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Heyman RE, Daly KA, Slep AMS, Wolff MS. Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study. J Public Health Dent 2024; 84:36-42. [PMID: 38114444 PMCID: PMC11173353 DOI: 10.1111/jphd.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.
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Affiliation(s)
| | | | | | - Mark S. Wolff
- University of Pennsylvania School of Dental Medicine
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2
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Noirrit‐Esclassan E, Annerbäck E, Cuhna Soares F, Dahllöf G, Kvist T. Association between self-reported dental fear and exposure to violence among adolescents-A population-based study. Int J Paediatr Dent 2022; 32:812-818. [PMID: 35348256 PMCID: PMC9790500 DOI: 10.1111/ipd.12966] [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: 06/18/2021] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The etiology of dental fear (DF) is multifactorial and involves other contributing factors than dental traumatic experiences. AIM To study, among adolescents, associations between DF and exposure to child physical abuse (CPA), intimate partner violence (IPV), and bullying. DESIGN We extracted data from a population-based survey of 4977 adolescents who were 15-17 years old in 2017. The questionnaire queried socioeconomic background factors, DF, self-perceived oral health, general health, and exposure to child abuse. To estimate associations between DF and exposure to child abuse, we used multivariate logistic regression analysis. RESULTS Overall, 8.2% reported DF, girls (10.5%) reported DF significantly more often than boys (5%), and adolescents not identifying themselves as girl or boy reported the highest prevalence of DF (25.5%; p < .001). 15.3% had been exposed to child physical abuse; 11.1%, to IPV; and 11.2%, to bullying. Experiences of IPV and bullying, but not physical abuse, were statistically significantly associated with DF. The odds of developing DF for adolescents exposed to any type of violence was 1.9 times the odds for adolescents with no exposure to child abuse. CONCLUSION Exposure to violence is associated with dental fear in adolescents.
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Affiliation(s)
- Emmanuelle Noirrit‐Esclassan
- Division of Pediatric DentistryDepartment of Dental MedicineKarolinska InstitutetHuddingeSweden,Université de Toulouse IIIToulouseFrance,Pediatric Dentistry UnitCHU ToulouseToulouseFrance
| | - Eva‐Maria Annerbäck
- Child and Adolescent PsychiatryDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden,Center for Clinical Research SörmlandUppsala UniversityEskilstunaSweden
| | - Fernanda Cuhna Soares
- Division of Pediatric DentistryDepartment of Dental MedicineKarolinska InstitutetHuddingeSweden
| | - Göran Dahllöf
- Division of Pediatric DentistryDepartment of Dental MedicineKarolinska InstitutetHuddingeSweden,Center for Pediatric Oral Health ResearchStockholmSweden,Center for Oral Health Services and Research, Mid‐Norway, TkMidtTrondheimNorway
| | - Therese Kvist
- Division of Pediatric DentistryDepartment of Dental MedicineKarolinska InstitutetHuddingeSweden,Center for Pediatric Oral Health ResearchStockholmSweden,Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
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Kämppi A, Tanner T, Viitanen O, Pohjola V, Päkkilä J, Tjäderhane L, Anttonen V, Patinen P. Association of Dental Fear with Caries Status and Self-Reported Dentition-Related Well-Being in Finnish Conscripts. Dent J (Basel) 2022; 10:dj10030045. [PMID: 35323247 PMCID: PMC8947707 DOI: 10.3390/dj10030045] [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: 01/29/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
The main aim of this cross-sectional study was to examine the prevalence of dental fear among Finnish conscripts. Other aims were to study the association between dental fear and cariological status as well as their self-reported, dentition-related well-being. The study material consisted of 13,564 men and 255 women conscripts who underwent oral examinations. Of those, 8713 responded to a computer-based questionnaire. The mean number of decayed teeth (DT) was used in analyses for cariological status. Self-reported dental fear, dentition-related well-being and regular check-ups were analysed. Data were analysed with cross tables, Pearson Chi-Square tests, Fisher’s exact test and binary logistic regressive analysis. High dental fear or finding dental visits very scary was associated with DT > 2 both among women (14.6%, when DT = 0; 33.3%, when DT > 2) and men conscripts (2.3% and 10.8%, respectively). In addition, those reporting that dental health had a negative impact on their well-being and had no regular check-ups were more likely to need cariological treatment than the rest. A high education level, both one’s own and parental, was a protective factor for restorative treatment need in male conscripts. The findings of this study support the concept of a vicious cycle of dental fear and dental caries. A preventive, interactive way of work by dental teams would most likely be beneficial for dental health, avoiding the development of dental fear, and dentition-related well-being.
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Affiliation(s)
- Antti Kämppi
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00100 Helsinki, Finland;
- Correspondence: ; Tel.: +358-2941911
| | - Tarja Tanner
- Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, 90570 Oulu, Finland; (T.T.); (O.V.); (V.P.); (V.A.); (P.P.)
