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Hauge MS, Willumsen T, Stora B. Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety. BMC Oral Health 2023; 23:415. [PMID: 37349747 PMCID: PMC10288821 DOI: 10.1186/s12903-023-03061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Educating dentists in treatment methods for dental anxiety would increase the patients' access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD. METHODS A two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique "The Four Habits Model" (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52). RESULTS An Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found. CONCLUSIONS The study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators. TRIAL REGISTRATION The trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.
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Affiliation(s)
- Mariann Saanum Hauge
- Faculty of Dentistry, University of Oslo, Oslo, Norway.
- Oral Health Centre of Expertise, Rogaland, Stavanger, Norway.
| | | | - Bent Stora
- Oral Health Services Agder, Kristiansand, Norway
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Karibe H, Kato Y, Shimazu K, Okamoto A, Heima M. Gender differences in adolescents' perceptions toward dentists using the Japanese version of the dental beliefs survey: a cross-sectional survey. BMC Oral Health 2019; 19:144. [PMID: 31300056 PMCID: PMC6625028 DOI: 10.1186/s12903-019-0845-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background While adult women show greater dental anxiety than adult men, few studies have examined gender differences in adolescent perceptions of dentists. Therefore, this cross-sectional study aimed to evaluate the gender differences in adolescents’ perceptions toward dentists by using the Japanese version of the Dental Beliefs Survey (DBS) and the factor structure of the DBS. Methods We conducted surveys at schools, and 957 Japanese adolescents (403 girls and 554 boys, aged between 13 and 15 years) participated in this study. To assess their confidence in dentists, participants were asked to complete the self-reported, 15-item Japanese version of the DBS. We performed a Welch’s t-test and a one-way analysis of variance to assess differences in DBS scores by gender and age. Factor analysis (principal components, varimax rotation) was used to assess the scale’s factor structure. Results A significant gender difference was observed in the DBS scores (P = 0.018), suggesting that boys exhibit greater negative perceptions toward the behavior of dentists than girls. However, there was no significant difference found among ages. The factor analysis yielded two results: Factor 1, “trust” (seven items); and Factor 2, “lack of control” (five items). Notably, the factor structure differed according to gender. As such, by including only factors with eigenvalues above 1.0, the DBS for girls comprised “trust” (seven items) and “communication” (three items), while that for boys comprised “lack of control” (six items) and “belittlement” (six items). Conclusions This study identified two factors of differing strengths pertaining to the confidence of Japanese adolescents in dentists. Gender differences in perceptions toward dentists were observed. Accounting for these differences may improve the effectiveness of strategies to lower dental anxiety and foster positive dental beliefs in young patients.
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Affiliation(s)
- Hiroyuki Karibe
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan.
| | - Yuichi Kato
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Kisaki Shimazu
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Ayuko Okamoto
- Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda, Tokyo, 102-8159, Japan
| | - Masahiro Heima
- Department of Pediatric Dentistry, School of Dental Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4905, USA
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Gujjar KR, van Wijk A, Kumar R, de Jongh A. Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review. J Evid Based Dent Pract 2019; 19:140-155. [PMID: 31326046 DOI: 10.1016/j.jebdp.2019.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/25/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. DATA SOURCES A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. INCLUSION CRITERIA Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. RESULTS A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. CONCLUSIONS A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. CLINICAL SIGNIFICANCE The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. PROSPERO REGISTRATION NUMBER CRD42017064810.
