Prevalence and correlates of dental anxiety in patients seeking dental care

Exploring young adults' fears related to healthcare and dental procedures

Background and Purpose

Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in poor health outcomes.

Purpose

This cross-sectional study aimed to examine young adults' experiences of fear related to dental and healthcare procedures and the potential relationships between the two forms of fear experiences and demographic factors.

Methods

Young adults (252) were recruited from a large public university and completed a survey about their dental and healthcare fear/anxiety as well as their confidence in healthcare professionals. Descriptive and correlational analyses were completed to describe the experiences of young adults and the relationships between variables.

Results

Ten types of fear/anxiety were identified related to healthcare procedures, with the most common being needles and pain. Nine fears/anxieties were identified for dental visits, of which pain and sensory experiences other than pain were most common. Female participants were significantly more likely to report fear/anxiety related to dental procedures, and there was a statistically significant relationship between fear/anxiety related to healthcare procedures and that related to dental procedures. There was also a significant negative relationship found between confidence in healthcare providers and fear/anxiety related to healthcare procedures.

Conclusions

Young adults experience fear/anxiety related to healthcare and dentist visits, and this fear/anxiety can impact their confidence in healthcare providers, such as primary physicians. The findings of the current study suggest primary care providers should be aware of potential fears/anxieties and offer patients appropriate supports.

The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Associations between pain-related temporomandibular disorders and dental anxiety at 46 years of age in the Northern Finland Birth Cohort 1966

OBJECTIVES

The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms.

MATERIALS AND METHODS

Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named 'depression', 'anxiety' and 'distress'.

RESULTS

Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively.

CONCLUSIONS

Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis.

The influence of anxiety on pain perception and its repercussion on endodontic treatment: a systematic review

OBJECTIVE

To evaluate the influence of dental anxiety on the perception of pain before and during endodontic treatments.

MATERIALS AND METHODS

The PRISMA checklist was followed. A search was conducted in Scopus, Medline/PubMed, The Cochrane Library, and Web of Science databases. Based on PECOS criteria, the first outcome was a possible association between pre-operative pain and anxiety. The second outcome was a possible association between intraoperative pain and anxiety. The type of studies was observational. The JBI Critical Appraisal Checklist was used to evaluate the methodological quality of articles. The certainty of the evidence was analyzed using the GRADE approach.

RESULTS

Four articles were included with a total of 471 patients. Two studies found a positive association between pain and pre-endodontic treatment anxiety. Three studies investigated the relationship between anxiety and intraoperative pain; two identified an extremely significant positive association. One article noted that anxiety influences pain expectancy. The studies were of good quality as assessed by the JBI Critical Appraisal Checklist for cross-sectional studies. However, the certainty of the evidence was considered low and very low.

CONCLUSIONS

Dental anxiety can be directly associated with pre- and intraoperative pain during endodontic procedures.

CLINICAL RELEVANCE

It is necessary to identify patients with dental anxiety to employ therapies to bring their anxiety under control, avoiding the increase of endodontic infections, and the postponement and evasion of endodontic treatments.

Sedative and adverse effect comparison between oral midazolam and nitrous oxide inhalation in tooth extraction: a meta-analysis

OBJECTIVE

Oral midazolam and nitrous oxide inhalation were commonly used sedative and analgesic techniques during tooth extraction. It is still controversial whether oral midazolam can replace the nitrous oxide inhalation for sedative and analgesic treatment of tooth extraction. Therefore, we conducted this study in order to provide a reference for doctors to choose effective sedative and analgesic treatment in tooth extraction.

METHODS

We searched the Chinese and English databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Wanfang and VIP information databases.

RESULTS

Through this meta-analysis, we found that the success rate of sedation and analgesia treatment with oral midazolam during tooth extraction was 75.67% and the incidence of adverse reactions was 21.74%. The success rate of sedation and analgesia treatment using nitrous oxide inhalation during tooth extraction was 93.6% and the incidence of adverse reactions was 3.95%.