- MRC, Oulu University Hospital, University of Oulu, 90570 Oulu, Finland
| | - Olavi Viitanen
- Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, 90570 Oulu, Finland; (T.T.); (O.V.); (V.P.); (V.A.); (P.P.)
| | - Vesa Pohjola
- Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, 90570 Oulu, Finland; (T.T.); (O.V.); (V.P.); (V.A.); (P.P.)
- MRC, Oulu University Hospital, University of Oulu, 90570 Oulu, Finland
| | - Jari Päkkilä
- Department of Mathematical Sciences, University of Oulu, 90570 Oulu, Finland;
| | - Leo Tjäderhane
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00100 Helsinki, Finland;
- Helsinki University Hospital, 00029 Helsinki, Finland
| | - Vuokko Anttonen
- Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, 90570 Oulu, Finland; (T.T.); (O.V.); (V.P.); (V.A.); (P.P.)
- MRC, Oulu University Hospital, University of Oulu, 90570 Oulu, Finland
| | - Pertti Patinen
- Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, 90570 Oulu, Finland; (T.T.); (O.V.); (V.P.); (V.A.); (P.P.)
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Heima M, Stehli K. Reliability and Validity of the Dental Anxiety Question Used With Children. Anesth Prog 2022; 69:13-19. [PMID: 36223195 PMCID: PMC9552619 DOI: 10.2344/anpr-69-01-04] [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: 03/20/2020] [Accepted: 12/17/2021] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Dental fear screening is an important part of providing a positive pediatric dental experience. To improve efficiency, the development of a single-item dental fear assessment tool for children has been desired. In this psychometric analysis, the reliability and validity of the Dental Anxiety Question (DAQ) is studied when used in children aged 7 to 18 years. METHODS Participants completed the DAQ (pre-tx-DAQ), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and a demographic information questionnaire before treatment. Participants repeated the DAQ after treatment (post-tx-DAQ) and once more at least 2 weeks later (follow-up-DAQ). Stability reliability within the DAQ scores and criterion validity with the CFSS-DS were evaluated. RESULTS Stability reliability analyses between pre-tx-DAQ/post-tx-DAQ and post-tx-DAQ/follow-up-DAQ demonstrated significant positive correlations: Spearman rank correlation coefficient (rs) = 0.420, rs2 = 0.18, P < .001, and rs = 0.563, rs2 = 0.32, P < .001, respectively. Criterion validity analysis between the pre-tx-DAQ and CFSS-DS also demonstrated a significant correlation: Pearson correlation coefficient (r) = 0.584, r2 = 0.34, P < .001. CONCLUSION The stability reliability and criterion validity of the DAQ was proved among children.
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Karukivi M, Suominen A, Scheinin NM, Li R, Ahrnberg H, Rantavuori K, Karlsson H, Karlsson L, Lahti S. Gender-specific associations between the dimensions of alexithymia personality trait and dental anxiety in parents of the FinnBrain Birth Cohort Study. Eur J Oral Sci 2021; 130:e12830. [PMID: 34761432 DOI: 10.1111/eos.12830] [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] [Received: 04/29/2021] [Accepted: 09/05/2021] [Indexed: 12/30/2022]
Abstract
We evaluated gender-specific associations of two dimensions of dental anxiety (anticipatory and treatment-related dental anxiety) with three dimensions of alexithymia: difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. The sample comprised 2558 parents from the general population participating in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale and alexithymia with the 20-item Toronto Alexithymia Scale. Associations between dental anxiety and alexithymia dimensions were modelled using linear regression analysis adjusting for general anxiety and depressive symptoms, age, and education. Structural equation modeling assessed their interrelationships. In women, anticipatory dental anxiety was associated only with difficulty in identifying feelings, but treatment-related dental anxiety was associated with difficulty in identifying feelings, difficulty in describing feelings, and externally oriented thinking. In men, anticipatory dental anxiety was associated with only externally oriented thinking, whereas treatment-related dental anxiety was associated with difficulty in describing feelings, and with externally oriented thinking. Structural equation modelling showed that difficulty in identifying feelings was associated with anticipatory and treatment-related dental anxiety in women, whereas in men, only difficulty in describing feelings was associated with both types of dental anxiety. Anticipatory and treatment-related dental anxiety have different associations with alexithymia dimensions.
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Affiliation(s)
- Max Karukivi
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Auli Suominen
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Noora M Scheinin
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Ru Li
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Hanna Ahrnberg
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Kari Rantavuori
- Department of Oral Development and Orthodontics, University of Turku, Turku, Finland
| | - Hasse Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Satu Lahti
- Centre for Population Health Research, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.,Department of Community Dentistry, University of Turku, Turku, Finland
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Psychological Distress, Dental Health, and Dental Fear among Finnish University Students: A National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910245. [PMID: 34639546 PMCID: PMC8508373 DOI: 10.3390/ijerph181910245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023]
Abstract
The aim of this study was to investigate the association between dental fear, psychological distress, and perceived symptoms of teeth controlled for age, gender, educational sector, and tobacco use. The data from the Finnish University Student Health Survey 2016 targeting students (n = 10,000) of academic universities and universities of applied sciences were used. Psychological distress was measured with the Clinical Outcomes in Routine Evaluation 10 (CORE-10) and the General Health Questionnaire 12 (GHQ-12) and dental fear with the question ‘Do you feel scared about receiving dental care?’. The study included 3110 students. In logistic regression analyses those with psychological distress (measured with CORE-10 and GHQ-12) and those reporting teeth-related symptoms were more likely than their counterparts to have high dental fear. In gender-specific analyses men with psychological distress (measured with CORE-10) and women with teeth-related symptoms were more likely to have high levels of dental fear. Finnish university students with psychological distress and teeth-related symptoms were more likely to experience higher levels of dental fear than their counterparts were. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.