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Affiliation(s)
- Kumar Raghav Gujjar
- Faculty of Dentistry, SEGi University, Petaling Jaya, Selangor, Malaysia; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Arjen van Wijk
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ratika Kumar
- School of Public Health, The University of Queensland, Public Health Building, Brisbane, Australia
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, Worcester, United Kingdom; School of Psychology, Queen's University, Belfast, Northern Ireland
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Gujjar KR, Sharma R, Jongh AD. Virtual reality exposure therapy for treatment of dental phobia. ACTA ACUST UNITED AC 2017; 44:423-4, 427-8, 431-2, 435. [DOI: 10.12968/denu.2017.44.5.423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Kumar Raghav Gujjar
- PhD Candidate, Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands; Senior Lecturer, Faculty of Dentistry, SEGi University, No 9 Jalan Teknologi, Kota Damansara, PJU-5, Petalingjaya-47810, Selangor, Malaysia
| | - Ratika Sharma
- PhD Candidate, School of Public Health, The University of Queensland, Public Health Building, Cnr Wyndham St and Herston Rd, Herston QLD 4006, Australia
| | - Ad De Jongh
- Professor, Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1081 LA Amsterdam, The Netherlands; School of Health Sciences of Salford University, Manchester, UK
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Raghav K, Van Wijk AJ, Abdullah F, Islam MN, Bernatchez M, De Jongh A. Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial. BMC Oral Health 2016; 16:25. [PMID: 26920573 PMCID: PMC4769551 DOI: 10.1186/s12903-016-0186-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET. Methods This study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants’ dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis. Discussion This study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia. Trial registration number ISRCTN25824611, Date of registration: 26 October 2015.
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Affiliation(s)
- Kumar Raghav
- Department of Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1081 LA, Amsterdam, The Netherlands. .,Faculty of Dentistry, SEGi University, No:9 Jalan Teknologi, Kotadamansara, PJU-5, Petalingjaya-47810, Selangor, Malaysia.
| | - A J Van Wijk
- Department of Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1081 LA, Amsterdam, The Netherlands
| | - Fawzia Abdullah
- Faculty of Dentistry, SEGi University, No:9 Jalan Teknologi, Kotadamansara, PJU-5, Petalingjaya-47810, Selangor, Malaysia
| | - Md Nurul Islam
- Faculty of Dentistry, SEGi University, No:9 Jalan Teknologi, Kotadamansara, PJU-5, Petalingjaya-47810, Selangor, Malaysia
| | | | - Ad De Jongh
- Department of Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1081 LA, Amsterdam, The Netherlands.,School of Health Sciences of Salford University, Manchester, UK
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Gordon D, Heimberg RG, Tellez M, Ismail AI. A critical review of approaches to the treatment of dental anxiety in adults. J Anxiety Disord 2013; 27:365-78. [PMID: 23746494 DOI: 10.1016/j.janxdis.2013.04.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 04/04/2013] [Indexed: 11/30/2022]
Abstract
Dental anxiety and specific phobia of dental procedures are prevalent conditions that can result in substantial distress and oral health impairment. This paper critically reviews 22 randomized treatment trials aimed at reducing dental anxiety and avoidance in adults, published in peer-reviewed journals between 1974 and 2012. The following treatment techniques are reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, music distraction, hypnotherapy, acupuncture, nitrous oxide sedation, and the use of lavender oil scent. CBT delivered in a variety of formats, including one-session treatment, has the most evidence for its efficacy. Cognitive techniques, relaxation, and techniques to increase patients' sense of control over dental care are also efficacious but perform best when combined with repeated, graduated exposure. Other interventions require further study in randomized trials before conclusions about their efficacy are warranted. Limitations of the extant outcome research and implications for future treatment and research are discussed.
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Affiliation(s)
- Dina Gordon
- Adult Anxiety Clinic, Department of Psychology, Temple University, Philadelphia, PA 19122, USA.
