severe dental anxiety [Dental Anxiety Scale (DAS) score ≥ 13] were matched, according to age, gender, and socio-economic status, to a control group of 76 participants in a larger epidemiological study on oral health in the Netherlands (n = 1,125). The Wilcoxon signed-rank test was used to compare levels of HRQoL and OHRQoL in both groups. The total OHIP score (indicating lower OHRQoL) was higher for the patient group (10th percentile = 30.5; 90th percentile = 46.0) than for the control group (10th percentile = 1.0; 90th percentile = 14.5). The patient group showed higher scores on all seven OHIP domains. Lower utility scores were found in patients with severe dental anxiety (HRQOL: 10th percentile = 0.7; 90th percentile = 0.9) relative to the control group (HRQOL: 10th percentile = 0.9; 90th percentile = 1.0). A disease burden of 74,000 disability-adjusted life years (DALYs) was calculated for the Netherlands. The findings of this study show differences between patients visiting a dental fear clinic and matched controls from the general population for both OHRQoL and HRQoL, indicating that having severe dental anxiety generates a significant burden of disease.

Parallel study about the effects of psychotherapy on patients with dental phobia determined by anxiety scores and saliva secretion and composition

Background

The aim of this study was to determine the success of psychotherapeutic treatment for dental phobia by measurement of anxiety using the dental anxiety score (DAS), the state trait anxiety score (STAI state), salivary cortisol and protein concentrations and the salivary secretion rate. Primary endpoint of the study was the comparison of the data before and after psychotherapeutic treatment.

Methods

Forty patients were included into the study. Twenty-four were allocated to the phobic group, 16 to the control group. Saliva was collected upon entering the dental clinic and again after three weeks of psychotherapy. The results were compared with those of a control group. The DAS and STAI questionnaires were completed at each visit.

Results

A reduction in DAS values was found after psychotherapy. However, the values remained significantly higher in the phobic group than in the controls. Similar results were found for STAI scores. A slightly higher salivary cortisol level was found in the phobic group. No changes occurred in cortisol or protein concentrations. The salivary secretion rate increased in the phobic patients after psychotherapy.

Conclusions

It could be concluded that psychotherapy is effective in the treatment of dental phobic patients.

Trial registration

This study has been retrospectively registered in the German Clinical Trials Register (# DRKS00009552) on 10/19/15.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0264-2) contains supplementary material, which is available to authorized users.

Psychometric assessment of anxiety with the Modified Dental Anxiety Scale among central Indian adults seeking oral health care to a dental school

BACKGROUND

Anxiety toward dental treatment can cause people to delay or avoid seeking oral health care despite being in need of treatment. Therefore, recognizing such anxious patients and their appropriate management plays important aspects in clinical practice.

AIM

The aim of this study was to investigate the level of dental anxiety (DA), factors affecting it, and anxiety toward dental extraction among adults seeking dental care to a dental school in Central India.

MATERIALS AND METHODS

The study sample consisted of 1360 consecutive patients aged 18-70 years. Participants completed a questionnaire while in the waiting room, which included the Modified Dental Anxiety Scale (MDAS) to assess the level of DA. An additional item was included which asked participants to rate the anxiety felt on having a tooth extracted.

RESULTS

Among the study group, 65.1% were men and 34.9% were women. Based on the MDAS score, 41.8% of the participants were identified to be less anxious, 53.2% were moderately or extremely anxious, and 5% were suffering from dental phobia. Female participants and younger patients were more anxious (P = 0.0008). Patients who were anxious had postponed their dental visit (P = 0.0008). Participants who had negative dental experience were more anxious (P = 0.03). Nearly, 83% reported anxiety toward extraction procedure. A significant association was observed between anxiety toward dental extraction and the patients' gender (P = 0.03), age (P = 0.0007), education level (P = 0.03), employment status (P = 0.0006), income (P = 0.0007), self-perceived oral health status (P = 0.03), and their history of visit to dentist (P = 0.02).

