Dental fear among population aged 30 years and older in Finland

Do Subjects from Different Occupational Groups Experience Dental Fear and Anxiety Equally?

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients.

Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials

Introduction

Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.

Methods

Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).

Results

A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety-stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001).

Conclusion

Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.

Systematic review registration

INPLASY, identifier 202312000.

Breathing out dental fear: A feasibility crossover study on the effectiveness of diaphragmatic breathing in children sitting on the dentist's chair

BACKGROUND

Anxiety related to the dental context is a clinically significant challenge. In children, dental fear is often accompanied by disruptive and uncooperative behaviours that can render treatment difficult. Although techniques to reduce children's anxiety exist, many have not been formally evaluated.

DESIGN

Diaphragmatic breathing has been shown to reduce fear and anxiety, but few investigations have evaluated whether it can reduce dental anxiety in children. This crossover study tested the effectiveness and feasibility of diaphragmatic breathing in twenty children undergoing dental care.

RESULTS

Compared with the treatment as usual, such a simple technique had significant benefits on mood, self-reported pain and autonomic balance, thus reducing sympathetic activation.

CONCLUSION

Diaphragmatic breathing is a low-cost, easy-to-implement technique suitable for daily dental practice, and is a promising tool for reducing negative effect and physiological distress in children with dental anxiety that results in more cooperative behaviours and reduced visit time.

The Effect of an Informative Video upon Anxiety and Stress in Patients Requiring an Oral Biopsy: A Randomized Controlled Study

OBJECTIVE

The use of multimedia tools improves patient understanding of surgical procedures, reduces anxiety and increases satisfaction. The present study evaluates the impact of an audiovisual intervention (video) upon anxiety and stress in patients requiring an oral biopsy.

MATERIAL AND METHODS

A prospective randomized clinical trial was carried out in patients requiring an oral biopsy. The control group (n = 60) received verbal standard information while the experimental group (n = 60) received information in the form of a video. The following data were recorded: gender, age, educational level and hemodynamic parameters (blood pressure, heart rate and blood oxygen saturation). The following questionnaires were used to assess anxiety and stress before and after the biopsy procedure: Corah's Modified Dental Anxiety Scale (MDAS), the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

The final study sample consisted of 120 patients, of which 65.8% were women and 34.2% men, with a mean age of 40.5 ± 15.3 years. At the end of the study, the experimental group presented a significantly lower MDAS score than the control group (p = 0.041). The STAI score also showed a significant decrease with respect to the control group at the end of the study (p = 0.012). There were no statistically significant changes in the hemodynamic parameters in either group.

CONCLUSIONS

The video constituted a useful and easy tool for reducing anxiety among patients requiring an oral biopsy.

Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey

Background

Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods

We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results

In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions

Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.

The calming effect of roasted coffee aroma in patients undergoing dental procedures

Coffee beverage consumption is well-known to exert various health benefits; however, the effects of coffee aroma are rarely explored. This study aimed to investigate the calming effect of inhaling coffee aroma while the patients underwent dental procedures (probing and scaling). Salivary α-amylase (sAA) and cortisol (sCort) levels were measured as proxies of sympathetic nervous system and hypothalamic–pituitary–adrenal axis responses to stress respectively. Blood pressures and pulse rates were recorded. The results showed that undergoing dental procedures could increase sAA and sCort levels of the patients inhaling sham aroma while those inhaling coffee aroma had significantly decreased sAA and sCort levels (40% and 25% differences, respectively). The pulse rates of those inhaling coffee aroma were also lower. Subjective assessment using visual analog scale was in line with objective measures as well. The preference for coffee aroma or the frequency of coffee drinking had no effect on the sAA and sCort responses. This is the first study to provide evidence on the effect of coffee aroma on sAA and sCort levels in patients undergoing dental procedures.

Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial

Introduction:

Dental anxiety is common and causes symptomatic use of oral health services.

Objectives:

The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety.

Methods:

A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking.

Results:

Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001).

Conclusion:

Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080).

