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Shehani A F, Ponraj S, Ramar K, A VS, S R, J G. Non-pharmacological Behavior Management Techniques in Pediatric Dentistry: A Bibliometric Analysis. Cureus 2023; 15:e41329. [PMID: 37539414 PMCID: PMC10396316 DOI: 10.7759/cureus.41329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
As an emerging trend, non-pharmacological behavior management has gained immense research interest. By utilizing a bibliometric approach, this investigation aims to review the state of the non-pharmacological behavior management techniques research in pediatric dentistry. A Scopus search was done on non-pharmacological behavior management in pediatric dentistry, including literature from 1900 to 2022, using "Cited Reference Search" on 4/2/2022. After being screened, the articles were ranked according to the number of citations they had, and the publication year, authorship, contributing institutions, countries, article topic, study design, H index, and keywords were extracted. Out of the 1431 articles found during the literature search, the top 50 cited articles were used for analysis. The citation counts of the 50 selected articles varied from 163 to one, and their highest publications were in the years 2017 and 2019 (n = 7). Most studies were published in the United Kingdom (n = 10). The studies done in Australia and USA have the highest mean citation with the most significant contributions from the Department of Dental Medicine, Children's Hospital, Regional Medical Center, USA. The systematic review was the most frequent study design (n = 19). Among 110 unique keywords, dental anxiety (n = 11) was the most frequently used. This bibliometric analysis offers valuable details on the top 50 publications cited between 2006 and 2022. Although these methods have been employed for many years, only recently have they been the subject of significant scientific publications. It is hoped that this study will enable aspiring and seasoned researchers to envision and create potential future scenarios for interdisciplinary research collaborations on the use of non-pharmacological behavior management techniques in pediatric dentistry.
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Affiliation(s)
- Farah Shehani A
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
| | - Sujitha Ponraj
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
| | - Kavitha Ramar
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
| | - Victor Samuel A
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
| | - Rajakumar S
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
| | - Gayathri J
- Pediatric and Preventive Dentistry, SRM Kattankulathur Dental College, SRM Institute of Science & Technology, Chennai, IND
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Kankaala T, Rajavaara P, Kestilä M, Väisänen M, Vähänikkilä H, Laitala ML, Anttonen V. Methods Helping Dentists to Detect Dental Fear. Int Dent J 2023; 73:228-234. [PMID: 35918206 PMCID: PMC10023586 DOI: 10.1016/j.identj.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/07/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Dental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients' self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed. METHODS A cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new "traffic light" colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants. RESULTS Of the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF "traffic light" system. The association between dentists' and participants' estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen's kappa value = -0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS. CONCLUSIONS Colour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.
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Affiliation(s)
- Taina Kankaala
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland; Dental Teaching Unit, City of Oulu, Finland.
| | - Päivi Rajavaara
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland; Dental Teaching Unit, City of Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital
| | - Maria Kestilä
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland
| | - Minna Väisänen
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland
| | - Hannu Vähänikkilä
- Biostatistician Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Finland
| | - Marja-Liisa Laitala
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital
| | - Vuokko Anttonen
- Department of Cariology, Endodontology, and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital
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Mayer TMADS, Maior GBS, da Costa NP, do Nascimento MG, Colares V. Effectiveness of a smartphone application on dental anxiety in adolescents: A randomized controlled trial. Int J Paediatr Dent 2023. [PMID: 36840438 DOI: 10.1111/ipd.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 01/30/2023] [Accepted: 02/18/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Dental anxiety is a common issue among adolescents. Despite the use of smartphones being an important part of their daily lives, only a few digital-based interventions for dental anxiety have been tested in randomized controlled trials (RCT). AIM The aim of this study was to evaluate a new smartphone application (App) named FALE, which was designed to demonstrate interest from the dentist to adolescent and to reduce dental anxiety. DESIGN This is a RCT in which 184 adolescents aged 10-19 years were randomly allocated into the intervention group (IG) or the control group (CG). The intervention was applied in the waiting room before the consultation at a dental clinic. The IG answered the FALE, which contained 14 questions-of which the first and last questions addressed anxiety, whereas the CG answered the question about anxiety twice with an interval between them. RESULTS There was a significant difference in the distribution of anxiety rating frequencies before and after the intervention period in both groups. For the IG, there was a reduction in anxiety after the intervention of 16.29%, and, in the CG, a reduction of 2.2% (p < .001). CONCLUSION The FALE App effectively reduced dental anxiety before the appointment.
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Affiliation(s)
| | | | | | | | - Viviane Colares
- Department of Pediatric Dentistry, University of Pernambuco, Recife, Brazil.,Graduate Program in Hebiatrics, University of Pernambuco, Recife, Brazil.,Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
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Höglund M, Wårdh I, Shahnavaz S, Berterö C. Dental clinicians recognizing signs of dental anxiety: a grounded theory study. Acta Odontol Scand 2022:1-9. [DOI: 10.1080/00016357.2022.2154263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Markus Höglund
- Centre for Orofacial Medicine, Public Dental Service Östergötland, Linköping, Sweden
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Inger Wårdh
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- Academic Center of Geriatric Dentistry, Stockholm, Sweden
- Department of Health Sciences, University of Karlstad, Karlstad, Sweden
| | - Shervin Shahnavaz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- The Centre for Psychotherapy Education & Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Carina Berterö
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Can Intra-Oral Qualitative Sensory Testing Foretell Postoperative Dental Pain? A Preliminary Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138059. [PMID: 35805715 PMCID: PMC9265558 DOI: 10.3390/ijerph19138059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022]
Abstract
Pain prevention and management is one of the primary goals of dental care. Postoperative dental pain (PDP) following caries removal and performance of a restorative dental treatment is a common clinical phenomenon, often causing significant discomfort to dental patients. In the present study, a psychophysical non-invasive method, qualitative sensory testing (QualST), was used in an attempt to foretell PDP following dental restorative procedures. Forty-two dental patients underwent an intra-oral cold QualST four times: immediately prior to a restorative dental procedure and at a follow-up meeting 1−3 weeks later, on the treated and on the contralateral oral sides. The QualST measures included subjects’ evaluation of the magnitude of pain and cold sensations experienced (on visual analogue scales) and the duration of the cold sensation (in seconds). Additional measures included age, gender, level of dental anxiety, jaw treated, and type of dental restoration performed (Class I or Class V). Subjects’ PDP was assessed through the phone using numeric rating scales 24, 48, and 72 h postoperatively. The highest level of PDP experienced by subjects occurred 24 h postoperatively (ANOVA with repeated measures). Of the study variables, the QualST pain sensation (B = 0.645, p < 0.001), duration of the cold sensation (B = 0.042, p < 0.05), and an interaction between gender and dental anxiety (B = 0.136, p < 0.05) emerged as possible predictors of the highest PDP experienced by subjects (stepwise regression). The results suggest that subjects’ reaction to an intra-oral cold stimulation of the oral mucosa can serve as a potential tool to foretell postoperative dental pain following restorative dental procedures.