CONCLUSION

Majority of patients in this population revealed high levels of DA. Factors such as age, gender, education level, occupation, financial stability, and previous bad dental experience influence DA to various levels. Extraction followed by injection of local anesthetics and drilling of tooth provoked more anxiety.

Ambivalence in Coping with Dental Fear and Avoidance: A Qualitative Study

Dental phobia is a widespread problem, which can have significant impact on the individual’s health and daily life. This grounded theory study aims to explore the situation of dental phobic patients: how dental phobia interferes with their normal routines and functioning, social activities and relationships, what factors contribute to the maintenance of dental fear and how they cope with their fear. In the qualitative analysis of thematized in-depth interviews four main categories were developed: threat to self-respect and well-being, avoidance, readiness to act and ambivalence in coping. The results show that several psychological and social factors interact in determining how dental phobic individuals cope with their fear, and demonstrate in what way dental fear affects their daily lives.

Music before Dental Surgery Suppresses Sympathetic Activity Derived from Preoperative Anxiety: A Randomized Controlled Trial

The aim of this study was to estimate the relieving effect of music intervention on preoperative anxiety by using heart rate variability (HRV) analysis. In this randomized controlled trial, 86 adult patients were scheduled to undergo impacted tooth extraction under intravenous sedation and local anesthesia and were classified as either fearful or nonfearful based on a questionnaire. Thereafter, the patients were subdivided into 2 groups: those who listened to music from the time that they arrived at the outpatient clinic until immediately before entering the operating room and those who did not listen to music. The effect of music intervention was evaluated by assessing 1) the low-frequency/high-frequency ratio of HRV, in which positive changes indicate increased sympathetic nervous activity, and 2) the coefficient of component variance for high frequency, in which positive changes indicate increased parasympathetic nervous activity, assessed by means of HRV analysis. Subjective preoperative anxiety was evaluated on a visual analog scale. For fearful patients, the mean magnitude of low-frequency/high frequency changes from baseline among those who listened to music was significantly lower as compared with those who did not listen to music (in the private room: -1.45 ± 1.88 vs. 1.05 ± 1.88, P = 0.0096, 95% confidence interval of effect size = -4.52 to -0.48, Cohen's d = -0.75; in the operating waiting room: -2.18 ± 2.39 vs. -0.10 ± 3.37, P = 0.011, 95% confidence interval of effect size = -3.94 to -0.22, Cohen's d = -0.71, respectively). Visual analog scale scores were also significantly different. Coefficient of component variance for high frequency and heart rate did not differ significantly between the 2 groups. From the perspective of autonomic nervous activity, music intervention is useful for relieving anxiety in patients with dental fear before they enter a dental outpatient operating room. Music intervention may relieve anxiety by reducing sympathetic nervous activity, while parasympathetic nervous activity is not involved (UMIN000016882). Knowledge Transfer Statement: The results of this study revealed that music intervention is useful for clinicians when planning preoperative anxiety management of patients with dental fear who undergo impacted tooth extraction under intravenous sedation and local anesthesia. As a bridging intervention, music intervention enables stress management to continue uninterrupted from the patient's arrival at the dental outpatient clinic to intravenous sedation until completion of the dental surgery. With consideration of cost-effectiveness, absence of adverse physical effects, immediate effect, safety in terms of not using drugs, and lack of concerns about recovery, this information could lead to more appropriate decisions regarding anxiety management in dentistry.

Reliability and Validity of the Modified Dental Anxiety Scale in Turkish Patients

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corah's Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corah's DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corah's DAS at the cut-off point ≥ 15 and 8.8% (26/294) for the MDAS at the cut-off point ≥ 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

Pre-treatment anxiety in a dental hygiene recall population: a cross-sectional pilot study

Background

Increased levels of anxiety may affect a patient’s receptiveness to treatment, health care information and behaviour modification.

This study was undertaken to assess pre-treatment anxiety in a dental hygiene recall population maintaining a schedule of regular preventive care appointments.

Methods

The sample population consisted of 46 consecutive adult recall patients waiting for their regularly scheduled dental hygiene appointment. Pre-treatment state (current) anxiety was assessed using the State-Trait-Anxiety Inventory (STAI), State form; dental anxiety with the Hierarchical Anxiety Questionnaire (HAQ); subjective stress using a visual analogue scale (VAS); and mood/alertness/calmness using the Multidimensional Mood Questionnaire (MDMQ).