CONCLUSION

The use of nitrous oxide inhalation for sedation and analgesia during tooth extraction is very effective, and oral midazolam can be used as an alternative to nitrous oxide inhalation.

Rational thinking as a mediator of the relationship between mindfulness and dental anxiety

Dental anxiety causes people to postpone or refuse to go to the dentist, which further negatively impacts their quality of life and public health. Previous research has shown that mindfulness is inversely related to anxiety. However, little is known about the relationship between mindfulness and dental anxiety. The current research aimed to explore the relationship between mindfulness and dental anxiety and investigate the mediating role of rational thinking. Two studies were conducted. In study one, 206 Chinese participants completed questionnaires measuring trait mindfulness and dental anxiety (state, responding to a dental treatment scenario). In study two, 394 participants completed questionnaires measuring trait mindfulness, dental anxiety (trait), and rational thinking. The results for both studies showed that mindfulness is negatively correlated with dental anxiety. In study 1, each facet of mindfulness except Non-judging was negatively correlated with dental anxiety with Acting with Awareness having the strongest correlation, while in study 2, only Acting with Awareness was significantly negatively correlated with dental anxiety. Furthermore, rational thinking mediated the effect of mindfulness on dental anxiety. In conclusion, mindfulness is negatively related to both state and trait dental anxiety, and rational thinking mediates the relationship between mindfulness and dental anxiety. Implications of these findings are discussed.

Concurrent changes in dental anxiety and smoking in parents of the FinnBrain Birth Cohort Study

We evaluated associations between changes in dental anxiety and tobacco use, adjusted for general anxiety and depressive symptoms. The FinnBrain Birth Cohort Study data, collected at gestational weeks 14 and 34 and at 3 months postpartum, were used. Questionnaires included the Modified Dental Anxiety Scale (MDAS), the Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Symptom Checklist-90 (SCL). Smoking was categorized as "stable non-smoking", "started smoking", "quit smoking", and "stable smoking". Changes in smoking and dental anxiety were evaluated "during pregnancy" (i.e., from gestational week 14 to gestational week 34) in 2442 women and 1346 men and "after pregnancy" (i.e., from gestational week 34 to 3 months postpartum) in 2008 women and 1095 men. Changes were evaluated in three smoking categories (stable non-smoking, fluctuating, and stable smoking), using data from all three time-points (1979 women and 1049 men). Modeling used repeated measures analysis of covariance. Stable smoking mothers had statistically significantly higher levels of dental anxiety (mean MDAS 12.3-12.6) than non-smoking mothers (mean MDAS 10.1-10.7) or mothers who smoked at some point during pregnancy (mean MDAS 10.8-11.5). A similar tendency was observed in fathers. However, no systematic change in dental anxiety by changes in smoking habits was observed. Those smoking during pregnancy and with high dental anxiety may need special support for smoking cessation.

Associations between temperament dimensions and dental anxiety in parents of the FinnBrain Birth Cohort Study

We evaluated associations between dental anxiety and four temperament dimensions: effortful control, extraversion/surgency, negative affect and orienting sensitivity among 2558 parents in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale, and temperament with the Adult Temperament Questionnaire. Associations between dental anxiety and temperament dimensions were modelled using linear and logistic (cut-off ≥ 19 for high dental anxiety) regression analyses adjusting for general anxiety and depressive symptoms, age and education. In women and men, dental anxiety was positively associated with negative affect (women β = 1.10; 95%CI 1.06-1.15; men β = 1.11; 95%CI 1.05-1.18) and negatively associated with effortful control (women β = 0.95; 95% CI0.92-0.99, men β = 0.90; 95% CI 0.85-0.95). In women, extraversion/surgency was also positively associated with dental anxiety (β = 1.04; 95%CI 1.00-1.08). For high dental anxiety, negative affect in women (OR = 2.00; 95%CI 1.31-3.06) and men (OR = 5.21; 95%CI 1.72-15.83) and for extraversion/surgency in women (OR = 1.50; 95%CI 1.01-1.47) associated positively with dental anxiety, but for effortful control, the association was not statistically significant. Dentists should understand that temperament dimensions affect the risk for dental anxiety more strongly than general anxiety or depressive symptoms. Dimensions negative affect and extraversion/surgency may increase and effortful control decrease the risk.