Knowledge Transfer Statement:

Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Association between dental fear, physical activity and physical and mental well-being among Finnish university students

Objective: The aim of this study was to evaluate the association between physical and mental well-being and physical activity with dental fear among university students in Finland.Methods: We used the 2016 data from the Finnish student health survey (n = 3090). Perceived physical and mental well-being was ascertained with the questions 'How would you describe your current state of physical well-being?' and 'How would you describe your current state of mental well-being'. Dental fear was inquired with question 'Do you feel scared about dental care?' Associations between physical and mental well-being and dental fear were analyzed with cross tabulations and logistic regression analysis.Results: When controlling for age, gender, educational sector, tobacco and alcohol use, those reporting poor or moderate physical or mental well-being were more likely to have high dental fear than were those reporting good physical or mental well-being.Conclusions: In addition to mental well-being, physical well-being was also associated with dental fear; those with poor or moderate physical well-being were more likely to have dental fear than were those with good physical well-being.

Dental students' and patients' perceived importance and knowledge of dental anxiety

AIM

To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear.

METHODS

Dental students (N = 219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5-9, low fear = 10-18, high fear = 19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis.

RESULTS

Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety.

CONCLUSION

Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

Association between sensory processing and dental fear among female undergraduates in Japan

Objectives: The aim of cross-sectional study was to investigate the association between sensory processing patterns and dental fear among female undergraduates. Material and methods: Three hundred and ten female university students were included in the present study. Dental fear and sensory processing patterns were measured using the Dental Fear Survey and Adolescent/Adult Sensory Profile with other possible confounders, respectively. Sensory processing patterns were categorized into sensory sensitivity, sensory avoidance, low registration and sensation seeking. We conducted structural equation modelling based on the hypothesis that sensory processing directly affects dental fear, including the confounding role of negative experiences with dentistry, autistic traits and the mediating role of trait anxiety. Results: Based on our proposed model, sensory processing patterns, excluding sensation seeking and negative experiences significantly contributed to dental fear (β = 0.33, p < .001 and β = 0.32, p < .001, respectively) and autistic traits and trait anxiety did not significantly contribute to dental fear. Conclusions: Extreme sensory processing patterns seem to be associated with a high level of dental fear; thus, the difference in sensory processing might play an important role in the aetiology of dental fear.

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

Background

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

Methods

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

Results

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

Conclusions

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

A longitudinal study of changes and associations in dental fear in parent/adolescent dyads

BACKGROUND

Dental fear seems to fluctuate, but concordance of changes in dental fears between parent/adolescent dyads has not been reported.

AIM

To study longitudinally the associations between adolescent and parental dental fears and their changes.

DESIGN

Adolescents and parents reported their dental fear independently of each other when adolescents were between 11-12 and 15-16-year-olds. Eight hundred and seventeen eligible parent/adolescent dyads were included in the analyses. Dental fear was measured with a single question using five response alternatives. Associations between adolescent and parental dental fears and their changes were analysed using χ² tests and correlation coefficients.

RESULTS

Prevalence of dental fear remained rather similar during the study. There was a positive association between adolescent and parental dental fears in early adolescence (P < 0.001) but at middle adolescence only among parent/girl dyads (P = 0.007 for girls, P = 0.341 for boys). Changes in dental fear among parent/adolescent dyads did not correlate statistically significantly. Difference between girls' and boys' change in dental fear was statistically significant (P = 0.001). Dental fear increased more often among girls than among boys. Boys had stable low/no dental fear more often than girls did.

CONCLUSION

Adolescents' and parents' dental fears seemingly change independently of each other.

The role of cognitions in short-term temporal changes in dental fear among Australian adults

OBJECTIVES

To determine if temporal changes in dental fear over a 4-month period are predicted by changed cognitive vulnerability-related perceptions of going to the dentist.

METHODS

Australian adults (n = 484) completed mailed questionnaires at baseline and follow-up, containing measures of dental fear, cognitive vulnerability-related perceptions, dental services received, and possible aversive experiences during the study period. Change in dental fear was the main outcome measure, categorized as decreased (Fear^- ), unchanged (Fear⁰ ), and increased (Fear⁺ ).

