Toward a genetic understanding of dental fear: evidence of heritability

Adverse childhood experiences and dental anxiety among Chinese adults in Hong Kong: a cross-sectional study

Introduction

This study aimed to investigate the relationship between adverse childhood experiences (ACEs) and dental anxiety among Chinese adults in Hong Kong.

Methods

A cross-sectional survey was conducted at a university in Hong Kong. The recruiting period and data collection started in January 2023 and ended in June 2023. Participants completed an online questionnaire that assessed ACEs (using the Adverse Childhood Experiences International Questionnaire - ACE-IQ) and dental anxiety (using the Modified Dental Anxiety Scale - MDAS and Dental Fear Survey - DFS). The study examined the impacts of both cumulative (i.e., total number) and independent ACE components on dental anxiety. To explore the relationships between cumulative ACEs, individual ACE components and dental anxiety (MDAS and DFS score), Pearson correlations, linear regression and logistic regression were conducted.

Results

Significant associations were observed between ACEs and dental anxiety among 171 subjects. Cumulative ACEs were positively correlated with MDAS scores (r = 0.169, p = 0.027) and DFS scores (r = 0.253, p < 0.001). The odds of an individual having high dental anxiety increased by 26-43% for every additional increase in the number of ACEs. Individual types of ACEs, such as emotional and physical neglect, sexual abuse, and household substance abuse, significantly influenced the likelihood of having high dental anxiety.

Discussion

The results showed a positive association between ACEs and dental anxiety, highlighting the impact of ACEs on dental anxiety. Dental practitioners should consider inquiring about a patient's ACE history to develop personalized treatment plans.

Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

The role of neuroticism and pain in dental anxiety: A twin study

OBJECTIVES

Accumulating evidence has revealed that dental anxiety is robustly associated with dental care-related pain and discomfort, but also with the personality trait of neuroticism (i.e. the relatively stable disposition to experience the world as distressing, threatening and unsafe). However, there is a near absence of research on these risk factors in samples for which genetic information is available. With the aim of arriving at a more refined understanding of dental anxiety, this twin cohort study assessed genetic and environmental influences on neuroticism, dental care-related pain and dental anxiety, and the relation between these phenotypes.

METHODS

Participants were recruited from the Norwegian Twin Registry, and data collections were carried out in 1992-98 (Time 1) and 2011 (Time 2). Well-validated questionnaires were used to assess the study variables, including Corah's Dental Anxiety Scale, the Numerical Pain Rating Scale, the NEO Personality Inventory Revised (Time 2) and Eysenck's Personality Questionnaire (Time 1). Pearson correlation analysis and generalized estimating equations (GEE) were used to investigate phenotypic associations. Analyses of genetic and environmental influences were performed using Cholesky modelling.

RESULTS

A total of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 participated in the study. Moderate estimates of heritability for dental anxiety (0.29), treatment-related pain (0.24) and neuroticism (0.45-0.54) were found. Cholesky modelling showed furthermore that neuroticism assessed at Time 1 and Time 2 was related to dental anxiety and pain via both genetic and individual-specific environmental pathways, albeit not very strongly. The particularly high phenotypic correlation observed between dental care-related pain and anxiety (r = .68) was explained by both overlapping genetic and individual-specific environmental influences (the genetic and environmental correlations were .84 and .63 respectively).

CONCLUSIONS

The findings provide deeper insight into the aetiology of dental anxiety and confirm that while it is strongly linked to treatment-related pain experiences, this relation is to a considerable degree independent of general negative affectivity/neuroticism.

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.