Effectiveness of and Patient’s Satisfaction with Dental Emergency Unit in Pitié Salpêtrière Hospital (Paris), Focusing on Pain and Anxiety

Background

The Dental Emergency Unit (DEU) of the Pitié Salpêtrière Hospital receives mainly painful emergencies. This study aimed at evaluating the suppression of pain and anxiety as well as the patient's satisfaction after a visit to the DEU. Patients and Methods. A prospective study was carried out in 2019 (NCT03819036) in adult patients. Data was collected on D0 on site and then on D1, D3, and D7 by phone, during daytime. The main objective and secondary objectives were, respectively, to assess the intensity of pain on D1; the intensity of pain on D3 and D7; the evolution of anxiety on D1, D3, and D7; and the patients' satisfaction. They were evaluated with a 0–10 numeric scale (NS) on D1, D3 and D7; mean scores were compared with nonparametric statistics (ANOVA, Dunn's test).

Results

814 patients were contacted and 581 patients included; 87 were lost to follow-up. 376 patients completed all the questionnaires. In the final sample (59% men, 40 ± 16 y.o.), 86% had health insurance. The mean pain scores were as follows: D0: 6.36 ± 0.12; D1: 3.49 ± 0.13; D3: 2.23 ± 0.13; D7: 1.07 ± 0.11—indicating a significant decrease of 45%, 65%, and 93% on D1, D3, and D7, respectively, compared to D0 (p < 0.0001) between D0 and D1, D3, D7. The mean NS anxiety scores were as follows: D0: 3.32 ± 0.15; D1: 3.69 ± 0.16; D3: 2.75 ± 0.16; D7: 1.98 ± 0.15. The decrease was significant between D0 and D7 (p < 0.0001). The perception of general heath improved between D1 and D7. The overall score of satisfaction was 8.64 ± 0.06.

Conclusion

DEU enabled a significant reduction in pain and anxiety with high overall satisfaction.

Unveiling the Association between Body Image Dissatisfaction and Dental Anxiety

Background: Increased demands for invasive and non-invasive treatments related to body image disturbances are seen worldwide. These demands may be related to body image dissatisfaction. No study to date investigated the relationship between body image dissatisfaction and dental anxiety (namely, anticipatory dental anxiety and treatment dental anxiety) among a non-clinical population. The current study aims to unveil such relationships. Methods: Dentally anxious people may choose to ‘cope’ with their anxiety via unnecessary invasive procedures related to their body image dissatisfaction. In the current study, 553 individuals completed an online survey assessing their dental anxiety, dental neglect, and body image via self-report questionnaires. Results: Body image dissatisfaction was significantly correlated with dental anxiety. In contrast to previous studies, dental neglect was negatively associated with dental anxiety. Additionally, no link was found between body image dissatisfaction and dental neglect. Conclusions: The current study highlights the importance of addressing these factors prior to invasive procedures.

Translation and Validation of Italian Version of Index of Dental Anxiety and Fear (IDAF-4C+): A Cross-Sectional Study

Dental anxiety (DA) is defined as unreasonable apprehension toward dental procedures. About 4–20% of the worldwide adult population presents DA, with peaks of 30% in the younger population. Managing patients with dental anxiety and fear with a reliable and valid instrument is necessary to understand the multidimensional dimensions of dental fear. This work aimed to validate the Index of Dental Anxiety and Fear (IDAF-4C+) into Italian. Two hundred and eighty dental students attending an Italian university were enrolled. The IDAF-4C+ was translated by experts and a native English translator, blinded to the original version. The Modified Dental Anxiety Scale (MDAS) was used to assess the validity of IDAF-4C+. Spearman correlation coefficients and Exploratory Factorial Analysis (EFA) were used. Reliability was evaluated by Cronbach’s alpha. The reliability of the Italian version of IDAF-4C+ was good (Cronbach’s alpha = 0.88). Correlation between IDAF-4C+ and MDAS ranged between 0.42 to 0.68. From EFA, one factor explained 58.76% of the common variance. Women showed a higher level of dental fear. The Italian IDAF-4C+ is a valid and reliable tool to assess DA in any clinical context. This instrument allows for a proper understanding and management of DA, and therefore a better patient oral health-related quality of life and compliance with the dentist’s instructions.