RESULTS

Across the study period, 15.5 percent of people had Fear^- , 73.4 percent had Fear⁰ , and 11.1 percent had Fear⁺ . In a multinomial logistic regression, after controlling for participant gender, income, time since last dental visit at baseline, dental fear at baseline and experiencing an aversive event, increased vulnerability-related perceptions were significantly associated with Fear⁺ (OR = 2.83, P < 0.001) while decreased vulnerability-related perceptions were associated with Fear^- (OR = 0.17, P < 0.001).

CONCLUSIONS

This study found, across a relatively short 4-month period, that increased vulnerability-related perceptions of visiting the dentist predicted increased dental fear while decreased vulnerability-related perceptions predicted decreased dental fear. More appropriate study designs, such as longitudinal designs, and longer follow-up periods are needed to determine the possible causal nature of these associations.

Is there a relation between dental anxiety, fear and general psychological status?

Background

Dental anxiety is a widespread problem in many populations. This problem can be a barrier to dental care and may lead to poor oral health. Dental anxiety may be related to psychological status.

Aims

The aim of the present study was to assess the levels of dental anxiety, dental fear, Beck Depression, and state-trait anxiety according to age, gender and education level in patients at the periodontology clinic in the Diyarbakır Mouth and Dental Health Center.

Study Design

A total of 231 patients (115 males, 116 females) filled out dental fear scale (DFS), dental anxiety scale (DAS), Beck Depression Inventory (BDI), state-trait anxiety inventory-state (STAI-S), and state-trait anxiety inventory–trait (STAI-T) questionnaires, and evaluations of DFS, DAS, BDI, STAI-S, and STAI-T were conducted according to age, gender, and education level.

Results

The mean DFS, DAS, BDI, STAI-T, and STAI –S were 45.64, 9.15, 13.16, 38.90, and 40.18, respectively. There was a significant association among DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05). These surveys scores were significantly higher in females than males (p < 0.05). The results of this study indicated that gender age and education level have important effects on DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05).

Conclusion

Dental anxiety and dental fear were found to be related to psychological status (BDI, STAI-S, and STAI-T) over time. There are some patients with unaddressed psychological distress.

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

Background

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

Methods

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

Results

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

Conclusions

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

Evaluating the Relationship of Dental Fear with Dental Health Status and Awareness

INTRODUCTION

Dental fear is one of the most common problems in dentistry, for both the patient and for the dentist. This issue can have an important effect on an individual's dental health.

AIM

The aim of this paper was to report on the prevalence of dental anxiety and to explore if high levels of anxiety are associated with sociodemographic factors, oral health status, and level of oral health awareness.

MATERIALS AND METHODS

The sample for this cross-sectional study included 294 patients (154 males and 140 females). All participants filled out a Dental Fear Survey (DFS) to evaluate their level of dental fear. Gender, age, education level, socioeconomic status and oral health awareness were also noted. Oral health behaviors and oral health awareness levels were investigated using seven questions. Also, the periodontal status of all participants was evaluated using the Community Periodontal Index of Treatment Needs (CPITN). Differences between different subgroups were tested using the chi-square test.

RESULTS

There was a statistically significant difference between the DFS groups with regard to sociodemographic data. Women had significantly higher scores than men, and young patients had significantly higher scores than others. Patients with low education levels and low socioeconomic status had high DFS scores. Periodontal status was better in groups that had scores in the low and moderate ranges compared to groups that had high scores on the DFS. There was a statistically significant difference between the groups of DFS and CPITN (p<0.05). Patients with low and moderate levels of DFS answered the oral health knowledge questions correctly. There was a statistically significant difference between the DFS groups based on correct answers to the oral health knowledge questions (p<0.05).

CONCLUSION

The elimination of dental fear is very important and should be treated according to a patient-centered assessment. These individuals were informed about the dental treatment procedure so their prejudices were eliminated. Patients with a high level of dental fear may be given psychiatric support for comfortable treatment procedure.