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Vassend O, Røysamb E, Nielsen CS. Dental anxiety in relation to neuroticism and pain sensitivity. A twin study. J Anxiety Disord 2011; 25:302-8. [PMID: 21211939 DOI: 10.1016/j.janxdis.2010.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 08/23/2010] [Accepted: 09/10/2010] [Indexed: 11/24/2022]
Abstract
Predisposing personality traits as well as heightened pain sensitivity and fear of pain have been hypothesized as central factors in the development of dental anxiety. The aim of the study was to estimate the heritability of dental anxiety, and to investigate the genetic and environmental sources of covariance between dental anxiety on one hand, and pain sensitivity and the neuroticism trait on the other. A sample comprising 188 twins, aged 23-35 years (53 monozygotic and 39 dizygotic twin pairs, and 4 single twins whose co-twin did not participate), was included in the study. Measures of dental anxiety and personality were obtained using Corah's Dental Anxiety Scale and the NEO Personality Inventory Revised, respectively. Heat pain and cold pressor pain sensitivity were assessed using standard pain testing procedures. Bivariate Cholesky models were employed to decompose the correlations between phenotypes into genetic and environmental factors. Using models with common additive genetic (A) and individual-specific environmental (E) factors, moderate heritability (i.e., .41) for dental anxiety was demonstrated. Virtually all of the phenotypic correlation between neuroticism and dental anxiety could be accounted for by A. Furthermore, a substantial part of the variance in dental anxiety was due to specific genetic and individual environmental influences unrelated to neuroticism. The phenotypic correlations between dental anxiety and the pain sensitivity indices were close to zero. Thus, while neuroticism and dental anxiety share a sizeable proportion of genetic (but not environmental) risk factors, the results also suggest that these two attributes are distinct entities with overlapping, but not identical, etiologies.
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Affiliation(s)
- Olav Vassend
- Department of Psychology, University of Oslo, Norway.
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8
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Coolidge T, Heima M, Coldwell SE, Weinstein P, Milgrom P. Psychometric properties of the Revised Dental Beliefs Survey. Community Dent Oral Epidemiol 2005; 33:289-97. [PMID: 16008636 DOI: 10.1111/j.1600-0528.2005.00214.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objectives of this pair of studies were to examine the internal reliability, test-retest reliability, and construct validity of the Revised Dental Beliefs Survey. METHODS A total of 108 college students completed two questionnaires containing the Revised Dental Beliefs Survey, as well as the Revised Iowa Dental Control Index, and Desirability of Control scales. As part of another experiment, 141 study participants with dental injection phobia completed the Revised Dental Beliefs Survey and the Dental Anxiety Scale. RESULTS Both the internal and test-retest reliabilities of the Revised Dental Beliefs Survey were high. The measure demonstrated good convergent and discriminant validities. CONCLUSION The Revised Dental Beliefs Survey is well-suited for use with clinical and nonclinical populations, in which a stable and valid measure of perceptions of the dental situation is desired.
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Affiliation(s)
- Trilby Coolidge
- Dental Public Health Sciences, University of Washington, Seattle, WA 98195-7475, USA.
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9
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Abstract
This paper aims to provide an overview of the current knowledge regarding the management of adult dentally anxious patients. Furthermore, an attempt is made to formulate a number of preliminary clinical guidelines, based on the available literature. The findings are discussed in the light of the following four problem areas or types of patients, those with: 1) a mild form of fear or anxiety, 2) a phobia of specific dental procedures or situations, 3) interfering psychiatric symptoms and/or 4) a high treatment need. The literature suggests that particularly the implementation of a high level of predictability during treatment, the training of patients in the use of coping skills, and the application of in vivo exposure to anxiety provoking stimuli are the most appropriate options for the management of anxious dental patients and the reduction of their anxiety level.
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Affiliation(s)
- A De Jongh
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, The Netherlands
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10
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Kvale G, Berggren U, Milgrom P. Dental fear in adults: a meta-analysis of behavioral interventions. Community Dent Oral Epidemiol 2004; 32:250-64. [PMID: 15239776 DOI: 10.1111/j.1600-0528.2004.00146.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia. METHODS Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis. RESULTS The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4). CONCLUSIONS Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance ( >4 years after treatment) is 77%.