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Wolf TG, Baumgärtner E, Peter B. Personality Styles of Dentists Practicing Hypnosis Confirm the Existence of the Homo Hypnoticus. Front Psychol 2022; 13:835200. [PMID: 35369214 PMCID: PMC8965439 DOI: 10.3389/fpsyg.2022.835200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Several publications with healthcare professionals, such as psychotherapists, have shown a significant difference in personality styles in practitioners using hypnosis compared to those not using hypnosis. To investigate differences in personality styles, dentists were contacted to participate in a personality-inventory [Personality Style and Disorder Inventory (PSDI)] online survey. Dentists using hypnosis (HYP DGZH) (n = 418) were compared to dentists not using hypnosis (NONHYP DENT) (n = 162). Results show that hypnosis-practicing dentists score significantly higher in the intuitive/schizotypal ST personality style (p < 0.001) compared to non-hypnosis-practicing dentists. Female dentists scored significantly higher in intuitive/schizotypal ST and unselfish/self-sacrificing SL in the HYP DGZH sample but only in unselfish/self-sacrificing SL in the NONHYP DENT sample. The percentage of women was similar in both samples (68.2%; 67.3%). Intuitive/schizotypal ST was found to be the predominant personality style of men who are interested in or use hypnosis, metaphorically so-called "homo hypnoticus." Within the limitations of this cross-sectional non-interventional observational online-questionnaire study, results expand this notion to the so-called "homo hypnoticus dentalis." However, further research on the subject is needed to investigate and confirm this personality type in other than the German-speaking DACH countries.
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Affiliation(s)
- Thomas Gerhard Wolf
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Elena Baumgärtner
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Burkhard Peter
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- MEG-Stiftung München, Munich, Germany
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Ogawa M, Ayuse T, Fujisawa T, Sato S, Ayuse T. The methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology: a cross-sectional study. BMC Oral Health 2022; 22:38. [PMID: 35148728 PMCID: PMC8832685 DOI: 10.1186/s12903-022-02071-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Dental phobia is covered by medical insurance; however, the diagnostic methods are not standardized in Japan. Therefore, the aim of this study was to investigate the methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology. Methods We conducted an online survey to obtain information from the members of the Japanese Society for Disability and Oral Health (JSDH, n = 5134) and the Japanese Dental Society of Anesthesiology (JDSA, n = 2759). Response items included gender, qualification, affiliation type, methods of diagnosis and management of dental phobia, use of questionnaire, need to establish standardized diagnostic method for dental phobia, and others. The chi-squared test was used to compare answers between the three groups: JSDH only, JDSA only, and both JSDH and JDSA. Multiple logistic regression analysis was conducted to identify factors associated with the use of an assessment questionnaire. Results Data were obtained from 614 practitioners (JSDH only, n = 329; JDSA only, n = 195; both JSDH and JDSA: n = 90, response rate: 7.8% [614/7,893], men: n = 364 [58.5%]). Only 9.7% of practitioners used questionnaires to quantify the level of dental anxiety. The members of both JSDH and JDSA group used questionnaires more frequently than members of the JSDH only (19% and 7.1%, respectively; Bonferroni corrected p < 0.01). Most practitioners (89.1%) diagnosed dental phobia based on patient complaints of fear of treatment. Furthermore, majority of the participants (73.3%) felt the need to establish standardized diagnostic method for “dental phobia.” Multiple logistic regression analysis showed that membership of the JSDH only was negatively related (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.13–0.60), and use of behavioral therapy was positively related (OR 2.34, 95% CI 1.18–4.84) to the use of a questionnaire. Conclusions The results of this study showed that the use of questionnaires was very low, patients’ subjective opinions were commonly used to diagnose dental phobia, and a standardized diagnostic criterion was thus needed among practitioners. Therefore, it is necessary to establish diagnostic criteria for dental phobia in line with the Japanese clinical system and to educate dentists about them.
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Affiliation(s)
- Mika Ogawa
- Section of Anesthesiology, Department of Diagnostics and General Care, Fukuoka Dental University, Fukuoka, Japan
| | - Terumi Ayuse
- Department of Special Care Dentistry, Nagasaki University Hospital, Nagasaki, Japan.
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Hokkaido University, Hokkaido, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Takao Ayuse
- Department of Dental Anesthesiology, Nagasaki University Institute of Biomedical Sciences, Course of Medical and Dental Sciences, Nagasaki, Japan
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Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031499. [PMID: 35162520 PMCID: PMC8834804 DOI: 10.3390/ijerph19031499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 12/31/2022]
Abstract
Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.
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AlMuhaish L, AlArfaj A, AlGhannam M, AlMutiri H, Abuhassan S, Asiri A, Nazir MA. Dental Anxiety Screening and Management Practices in Dental Practice in Eastern Province, Saudi Arabia. Patient Prefer Adherence 2022; 16:3429-3439. [PMID: 36601029 PMCID: PMC9807122 DOI: 10.2147/ppa.s393399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate dental anxiety (DA) screening and management practices among dental professionals in Saudi Arabia. The study also evaluated correlation between patients' self-reported DA and dentists' ratings of patients' DA. PARTICIPANTS AND METHODS This cross-sectional observational study included dentist/patient pairs (N = 279) from the Eastern Province of Saudi Arabia. The dentists responded to a questionnaire about their DA screening and management practices and they evaluated patients' DA using the visual analogue scale (VAS). In addition, patients responded to the Modified Dental Anxiety Scale (MDAS) to measure their DA. RESULTS About 15.1% of dentists reported using a published scale for screening DA in dental practice and Corah's Dental Anxiety Scale and Dental Fear Survey were their main scales. However, 69.2% reported directly asking their patients about DA. The use of DA management technique was reported by 89.6% of the dentists. Approximately half of the participants (53%) reported receiving DA training in their undergraduate dentistry programs and 65.2% expressed their interest in continuing education courses related to DA. In multiple logistic regression analysis, statistically significant factors associated with DA screening practice included gender (AOR = 0.46, P = 0.037), place of work (AOR = 3.68, P = 0.039), and interest in continuing education courses (AOR = 3.21, P = 0.015). Monthly income (AOR = 0.20, P = 0.029) and directly asking patient about DA (AOR = 6.15, P = 0.025) were significant factors associated with management of patients with DA. The study also showed a significant but weak correlation between DA evaluated by the dentists and DA reported by the patients (rho = 0.185, P = 0.002). CONCLUSION The present study showed a low prevalence of DA screening practices among dentists. Dentists' rating of patients' DA weakly correlated with patients' self-reported DA.
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Affiliation(s)
- Luba AlMuhaish
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - AlHanoof AlArfaj
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maha AlGhannam
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hadeel AlMutiri
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarah Abuhassan
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal Asiri
- Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Correspondence: Muhammad Ashraf Nazir, Tel +966-543569615, Email
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Townsend JA, Randall CL. Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance. Dent Clin North Am 2021; 65:731-751. [PMID: 34503664 DOI: 10.1016/j.cden.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.