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

Background

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

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

Methods

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

Results

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

Conclusions

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

Electronic supplementary material

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

Association between dental fear and oral health habits and treatment need among University students in Finland: a national study

BACKGROUND

First-year university students are in a new, independent life situation, which may affect health behaviour, including oral health habits. The aim of this study was to evaluate the association between dental fear and oral health habits, while considering the simultaneous effects of attitude toward food and treatment need at dental check-ups.

METHODS

The data (n = 8514) for this national cross-sectional study were collected from health registers of Finnish Student Health Service. As part of health examination all first-year university students in Finland were sent an electronic questionnaire asking about general, psychological and oral health, and health habits. Dental fear was measured by the question: "How afraid are you of visiting a dentist?" (reply alternatives: "Not at all", "Somewhat" and "Very"). Chi-square tests and Multiple logistic regression analyses were used to determine the associations between dental fear and oral health habits (tooth brushing, tobacco use, frequency of eating and drinking, eating habits and interval between dental check-ups) as well as attitude to food and treatment need at dental check-ups while controlling for age, gender, general mood and feelings in social situations.

RESULTS

Of the oral health habits, tooth brushing and tobacco use were associated with dental fear. Those who brushed their teeth once a day or less often or used tobacco regularly were more likely to have high dental fear than those who brushed their teeth twice a day or more often or used tobacco occasionally or not at all. Students who reported not having a normal attitude to food were more likely to have high dental fear than were those reporting normal attitude to food, but the frequency of eating and drinking was not associated with dental fear. Students who reported needing treatment frequently or at every dental check-up were more likely to have high dental fear than those who reported rarely or never needing treatment.

CONCLUSION

Those students with high dental fear seem to be at risk of having poor oral health habits and abnormal attitude to food, which may increase the risk of deterioration of oral health and the need for treatment. Dental teams should make efforts in helping fearful patients to find motivation for good oral health habits.

Changes in dental fear among Finnish adults: a national survey

OBJECTIVES

The aim of this study was to evaluate changes in dental fear among adult Finns aged 19 years and over at the beginning of the study in 2000-2011 in a nationally representative sample.

METHODS

The study was based on Health 2000 and 2011 Surveys by the National Institute for Health and Welfare in Finland. The Health 2000 Survey used a stratified two-stage cluster sampling design (N = 9 922). Those who participated in 2000 (n = 7 964) were invited to participate in 2011. The number of participants was 3 961. Dental fear was assessed by a single question: 'How afraid are you of visiting a dentist?' (not at all, somewhat, very much). Background variables included were age (categories 30-34, 35-39, 40-44, 45-54, 55-64, 65-74, 75+ years), gender, marital status (nonsingle, single), and education (basic, secondary, higher). To match the population sizes in different areas and thus forming a nationally representative data, the data were weighted based on age, gender, and area. General linear modeling for repeated measures was used to evaluate changes in dental fear and associations with background variables.

RESULTS

Between 2000 and 2011, dental fear decreased more often than increased among adults in Finland. Change from being very afraid to not at all afraid of visiting a dentist was most common in the oldest group. For most participants, dental fear remained stable; being very afraid of visiting a dentist was more stable among participants from 35 to 54 years of age than among younger or older participants.

CONCLUSIONS

Dental fear is still common among adult Finns and it seems to depend on age. As the most obvious consequence of dental fear is avoidance of dental care, reducing dental fear should be taken into account when planning and reorienting oral healthcare services.

Dental fear and previous childhood traumatic experiences, life events, and parental bonding

We aimed to determine whether adult dental fear is associated with traumas, life events, and perceived parental bonding. Pilot data for the FinnBrain Cohort study were used. Of the 254 families expecting a baby, 80% agreed to participate. At 32-34 wk of pregnancy, 125 women and 81 men completed a Modified Dental Anxiety Scale questionnaire and were included in this study. Other instruments used were the Trauma and Distress Scale (TADS), the Life Event Checklist, and the Parental Bonding Index. All scales were analyzed as summated rating scale scores. Associations between dental fear, TADS domains, and life events were evaluated using Spearman correlation coefficients. The association between dental fear and parental bonding was evaluated using the Kruskal-Wallis test. Among women, dental fear did not correlate with trauma measures, but among men dental fear correlated with emotional neglect and abuse. Dental fear correlated positively with the number of life events among women. Life events and dental fear did not correlate among men. Dental fear was not associated with parental bonding among women or men. The association between traumas, life events, and dental fear seems to be different in women and men.