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Affiliation(s)
- Gerd Kvale
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
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Kulich KR, Berggren U, Hakeberg M, Gustafsson JE. Factor structure of the Dental Beliefs Survey in a dental phobic population. Eur J Oral Sci 2001; 109:235-40. [PMID: 11531069 DOI: 10.1034/j.1600-0722.2001.00118.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to investigate the factor structure of the 15-item Dental Beliefs Survey (DBS) in a population of dental phobic patients (n=362). Exploratory (EFA) and confirmatory (CFA) factor analyses were used. The EFA indicated three factors: 'communication', 'trust', and 'fear of negative information'. However, the EFA further suggested a general factor with all 15 items. By using the CFA, five factors were found based on the EFA solution and the original DBS dimensions. A general factor, 'social interaction distress in dental treatment', and four more narrow dimensions, 'communication', 'trust', 'fear of negative information' (originally labelled 'belittlement'), and 'lack of control', was the most adequate result with regard to theoretical and statistical properties. However, some items in the factors were partly different from the original version of the DBS. In conclusion, the DBS attempts to measure a complex phenomenon with regard to patients' perceptions and attitudes to dental care. This study has revealed psychometric properties of the DBS in a population of dental phobic patients. The important finding was a general dimension, which suggests the use of DBS as an overall measure of dental beliefs. However, more research is needed in epidemiological and clinical studies with non-phobic individuals.
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Affiliation(s)
- K R Kulich
- Department of Psychology, Faculty of Odontology, Göteborg University, Sweden
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12
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Hägglin C, Hakeberg M, Hällström T, Berggren U, Larsson L, Waern M, Pálsson S, Skoog I. Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women. Eur J Oral Sci 2001; 109:27-33. [PMID: 11330931 DOI: 10.1034/j.1600-0722.2001.00946.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Little is known about the longitudinal course of dental anxiety in relation to age, mental health and personality factors. In 1968 69 a representative sample of 778 women aged 38 to 54 yr took part in a psychiatric examination. Three hundred and ten were followed up in 1992-93. A phobia questionnaire, including assessment of dental fear, and the Eysenck Personality Inventory were distributed to the participants at both occasions. High dental fear was reported by 16.8% of the women at baseline and was associated with a higher number of other phobias, a higher level of neuroticism, more psychiatric impairment, more social disability due to phobic disorder, and a higher anxiety level. Among women who reported high dental fear in 1968 69 (n=36), 64% remitted and 36% remained fearful. Among women with low dental fear in 1968 69 (n = 274), 5% reported high dental fear in 1992-93. Chronicity was associated with higher neuroticism, lower extraversion, and more psychiatric impairment at base-line. Remission was associated with higher extraversion at baseline. Dental anxiety increased or decreased over time in concert with the number of other fears.
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Affiliation(s)
- C Hägglin
- Department of Endodontology/Oral Diagnosis, Göteborg University Sweden.
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13
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Vassend O, Willumsen T, Hoffart A. Effects of dental fear treatment on general distress. The role of personality variables and treatment method. Behav Modif 2000; 24:580-99. [PMID: 10992613 DOI: 10.1177/0145445500244006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to clarify the effects of applied relaxation, cognitive therapy, and nitrous oxide sedation on dental fear and general emotional distress symptoms. Relationships among outcome measures and the Big Five personality dimensions (i.e., Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) were also investigated. After treatment, a highly significant decline in a broad range of emotional distress symptoms as well as dental fear was found. No main treatment method effect or treatment x phase interaction effect with regard to dental fear or distress symptoms was found. Thus, the three treatment methods had highly similar effects, at least on a short-term basis. Significant correlations between neuroticism, extraversion, and agreeableness on one hand, and emotional distress symptoms on the other, were demonstrated. However, when initial symptom level was controlled for in multiple regression analysis, the statistical effects of personality variables generally disappeared.