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Affiliation(s)
- Janice A Townsend
- Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, LA Suite 5A, Columbus, OH 43205, USA; Division of Pediatric Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA
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Kurki P, Korhonen M, Honkalampi K, Suominen AL. Patients' multifaceted views of dental fear in a diagnostic interview. Acta Odontol Scand 2021; 79:194-204. [PMID: 32924725 DOI: 10.1080/00016357.2020.1817545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim was to examine how patients describe and perceive their dental fear (DF) in diagnostic interviews. MATERIAL AND METHODS The sample consisted of dentally anxious patients according to the Modified Dental Anxiety Scale (MDAS), who had problems coping with conventional dental treatment. The voluntary participants (n = 7, aged 31-62 years) attended a diagnostic interview aiming to map their DF before dental treatment. The data were analysed by theory-driven qualitative content analysis. The themes consisted of the four components of DF: emotional, behavioural, cognitional, and physiological, derived from the Index of Dental Anxiety and Fear. RESULTS Within these four themes, treated as the main categories, 27 additional categories related to the patients' interpretations of DF were identified in three contexts: before, during and after dental treatment. 10 categories depicted difficult, uncontrollable, or ambivalent emotions; nine depicted behavioural patterns, strategies, or means; five depicted disturbing, strong, or long-lasting physiological reactions, including panic and anxiety symptoms. The remaining three categories related to cognitive components. CONCLUSIONS The results indicate that dental care professionals may gain comprehensive information about their patients' DF by means of four component-based diagnostic interviews. This helps them to better identify and encounter patients in need of fear-sensitive dental care. TRIAL REGISTRATION NUMBER NCT02919241.
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Affiliation(s)
- Pirjo Kurki
- Institute of Dentistry, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maija Korhonen
- Psychology, School of Educational Sciences and Psychology, University of Eastern Finland
| | - Kirsi Honkalampi
- Psychology, School of Educational Sciences and Psychology, University of Eastern Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, School of Medicine, University of Eastern Finland, Kuopio, Finland
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Nazir M, Almulhim KS, AlDaamah Z, Bubshait S, Sallout M, AlGhamdi S, Alhumaid J. Dental Fear and Patient Preference for Emergency Dental Treatment Among Adults in COVID-19 Quarantine Centers in Dammam, Saudi Arabia. Patient Prefer Adherence 2021; 15:1707-1715. [PMID: 34354346 PMCID: PMC8331203 DOI: 10.2147/ppa.s319193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/10/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia. MATERIALS AND METHODS Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June-July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information. RESULTS The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear. CONCLUSION Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.
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Affiliation(s)
- Muhammad Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
- Correspondence: Muhammad Nazir Tel +966-543569615 Email
| | - Khalid S Almulhim
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
| | - Ziyad AlDaamah
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
| | - Salman Bubshait
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
| | - Mohammed Sallout
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
| | - Salman AlGhamdi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
| | - Jehan Alhumaid
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia
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13
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Ogawa M, Sago T, Lahti S, Taniguchi S. Psychometric Properties of the Japanese Version of the Single Dental Anxiety Question: A Cross-sectional Online Survey. Open Dent J 2020. [DOI: 10.2174/1874210602014010426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Assessment of dental anxiety using a validated questionnaire is important for its management and survey.
Objective:
The aim of this cross-sectional online survey was to evaluate the psychometric properties of the Japanese version of the Single Dental Anxiety Question (SDAQ).
Methods:
The single question was translated into Japanese following the forward-backward method. Four hundred Japanese internet monitors (age 20–79 years) were included in the study. Sensitivity–specificity analysis and the Kappa coefficient were calculated against the Modified Dental Anxiety Scale (MDAS) using the 19 cutoff score for high dental anxiety. Criterion validity was evaluated using age, gender, dental attendance pattern, negative dental experiences, and subjective oral health.
Results:
Among these subjects, 11% were found to have high dental anxiety on the MDAS score and 9% rated themselves as very afraid of SDAQ. The Kappa coefficient between the MDAS cutoff score and the SDAQ classification was 0.58, the sensitivity was 0.56, and the specificity was 0.97. The SDAQ was associated with gender (P = 0.018), dental attendance pattern (P = 0.020), negative dental experiences (P < 0.001), and subjective oral health (P < 0.001).
Conclusion:
The Japanese version of the SDAQ has good criterion and construct validity but lower sensitivity than the original version. It can be used to assess dental anxiety in large dental surveys or clinical settings where a multi-item questionnaire is not feasible.
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14
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The Reliability and Validity of the Japanese Version of the Modified Dental Anxiety Scale among Dental Outpatients. ScientificWorldJournal 2020; 2020:8734946. [PMID: 32410911 PMCID: PMC7211259 DOI: 10.1155/2020/8734946] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction A careful assessment of dental anxiety is necessary for its management. The Modified Dental Anxiety Scale (MDAS) is one of the most commonly used questionnaires to measure dental anxiety in the world. The reliability and validity of the Japanese version of MDAS have been demonstrated using undergraduates and a few patients with dental anxiety. The aim of the present study was to examine the reliability and validity of the Japanese version of the MDAS using a wide range of age samples in dental clinics. Methods A total of 275 outpatients (145 men and 130 women; 21–87 years) from two dental clinics participated in the present study. Dental anxiety was assessed using the Japanese version of the MDAS and the Dental Fear Survey (DFS). The psychometric evaluation included exploratory factor analysis, and Cronbach's α was used to evaluate for internal consistency. Criterion validity was assessed by correlating the MDAS and DFS scores using Spearman's correlation coefficient. validity was evaluated by examining related factors' differences in the MDAS score (e.g., sex and negative dental experiences). Results Six patients (2.2%) reported high levels of dental anxiety (MDAS score ≥ 19). The internal consistency of the MDAS score was high (Cronbach's α = 0.88). Dental anxiety was significantly higher among women (P=0.007), in patients with previous negative dental experiences (P < 0.001), and among those with lower frequencies of dental visits (P < 0.001). The MDAS score was significant and related to age (r = 0.48) and the DFS score (r = 0.87). Factor analysis revealed all items measured only one construct. Conclusions The Japanese version of the MDAS score was found to be a reliable and valid measure of dental anxiety among dental outpatients. It could be useful for the Japanese dental practitioner to measure dental anxiety in a clinical setting.
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Höglund M, Bågesund M, Shahnavaz S, Wårdh I. Evaluation of the ability of dental clinicians to rate dental anxiety. Eur J Oral Sci 2019; 127:455-461. [PMID: 31317603 PMCID: PMC6790589 DOI: 10.1111/eos.12648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 02/06/2023]
Abstract
The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (rs ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.