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Slabšinskienė E, Kavaliauskienė A, Žemaitienė M, Vasiliauskienė I, Zaborskis A. Dental Fear and Associated Factors among Children and Adolescents: A School-Based Study in Lithuania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168883. [PMID: 34444632 PMCID: PMC8395053 DOI: 10.3390/ijerph18168883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
Dental fear is a challenging problem in dentistry and many contributing factors have been identified. Although this problem among children and adolescents has been studied in the literature for a long time, few such studies have been conducted in Lithuania. This study aimed to evaluate the prevalence of dental fear and examine its association with gender, age and several psychological and social factors among children and adolescents in Lithuania. The cross-sectional survey included a randomly selected sample (n = 1590) of children aged 11-14 and adolescents aged 15-18. The data were supplemented by interviewing the parents of these subjects (n = 1399). Dental fear was measured with a single five-score question. The data collection also included questions on oral health, socioeconomic status, oral health-related quality of life and self-esteem. Poisson regression analysis was used to assess the association between perception of dental fear and potential predictor variables. It was found that 32.2% (95% CI: 29.9-34.4%) of children and adolescents reported no fear of dental treatment, 12.5% (10.8-14.2%) of their peers were highly afraid of dental treatment, and other subjects assessed their dental fear gradually. Girls reported greater dental fear scores than boys, but the level of dental fear did not depend on the age. We identified the groups of subjects by gender and age, and a higher level of dental fear was significantly associated with untreated caries experience, a delay in the age of the subject's first visit to the dentist, low self-esteem, low oral health-related quality of life, low overall life satisfaction and low family affluence. The results also suggested that dental fear could originate from previous toothache, dentists' actions, high sensitivity in the child and poor psychological readiness for treatment. It was concluded that dental fear among Lithuanian children and adolescents is a common problem that is associated with gender and several dental, psychological and social factors. The findings indicate that school-based health policies, paediatric dentists and parents should be encouraged to focus on the psychosocial factors associated with dental fear because most of them can be prevented.
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Affiliation(s)
- Eglė Slabšinskienė
- Department of Oral Health and Paediatric Dentistry, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.Ž.); (I.V.)
- Correspondence: ; Tel.: +37-037-388-192
| | - Aistė Kavaliauskienė
- Department of Orthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
| | - Miglė Žemaitienė
- Department of Oral Health and Paediatric Dentistry, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.Ž.); (I.V.)
| | - Ingrida Vasiliauskienė
- Department of Oral Health and Paediatric Dentistry, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.Ž.); (I.V.)
| | - Apolinaras Zaborskis
- Department of Preventive Medicine & Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania;
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Development of a one-item version of the Orofacial Esthetic Scale. Clin Oral Investig 2021; 26:713-718. [PMID: 34231057 PMCID: PMC8791892 DOI: 10.1007/s00784-021-04049-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/22/2021] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Orofacial appearance is increasingly recognized as an important dental patient-reported outcome making instrument development and refinement efforts to measure the outcome better necessary. The aim of this study was to derive a one-item version of the Orofacial Esthetic Scale (OES). MATERIALS AND METHODS OES data were collected from a consecutive sample of a total of 2113 adult English- or Spanish-speaking dental patients from HealthPartners dental clinic in Minnesota. Participants with missing data were excluded and analysis were performed using data from 2012 participants. Orofacial appearance was assessed with the English and the Spanish language version of the OES. Linear regression analysis was performed, with the OES item 8 ("Overall, how do you feel about the appearance of your face, your mouth, and your teeth?") as the predictor variable and the OES summary score as the criterion variable, to calculate the adjusted coefficients of determination (R2). RESULTS The value of adjusted R2 was 0.83, indicating that the OES item 8 score explained about 83% of the variance of the OES summary score. The difference in R2 scores between the two language groups was negligible. CONCLUSION The OES item 8 can be used for the one-item OES (OES-1). It is a psychometrically sound instrument for measuring orofacial appearance. CLINICAL RELEVANCE Due to its easy application and sufficient psychometric properties, the OES-1 can be used effectively as an alternative to longer OES instruments in all areas of dental practice and research.
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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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Sharifian MJ, Pohjola V, Kunttu K, Virtanen JI. Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey. BMC Oral Health 2021; 21:93. [PMID: 33663476 PMCID: PMC7934505 DOI: 10.1186/s12903-021-01449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Mohammad Jalil Sharifian
- Medical Research Centre, Oulu University Hospital, Oulu, Finland.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Vesa Pohjola
- Medical Research Centre, Oulu University Hospital, Oulu, Finland.,Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | | | - Jorma I Virtanen
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway. .,Institute of Dentistry, University of Turku, Turku, Finland.