Gender-specific associations between the dimensions of alexithymia personality trait and dental anxiety in parents of the FinnBrain Birth Cohort Study

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.

Using Virtual Technology for Fear of Medical Procedures: A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions

BACKGROUND

Innovations in virtual reality (VR) technologies have improved the adaptability of its use in therapeutic settings, and VR has shown to be a promising treatment for fear of medical procedures, with research increasing in this area in recent years.

PURPOSE

This review aims to collate evidence for the impact of VR on fear of medical procedures.

METHODS

CENTRAL (Cochrane), MEDLINE, EMBASE, and PsychINFO databases were searched up to October 2020. A mix of experimental and case-control studies were included for review, which evaluated the effectiveness of VR for fear, anxiety, and pain of medical procedures for people with needle phobia, dental phobia, claustrophobia of medical scans, and burn wound care anxiety. Risk of bias (RoB) was assessed by Cochrane and ROBINS-I tools.

RESULTS

Twenty-eight studies were selected. Some studies included mixed participant groups of young people adults. The interventions varied, with VR used for distraction, hypnosis, or exposure. These were shown to be effective for reducing fear of medical procedures. However, effectiveness for blood-injection-injury phobias and burn wound care patients was unclear.

CONCLUSIONS

Evidence on the effectiveness of VR suggests that it does decrease fear of medical procedures in some situations. However, the RoB assessment illustrated a poor quality of studies across those included in this review, limiting the ability to draw firm general conclusions from the study findings. There is a need for further research exploring the use of VR technologies in the management of anxiety in physical health care settings.

Psychological Distress, Dental Health, and Dental Fear among Finnish University Students: A National Survey

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.

What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations

There is a dearth of tools designed to inform people about what to expect from person-centred dental encounters and to guide them during the care process. This is why we propose the Montreal-Toulouse Wheel of patients' expectations for dental visits, which describes what people could expect during person-centred clinical encounters. The Wheel comprises four core expectations: 1) be understood; 2) be respected; 3) have power; and 4) be given enough time. It also includes three expectations that are more specific to the process of care: 5) be informed and understand; 6) share decisions with the dentist and even co-construct the treatment plan; and 7) be comfortable during clinical procedures and the whole care process. We also propose a Q-List to help patients reflect on their relationship with dental professionals and engage them in person-centred dental care. This Q-List describes the seven expectations of the Wheel and provides open-ended questions that we invite patients to reflect upon. We also hope that dental professionals and educators will find the Wheel and the Q-List useful to develop person-centredness and promote inclusive and equitable dentistry.

Dental anxiety and the effectiveness of local anesthesia

Aim: The successful anesthesia is an essential factor for dental treatment. This study aimed at determining the effectiveness of local anesthesia and it’s relationship with dental Anxiety. Methods: This cross-sectional study was carried out on 256 dental patients, in 2017. Dental Anesthesia was administered after completing the Modified Dental Anxiety Scale by the patients. The level of anesthesia was recorded in one of three states (successful, difficult, and failed). Collected data was analyzed using SPSS version 22 and tests of, Chi-square, independent t-test, analysis of variance, and logistic regression model.  Results: About 60.5% subjects had moderate-severe dental anxiety. The mean of dental anxiety significantly was lower in the successful anesthesia group (P<0.01). Patients with elementary education had a significantly higher level of dental anxiety (P<0.01). Dental anxiety was significantly higher in the age group of ≥59 years, compared to the other age groups, except for 49-58 years (P<0.05). Subjects with a significantly higher level of dental anxiety more delayed their visits to the dentist. The logistic regression model showed that the dental anxiety (high anxiety) and literacy level (elementary) were the most important predictors of failed or difficult anesthesia. Conclusion: Informing patients about dental treatment procedures, regular and periodic visits to the dentist, using psychotherapeutic techniques to reduce dental anxiety before anesthesia, could play an important role in the success of anesthesia.