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Affiliation(s)
- Markus Höglund
- Centre for Orofacial Medicine, Public Dental Service Östergötland, Linköping, Sweden.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Mats Bågesund
- Centre for Orthodontics and Paediatric Dentistry, Norrköping, Public Dental Service Östergötland, Sweden.,Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Shervin Shahnavaz
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.,Department of Clinical Neuroscience, Centre for Psychotherapy Education and Research, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Inger Wårdh
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Academic Centre of Geriatric Dentistry, Stockholm, Sweden
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16
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Alsanawi EA, Abusaris R, El-Metwally AA. Cross-cultural adaptation and validation of the Arabic version of the Index of Dental Anxiety and Fear (IDAF-4C). J Oral Sci 2019; 61:229-237. [DOI: 10.2334/josnusd.18-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - Raghib Abusaris
- College of Public Health and Health Informatic, King Saud Bin Abdulaziz University for Health Sciences
| | - Ashraf A. El-Metwally
- College of Public Health and Health Informatic, King Saud Bin Abdulaziz University for Health Sciences
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17
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Sinha E, Rekha R, Nagashree SR. Anxiety of dental treatment among patients visiting primary health centers. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2019. [DOI: 10.4103/jiaphd.jiaphd_178_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Kamel AF, Al-Harbi A, Al-Otaibi F, Al-Qahtani F, Al-Garni A. Dental anxiety at Riyadh Elm University Clinics. SAUDI JOURNAL OF ORAL SCIENCES 2019. [DOI: 10.4103/sjos.sjoralsci_33_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Alshammasi H, Buchanan H, Ashley P. Dentists' use of validated child dental anxiety measures in clinical practice: a mixed methods study. Int J Paediatr Dent 2018; 28:62-70. [PMID: 28406548 DOI: 10.1111/ipd.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessing anxiety is an important part of the assessment of a child presenting for dental treatment; however, the use of dental anxiety scales in practice is not well-documented. AIMS To introduce child dental anxiety scales, and to monitor the extent to which dentists used them; to explore the experience and views of dentists regarding anxiety assessment. DESIGN A mixed-methods design was employed. METHOD A protocol for child anxiety assessment was introduced to paediatric dentists in Eastman Dental Hospital. After 6 months, 100 patient files were audited to examine compliance with the protocol. Fourteen dentists were interviewed to explore their experience and views regarding anxiety assessment. RESULTS Only five patients were assessed using the scales. Thematic analysis of the dentist interviews revealed three themes: 'Clinical observations and experience: The gold standard'; 'Scales as an estimate or adjunct'; and 'Shortcomings and barriers to using scales'. CONCLUSIONS The dentists in our study did not use anxiety scales, instead they rely on their own experience/judgement. Therefore, scales should be recommended as an adjunct to judgement. Brief scales are recommended as clinicians lack time and expertise in administering anxiety questionnaires. Advantages of using scales and hands-on experience could be incorporated more in undergraduate training.
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Affiliation(s)
| | - Heather Buchanan
- Division Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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20
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Fayad MI, Elbieh A, Baig MN, Alruwaili SA. Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia. J Int Soc Prev Community Dent 2017; 7:100-104. [PMID: 28462178 PMCID: PMC5390573 DOI: 10.4103/jispcd.jispcd_19_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Anxiety towards dental procedures are common difficulties that may be experienced by dental patients all over the world. This study focused on evaluating the dental anxiety frequency and its relationship with age, gender, educational level, and past dental visits among patients attending the outpatient clinics of College of Dentistry, Al Jouf University, Saudi Arabia. MATERIAL AND METHODS A total of 221 patients, aged 21-50 years were selected for the study. A questionnaire comprising the Modified Dental Anxiety Scale (MDAS) was used to measure the level of dental anxiety. Data was analyzed using SPSS version 20. RESULTS The mean anxiety score of the 221 patients was 11.39 (SD ± 2.7). Independent t-test showed a significant variation between the age groups with regards to their mean overall anxiety score (P < 0.05), which reduced with increasing age. A significant difference was found by independent t-test in the mean total score between male and female groups and regarding previous dental visit (P < 0.05). Regarding education level, there was no significant difference between the groups (P > 0.05). CONCLUSION Younger patients, female, and patients with previous unpleasant dental experience were associated with increased MDAS score. CLINICAL SIGNIFICANCE The present study was done for better patient management and proper treatment plan development for dentally anxious patients.
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Affiliation(s)
- Mostafa I Fayad
- Department of Removable Prosthodontics, Faculty of Dental Medicine, Al-Azhar University, Egypt
| | - Ahmed Elbieh
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, MSA University, Egypt
| | - Mohammed N Baig
- Department of Preventive and Community Dentistry, College of Dentistry, Aljouf University, Saudi Arabia
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21
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Rosa A, Miranda M, Franco R, Guarino MG, Barlattani A, Bollero P. Experimental protocol of dental procedures In patients with hereditary angioedema: the role of anxiety and the use of nitrogen oxide. ORAL & IMPLANTOLOGY 2017; 9:49-53. [PMID: 28042430 DOI: 10.11138/orl/2016.9.2.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- A Rosa
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - M Miranda
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - R Franco
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - M G Guarino
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - A Barlattani
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - P Bollero
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
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22
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Kakkar M, Wahi A, Thakkar R, Vohra I, Shukla AK. Prevalence of dental anxiety in 10-14 years old children and its implications. J Dent Anesth Pain Med 2016; 16:199-202. [PMID: 28884153 PMCID: PMC5586557 DOI: 10.17245/jdapm.2016.16.3.199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/09/2016] [Accepted: 09/21/2016] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to provide insight on dental fear amongst schoolchildren and evaluate the association between caries experience and fear of dental procedures. Methods A sample size of 250 students (both sexes) of ages 10-14 years were enrolled in the study. Before dental examination, each participant was informed about the study and given the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) questionnaire. Children who scored greater than 38 were included in the 'with dental fear' group and those who scored less than 38 were assigned to the 'without dental fear' group. All oral check-ups were carried out on the school premises according to WHO criteria. Results There were 105 children (42%) who experienced dental fear. As CFSS-DS scores increased, scores on the Decayed, Missing and Filled Surfaces Index (DMFS) also increased. Scores were highest on "injections" followed by "dentist drill" and "feeling of choking". Children were significantly less anxious about items of dental treatment if they had experienced that particular form of treatment. Female participants were found to be more dentally anxious than the male participants. Conclusions The data revealed dental fear in 10-14 years old children and showed that dental fear scores decreased with increase in age and experience.
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Affiliation(s)
- Mayank Kakkar
- K.L.E V.K Institute of Dental sciences, Belgaum, Karnataka, India
| | - Astha Wahi
- Maharishi Markandeshwar University Ringgold standard institution-College of Dental Science and Research, Mullana, Haryana, India
| | - Radhika Thakkar
- Hemchandracharya North Gujarat University Ringgold standard institution- Narsinghbhai dental college and hospital, Visnagar, Gujarat, India
| | - Iqra Vohra
- Al Farabi College of Dentistry and Nursing, Riyadh, Saudi Arabia
| | - Arvind Kumar Shukla
- Chandra Dental College and Hospital Ringgold standard institution, Safedabad, Uttar Pradesh, India
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23
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Suhani RD, Suhani MF, Badea ME. Dental anxiety and fear among a young population with hearing impairment. ACTA ACUST UNITED AC 2016; 89:143-9. [PMID: 27004038 PMCID: PMC4777458 DOI: 10.15386/cjmed-556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/22/2015] [Accepted: 10/04/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Dental fear and anxiety is a major barrier for dental care provision. Identifying anxious patients can help dental professionals manage them appropriately. The study aimed at assessing dental fear and anxiety among a deaf population in Cluj-Napoca, Romania and their associated and contributing factors. METHOD In this cross sectional study 165 deaf participants were invited to complete a questionnaire comprising three sections. The first section contained questions about social and economical status, the second comprised a Romanian version of the Modified Dental Anxiety Scale (MDAS) while part three was the Dental Fear Survey (DFS). Data was introduced and analyzed with the Statistical Package for Social Sciences (SPSS) program, version 20.0 (SPSS Inc., Chicago, Illinois, USA). RESULTS Thirty four point nine percent (34.9%) of respondents were found to be insignificantly anxious, 59.7% were moderately or extremely anxious with 5.3% being identified with dental phobia based on the MDAS scores. Mean total score for dental anxiety on the MDAS scale was 13.7. Patients suffering from a prior negative experience were found to be more anxious (p<0.05). CONCLUSIONS Dental fear and anxiety is widespread in the deaf communities. Higher percentages were observed among women and people with a previous traumatic dental experience.