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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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Pohjola V, Puolakka A, Kunttu K, Virtanen JI. Association between dental fear, physical activity and physical and mental well-being among Finnish university students. Acta Odontol Scand 2020; 78:45-51. [PMID: 31386825 DOI: 10.1080/00016357.2019.1649457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Vesa Pohjola
- Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Antti Puolakka
- Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | | | - Jorma I. Virtanen
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Institute of Dentistry, University of Turku, Turku, Finland
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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13
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Liinavuori A, Tolvanen M, Pohjola V, Lahti S. Longitudinal interrelationships between dental fear and dental attendance among adult Finns in 2000‐2011. Community Dent Oral Epidemiol 2019; 47:309-315. [DOI: 10.1111/cdoe.12458] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Arja Liinavuori
- Department of Community DentistryUniversity of Turku Turku Finland
- Social and Health Services Kirkkonummi Finland
| | - Mimmi Tolvanen
- Department of Community DentistryUniversity of Turku Turku Finland
| | - Vesa Pohjola
- Faculty of MedicineDepartment of Community DentistryUniversity of Oulu Oulu Finland
- Medical Research CenterOulu University Hospital Oulu Finland
| | - Satu Lahti
- Department of Community DentistryUniversity of Turku Turku Finland
- Turku Clinical Research CentreTurku University Hospital Turku Finland
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14
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Kankaanpää R, Auvinen J, Rantavuori K, Jokelainen J, Karppinen J, Lahti S. Pressure pain sensitivity is associated with dental fear in adults in middle age: Findings from the Northern Finland 1966 birth cohort study. Community Dent Oral Epidemiol 2018; 47:193-200. [DOI: 10.1111/cdoe.12443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Rami Kankaanpää
- Department of Community Dentistry University of Turku Turku Finland
- Oral and Maxillofacial Deceases Tampere University Hospital Tampere Finland
- Oral Health Services City of Tampere Tampere Finland
| | - Juha Auvinen
- Center for Life Course Health Research University of Oulu Oulu Finland
- Unit of Primary Care Oulu University Hospital Oulu Finland
- Medical Research Center Oulu University of Oulu Oulu University Hospital OuluFinland
| | - Kari Rantavuori
- Department of Oral Development and Orthodontics University of Turku Turku Finland
| | - Jari Jokelainen
- Center for Life Course Health Research University of Oulu Oulu Finland
- Unit of Primary Care Oulu University Hospital Oulu Finland
- Medical Research Center Oulu University of Oulu Oulu University Hospital OuluFinland
| | - Jaro Karppinen
- Center for Life Course Health Research University of Oulu Oulu Finland
- Medical Research Center Oulu University of Oulu Oulu University Hospital OuluFinland
- Finnish Institute of Occupational Health Oulu Finland
| | - Satu Lahti
- Department of Community Dentistry University of Turku Turku Finland
- Turku Clinical Research Centre Turku University Hospital Turku Finland
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15
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Hagqvist O, Tolvanen M, Rantavuori K, Karlsson L, Karlsson H, Lahti S. Short‐term longitudinal changes in adult dental fear. Eur J Oral Sci 2018; 126:300-306. [DOI: 10.1111/eos.12531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Outi Hagqvist
- FinnBrain Birth Cohort Study Turku Brain and Mind Center Institute of Clinical Medicine University of Turku Turku Finland
- Department of Community Dentistry Institute of Dentistry University of Turku Turku Finland
| | - Mimmi Tolvanen
- FinnBrain Birth Cohort Study Turku Brain and Mind Center Institute of Clinical Medicine University of Turku Turku Finland
- Department of Community Dentistry Institute of Dentistry University of Turku Turku Finland
| | - Kari Rantavuori
- Department of Orthodontics Institute of Dentistry University of Turku Turku Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study Turku Brain and Mind Center Institute of Clinical Medicine University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital University of Turku Turku Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study Turku Brain and Mind Center Institute of Clinical Medicine University of Turku Turku Finland
- Department of Psychiatry Turku University Hospital University of Turku Turku Finland
| | - Satu Lahti
- FinnBrain Birth Cohort Study Turku Brain and Mind Center Institute of Clinical Medicine University of Turku Turku Finland
- Department of Community Dentistry Institute of Dentistry University of Turku Turku Finland
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16
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Luoto A, Tolvanen M, Pohjola V, Rantavuori K, Karlsson L, Lahti S. A longitudinal study of changes and associations in dental fear in parent/adolescent dyads. Int J Paediatr Dent 2017; 27:506-513. [PMID: 28130962 DOI: 10.1111/ipd.12289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Anni Luoto
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland
| | - Mimmi Tolvanen
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland
| | - Kari Rantavuori
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Satu Lahti
- Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland.,FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
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17
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Silveira ERD, Goettems ML, Demarco FF, Azevedo MS. Clinical and Individual Variables in Children’s Dental Fear: A School-Based Investigation. Braz Dent J 2017; 28:398-404. [DOI: 10.1590/0103-6440201601265] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/02/2017] [Indexed: 12/14/2022] Open
Abstract
Abstract This cross-sectional study evaluated the prevalence of dental fear and associated factors in schoolchildren aged 8 to 12 years old, in Pelotas, southern Brazil. Schoolchildren enrolled in 20 public and private schools were selected using a multi-stage sample design. Sociodemographic characteristics, children’s dental visit and oral hygiene habits were assessed by questionnaires. The Dental Anxiety Question was used to measure dental fear prevalence. Children’s clinical examination evaluated presence of dental caries (DMFT/dmft index) and gingival bleeding. Data were analyzed using Poisson regression with robust variance (prevalence ratio; 95% confidence interval). One thousand two hundred and two children were included. Dental fear prevalence was 24.6%. After the adjustment, girls [PR=1.71 (CI 95%: 1.31-2.22)], children from poorer families [PR=1.96 (CI 95%: 1.36-2.83)], those who had decayed teeth (D/d index>0)[PR=1.32 (CI 95%: 1.01-1.72), and who had never been at the dentist [PR=1.85 (CI 95%: 1.42-2.41) remained significantly associated with dental fear. The prevalence of dental fear indicates that it is a common problem among schoolchildren. Early dental care and dental caries prevention are important factors to prevent dental fear.