Individual changes in dental fear among children and parents: a longitudinal study

OBJECTIVE

The aim was to study longitudinal changes in dental fear among children and one of their parents separately for girls, boys, mothers and fathers over a 3.5-year period.

MATERIALS AND METHODS

11-12-year-old children in Pori, Finland (n = 1691) and one of their parents were invited to participate in this longitudinal study. Dental fear was measured in 2001, 2003 and 2005 when the children were 11-12, 13-14 and 15-16-years-old, respectively. The participants were asked if they were afraid of dental care (1 = 'not afraid', 2 = 'slightly afraid', 3 = 'afraid to some degree', 4 = 'quite afraid', 5 = 'very afraid' and 6 = 'I don't know'). The participants' gender was also registered. Mean values of the change scores were studied. Prevalence and incidence of dental fear and changes in dichotomized dental fear (responses 4-5 = high dental fear and responses 1-3 = low dental fear) were studied using cross-tabulations and Cochran's Q test.

RESULTS

Overall, the prevalence of dental fear slightly increased and female preponderance in dental fear became more evident during the follow-up. Of the mothers and children with high dental fear at the baseline, 24% and 56%, respectively, reported not to be fearful at the end of the follow-up.

CONCLUSIONS

Dental fear seems to be more stable in adulthood than in childhood. Thus, it might be better to intervene in dental fear during childhood rather than during adulthood.

Dental fear, tobacco use and alcohol use among university students in Finland: a national survey

Background

Tobacco- and alcohol use are associated with psychological problems. Individuals with high dental fear also more often report other psychological problems than do those with lower level of dental fear. We evaluated the association between dental fear and tobacco- and alcohol use while controlling for age, gender, general mood and feelings in social situations.

Methods

The data (n = 8514) were collected from all universities in Finland with an electronic inquiry sent to all first-year university students. Dental fear was measured with the question: “How afraid are you of visiting a dentist?” with reply alternatives “Not at all”, “Somewhat” and “Very”. Regularity of tobacco use was determined with the question: “Do you smoke or use snuff?”, with reply alternatives “Not at all”, “Occasionally” and “Daily”. The Alcohol Use Disorders Identification Test (AUDIT) was used for determination of alcohol use; an AUDIT sum score of 8 or more indicated hazardous, harmful or dependent alcohol use. The statistical tests used were Chi-square tests and Multiple logistic regression analyses.

Results

When controlled for age, gender, alcohol use, general mood and feelings in social situations, those who used tobacco regularly were more likely to have high dental fear than were those who used tobacco occasionally or not at all. When controlled for age, gender, general mood and feelings in social situations, those with hazardous, harmful or dependent alcohol use were more likely to have high dental fear than were those with low-risk of alcohol use, the association between alcohol use and dental fear was not strong. When tobacco use was added into this model, alcohol use was no longer statistically significantly associated with dental fear.

Conclusions

The findings of this study support the suggestion that some people may have common vulnerability factors linked to tobacco use, alcohol use, and dental fear.

Characteristics and medical-care-seeking of head and neck cancer patients: a population-based cross-sectional survey

OBJECTIVES

Well-known risk factors, such as smoking and alcohol consumption, easily denounce head and neck cancer patients as smokers, alcohol abusers, and persons who are socially excluded and have low socioeconomic status. To diagnose these patients as early as possible, we should not have a prejudiced assumption of their characteristics.

MATERIALS AND METHODS

We collected detailed data on patient characteristics and health behavior and explored whether these traits had any effect on seeking medical advice in a population-based cross-sectional study involving 85 patients with head and neck cancer diagnosed between January 2003 and December 2007, residing in two health care districts (population 1,600,000) in Finland. The data were gathered from patient charts and questionnaires. The questionnaire data were compared with the general population in Finland.