Results

Two distinct groups, based on state anxiety scores, were formed; one displaying increased levels of pre-treatment anxiety (n = 14), the other low anxiety (n = 32). The HA group was characterized by significantly higher dental anxiety and subjective stress levels prior to treatment; as well as worse mood, lower alertness, and less calmness in the dental office setting. There was no correlation between anxiety level and years in dental hygiene recall.

Conclusions

A high level of pre-treatment anxiety was present in about one third of the sample population. The prevalence of this anxiety demonstrates the need for both early recognition and patient management strategies (psychological and pain management) to positively influence their treatment experience.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0198-8) contains supplementary material, which is available to authorized users.

Methods and background characteristics of the TOHNN study: a population-based study of oral health conditions in northern Norway

Objectives

The aim of the Tromstannen – Oral Health in Northern Norway (TOHNN) study was to investigate oral health and dental-related diseases in an adult population. This article provides an overview of the background of the study and a description of the sample characteristics and methods employed in data collection.

Study design

Cross-sectional population-based study including a questionnaire and clinical dental examination.

Methods

A randomly selected sample of 2,909 individuals (20–79 years old) drawn from the population register was invited to participate in the study. The data were collected between October 2013 and November 2014 in Troms County in northern Norway. The questionnaire focused on oral health-related behaviours and attitudes, oral health-related quality of life, sense of coherence, dental anxiety and symptoms from the temporomandibular joint. The dental examinations, including radiographs, were conducted by 11 dental teams in 5 dental offices. The examination comprised of registration of dental caries, full mouth periodontal status, temporomandibular disorders, mucosal lesions and height and weight. The participants were grouped by age (20–34, 35–49, 50–64 and 65–79) and ethnicity (Norwegian, Sámi, other European and other world).

Results

From the original sample of 2,909 individuals, 1,986 (68.3%) people participated, of whom 1,019 (51.3%) were women. The highest attendance rate was among women 20–34 years old (80.3%) and the lowest in the oldest age group of women (55.4%). There was no difference in response rate between rural and urban areas. There was a positive correlation between population size and household gross income (p < 0.001) and education level (p < 0.001). The majority of Sámi resided in smaller municipalities. In larger cities, most participants used private dental health care services, whereas, in rural areas, most participants used the public dental health care service.

Conclusion

The TOHNN study has the potential to generate new knowledge on a wide range of oral health conditions beneficial to the population in Troms County. Due to the high participation rate, generalization both nationally and to the circumpolar area ought to be possible.

Cross-Cultural Adaptation of Kannada Version of Modified Dental Anxiety Scale Among an Adult Indian Population

BACKGROUND

Dental anxiety is one of the most common barriers in seeking dental care. In order to overcome this barrier dentist need to screen patients to successfully help in treatment. A scale is thus needed to measure dental anxiety which is socially & culturally acceptable.

AIM

This study aimed to assess the Cross cultural adaptation and validity of the Kannada translation of the Modified Dental Anxiety Scale (MDAS-K).

MATERIALS AND METHODS

A test-retest was conducted on 30 patients visiting a dental institution to assess the reliability of MDAS- K. A cross-sectional survey of 301 patients was conducted in different departments at a dental institution to test the psychometric properties of MDAS-K. The assessment tool consisted of a proforma containing socio-demographic, non socio- demographic variables, MDAS-K and Visual analogue scale (VAS).

STATISTICAL ANALYSIS

Reliability was assessed using Cronbach's alpha, inter-item Spearman's correlation. Independent t-test, ANOVA and post hoc Bonferroni were used to analyse dental anxiety in the psychometric constructs.

RESULTS

The internal consistency of MDAS-K was good with Cronbach's alpha of 0.83. The test-retest reliability for MDAS K had a good correlation of 0.901. The psychometric variables established the construct validity of MDAS-K.MDAS-K also showed good convergent validity with VAS score. The anxiety levels differed in patients visiting different dental departments.