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18
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Tolvanen M, Puijola K, Armfield JM, Lahti S. Translation and validation of the Finnish version of index of dental anxiety and fear (IDAF-4C +) among dental students. BMC Oral Health 2017; 17:85. [PMID: 28525993 PMCID: PMC5438555 DOI: 10.1186/s12903-017-0375-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental fear accounts for 41% of the non-habitual dental attendance such as visiting only when in pain among adult Finns. Dentists should be able to recognize patients in risk for irregular attendance due to dental fear and measure their fear with valid and reliable instrument that capture the multidimensionality of dental fear. The study's aim was to translate the Index of Dental Anxiety and Fear (IDAF-4C+) into Finnish and test its reliability and validity. METHODS The study population consisted of dental students in a Finnish university (n = 202). The IDAF-4C+ was back-and forward translated by experts as well as a native English translator, blinded to the original version. Reliability was assessed using Cronbach's alpha. Validity of the IDAF-4C+ was assessed against the Modified Dental Anxiety Scale (MDAS) using Spearman correlation coefficients and through the use of Exploratory factor analysis (EFA) and between genders using Mann-Whitney U tests. RESULTS The reliability of the IDAF-4C+ was good, the Cronbach's alpha being 0.88. The IDAF-4C+ and MDAS and their subscales were correlated, with coefficients varying between 0.34 and 0.85. Correlations were stronger with the emotional and physiological components of the IDAF-4C+. EFA revealed one factor explaining 51.7% of the common variance (eigenvalue = 4.6). Women tended to have slightly higher mean scores than men (1.49 vs. 1.36, p = 0.247). CONCLUSIONS The translation and localization of the Finnish version of the IDAF-4C+ can be considered as providing some evidence of the validity and reliability of the scale. It adds to previously used measures as it considers also the behavioral, cognitive and physiological dimension involved in dental fear.
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Affiliation(s)
- Mimmi Tolvanen
- Department of Community Dentistry, Institute of Dentistry, FI-20014 University of Turku, Turku, Finland.,FinnBrain Study Group, Department of Psychiatry and Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Katri Puijola
- Department of Community Dentistry, Institute of Dentistry, FI-20014 University of Turku, Turku, Finland
| | - Jason M Armfield
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, 5005, Australia
| | - Satu Lahti
- Department of Community Dentistry, Institute of Dentistry, FI-20014 University of Turku, Turku, Finland. .,Turku Clinical Research Center, Turku University Hospital, Turku, Finland.