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Affiliation(s)
- Raluca Diana Suhani
- Department of Pediatric Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mîndra Eugenia Badea
- Department of Preventive Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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24
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Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016; 8:35-50. [PMID: 27022303 PMCID: PMC4790493 DOI: 10.2147/ccide.s63626] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.
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Affiliation(s)
- Deva Priya Appukuttan
- Department of Periodontics, Sri Ramakrishna Mission Dental College and Hospital, Chennai, India
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25
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Chikkala J, Chandrabhatla SK, Vanga NRV. Variation in levels of anxiety to dental treatment among nonorphan and orphan children living under different systems. J Nat Sci Biol Med 2015; 6:S13-6. [PMID: 26604601 PMCID: PMC4630745 DOI: 10.4103/0976-9668.166053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: It is essential to understand the factors influencing the level of anxiety to dental treatment among different children as it can influence seeking dental care. Here, we assessed the impact of parental loss on dental anxiety among 6-13-year-old children. Materials and Methods: A total of 444 children within the age group 6-13 years were selected. Group 1 consisted of orphan children living in government-run orphanages, Group 2 consisted of orphan children taken care by a person with a motherly relationship, Group 3 consisted of abandoned children living in private organization and Group 4 consisted of children living with their parents. Dental anxiety was measured using children's fear survey schedule-dental subscale and modified faces version of modified child dental anxiety scale. Results: The highest number of anxious children were observed in Group 4 and the difference in the anxiety levels among the four groups was found to be highly statistically significant. Children living in government-run orphanages had least dental anxiety. Conclusion: All the orphans may not have the same anxiety levels and the environment of upbringing the orphans plays a significant role in the development of the anxiety.
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Affiliation(s)
- Jayanth Chikkala
- Department of Pedodontics and Preventive Dentistry, Gitam Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Srinivas Kumar Chandrabhatla
- Department of Pedodontics and Preventive Dentistry, Gitam Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Narasimha Rao V Vanga
- Department of Pedodontics and Preventive Dentistry, Gitam Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
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Armfield JM, Mohan H, Luzzi L, Chrisopoulos S. Dental anxiety screening practices and self-reported training needs among Australian dentists. Aust Dent J 2014; 59:464-72. [PMID: 25091082 DOI: 10.1111/adj.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is recommended that dentists screen for dental anxiety (DA) so that fearful patients may be better managed. The main aim of this study was to determine what dentists are being taught in relation to DA as well as whether and how anxious patients are identified in the clinic. METHODS Two hundred and forty-six practising dentists (adjusted response rate = 40.1%), from a random sample of registered Australian dentists, completed a mailed questionnaire. RESULTS Dentists estimated that high DA affected 23.3% of children and 19.4% of adults seen. Only 3.7% of dentists reported using a published scale for screening DA, with the most common reason being lack of awareness (56.5%). Approximately one-half of responding dentists directly asked their patients about DA and this was more common among younger dentists (χ(2) = 7.75, p = 0.021). There were few differences in DA screening by other practitioner or practice characteristics (p > 0.05). Only one-third of dentists had received undergraduate training related to DA and only 41.7% considered this to be 'good' or better. Almost 37% of respondents expressed an interest in future training opportunities. CONCLUSIONS The use of formal, validated scales for screening DA is minimal. Training in anxiety management appears to be low and is an area that could be expanded upon.
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Affiliation(s)
- J M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia
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27
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McDonnell-Boudra D, Martin A, Hussein I. In vivo exposure therapy for the treatment of an adult needle phobic. ACTA ACUST UNITED AC 2014; 41:533-6, 539-40. [PMID: 25195486 DOI: 10.12968/denu.2014.41.6.533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Dental anxiety is a widespread problem. Behavioural interventions are effective in reducing dental anxiety and dentists are well placed to carry out these interventions. This article aims to familiarize dentists with simple behavioural techniques that can be used to treat patients presenting with dental anxiety. A case study detailing the assessment and treatment of an uncomplicated needle phobia using in vivo graded exposure is included in order to demonstrate the use of these techniques. CLINICAL RELEVANCE Familiarity with simple, behavioural interventions for dental anxiety will enable dentists to respond appropriately to patients who present with mild fear and anxiety. Early intervention may play a role in the reduction of phobic anxiety in the dental setting. Dentists with an interest in behavioural management may also wish to treat patients with uncomplicated dental phobia.
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28
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Sitheeque M, Massoud M, Yahya S, Humphris G. Validation of the Malay version of the Modified Dental Anxiety Scale and the prevalence of dental anxiety in a Malaysian population. ACTA ACUST UNITED AC 2014; 6:313-20. [PMID: 25045162 DOI: 10.1111/jicd.12106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 04/04/2014] [Indexed: 12/22/2022]
Abstract
AIM The aims of the present study were to evaluate the reliability and validity of the Malay version of the Modified Dental Anxiety Scale (MDAS), and to determine the prevalence of dental anxiety and associated factors in a Malaysian population. METHODS A Malay-language questionnaire with questions to elicit demographic and dental care-related information, and the Malay version of the MDAS, were administered to 455 patients at the dental outpatient clinics of the Hospital Universiti Sains Malaysia. Factor analysis and internal consistency statistics were generated. A test-retest of the questionnaire was performed with 30 participants. RESULTS Cronbach's alpha was 0.854, indicating good internal consistency. Factor analysis yielded results showing good validity. Approximately 3.5% of the participants expressed the highest levels of anxiety. Dental anxiety was significantly higher among females than males. Age correlated inversely with dental anxiety. Individuals seeking dental care only if a problem appeared had significantly more anxiety than regular attendees. Patients who postponed treatment because of fear had significantly higher anxiety levels than those who delayed treatment for other reasons. Past adverse dental experience exacerbated dental anxiety. CONCLUSION The Malay version of the MDAS had good reliability and validity. Anxiety levels found in the Malaysians studied were comparable to participants from other countries.
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Affiliation(s)
- Mohaideen Sitheeque
- School of Dental Sciences, University Sains Malaysia, Kubang Kerian, Malaysia.,Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Moustafa Massoud
- School of Dental Sciences, University Sains Malaysia, Kubang Kerian, Malaysia
| | - Suzana Yahya
- School of Dental Sciences, University Sains Malaysia, Kubang Kerian, Malaysia
| | - Gerry Humphris
- Department of Health Psychology, University of St Andrews, St Andrews, UK
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29
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Armfield JM, Heaton LJ. Management of fear and anxiety in the dental clinic: a review. Aust Dent J 2014; 58:390-407; quiz 531. [PMID: 24320894 DOI: 10.1111/adj.12118] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/30/2022]
Abstract
People who are highly anxious about undergoing dental treatment comprise approximately one in seven of the population and require careful and considerate management by dental practitioners. This paper presents a review of a number of non-pharmacological (behavioural and cognitive) techniques that can be used in the dental clinic or surgery in order to assist anxious individuals obtain needed dental care. Practical advice for managing anxious patients is provided and the evidence base for the various approaches is examined and summarized. The importance of firstly identifying dental fear and then understanding its aetiology, nature and associated components is stressed. Anxiety management techniques range from good communication and establishing rapport to the use of systematic desensitization and hypnosis. Some techniques require specialist training but many others could usefully be adopted for all dental patients, regardless of their known level of dental anxiety. It is concluded that successfully managing dentally fearful individuals is achievable for clinicians but requires a greater level of understanding, good communication and a phased treatment approach. There is an acceptable evidence base for several non-pharmacological anxiety management practices to help augment dental practitioners providing care to anxious or fearful children and adults.