CONCLUSION

The high reliability and validity of the MDAS-K supports its cross cultural adaptation and indicates that it can be a valuable tool for dental practioners in quantifying anxiety among patients and provide quality dental care.

Predicting children's behaviour during dental treatment under oral sedation

AIMS

The primary aim of this study was to assess whether parents' own anxiety and their perception of their child's dental fear and child's general fear can predict preoperatively their child's behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child's age, gender and ASA classification grade are associated with a child's behaviour under oral sedation.

STUDY DESIGN

Cross-sectional prospective study.

METHODS

The Corah's Dental Anxiety Scale (DAS), Children's Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children's Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ (2), t test and logistic regression analysis.

RESULTS

In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children.

STATISTICS

The level of a child's dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child's dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33-3.88, p = 0.003).

CONCLUSIONS

CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.

Study comparing midazolam and nitrous oxide in dental anxiety control

The purpose of this study is to comparatively assess the effect of midazolam and nitrous oxide associated with oxygen, in lower third molar extractions, on the change in the anxiety level of patients by salivary cortisol dosage. Twenty-eight male patients underwent lower third molar extraction under sedation with midazolam and nitrous oxide. Objective (salivary cortisol dosage) and subjective (Corah Dental Anxiety Scale) data have been obtained. By salivary cortisol, 40 minutes after midazolam administration, there has been a statistically significant difference compared with the mean baseline value. Midazolam was the most effective sedation method for reducing salivary cortisol level.

Dental Investigations. Impact Of Dental Anxiety On The Decision To Have Implant Treatment / Влияние Стоматологической Тревожности На Выбор Имплантологического Лечения

INTRODUCTION: Dental implants are increasingly used in modern dentistry as anchors for prosthetic restorations. Anxiety is a complex phenomenon which can become a risk factor for suppression of many functions of the body. Aim: The aim of this study was to investigate the effect dental anxiety exerts on the choice of method of treatment by patients wanting to have dental implants. Materials and methods: The study included 174 patients that were referred to us for dental implants placement because of partial or total loss of teeth. Their dental anxiety was measured using the Dental Anxiety Scale (DAS) proposed by Norman Corah. The patients decided to have or refused to have treatment with dental implants either because they had dental anxiety or gave other reasons. Results: Distribution of patients by level of anxiety was as follows: 33% were anxiety free, in 34% the dental anxiety was moderate, 25% had severe anxiety, and 8% experienced an extremely severe anxiety. Dental fear was given as a reason for refusal of treatment by 24.1% of the patients wanting to have dental implants. Of the patients wanting to have dental implants, 40.8% decided to proceed with the treatment; these patients exhibited low dental anxiety. Conclusion: The decision to have dental treatment with implants is affected by the patient’s level of dental anxiety. Only those with low level of dental anxiety decide to proceed with such a treatment. The mild anxiety some patients experience is beneficial as it eliminates a risk factor that may hinder the process of osseointegration.

Self-reported gagging in dentistry: prevalence, psycho-social correlates and oral health

Although gagging has a profound effect on the delivery of dental care, it is a relatively under-investigated phenomenon. This study aimed to derive a prevalence estimate of gagging during dental treatment based on patient-reported information, to determine some socio-demographic and psychological correlates and to assess the relationship of gagging with self-reported oral health and avoidance of dental care. Data were collected with a survey among Dutch twin families (n = 11 771). Estimated overall prevalence of gagging during dental treatment was 8·2% (95% CI 7·7-8·7). Patients' self-report of gagging was found to be significantly associated with female sex, a lower level of education and higher levels of dental trait anxiety, gagging-related fears (e.g. fear of objects in the mouth), anxious depression and neuroticism. Gagging also appeared to be significantly associated with untreated cavities, gingival bleeding and wearing full dentures, but not with avoidance of dental care. It can be concluded that individuals who report to gag during dental treatment are moderately dentally anxious, fear-specific situations that can trigger a gagging response and, albeit visiting the dentist equally frequently, report to have a poorer oral health compared to those who do not gag.