RESULTS

We found these patients to be ordinary elderly people whose demographic and social features resembled those of the general population. They smoked more often, but otherwise had a rather healthy lifestyle. Only half were aware that smoking and alcohol consumption were risk factors of head and neck cancer. In a multivariate analysis, fear of physicians (adjusted odds ratio 11.0; 95% confidence interval 1.2-103), medical-care-seeking for symptoms other than pain (18.5; 2.2-156), and not suspecting cancer (11.2; 1.7-75.1) were independent risk factors for delayed consultation (combined appraisal and help-seeking interval over 3 months).

CONCLUSION

Head and neck cancer patients deviated from the same-aged general population only in excessive smoking. Fear of doctors, having no pain, and no suspicion of cancer resulted in delayed medical-care-seeking.

Management of fear and anxiety in the dental clinic: a review

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.

Dental fear and sense of coherence among 18-yr-old adolescents in Finland

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovsky's Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.

Psychometric properties of the Dental Hygienist Anxiety Scale in a group of general dental patients

OBJECTIVE

The aim of the present study was to evaluate the psychometric properties of the Dental Hygienist Anxiety Scale (DHAS) in a sample of adult general dental patients.

MATERIALS AND METHODS

The DHAS is a questionnaire adapted to assess fear and anxiety of dental hygienist (DH) treatment. The DHAS contains four items and the sum of scores range from 4 (no anxiety) to 20 (extreme fear). A convenient sample of 80 patients in treatment at two DH programs in Sweden were consecutively included in the study. The DHAS was distributed together with questions regarding self-perceived oral health and experience of dental care at the first visit after a clinical examination performed by a DH. Re-test assessments of DHAS were conducted ≈ 2 weeks later in conjunction with the next visit to the DH before treatment (scaling session).

RESULTS

The results verified a significant positive correlation between the average DHAS sum of scores and global fear of DH and dentist treatment, perceived pain during the last DH treatment and female gender. The DHAS sum of scores had a high internal consistency, Cronbach's coefficient of 0.89 and 0.87 at the first and at the second assessment, respectively. The test-re-test reliability of the DHAS sum of scores was acceptable, with an intra-class coefficient of 0.82 and Kappa coefficients between 0.49-0.78 for the four single items in the DHAS.

CONCLUSIONS

These results suggest that the DHAS has acceptable psychometric proprieties and is a valid and reliable scale to assess anxiety in DH treatment.

Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

BACKGROUND

Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients' overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care.

METHODS

The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (<6, 6-12, 13-17, 18-68), gender, immigration, previous conscious sedation and previous DGA; medical background; reasons for DGA and treatments provided. Chi-square tests, Fisher's exact test, and logistic regression modelling were employed in the statistical analyses.

RESULTS

The DGA patients (n=349) were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p<0.001) and medically compromised patients among the adults (p<0.001) relative to the other age groups. The main reason for DGA was extreme non-cooperation (65%) followed by dental fear (37%) and an excessive need for treatment (26%). In total, 3435 treatments were performed under DGA, 57% of which were restorations, 24% tooth extractions, 5% preventive measures, 5% radiography, 4% endodontics and the remaining 5% periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given.

CONCLUSIONS

Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

Association of dental anxiety to personality traits in a general population sample of Finnish University students

OBJECTIVE

To estimate the association between personality and dental anxiety among Finnish University students.

MATERIALS AND METHODS

A total of 880 university students in Finland returned the questionnaires addressing dental anxiety by using the Modified Dental Anxiety Scale (MDAS) questionnaire. In addition, the personality of traits (neuroticism, extraversion, agreeableness, conscientiousness and openness to experience) were noted. Personality traits of students were compared with the level (high, mild or none) of dental anxiety derived from the MDAS questionnaire. The relative odds of dental anxiety associated with the level of dental anxiety were estimated by logistic regression, Chi-Square tests and one-way analysis of variance (ANOVA).