Effect of an Informative Video on Anxiety and Hemodynamic Parameters in Patients Requiring Mandibular Third Molar Extraction: A Randomized Clinical Trial

PURPOSE

The purpose was to determine the effect of watching an informative video about mandibular third molar (M3M) removal on patient anxiety and hemodynamic parameters.

PATIENTS AND METHODS

A randomized controlled clinical trial was carried out in healthy patients (aged between 18 and 40 years) requiring M3M extraction under local anesthesia. Patients with previous tooth extractions, psychiatric disorders, or cardiac problems or patients undergoing anxiolytic or antidepressant drug treatment were excluded. Participants were randomized into 2 groups according to whether they watched an informative video about the surgical procedure (video group) or not (control group). The primary outcome variable was the difference between groups regarding patient anxiety assessed with the State-Trait Anxiety Inventory (STAI) and the Modified Dental Anxiety Scale (MDAS). The secondary outcome variables were hemodynamic parameters recorded during different moments of the surgical procedure. Descriptive, bivariate, and multivariate analyses were performed, and a repeated-measures mixed model was generated. Statistical significance was considered for P < .05.

RESULTS

Fifty patients referred for M3M extraction met the inclusion criteria. The final data analysis was based on 47 patients: 25 from the video group and 22 controls. The bivariate analysis showed the video group to have a significant decrease in anxiety as measured by the MDAS (P = .006; 95% confidence interval [CI], -4.1 to -0.7) and STAI-State (P = .003; 95% CI, -13.7 to -0.7). A significantly lower heart rate was likewise found in the video group (χ² = 4.30, df = 1, P = .038). The linear regression analysis adjusting for the STAI-Trait also showed lower dental anxiety measured by the MDAS in the video group (P = .023; 95% CI, 0.32 to 4.14).

CONCLUSIONS

Providing preoperative information through an informative video about M3M removal significantly reduces patient anxiety and heart rate during the surgical procedure.

Postoperative online follow-up improves the quality of life of patients who undergo extraction of impacted madibular third molars: a randomized controlled trial

Objective

To evaluate the effect of online follow-up on the quality of life of patients who undergo extraction of impacted mandibular third molars.

Materials and methods

This study enrolled patients with impacted mandibular third molars who were treated at the Department of Oral and Maxillofacial Surgery of the Stomatological Hospital at Southern Medical University and divided them into test and control groups. The test group received an online follow-up on the first, third, and fifth days after tooth extraction, while the control group was not followed up with. Patients in both groups were reexamined on the postoperative seventh day, completing the postoperative symptom severity (PoSSe) scale to comprehensively and quantitatively evaluate their quality of life after tooth extraction. A visual analogue scale (VAS) was used to evaluate the degree of approval for an online follow-up after tooth extraction by 20 senior doctors (≥ 40 years old) and 20 young doctors (<4 0 years old).

Results

The PoSSe scale scores of the remaining options in the test group were significantly lower than those in the control group. The VAS score of senior doctors for online follow-up was significantly lower than that of young doctors.

Conclusions

A postoperative online follow-up effectively improved the quality of life of patients who underwent extraction of impacted mandibular third molars. Compared with senior doctors, young doctors were more likely to approve an online follow-up after tooth extraction.

Clinical relevance

Online medical care can be considered as an auxiliary tool to improve the effect of oral treatment.

Association of depression and anxiety with different aspects of dental anxiety in pregnant mothers and their partners

OBJECTIVES

The aim was to confirm the factor structure of Modified Dental Anxiety Scale (MDAS) and to investigate whether the association of these factors with general anxiety and depression varied across gender.