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19
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Factors associated with dental anxiety in Brazilian children during the first transitional period of the mixed dentition. Eur Arch Paediatr Dent 2017; 18:39-43. [DOI: 10.1007/s40368-016-0264-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
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20
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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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21
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Pohjola V, Rekola A, Kunttu K, Virtanen JI. Association between dental fear and oral health habits and treatment need among University students in Finland: a national study. BMC Oral Health 2016; 16:26. [PMID: 26922793 PMCID: PMC4769491 DOI: 10.1186/s12903-016-0179-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/12/2016] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Vesa Pohjola
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
| | - Aino Rekola
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | | | - Jorma I Virtanen
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
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22
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Liinavuori A, Tolvanen M, Pohjola V, Lahti S. Changes in dental fear among Finnish adults: a national survey. Community Dent Oral Epidemiol 2015; 44:128-34. [PMID: 26482701 DOI: 10.1111/cdoe.12196] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 09/12/2015] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Arja Liinavuori
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Mimmi Tolvanen
- Department of Community Dentistry, University of Turku, Turku, Finland
| | - Vesa Pohjola
- Department of Community Dentistry, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Satu Lahti
- Department of Community Dentistry, University of Turku, Turku, Finland
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23
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Hagqvist O, Tolvanen M, Rantavuori K, Karlsson L, Karlsson H, Lahti S. Dental fear and previous childhood traumatic experiences, life events, and parental bonding. Eur J Oral Sci 2015; 123:96-101. [PMID: 25676735 DOI: 10.1111/eos.12171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2014] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Outi Hagqvist
- FinnBrain Study Group, Department of Psychiatry, Institute of Clinical Medicine, University of Turku, Turku, Finland; Department of Community Dentistry, Institute of Dentistry, University of Turku, Turku, Finland
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24
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Luoto A, Tolvanen M, Rantavuori K, Pohjola V, Karlsson L, Lahti S. Individual changes in dental fear among children and parents: a longitudinal study. Acta Odontol Scand 2014; 72:942-7. [PMID: 24922091 DOI: 10.3109/00016357.2014.923582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Anni Luoto
- Department of Community Dentistry, Institute of Dentistry, University of Turku , Turku , Finland
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25
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Dental fear among medical and dental undergraduates. ScientificWorldJournal 2014; 2014:747508. [PMID: 25386615 PMCID: PMC4216710 DOI: 10.1155/2014/747508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/01/2014] [Accepted: 09/01/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To assess the prevalence and level of dental fear among health related undergraduates and to identify factors causing such fear using Kleinknecht's Dental Fear Survey (DFS) questionnaire. METHODS Kleinknecht's DFS questionnaire was used to assess dental fear and anxiety among the entire enrollment of the medical and dental undergraduates' of the University of Malaya. RESULTS Overall response rate was 82.2%. Dental students reported higher prevalence of dental fear (96.0% versus 90.4%). However, most of the fear encountered among dental students was in the low fear category as compared to their medical counterpart (69.2 versus 51.2%). Significantly more medical students cancelled dental appointment due to fear compared to dental students (P = 0.004). "Heart beats faster" and "muscle being tensed" were the top two physiological responses experienced by the respondents. "Drill" and "anesthetic needle" were the most fear provoking objects among respondents of both faculties. CONCLUSION Dental fear and anxiety are a common problem encountered among medical and dental undergraduates who represent future health care professionals. Also, high level of dental fear and anxiety leads to the avoidance of the dental services.
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Pohjola V, Rannanautio L, Kunttu K, Virtanen JI. Dental fear, tobacco use and alcohol use among university students in Finland: a national survey. BMC Oral Health 2014; 14:86. [PMID: 25012119 PMCID: PMC4108271 DOI: 10.1186/1472-6831-14-86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/02/2014] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.
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27
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Tolvanen M, Hagqvist O, Luoto A, Rantavuori K, Karlsson L, Karlsson H, Lahti S. Changes over time in adult dental fear and correlation to depression and anxiety: a cohort study of pregnant mothers and fathers. Eur J Oral Sci 2013; 121:264-9. [DOI: 10.1111/eos.12026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | - Hasse Karlsson
- FinnBrain study group; Department of Psychiatry; Institute of Clinical Medicine; University of Turku; Turku; Finland
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Pohjola V, Mattila AK, Joukamaa M, Lahti S. Alcohol use disorder, smoking and dental fear among adults in Finland. Acta Odontol Scand 2013; 71:300-6. [PMID: 22545790 DOI: 10.3109/00016357.2012.680902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated the association between dental fear and alcohol use disorder and smoking controlling for age, gender and attained level of education as well as anxiety and depressive disorders. MATERIALS AND METHODS Nationally representative data on Finnish adults, 30 + years old (n = 5953), were gathered in interviews. Dental fear was measured in an interview using the question: 'How afraid are you of visiting a dentist?' The alternatives for replying were: 'Not at all', 'Somewhat' and 'Very'. Alcohol use, anxiety and depressive disorders were assessed with a standardized structured psychiatric interview based on DSM-IV criteria. The question on regularity of smoking gave three reply alternatives: smoking 'Daily', 'Occasionally' or 'Not at all'. RESULTS When socio-demographics and anxiety and depressive disorders were controlled for, those with lifetime alcohol use disorder were more likely to have high dental fear than were those without this disorder. When smoking was added to the model, those who smoked regularly were more likely to have high dental fear than those who smoked occasionally or not at all. In this model, alcohol use disorder was not statistically significantly associated with dental fear. CONCLUSIONS The results of this study support the suggestion that some individuals may have personality traits that make them vulnerable to substance use disorders and dental fear.
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Affiliation(s)
- Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.