RESULTS

Median age of the respondents was 22 years. Of the respondents, 99 (11.3%) were classified as dentally anxious patients (90, 12.2% of females; 9, 6.6% of males)). Neuroticism was the only personality trait that was significantly associated with dental fear (p < 0.001). A tendency, although not significant, was seen between high dental fear and lower extraversion and agreeableness.

CONCLUSIONS

Of the five different personality traits, neuroticism was a significant risk factor for developing dental anxiety, and this should be recognized in clinical practice.

Dental anxiety in relation to neuroticism and pain sensitivity. A twin study

Predisposing personality traits as well as heightened pain sensitivity and fear of pain have been hypothesized as central factors in the development of dental anxiety. The aim of the study was to estimate the heritability of dental anxiety, and to investigate the genetic and environmental sources of covariance between dental anxiety on one hand, and pain sensitivity and the neuroticism trait on the other. A sample comprising 188 twins, aged 23-35 years (53 monozygotic and 39 dizygotic twin pairs, and 4 single twins whose co-twin did not participate), was included in the study. Measures of dental anxiety and personality were obtained using Corah's Dental Anxiety Scale and the NEO Personality Inventory Revised, respectively. Heat pain and cold pressor pain sensitivity were assessed using standard pain testing procedures. Bivariate Cholesky models were employed to decompose the correlations between phenotypes into genetic and environmental factors. Using models with common additive genetic (A) and individual-specific environmental (E) factors, moderate heritability (i.e., .41) for dental anxiety was demonstrated. Virtually all of the phenotypic correlation between neuroticism and dental anxiety could be accounted for by A. Furthermore, a substantial part of the variance in dental anxiety was due to specific genetic and individual environmental influences unrelated to neuroticism. The phenotypic correlations between dental anxiety and the pain sensitivity indices were close to zero. Thus, while neuroticism and dental anxiety share a sizeable proportion of genetic (but not environmental) risk factors, the results also suggest that these two attributes are distinct entities with overlapping, but not identical, etiologies.

Dental anxiety in adults in Bulgaria

The anxiety experienced by some patients before or during dental visits poses a problem for patients and the dental practitioners alike. Some people consider them a stressful experience which manifests itself as anxiety, fear and even phobia and results in avoidance of proper dental care. The dental anxiety, dental fear and dental phobia stand out against the background of general anxiety. The aim of the present study was to investigate dental anxiety in Bulgaria by means of a self-assessment scale.

MATERIAL AND METHODS

The self-assessment Dental Anxiety Scale (DAS), developed by N Corah, was used in the form of a questionnaire containing questions about the gender, age, education and occupation of respondents. Subjects were 746 adults aged 18-82 years living in urban areas. Individual and group interviews were conducted directly with them.

RESULTS

The respondents with moderate dental anxiety were the most of all subjects (35.5%, DAS score: 9-12 points), followed by the anxiety-free subjects (34.6%, 4-8 points). The third most numerous group was the high anxiety group (18.2%, 13-14 points), followed by the subjects with severe anxiety (11.7%, 15-20 points). The mean score was 10.26 +/- 0.14. We found a statistically significant correlation between anxiety, age (P < 0.05), education (P < 0.05) and type of labour (manual or mental labour) (P < 0.01). No significant difference was found between anxiety and sex (P > 0.05).

CONCLUSIONS

The percentage of people scoring high on dental anxiety (DAS 13-20) in Bulgaria (29.9%) is considerably higher than that in some European and North American countries. The present study is the first in Bulgaria on dental anxiety. Further studies are needed to reveal other factors related to dental anxiety.

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' and subjective oral impacts were measured using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP-14 items fairly often or very often, and the 'extent' and 'severity'. Those with high dental fear reported higher levels of prevalence, 'extent', and 'severity' of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP-14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.

Dental anxiety and alexithymia: gender differences

OBJECTIVE

Alexithymia refers to a personality construct that is characterized by impoverishment of imagination, poor capacity for symbolic thought, and inability to experience and describe feelings. Our aim was to investigate the association of alexithymia and dental anxiety in patients attending dental practice. A further aim was to discover whether gender differences exist in this association when adjusting for the effect of age.