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Affiliation(s)
- J M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia
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Humphris G, Crawford JR, Hill K, Gilbert A, Freeman R. UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results. BMC Oral Health 2013; 13:29. [PMID: 23799962 PMCID: PMC3691614 DOI: 10.1186/1472-6831-13-29] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 06/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct. METHODS A two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All interviewers were trained on survey procedures. Within the 7,233 households sampled there were 13,509 adults who were asked to participate in the survey and 11,382 participated (84%). RESULTS The scale was reliable and showed some evidence of unidimensionality. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Percentiles and confidence intervals were presented and can be estimated for individual patients across various age ranges and gender using an on-line tool. CONCLUSIONS The largest reported data set on the MDAS from a representative UK sample was presented. The scale's psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Practitioners within the UK have a resource to estimate the rarity of a particular patient's level of dental anxiety, with confidence intervals, when using the on-line percentile calculator.
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Affiliation(s)
- Gerry Humphris
- Health Psychology, University of St Andrews, Scotland, UK
| | | | - Kirsty Hill
- Dental Public Health, University of Birmingham, England, UK
| | - Angela Gilbert
- Dundee Dental School, University of Dundee, Scotland, UK
| | - Ruth Freeman
- DHSRU, University of Dundee, Scotland, UK
- Dental Public Health, NHS Tayside, Scotland, UK
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Yıldırım E, Karacay S. Evaluation of anxiety level changes during the first three months of orthodontic treatment. Korean J Orthod 2012; 42:201-6. [PMID: 23112951 PMCID: PMC3481991 DOI: 10.4041/kjod.2012.42.4.201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 03/22/2012] [Accepted: 03/26/2012] [Indexed: 11/12/2022] Open
Abstract
Objective To determine the changes in dental anxiety, state anxiety, and trait anxiety levels of patients and their parents after 3 months of active orthodontic treatment. Methods We evaluated 120 patients and one parent of each patient. State Anxiety (STAI-S), Trait Anxiety (STAI-T), and Corah's Dental Anxiety Scale (DAS) were administered before orthodontic treatment (T1) and after 3 months of treatment (T2). Differences in scores between T1 and T2 were compared using paired-sample t-tests and the relationship between the scores of the DAS and the STAI were analyzed using a bivariate two-tailed Pearson correlation test. Results Dental anxiety and state anxiety levels decreased among the patients after adjustment to orthodontic treatment (p < 0.001). However, 3 months of treatment was not sufficient to decrease the anxiety levels of parents (p > 0.05). Patient trait anxiety affected patient state anxiety and dental anxiety (p < 0.01). Additionally, a significant correlation was found between patient dental anxiety and parent dental anxiety (p < 0.05). Conclusions Dental anxiety and state anxiety levels decrease after patients become familiar with their orthodontist and they became accustomed to orthodontic treatment. However, 3 months is not a sufficient length of time to decrease parental anxiety levels.
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Affiliation(s)
- Ersin Yıldırım
- GMMA Haydarpasha Training Hospital, Section of Orthodontics, Istanbul, Turkey
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Evidence-based dentistry: analysis of dental anxiety scales for children. Br Dent J 2012; 212:219-22. [PMID: 22402535 DOI: 10.1038/sj.bdj.2012.174] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To review paediatric dental anxiety measures (DAMs) and assess the statistical methods used for validation and their clinical implications. METHOD A search of four computerised databases between 1960 and January 2011 associated with DAMs, using pre-specified search terms, to assess the method of validation including the reliability as intra-observer agreement 'repeatability or stability' and inter-observer agreement 'reproducibility' and all types of validity. RESULTS Fourteen paediatric DAMs were predominantly validated in schools and not in the clinical setting while five of the DAMs were not validated at all. The DAMs that were validated were done so against other paediatric DAMs which may not have been validated previously. Reliability was not assessed in four of the DAMs. However, all of the validated studies assessed reliability which was usually 'good' or 'acceptable'. None of the current DAMs used a formal sample size technique. Diversity was seen between the studies ranging from a few simple pictograms to lists of questions reported by either the individual or an observer. CONCLUSION To date there is no scale that can be considered as a gold standard, and there is a need to further develop an anxiety scale with a cognitive component for children and adolescents.
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Sanikop S, Agrawal P, Patil S. Relationship between dental anxiety and pain perception during scaling. J Oral Sci 2012; 53:341-8. [PMID: 21959662 DOI: 10.2334/josnusd.53.341] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Dental pain, anxiety and fear are important factors that prevent patients from seeking dental care. In this study, we aimed to evaluate the pain perception of patients during scaling and its relationship with dental anxiety. One hundred dental patients participated in the study. Pain levels after scaling were assessed with a Visual Analog Scale (VAS) and an Anxiety Questionnaire consisting of seven questions. The mean VAS score for the entire study group was 17.3 ± 13.8 with no statistically significant differences between gender and different age groups. The mean anxiety score was 11.66 ± 4.17. This was significantly higher in women (P = 0.005), but there were no statistically significant differences between different age groups. There was a statistically significant correlation between VAS and total anxiety score (P < 0.001) as well as each question, except for questions number 3 and 4 in men. Patients were found to experience only limited pain during scaling. They were anxious because they expected pain, women being more anxious than men. Hence, dentists should seek to alleviate or reduce pain and anxiety related to treatment not only to successfully complete the treatment, but also to sustain and carry the patients into successful maintenance and patient recall.
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Affiliation(s)
- Sheetal Sanikop
- Department of Periodontics, KLE V. K. Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India
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Diercke K, Ollinger I, Bermejo JL, Stucke K, Lux CJ, Brunner M. Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists. Int J Paediatr Dent 2012; 22:60-7. [PMID: 21762409 DOI: 10.1111/j.1365-263x.2011.01158.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. AIM. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. DESIGN. Eight hundred dentists in Germany were interviewed via e-mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. RESULTS. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. CONCLUSIONS. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.