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Thom A, Sartory G, Jöhren P. Comparison between one-session psychological treatment and benzodiazepine in dental phobia. J Consult Clin Psychol 2000; 68:378-87. [PMID: 10883554 DOI: 10.1037/0022-006x.68.3.378] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To compare the effects of a single session of psychological treatment and acute administration of benzodiazepine, 50 dental phobic patients were allocated either to psychological treatment, benzodiazepine, or no treatment for anxiety. Psychological treatment consisted of stress management training and imaginal exposure to phobic stimuli with homework assignments. Benzodiazepine was administered 30 min before dental treatment. Both treatment conditions led to less anxiety during dental surgery than did the control condition. Phobic patients in the benzodiazepine condition showed a relapse after dental treatment, whereas those in the psychological treatment condition showed further improvement until the follow-up 2 months later. Of the latter group, 70% continued dental treatment; only 20% and 10% returned in the benzodiazepine and control conditions, respectively.
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Affiliation(s)
- A Thom
- University of Wuppertal, Germany
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Hakeberg M, Berggren U, Carlsson SG, Gustafsson JE. Repeated measurements of mood during psychologic treatment of dental fear. Acta Odontol Scand 1997; 55:378-83. [PMID: 9477031 DOI: 10.3109/00016359709059203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aims of the present study were to analyze mood changes during psychologic treatment of dental fear by assessing the rate of improvement. Twenty-one patients who refused conventional dental treatment and reported extreme dental anxiety participated in the study. Levels of dental anxiety and mood were measured with the Dental Anxiety Scale (DAS) and a Mood Adjective Checklist (MACL). MACL included two dimensions, degree of relaxation (r) and pleasantness (h) as experienced in a dental situation. Mood was monitored at each treatment session from base line to termination of the therapy (eight measurements). Two different treatment modalities were used, one with a more cognitive approach (n = 9) and one emphasizing the relaxation component (n = 12). A hierarchical linear models approach was applied to analyze individual change with repeated measurements. The results showed that positive mood changes over time were statistically significant. The mean improvement in mood scores per week and session was estimated for MACL(r) and MACL(h) to be 0.14/week and 0.09/week, respectively. The growth was not affected by DAS levels or treatment mode. This study also illustrated a powerful method for analyzing a longitudinal clinical trial design with repeated measurements.
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Affiliation(s)
- M Hakeberg
- Department of Endodontology/Oral Diagnosis, Faculty of Odontology, Göteborg University, Sweden
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Kvale G, Berg E, Nilsen CM, Raadal M, Nielsen GH, Johnsen TB, Wormnes B. Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample. Community Dent Oral Epidemiol 1997; 25:160-4. [PMID: 9181291 DOI: 10.1111/j.1600-0528.1997.tb00915.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to validate the Kleinknecht's Dental Fear Scale and the Getz's Dental Belief Survey in a Norwegian sample by 1) testing their ability to discriminate between fearful (n = 151) and regular (n = 160) patients, and 2) correlating them. Both instruments were highly reliable (Cronbach's alpha > 0.90). Between 81% and 95% of the fearful and regular patients were correctly assigned to their appropriate groups with both instruments. It may thus be concluded that both instruments are valid. Also, the correlation between the instruments was 0.68, indicating that they to a large extent seem to measure the same concept. The most important predictor items for both instruments were related to avoidance of dental treatment.
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Affiliation(s)
- G Kvale
- Department of Clinical Psychology, University of Bergen, Norway.
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Berggren U, Carlsson SG, Gustafsson JE, Hakeberg M. Factor analysis and reduction of a Fear Survey Schedule among dental phobic patients. Eur J Oral Sci 1995; 103:331-8. [PMID: 8521126 DOI: 10.1111/j.1600-0722.1995.tb00035.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A fear survey instrument, based on the Fear Survey Schedule-II and five additional fear items, was administered to 109 patients (70 women and 39 men) on a waiting list at a specialized dental fear clinic. The fear survey was analyzed to identify its factorial structure. Five fear factors, explaining 54% of the total variance, were identified concerning areas of "illness and death", "failures and embarrassment", "social situations", "physical injuries", and "animals and natural phenomena". An ad hoc reduction of items was carried out to form a shorter, more practical to use questionnaire, which resulted in factors of four or five items with loadings greater than 0.50. The factors intercorrelated significantly (rp varying between 0.33 and 0.59) and "illness and death" correlated highly with "physical injuries" (rp = 0.59) and "animals and natural phenomena" (rp = 0.56), while "failures and embarrassment" correlated highly to "social situations" (rp = 0.54). Statistically significant, but generally lower correlations were found between each factor and the dental fear measures. The highest correlations were found between fear of "physical injuries" and dental fear. There was also a high and significant correlation between sex and fear of "animals and natural phenomena".