METHODS

The FinnBrain Birth Cohort Study (www.finnbrain.fi) data from the first collection point at gestational week 14 were used. Of the invited participants (n = 5790), 3808 (66%) expectant mothers and 2623 fathers or other partners of the mother agreed to participate, and 3095 (81.3%) mothers and 2011 (76.7%) fathers returned the self-report questionnaire. Dental anxiety was measured with the MDAS, general anxiety symptoms with Symptom Checklist-90 (anxiety subscale) and depressive symptoms with the Edinburgh Postnatal Depression Scale. Multiple group confirmatory factor analysis (MGCFA) was conducted to test the equivalence of the factor structure and multiple group SEM (MGSEM) to test the configural invariance (unconstrained model) and metric invariance (structural weights model), across genders.

RESULTS

Of those consenting, 3022 (98%) women and 1935 (96%) men answered the MDAS. The MGCFA indicated good convergent validity for the two-factor model for MDAS, but somewhat low discriminant validity (factors demonstrated 72% shared variance). The MDAS items loaded clearly higher for the assigned factor than to the other factor (differences in loadings >0.2), indicating that the 2-factor model has merit. According to the final MGSEM model, anxiety symptoms were directly related to anticipatory dental anxiety, but not to treatment-related dental anxiety.

CONCLUSIONS

When assessing dental anxiety with MDAS, considering also its two factors may help clinicians in understanding the nature of patient's dental anxiety.

The relationship between trait mindfulness and affective symptoms: A meta-analysis of the Five Facet Mindfulness Questionnaire (FFMQ)

Trait mindfulness appears to be related to lower levels of negative affective symptoms, but it remains uncertain which facets of mindfulness are most important in this relationship. Accordingly, the present meta-analysis examined studies reporting correlations between affective symptoms and trait mindfulness as assessed by the Five Facet Mindfulness Questionnaire. A comprehensive search yielded 148 eligible studies, comprising 157 distinct samples and 44,075 participants. The weighted mean correlation for affective symptoms and overall trait mindfulness was r = -0.53. Among mindfulness facets, Nonjudge (r = -0.48) and Act with Awareness (r = -0.47) demonstrated the largest correlations, followed by Nonreact (r = -0.33) and Describe (r = -0.29). Observe was not significantly correlated with affective symptoms. No significant differences in the strength of correlations were found between anxiety, depression and posttraumatic stress disorder (PTSD) symptoms, though symptoms of generalized anxiety disorder exhibited a weaker negative relationship with the Describe facet compared to PTSD symptoms. Describe also showed a stronger relationship with affective symptoms in Eastern samples compared to Western samples, whereas Western samples had a stronger relationship with Nonjudge. These results provide insight into the nature of the association between trait mindfulness and negative affect.

Dental anxiety in first- and final-year Indian dental students

Objectives

The study aims to investigate dental anxiety in first- and final-year undergraduate dental students in India.

Design

Questionnaire Study Setting: BDS Students in four University dental colleges in India carried-out during 2013 and 2014.

Subjects (materials and methods)

The students (n = 614) were assessed using a pre-tested questionnaire. We estimated the level of dental anxiety by using the Modified-Dental-Anxiety-Scale (MDAS). ANCOVA and Mann–Whitney U, and Chi-squared contingency tests were employed to analyze the extensive dataset acquired. Univariate clustering analysis and principal component regression were also applied. Students had similar demographic and lifestyle patterns.

Interventions

Assessments of the level of dental anxiety amongst undergraduate dental students.

Main outcome measures

Mean ± SD MDAS scores for first- and final-year Bachelor of Dental Surgery (BDS) students were 12.96 ± 4.00 and 10.54 ± 3.41, respectively.

Results

Six hundred and fourteen (n = 614) students from four dental colleges were included in this study. In total 77% were female (n = 478) and 23% were male (n = 136). The mean age of the first- and final-year students were 18.31 and 21.54 years, respectively. First-year BDS students had dental anxiety score (Mean ± SD 12.96 ± 4.00) compared to that of the final year (10.54 ± 3.41), a difference which was very highly statistically significant (p < 0.0001).

Conclusion(s)

Dental anxiety was moderately higher amongst first year BDS students over that of final-year students but it is lesser than the dental phobic threshold level.