MATERIAL AND METHODS

The data were collected among adult (18 +years) patients attending the public dental health centers in Pori, Finland. Patients received a questionnaire assessing dental anxiety (Modified Dental Anxiety Scale, MDAS), alexithymia (20-item Toronto Alexithymia Scale, TAS-20), and demographic profile. Total score and scores for three TAS factors: 1) "difficulty identifying with feelings", 2) "difficulty describing feelings", and 3) "externally orientated thinking", were computed.

RESULTS

Of 823 patients, 81% correctly completed the questionnaires. Nine percent belonged to the high anxiety (MDAS score 19 or higher) group and 7% reported alexithymia (total score 61 or higher). The prevalence of alexithymia was 15.5% among those reporting high dental anxiety compared with 5.9% among those reporting low dental anxiety (p = 0.005). Those with high dental anxiety scored higher in TAS factor 1 than those with lower dental anxiety. No statistically significant bivariate associations with other TAS factors were found. When adjusting for the effect of age and gender, the association between TAS factors and dichotomized MDAS was significant in all TAS scores except TAS factor 3.

CONCLUSIONS

In a sample representing Finnish adult dental patients, alexithymia was associated with dental anxiety.

Pain perception and anxiety during scaling in periodontally healthy subjects

BACKGROUND

Dental pain, anxiety, and fear may result in avoiding dental treatment. In this study, we aimed to evaluate patients' pain perception during scaling and its relationship with dental anxiety.

METHODS

One hundred thirteen patients (72 women and 41 men; mean age, 35.59 +/- 9.28 years) participated. Pain levels after scaling were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of seven questions, each with five possible answers.

RESULTS

The patients were asked to indicate their pain level on a 100-mm VAS, and the mean VAS score was 19.91 +/- 17.76 mm. No age and gender differences with regard to pain perception were found. VAS scores were significantly higher in non-smokers (P <0.001); there was a slightly significant relationship between smoking and pain (0.264; P <0.05). The anxiety score ranged from 7 to 35; the mean anxiety score was 14.00 +/- 5.30 (range, 7 to 29). The anxiety score was significantly higher in women (P <0.001). The only question correlated with pain during scaling in men was, "How fearful are you of having your teeth cleaned?" (0.322; P = 0.040). Scores for patients aged 29 to 39 years were significantly higher than scores for those aged 51 to 61 years (P <0.01).

CONCLUSIONS

Although most patients experienced limited pain during scaling, a significant relationship was found between pain and smoking. Women and patients aged 30 to 40 years are likely to be more anxious during scaling. The question, "How fearful are you of having your teeth cleaned?" may not adequately cover all aspects of anxiety for patients' experience of pain during scaling. Clinicians should determine individual treatment approaches to reduce patients' fear, pain, and anxiety related to scaling.

Cognitive vulnerability and dental fear

Background

The Cognitive Vulnerability Model proposes that perceptions of certain characteristics of a situation are critical determinants of fear. Although the model is applicable to all animal, natural environment and situational fears, it has not yet been applied specifically to dental fear. This study therefore aimed to examine the association between dental fear and perceptions of dental visits as uncontrollable, unpredictable and dangerous.

Methods

The study used a clustered, stratified national sample of Australians aged 15 years and over. All participants were asked in a telephone interview survey to indicate their level of dental fear. Participants who received an oral examination were subsequently provided with a self-complete questionnaire in which they rated their perceptions of uncontrollability, unpredictability and dangerousness associated with dental visiting.

Results

3937 participants were recruited. Each of the three vulnerability-related perceptions was strongly associated with the prevalence of high dental fear. In a logistic regression analysis, uncontrollability and dangerousness perceptions were significantly associated with high dental fear after controlling for age and sex. However, unpredictability perceptions did not have a statistically significant independent association with dental fear after controlling for all other variables.

Conclusion

Results are mostly consistent with the Cognitive Vulnerability Model of the etiology of fear, with perceptions of uncontrollability, unpredictability and dangerousness each showing a strong bivariate relationship with high dental fear prevalence. However, more extensive measures of vulnerability perceptions would be valuable in future investigations.