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Affiliation(s)
- Katja Diercke
- Department of Orthodontics, University of Heidelberg, Germany
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Estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) – a novel assessment tool. Br Dent J 2011; 211:E10. [DOI: 10.1038/sj.bdj.2011.725] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2011] [Indexed: 11/08/2022]
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Abstract
BACKGROUND In recent years there has been an increase in the provision of conscious sedation, which is said to be a safe and effective means of managing the anxious patient. However, there are no guidelines to aid the dental practitioner in assessing the patient's need for sedation based on their level of anxiety. AIMS AND METHODS The present study investigated the importance of patient anxiety as an indicator for IV sedation, using focus groups to inform the development of narrative vignettes. Ninety-nine practitioners responded to a series of scenarios to determine whether the level of patient anxiety and the patient's demand for IV sedation influenced their decision making. RESULTS Level of dental anxiety had a stronger influence on the clinician's decision making than patient demand, with increasing levels of dental anxiety being positively associated with the likelihood of clinicians indicating a need for IV patient sedation and also, the likelihood of clinicians providing IV sedation to these patients. Only 14% (n = 14) of respondents reported formally assessing dental anxiety. CONCLUSIONS While dental anxiety is considered to be a key factor in determining the need for IV sedation, there is a lack of guidance regarding the assessment of anxiety among patients.
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Abstract
BACKGROUND The Index of Dental Anxiety and Fear (IDAF-4C) is a theoretically derived test developed to allow clinicians and researchers to measure a person's level of dental fear. Population norms have not previously been made available for the IDAF-4C. The aim of this study was to provide Australian norms for the IDAF-4C using percentile ranks and to examine associations between scores and individual-level characteristics, dental avoidance and fear of pain. METHODS A stratified random sample of 1511 Australian adults yielded complete questionnaire data for 1063 individuals (70.4%). Percentile ranks were calculated for IDAF-4C full scale scores stratified by age and gender. RESULTS IDAF-4C mean scores varied significantly by age, gender, income, and speaking a language other than English at home. Tables to convert raw scores to percentiles showed that full scale scores varied by age and gender. Scores on the IDAF-4C had strong and significant associations with avoidance of the dentist due to fear, average dental visiting frequency and anxiety about pain when going to the dentist. CONCLUSIONS Population norms allow clinicians or researchers to compare results for an individual or subgroup to the Australian population. It is recommended that a dental fear scale be used to screen all dental patients for dental fear to enable a more tailored and effective dental treatment experience.
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Affiliation(s)
- J M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, The University of Adelaide, South Australia, Australia.
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Brown S, Greenwood M, Meechan JG. General medicine and surgery for dental practitioners. Part 5--Psychiatry. Br Dent J 2010; 209:11-6. [PMID: 20616832 DOI: 10.1038/sj.bdj.2010.578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2010] [Indexed: 12/18/2022]
Abstract
There are a significant number of patients in society who have some form of psychiatric disorder. It is important that dental practitioners have an awareness of the more common psychiatric disorders and their potential implications as they are likely to encounter them in clinical practice.
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Affiliation(s)
- S Brown
- Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW
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Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health 2009; 9:20. [PMID: 19709436 PMCID: PMC2743651 DOI: 10.1186/1472-6831-9-20] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 08/26/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Modified Dental Anxiety Scale (MDAS) is a brief, self-complete questionnaire consisting of five questions and summed together to produce a total score ranging from 5 to 25. It has reasonable psychometric properties, low instrumental effects and can be integrated into everyday dental practice as a clinical aid and screen for dental anxiety. The objectives were to (i) produce confirmatory evidence of reliability and validity for the MDAS, (ii) provide up-to-date UK representative norms for the general public to enable clinicians to compare their patients' scores, (iii) to determine the nature of the relationship between dental anxiety and age. METHODS Telephone survey of a representative quota sample of 1000 UK adults (>18 years of age) conducted between 7-21 April, 2008. RESULTS Attrition of potential participants was high in the recruitment process, although bias was minimal. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Dental anxiety was four times greater in the youngest age group (18-39 yrs) compared to older participants (60+ yrs), controlling for sex, social class and self-reported dental visiting behaviour confirming previous developed-world reports. CONCLUSION The scale's psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Dental anxiety was high in younger compared to older people.
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Affiliation(s)
- Gerry M Humphris
- Health Psychology, Bute Medical School, University of St Andrews, UK
| | - Tom A Dyer
- Department of Oral Health and Development, University of Sheffield, Sheffield, UK
| | - Peter G Robinson
- Department of Oral Health and Development, University of Sheffield, Sheffield, UK
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Lin KC. Behavior-Associated Self-Report Items in Patient Charts As Predictors of Dental Appointment Avoidance. J Dent Educ 2009. [DOI: 10.1002/j.0022-0337.2009.73.2.tb04657.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Kevin C. Lin
- School of Dentistry; University of California; Los Angeles
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Casap N, Alterman M, Sharon G, Samuni Y. The Effect of Informed Consent on Stress Levels Associated With Extraction of Impacted Mandibular Third Molars. J Oral Maxillofac Surg 2008; 66:878-81. [DOI: 10.1016/j.joms.2007.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
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Evaluation of dentists' perceived needs regarding treatment of the anxious patient. Br Dent J 2008; 204:E13; discussion 442-3. [PMID: 18425075 DOI: 10.1038/sj.bdj.2008.318] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2007] [Indexed: 11/09/2022]
Abstract
BACKGROUND With regard to the management of dental anxiety in general dental practice, it has been considered that general dental practitioners (GDPs) are well placed to treat adults with mild forms of dental anxiety. However, little is known about the specific anxiety management techniques being used by GDPs in the UK. Aim To determine the views and experiences of dental practitioners in their current use of anxiety management techniques, their undergraduate and post-graduation training in these techniques and future training needs. METHODS A postal questionnaire was sent to a sample of GDPs working in the Midlands region (n = 750) in the UK. Dentists were randomly selected using lists provided by the primary care trusts for each locality. RESULTS The response rate was 73% (n = 550). Of these, 90 were not included in the final analysis due to exclusion criteria set prior to questionnaire release. This left 460 questionnaires for analysis. Eighty-five percent of respondents agreed that dentists had a responsibility to help dentally anxious patients (n = 391). Dentists were asked their reasons for not using anxiety management techniques in practice. Psychological techniques, sedation (oral, inhalation, or intravenous) and hypnosis were reported as not having been used due to the paucity of time available in practice, a shortage of confidence in using these techniques and the lack of fees available under the NHS regulations. Also, 91% reported feeling stressed when treating anxious patients. When asked about the quality of teaching they had received (undergraduate and postgraduate), 65% considered that the teaching was less than adequate in the use of psychological methods, whereas 44% indicated that they would be interested in further training in psychological methods if financial support was available. CONCLUSION The need for further training in managing the dentally anxious patient is supported by dentists' lack of confidence and inadequate training in treating such patients, as determined from the results of a postal questionnaire to UK GDPs.