The fear of needles: A systematic review and meta-analysis

AIMS

The aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear.

BACKGROUND

Injections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE (1966-2017), Embase (1947-2017), PsycINFO (1967-2017), and CINAHL (1961-2017) were searched, with no restrictions by age, gender, race, language, or country.

REVIEW METHODS

The prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta-analysis and meta-regression.

RESULTS

The search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta-analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20-50% in adolescents and 20-30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection.

CONCLUSIONS

Fear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high-risk groups.

The Association Between Dental Anxiety And Psychiatric Disorders And Symptoms: A Systematic Review

Background

A growing amount of evidence suggests that dental anxiety is associated with other psychiatric disorders and symptoms. A systematic review was conducted to critically evaluate the studies of comorbidity of dental anxiety with other specific phobias and other Axis I psychiatric disorders.

Objective

The aim of the review was to explore how dental anxiety is associated with other psychiatric disorders and to estimate the level of comorbid symptoms in dental anxiety patients.

Methods

The review was conducted and reported in accordance with the MOOSE statement. Data sources included PubMed, PsycInfo, Web of Science and Scopus.

Results

The search produced 631 hits, of which 16 unique records fulfilled the inclusion criteria. The number of eligible papers was low. Study populations were heterogeneous including 6,486 participants, and a total of 25 tests and in few cases clinical interviews were used in the evaluation processes. The results enhanced the idea about the comorbidity between dental anxiety and other psychiatric disorders. The effect was found strong in several studies.

Conclusion

Patients with a high level of dental anxiety are more prone to have a high level of comorbid phobias, depression, mood disorders and other psychiatric disorders and symptoms.

The prevalence of dental anxiety and its association with pain and other variables among adult patients with irreversible pulpitis

BACKGROUND

The aim is to investigate the prevalence of dental anxiety and its association with pain and other related factors in adult patients with irreversible pulpitis.

METHODS

One hundred and thirty patients with irreversible pulpitis were included in this cross-sectional study. Participants were asked to fill out an information table and a battery of questionnaires to assess their level of dental anxiety, pain at their first and most recent dental experience, and pain intensity before/during the present endodontic treatment. The level of anxiety that participants displayed during the present treatment was also evaluated by the dentists using an anxiety rating scale. Data were analyzed by t-test, ANOVA, and Spearman correlation tests.

RESULTS

83.1% of participants suffered from moderate or high dental anxiety, and 16.2% met criteria for specific phobia. Subjects who had higher MDAS scores were more likely to postpone their dental visits (P < 0.05). Subjects who had bad experiences at their most recent dental visit were more anxious (P < 0.05). Pain at the most recent dental visit (P < 0.01) or before the present dental visit (P < 0.05) was important factor correlating with dental anxiety among participants. Notably, 36.2% of participants displayed moderate or severe anxiety during this present visit for endodontic treatment based on dentist's judgement.

CONCLUSIONS

A high percentage of people with irreversible pulpitis suffer from dental anxiety. Pain at the most recent dental visit and during endodontic treatment have strongly positive association with dental anxiety. Effective pain control in endodontics is beneficial to manage the anxiety.

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.

Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.

Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].

Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.

State, trait, and dental anxiety in caregivers of individuals with disabilities

PURPOSE

The aim of this study was to compare state anxiety, trait anxiety, and dental anxiety in caregivers of patients with special needs and caregivers of pediatric patients without special needs at dental clinics.

MATERIALS AND METHODS

A quantitative, cross-sectional study was conducted. Data were collected using a semistructured questionnaire. All respondents were older than 18 years of age. Individuals with cognitive impairment and those taking anxiolytics, antidepressants, or sleep-inducing medication were excluded from the study. The sample consisted of 55 caregivers of patients with special needs and 55 caregivers of pediatric dental patients. A questionnaire was administered to determine the sociodemographic profile of the patients based on the 2015 Brazilian Economic Classification Criteria. Anxiety regarding dental treatment was measured using the dental anxiety scale. The state-trait anxiety inventory was used to identify state and trait anxiety levels.