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Affiliation(s)
- U Berggren
- Department of Endodontology, Faculty of Odontology, Göteborg University, Sweden
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Hakeberg M, Gustafsson JE, Berggren U, Carlsson SG. Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale. Eur J Oral Sci 1995; 103:339-44. [PMID: 8521127 DOI: 10.1111/j.1600-0722.1995.tb00036.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study analyzed and assessed dimensions of a questionnaire developed to measure general fears and phobias. A previous factor analysis among 109 dental phobics had revealed a five-factor structure with 22 items and an explained total variance of 54%. The present study analyzed the same material using a multivariate statistical procedure (LISREL) to reveal structural latent variables. The LISREL analysis, based on the correlation matrix, yielded a chi-square of 216.6 with 195 degrees of freedom (P = 0.138) and showed a model with seven latent variables. One was a general fear factor correlated to all 22 items. The other six factors concerned "Illness & Death" (5 items), "Failures & Embarrassment" (5 items), "Social situations" (5 items), "Physical injuries" (4 items), "Animals & Natural phenomena" (4 items). One item (opposite sex) was included in both "Failures & Embarrassment" and "Social situations". The last factor, "Social interaction", combined all the items in "Failures & Embarrassment" and "Social situations" (9 items). In conclusion, this multivariate statistical analysis (LISREL) revealed and confirmed a factor structure similar to our previous study, but added two important dimensions not shown with a traditional factor analysis. This reduced FSS-II version measures general fears and phobias and may be used on a routine clinical basis as well as in dental phobia research.
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Affiliation(s)
- M Hakeberg
- Department of Endodontology & Oral diagnosis, Faculty of Odontology, Göteborg University, Sweden
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Abstract
Explanations of dental anxiety in terms of either conditioning or personality predispositions alone are not sufficient to account for all individuals presenting with dental anxiety, since they are not a homogenous group. It was hypothesized that individuals, with wide ranging anxiety problems would be more likely to carry dental anxiety into old age. This prediction was supported by a comparison of older dentally anxious individuals with other older individuals who admitted to dental anxiety previously but were no longer dentally anxious. The results were interpreted in terms of Lang's bioinformation model of anxiety.
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Affiliation(s)
- A Liddell
- Department of Psychology, Memorial University of Newfoundland, St. John's, Canada
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Abstract
Behavioural treatment programmes have been shown repeatedly to be effective in alleviating dental anxiety but few studies have provided long-term follow-ups. In this study, dentally anxious Ss who had completed a 4-session behavioural group programme were followed up for periods between 1 and 4 years after successful completion of treatment. It was hypothesized that dental visit satisfaction would be associated with regular dental attendance. 88% of Ss contacted agreed to cooperate; of these, 70% were still maintaining regular check-ups. There were no differences between regular and irregular attenders in terms of age, gender, education, marital status, degree of pre-treatment avoidance or time elapsed since completion of the programme. However, Ss who did not see their dentists regularly were more likely to have shown higher levels of anxiety immediately after completing the programme, less concordance between the subjective and overt behavioural aspects of anxiety and to have experienced more invasive than non-invasive procedures than the others. It was argued that dentally anxious individuals are not a homogeneous group and that a better understanding of their individual differences would lead to the development of more efficacious treatment procedures.
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Affiliation(s)
- A Liddell
- Department of Psychology, Memorial University of Newfoundland, St John's, Canada
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