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Summary of: Evaluation of dentists' perceived needs regarding treatment of the anxious patient. Br Dent J 2008. [DOI: 10.1038/sj.bdj.2008.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yuan S, Freeman R, Lahti S, Lloyd-Williams F, Humphris G. Some psychometric properties of the Chinese version of the Modified Dental Anxiety Scale with cross validation. Health Qual Life Outcomes 2008; 6:22. [PMID: 18364045 PMCID: PMC2289811 DOI: 10.1186/1477-7525-6-22] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 03/25/2008] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the factorial structure and construct validity for the Chinese version of the Modified Dental Anxiety Scale (MDAS). Materials and methods A cross-sectional survey was conducted in March 2006 from adults in the Beijing area. The questionnaire consisted of sections to assess for participants' demographic profile and dental attendance patterns, the Chinese MDAS and the anxiety items from the Hospital Anxiety and Depression Scale (HADS). The analysis was conducted in two stages using confirmatory factor analysis and structural equation modelling. Cross validation was tested with a North West of England comparison sample. Results 783 questionnaires were successfully completed from Beijing, 468 from England. The Chinese MDAS consisted of two factors: anticipatory dental anxiety (ADA) and treatment dental anxiety (TDA). Internal consistency coefficients (tau non-equivalent) were 0.74 and 0.86 respectively. Measurement properties were virtually identical for male and female respondents. Relationships of the Chinese MDAS with gender, age and dental attendance supported predictions. Significant structural parameters between the two sub-scales (negative affectivity and autonomic anxiety) of the HADS anxiety items and the two newly identified factors of the MDAS were confirmed and duplicated in the comparison sample. Conclusion The Chinese version of the MDAS has good psychometric properties and has the ability to assess, briefly, overall dental anxiety and two correlated but distinct aspects.
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Affiliation(s)
- Siyang Yuan
- Dental Health Research Unit, Mackenzie Building, Ninewells Hospital, University of Dundee, UK.
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Viinikangas A, Lahti S, Yuan S, Pietilä I, Freeman R, Humphris G. Evaluating a single dental anxiety question in Finnish adults. Acta Odontol Scand 2007; 65:236-40. [PMID: 17762987 DOI: 10.1080/00016350701395932] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the psychometric properties (criterion validity, construct validity, sensitivity, and specificity) of a single-item question screening for dental anxiety in a Finnish adult population. MATERIAL AND METHODS A total of 823 subjects, ranging in age from 18 to 87 years, answered a questionnaire comprising sections assessing the respondents' demographic profile and dental attendance patterns. A single dental anxiety question and the Modified Dental Anxiety Scale (MDAS) were included. The final response rate was 85%. RESULTS Eight percent of the sample was highly dentally anxious using the MDAS cut-off point of 19 or above. Twelve percent of the respondents rated themselves as "very scared" on the single-item question. The percentage agreement between the single-item question and the MDAS was 93; the Kappa coefficient was 0.63. Specificity of the single question was 0.95 while sensitivity was 0.80 using the MDAS dichotomous classification. The single-item question related to age (p<0.001), gender (p<0.001), and dental attendance (p<0.001), as predicted. CONCLUSIONS The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.
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Affiliation(s)
- Aki Viinikangas
- Department of Community Dentistry, University of Oulu, Finland
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Humphris GM, Hull P. Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A two-wave panel study. ACTA ACUST UNITED AC 2007; 14:7-11. [PMID: 17288717 DOI: 10.1308/135576107779398165] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire. BASIC RESEARCH DESIGN Patients were initially screened to include only those who were dentally anxious. A pre- and post-test was planned with the completion of the Modified Dental Anxiety Scale (MDAS) questionnaire as the intervention. CLINICAL SETTING Two dental access centres in the North West of England. PARTICIPANTS Initially, 583 patients were screened. Of these, 182 (31%) were found to be dentally anxious and were recruited into the study. MAIN OUTCOME MEASURES State-Trait Anxiety Inventory Scale Short Form. RESULTS State anxiety did not change with the completion of the MDAS questionnaire in either designated dental phobics (MDAS >or=19) or those classified as non-phobics (MDAS <19). CONCLUSIONS The MDAS can be used to assess dental anxiety without raising anxiety in patients with or without self-reported dental phobia.
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Heaton LJ, Carlson CR, Smith TA, Baer RA, de Leeuw R. Predicting anxiety during dental treatment using patients'self-reports. J Am Dent Assoc 2007; 138:188-95; quiz 248-9. [PMID: 17272373 DOI: 10.14219/jada.archive.2007.0135] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment. METHODS One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales. RESULTS Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment. CONCLUSIONS Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.
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Affiliation(s)
- Lisa J Heaton
- University of Washington, Department of Dental Public Health Sciences, Seattle, WA 98195-7475, USA.
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Humphris GM, Clarke HMM, Freeman R. Does completing a dental anxiety questionnaire increase anxiety? A randomised controlled trial with adults in general dental practice. Br Dent J 2006; 201:33-5. [PMID: 16829885 DOI: 10.1038/sj.bdj.4813772] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2005] [Indexed: 11/09/2022]
Abstract
UNLABELLED The assessment of dental anxiety can be achieved by using brief multi-item scales. OBJECTIVE To test the null hypothesis that completing the Modified Dental Anxiety Scale had no immediate influence on patient state anxiety. OUTCOME MEASURE Speilberger State Anxiety Inventory-6 item Short Form. STUDY DESIGN Randomised controlled trial. PARTICIPANTS Patients (n = 1,028) attending 18 dental practices in Northern Ireland were invited to participate. RESULTS Twenty-four patients refused (response rate 98%) providing 1,004 patients (mean age = 41 years, range = 16 to 90 years; 65% female) for analysis. Patients who completed the dental anxiety scale were found to have a virtually identical state anxiety score: mean (SD) = 11.36 (4.33) compared to those who completed the state anxiety assessment only: mean (SD) = 11.01 (4.35). The mean (CI95%) difference was 0.35 (0.89 to -0.18), t = 1.29, df1002, p = 0.2. CONCLUSION The completion of a brief dental anxiety questionnaire before seeing the dentist has a non significant effect on state anxiety.
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Affiliation(s)
- G M Humphris
- Bute Medical School, University of St Andrews, Fife KY16 9TS
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Buchanan H, Niven N. Self-report treatment techniques used by dentists to treat dentally anxious children: a preliminary investigation. Int J Paediatr Dent 2003; 13:9-12. [PMID: 12542618 DOI: 10.1046/j.1365-263x.2003.00413.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the extent to which dentists report their encouragement to dentally anxious children to blunt (distract from the procedure) or monitor (give information about the procedure) during treatment. SETTING British Society of Paediatric Dentistry conference. SUBJECTS AND METHODS One hundred and two of 155 delegates (66% response rate) completed a Monitor Blunter Treatment Checklist (MBTC), which was included in their conference pack. Participants were asked to tick all of the 10 statements (five monitoring and five blunting) that reflected how, in general, they would treat a dentally anxious child. RESULTS Dentists chose significantly more monitoring than blunting statements. Treatment strategies relating to explaining procedures were endorsed by the majority of dentists, while distraction was chosen by less than a third. CONCLUSION Dentists tend to use monitoring strategies that adhere generally to the principles of the Tell-Show-Do technique. This may have implications if the anxious child has a 'blunting' coping style.
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Affiliation(s)
- H Buchanan
- Department of Child Dental Health, Dental School, Newcastle upon Tyne, UK
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50
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Dailey YM, Humphris GM, Lennon MA. Reducing patients' state anxiety in general dental practice: a randomized controlled trial. J Dent Res 2002; 81:319-22. [PMID: 12097444 DOI: 10.1177/154405910208100506] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients' state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger's state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P < 0.0001). Providing the dentist with information of the high level of a patient's dental anxiety prior to treatment, and involving the patient in this, reduced the patient's state anxiety.
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Affiliation(s)
- Y-M Dailey
- Department of Clinical Dental Sciences, The University of Liverpool, School of Dentistry, Liverpool, L69 3GN UK.
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