RESULTS

Caregivers of individuals with disabilities had a similar level of anxiety as caregivers of pediatric dental patients. Most caregivers of individuals with disabilities were mothers with an older age and a greater frequency of trait anxiety, especially when these mothers had health problems. State anxiety was associated with a lower education level.

CONCLUSIONS

Higher dental anxiety levels were found among caregivers with a higher level of trait anxiety, independently of the type of patient to which care was given.

Validation and Invariance of the Dental Anxiety Scale in a Brazilian sample

The aim of this study was to evaluate the properties of the Dental Anxiety Scale (DAS) when applied to Brazilian adults and to test its invariance across independent samples and different sociodemographic groups. Sociodemographic data, reports on previous unpleasant dental experiences and DAS responses were collected through telephone interviews. Metric properties of the one and two-factor models were evaluated using confirmatory factor analysis. The analysis included the chi-square ratio divided by degrees of freedom (χ2/df), the comparative fit index (CFI), the goodness of fit index (GFI) and the root mean square error of approximation (RMSEA). Convergent validity was evaluated using the average variance extracted (AVE). Cronbach's alpha (α) and composite reliability (CR) were calculated. In the two-factor model, discriminant validity was evaluated. The invariance of the models was evaluated using a multigroup analysis of the independent samples (pΔχ2λ, pΔχ2 i and pΔχ2 Res ≥ 0.05). Telephone interviews were held with 350 individuals (74.3% women). Of the participants, 135 (38.6%) had previous unpleasant dental experiences, and 117 (33.4%) knew someone who had had this type of experience. The one- and two-factor model (χ2/df < 2.0; CFI,GFI > 0.90; RMSEA < 0.10; AVE > 0.50; α,CR > 0.70) were adjusted to the data. Discriminant validity was limited (ρ2 = 0.66). Both models presented strong invariance across independent samples, but the invariance was weak (pΔχ2i < 0.05) when samples were defined by socioeconomic variables. In conclusion, both DAS models were valid and reliable when applied to a sample of Brazilian adults. However, the weak invariance of the models suggests that sample characteristics interfered with the measurement of dental anxiety.

Effectiveness of benzocaine in reducing deep cavity restoration and post-extraction stress in dental patients

Objectives:

To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA).

Methods:

A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS). Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm).

Results:

There were statistically significant differences between the mean stress scores for patients in the benzocaine and normal saline groups post-operatively (p=0.002). There were significant differences between the mean pain scores for patients in the post buccal injection (p=0.001), post palatal injection (p=0.01), and the post inferior alveolar nerve block groups (p=0.02). Buccal, palatal, and inferior alveolar nerve block injections were more painful for patients in the normal saline group than the benzocaine group.

Conclusion:

This investigation has demonstrated that post-operative stress associated with deep cavity restoration and dental extractions under LA can be reduced by the application of topical anesthetic (20% benzocaine) at the operative site for intra-oral injections.

Computerized Tool to Manage Dental Anxiety

Anxiety regarding dental and physical health is a common and potentially distressing problem, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health–related quality of life. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention that could be easily implemented in dental health care settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted ( N = 151) to test its efficacy. Consenting adult dental patients who met inclusion criteria (e.g., high dental anxiety) were randomized to 1 of 2 groups: immediate treatment ( n = 74) or a wait-list control ( n = 77). Analyses of covariance based on intention-to-treat analyses were used to compare the 2 groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates. Groups were equivalent at baseline but differed at 1-mo follow-up. Both groups showed improvement in outcomes, but analyses of covariance demonstrated significant differences in dental anxiety, fear, avoidance, and overall severity of dental phobia in favor of immediate treatment at the follow-up assessment. Of the patients who met diagnostic criteria for phobia at baseline, fewer patients in the immediate treatment group continued to meet criteria for dental phobia at follow-up as compared with the wait-list group. A new computer-based tool seems to be efficacious in reducing dental anxiety and fear/avoidance of dental procedures. Examination of its effectiveness when administered in dental offices under less controlled conditions is warranted ( ClinicalTrials.gov NCT02081365).