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Armfield JM, Pohjola V, Joukamaa M, Mattila AK, Suominen AL, Lahti SM. Exploring the associations between somatization and dental fear and dental visiting. Eur J Oral Sci 2011; 119:288-93. [DOI: 10.1111/j.1600-0722.2011.00839.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pohjola V, Mattila AK, Joukamaa M, Lahti S. Dental fear and alexithymia among adults in Finland. Acta Odontol Scand 2011; 69:243-7. [PMID: 21294672 DOI: 10.3109/00016357.2011.554861] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
population sample, controlling for age, gender, education and marital status as well as depressive and anxiety disorders. An additional aim was to evaluate whether gender modified this association. MATERIAL AND METHODS. The two-stage stratified cluster sample (n = 8028) represented the Finnish population aged 30 years and older. Participants (n = 5241) answered the question 'How afraid are you of visiting a dentist?' They also filled out the 20-Item Toronto Alexithymia Scale (TAS-20), which included three sub-scales, i.e. difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF) and externally oriented thinking (EOT). Anxiety and depressive disorders were assessed with a standardized structured psychiatric interview according to DSM-IV criteria. To evaluate the association between dental fear and alexithymia, multiple logistic regression analyses were performed, adjusting simultaneously for the effects of possible confounding variables. RESULTS. Gender modified the association between dental fear and alexithymia. Among women, those reporting higher scores for TAS-20, DIF and EOT sub-scale scores were more likely to have high dental fear than were those reporting lower scores. Among men no such association was observed. Those participants who reported high DDF sub-scale scores were more likely to have high dental fear than were those reporting lower scores. CONCLUSIONS. Alexithymics are more likely to have high dental fear than non-alexithymics are. The findings support the suggestion that some people with dental fear may have internal personality vulnerability to anxiety disorders.
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Affiliation(s)
- Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Finland
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Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland. Eur J Oral Sci 2011; 119:55-60. [PMID: 21244512 DOI: 10.1111/j.1600-0722.2010.00795.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied the association between dental fear and anxiety or depressive disorders, as well as the comorbidity of dental fear with anxiety and depressive disorders, controlling for socio-demographic characteristics, dental attendance, and dental health. Nationally representative data on Finnish adults, ≥ 30 yr of age (n = 5,953), were gathered through interviews and clinical examination. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' Anxiety and/or depressive disorders were assessed using a standardized structured psychiatric interview according to criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV).Those with depressive disorders, generalized anxiety disorder or social phobia more commonly reported high dental fear than did those without these disorders. When age, gender, education, dental attendance, and the number of decayed, missing, and restored teeth were considered, those with generalized anxiety disorder were more likely to have high dental fear than were participants with neither anxiety nor depressive disorders. The comorbidity of depressive and anxiety disorders also remained statistically significantly associated with dental fear; those with both depressive and anxiety disorders were more likely to have high dental fear than were those without these disorders. Our findings support the suggestion that some individuals may have a personality that is vulnerable to dental fear.
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Affiliation(s)
- Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.
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Aminabadi NA, Ghoreishizadeh A, Ghoreishizadeh M, Oskouei SG. Can drawing be considered a projective measure for children's distress in paediatric dentistry? Int J Paediatr Dent 2011; 21:1-12. [PMID: 20642462 DOI: 10.1111/j.1365-263x.2010.01072.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several tools have been developed for the measurement of emotional status of the child in paediatric dental clinics including nonverbal self-report techniques. Subjective methods like drawing and Child Drawing: Hospital (CD:H) score have recently been applied in hospitalized children. Studies, however, have not attempted to analyse children's drawings as an aid to investigate the subjective feelings of children in paediatric dental settings. AIM To assess drawing as a measure for child's distress in paediatric dental settings. DESIGN Fifty-four children, aged 4-11 years, participated in this study. After finishing the first therapeutic session, the child was instructed to draw a picture of a person in a dental clinic. The pictures were scored using CD:H score sheet and the findings were compared with SEM and Frankl scores. RESULTS CD:H was correlated with both Frankl (correlation coefficient = -0.550) and SEM (correlation coefficient = +0.483) scales (P < 0.001). CONCLUSION Drawing is a useful measure of children's emotional status in dental settings in a way that is easier, familiar and more enjoyable for the child patient.
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Affiliation(s)
- Naser Asl Aminabadi
- Department of Paediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
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Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance. MOTIVATION AND EMOTION 2010. [DOI: 10.1007/s11031-010-9154-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pohjola V, Lahti S, Suominen-Taipale L, Hausen H. Dental fear and subjective oral impacts among adults in Finland. Eur J Oral Sci 2009; 117:268-72. [PMID: 19583754 DOI: 10.1111/j.1600-0722.2009.00631.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Vesa Pohjola
- Department of Community Dentistry, Institute of Dentistry, University of Oulu, Oulu, Finland.
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Jaakkola S, Rautava P, Alanen P, Aromaa M, Pienihäkkinen K, Räihä H, Vahlberg T, Mattila ML, Sillanpää M. Dental fear: one single clinical question for measurement. Open Dent J 2009; 3:161-6. [PMID: 19672334 PMCID: PMC2724646 DOI: 10.2174/1874210600903010161] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 12/23/2008] [Accepted: 06/03/2009] [Indexed: 11/22/2022] Open
Abstract
A new dental fear measurement instrument, the Short Dental Fear Question (SDFQ), was developed and tested for clinical practice purposes. The correlations of the SDFQ with the Dental Anxiety Scale (DAS) and the Dental Fear Survey (DFS) were tested in 15-16-year-old adolescents. The Spearman correlations (rs) between the dental fear measurement instruments were: SDFQ – DFS: rs = 0.79, n = 26; DFS – DAS: rs = 0.72, n = 26; SDFQ– DAS: rs = 0.69, n = 27. DAS and DFS mean scores were clearly higher in the SDFQ fear group than SDFQ in the relaxed group. The SDFQ is a short and compact instrument which might be convenient for the measurement of dental fear in clinical practice.
