Methods Helping Dentists to Detect Dental Fear

Dental professional recognition of dental anxiety from a patient perspective: a grounded theory study

OBJECTIVE

To explore patients' experiences of dental staff recognising their dental anxiety.

MATERIAL AND METHODS

Semi-structured interviews were conducted with 10 adults who identified themselves as dentally anxious. The sampling of study participants was purposive, and the audio-recorded interviews were transcribed verbatim. Classical grounded theory and constant comparative analysis were used to analyse the interview data inductively. Theoretical saturation was reached after eight interviews.

RESULTS

Hope for 'Fingerspitzengefühl' from the dental staff emerged as the core category, which means having an intuitive instinct about a situation and knowing how to react to it. It also is tact or sensitivity that comes with experience. The foundation for this core was four categories: Dental anxiety causes involuntary signals, Strategies to minimise contact, Seen and respected by the staff, and Recognisable strategies. The interviewees hoped that the dental staff would notice their dental anxiety and understand their feelings of shame, and take relevant actions to alleviate their anxiety.

CONCLUSIONS

Dentally anxious patients often struggle to express their anxiety but hope to find a dentist with Fingerspitzengefühl. The result cannot be generalised but transferred to a similar population.

Cross-cultural adaptation and validation of the Swedish version of the Modified Dental Anxiety Scale

INTRODUCTION

The impact of dental anxiety is profound. At the same time, dental anxiety is sometimes difficult to detect. Therefore, a patient-reported outcome measure is needed. The Modified Dental Anxiety Scale (MDAS) is a short, internationally used self-assessment questionnaire for screening of dental anxiety.

AIM

To cross-culturally adapt the original English MDAS to Swedish (MDAS-S), and to validate it in a Swedish setting.

MATERIALS AND METHODS

The adaptation was conducted in accordance with recommended guidelines. Field testing was performed both among adults presenting for their regular dental check-ups and among adults diagnosed by a psychologist as dentally phobic.

RESULTS

The MDAS-S was formed during the adaptation procedure. Field testing included 246 adults presenting for their regular dental check-ups and 7 adults diagnosed with dental phobia. The MDAS-S score was significantly higher (p < 0.001) in the dentally phobic group than in the regular dental check-up group. Reliability was good with Cronbach's Alpha values between 0.880 to 0.909. Test-retest of 37 individuals showed an excellent Intraclass Correlation Coefficient of 0.956. Confirmatory factor analysis (CFA) finds support for a two-factor model although with 78% shared variance between the factors.

CONCLUSIONS

The MDAS-S demonstrates good reliability and appears valid as a screening tool for dental anxiety among Swedish adults.

A Pre-Adoption Assessment of a Collaborative Care Approach to Dental-Fear Treatment

Background

With an estimated global prevalence rate of over 30%, dental fear is a ubiquitous public health phenomenon. Dental fear's adverse effects on patient oral health and quality of life are well established; the stresses and financial repercussions it can pose to providers are increasingly recognized. Although dental fear is highly treatable, a disseminable intervention that satisfies the needs of patients and dental care providers has yet to be realized.

Objectives

We sought to understand allied dental professionals' experiences treating patients with dental fear and their impressions of, and receptivity to, a stepped-care approach, including perceived barriers and facilitators to its adoption.

Methods

Thirteen semi-structured focus groups comprising students in (a) current dental hygiene programs and (b) other dental programs, who had prior experience working as licensed dental hygienists or allied professionals (i.e., dental assistants, dental therapists, dental treatment coordinators; N = 49) were conducted. Focus group discussions were recorded, transcribed, and thematically analyzed.

Results

Participant responses supported the need for innovation in managing dental fear in practices, and supported hygienists as likely facilitators of any new behavioral approach. Overall, participants were receptive to the idea of a stepped-care treatment approach but identified several factors (e.g., accessibility, costs, treatment credibility) that would need to be addressed for its adoption by patients and dental professionals.

Conclusion

A stepped-care approach to dental fear treatment has promise to meet the needs of patients and dental professionals. Potential barriers and facilitators to adoption provide a roadmap for future intervention refinement and efficacy testing.

Effectiveness of wearing glasses with green lenses on dental anxiety for third-molar surgery: A randomized clinical trial

BACKGROUND

Dental anxiety is a common problem for oral surgeries. This study investigated the effectiveness of wearing glasses with green lenses in reducing dental anxiety, blood pressure, heart rate, and intraoperative pain in patients undergoing first-time third-molar surgery.

METHODS

The authors planned this study as a randomized and parallel-group clinical trial. Patients' dental anxiety was measured with the use of a visual analog scale and a State-Trait Anxiety Inventory for baseline measurement purposes. At the same time, blood pressure, oxygen saturation, and heart rate values were recorded. Patients were given glasses with clear or green lenses, depending on their group. After 10 minutes, all parameters were measured again for preoperative measurement. Patients wore glasses with either green or clear lenses throughout the operation. After the operation, patients were asked to estimate the degree of intraoperative pain using the visual analog scale.

RESULTS

The study included 128 patients. On the basis of the change between baseline and preoperative measurements, the authors found a statistically significant difference in anxiety and heart rate. Intraoperative pain showed a significant difference between groups. No significant changes were found in blood pressure and oxygen saturation.

CONCLUSIONS

Patients with anxiety could wear low-cost, easy-to-use glasses with green lenses for 10 minutes before an operation to reduce anxiety and heart rate. In addition, wearing glasses during the surgical procedure can reduce intraoperative pain.

PRACTICAL IMPLICATIONS

By means of using glasses with green lenses throughout the procedure, existing anxiety and pain can be reduced. An operation can be performed more comfortably for both the patient and the dentist. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05584696.

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Exploring dental students' attitudes toward patient-centered management of dental fear

PURPOSE/OBJECTIVES

A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior.

METHODS

In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims.

RESULTS

Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists.

CONCLUSION(S)

Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.