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Affiliation(s)
- S Jaakkola
- Dental Healthcare Clinic and Public Health Center City of Turku, Finland.
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Armfield JM, Slade GD, Spencer AJ. Are people with dental fear under-represented in oral epidemiological surveys? Soc Psychiatry Psychiatr Epidemiol 2009; 44:495-500. [PMID: 18974907 DOI: 10.1007/s00127-008-0454-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 10/13/2008] [Indexed: 01/27/2023]
Abstract
BACKGROUND Dental phobia is associated with poorer dental attendance so epidemiological surveys requiring participants to undertake a dental examination may result in an under-representation of participants with high dental fear. METHOD We compared the dental fear distribution of participants and non-participants in an oral examination component of a national epidemiological survey of oral health. Of 12,606 in-scope dentate people aged 15+ who completed a structured computer-assisted telephone interview (CATI) survey, 5,505 (43.7%) participated in the oral examination. Dental fear was assessed with a single-item measure in the CATI. RESULTS There was a significant difference between the percentages of participants and non-participants who rated themselves as "extremely" afraid, although the absolute difference (1.9%) was small. The association between extreme dental fear and participation was significant (OR = 0.66, 95% CI = 0.56-0.77) in multivariate analyses after controlling for possible confounders. Females with extreme dental fear were also significantly less likely to undertake an oral examination. CONCLUSION Even though people with dental fear and phobia may delay or avoid dental visits, they do not appear to be appreciably under-represented in oral epidemiological surveys.
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Affiliation(s)
- Jason M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, 122 Frome Road, Adelaide, SA, 5000, Australia.
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Pohjola V, Lahti S, Vehkalahti MM, Tolvanen M, Hausen H. Age-specific associations between dental fear and dental condition among adults in Finland. Acta Odontol Scand 2008; 66:278-85. [PMID: 18720054 DOI: 10.1080/00016350802293960] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our objective was to study whether dental condition, measured by numbers of sound, decayed, missing, and restored teeth, was associated with dental fear, and whether age, dental attendance, and/or gender modified this association. MATERIAL AND METHODS The sample (n=8,028) comprised Finnish adults aged 30 years and older and the study included people (n=6,335) who participated in a home interview and a clinical dental examination. Dental fear was measured by the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analysis was used to determine the association between dental fear and dental condition variables, i.e. numbers of decayed, missing, sound, and restored teeth considering the effects of age, attendance, and gender. RESULTS With the exception of number of restored teeth, all dental condition variables were associated with dental fear. The association between dental fear and number of decayed teeth was positive and was independent of age, gender, and attendance. Age modified the association between dental fear and number of missing and sound teeth. Among the oldest age group, the numbers of missing and sound teeth were positively associated with dental fear while being negatively associated among the youngest age group. CONCLUSIONS People with high dental fear have poorer dental condition than those with lower fear. Neither gender nor dental attendance affects the association between dental fear and dental condition. The associations between dental fear and numbers of missing and sound teeth vary according to year of birth.
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Pohjola V, Lahti S, Tolvanen M, Hausen H. Dental fear and oral health habits among adults in Finland. Acta Odontol Scand 2008; 66:148-53. [PMID: 18568473 DOI: 10.1080/00016350802089459] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of our study was to evaluate the association between dental fear and oral health habits (tooth-brushing, use of toothpaste, dental floss and toothpicks, smoking and dental attendance), while simultaneously considering the effect of age, gender, and attained level of education. MATERIAL AND METHODS The nationwide two-stage stratified cluster sample (n=8028) was representative of Finnish adults aged 30 years and older. The response rate was 88%. Dental fear was determined by the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and oral health habits, including age, gender, and attained level of education. RESULTS Regular smokers were more likely to be very afraid of visiting a dentist than were those who smoked occasionally or not at all. Age modified the effect of dental attendance and tooth-brushing on dental fear. Among 65+-year-olds, those who brushed their teeth less than twice a day were more likely to be very afraid of visiting a dentist than were those who brushed at least twice a day. Irregular attenders were more likely to be very afraid of visiting a dentist than were regular attenders, the effect being strongest among 65+-year-olds. CONCLUSIONS Birth cohort has to be taken into account when associations between dental fear and oral health habits are studied. Dental teams have to be aware of the associations between dental fear and smoking because of the adverse effects of smoking on oral health and the risk of irregular attendance among those with high dental fear.
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Armfield JM, Slade GD, Spencer AJ. Cognitive vulnerability and dental fear. BMC Oral Health 2008; 8:2. [PMID: 18218075 PMCID: PMC2266729 DOI: 10.1186/1472-6831-8-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 01/24/2008] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Jason M Armfield
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, South Australia, Australia.
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