Genome-wide Scan of Dental Fear and Anxiety Nominates Novel Genes

Dental care-related fear and anxiety (DFA) is prevalent, affects oral health care utilization, and is related to poor oral health and decreased quality of life. In addition to learned and cultural factors, genetics is hypothesized to contribute to DFA. Therefore, we performed a genome-wide association study to identify genetic variants contributing to DFA. Adult and adolescent participants were from 4 cohorts (3 from the US-based Center for Oral Health Research in Appalachia, n = 1,144, 1,164, and 535, and the UK-based Avon Longitudinal Study of Parents and Children [ALSPAC], n = 2,078). Two self-report instruments were used to assess DFA: the Dental Fear Survey (US cohorts) and Corah's Dental Anxiety Scale (ALSPAC). Genome-wide scans were performed for the DFA total scores and subscale scores (avoidance, physiological arousal, fear of dental treatment-specific stimuli), adjusting for age, sex, educational attainment, recruitment site, and genetic ancestry. Results across cohorts were combined using meta-analysis. Heritability estimates for DFA total and subscale scores were similar across cohorts and ranged from 23% to 59%. The meta-analysis revealed 3 significant (P < 5E-8) associations between genetic loci and 2 DFA subscales: physiological arousal and avoidance. Nearby genes included NTSR1 (P = 3.05E-8), DMRTA1 (P = 4.40E-8), and FAM84A (P = 7.72E-9). Of these, NTSR1, which was associated with the avoidance subscale, mediates neurotensin function, and its deficiency may lead to altered fear memory in mice. Gene enrichment analyses indicated that loci associated with the DFA total score and physiological arousal subscale score were enriched for genes associated with severe and persistent mental health (e.g., schizophrenia) and neurocognitive (e.g., autism) disorders. Heritability analysis indicated that DFA is partly explained by genetic factors, and our association results suggested shared genetic underpinnings with other psychological conditions.

Predictors of use of dental care by children in north-central Appalachia in the USA

Use of dental services in childhood, especially preventive care, is associated with many important oral health outcomes throughout life. The Andersen behavioral model of healthcare utilization posits that predisposing characteristics, enabling resources, and need factors predict utilization in oral and other healthcare domains. Inequities that produce lower utilization of dental services in north-central Appalachia have been documented in comparison to the USA generally. Additionally, within Appalachia, there are disparities, such as those across different states related to varying public policies and resources supporting healthcare. Predictors of dental utilization in Appalachia have been a focus in adults, but less so in children. The aim of the current study was to understand predictors of dental utilization in children in north-central Appalachia in order to inform future research about how to intervene to address these disparities. In this study, there were 1,178 children, ages 1 through 10 years, from selected representative counties in West Virginia and Pennsylvania, along with a parent/caregiver, who were part of the Center for Oral Health Research in Appalachia (COHRA1) cohort. Use of dental services by their child was indicated by parents/caregivers, who also reported on sociodemographic, dental care-related anxiety and fear, and values and attitudes associated with oral healthcare. Results indicated that use of professional dental services by children was related to child age, dental anxiety and fear, and parental oral health values and attitudes. Older children in this age group, those who evidenced more dental care-related anxiety and fear, and whose parent/caregiver placed higher value on oral health and healthcare for themselves, were more likely to have had a dental visit in the past year.

Relationship Between Maternal Dental Anxiety and Children's Dental Caries in the Eastern Province of Saudi Arabia

Purpose

Dental anxiety is a barrier to dental care utilization and is associated with poor oral health outcomes. The aim of the study was to assess the relationship between dental anxiety of mothers and dental caries of their children in the Eastern Province, Saudi Arabia.

Methodology

A cross-sectional study was conducted on a sample of mother-child pairs (N= 199) in Dammam, AlKhobar, and Dhahran, Saudi Arabia. Dental caries experience among children was determined using dmft/DMFT indexes following the World Health Organization's guidelines. Maternal dental anxiety was assessed by using the Modified Dental Anxiety Scale (MDAS).

Results

The mean ages of mothers and children were 33.98 ± 5.41 and 6.74 ± 2.29 years, respectively. The mean dmft score was 4.3 ± 3.99 in primary dentition and the mean maternal dental anxiety score was 13.89 ± 5.33. Ninety-two percent of mothers had low to extreme dental anxiety and only 8% reported no dental anxiety. Dental caries experience in primary teeth was higher in children of dentally anxious mothers (mean dmft 4.45 ± 3.92) than the children of mothers who were non-anxious (mean dmft 2.56 ± 4.59) (P=0.07). The mean maternal anxiety score was significantly higher in children with untreated decay in primary dentition (14.49 ± 5.08) than those with sound primary dentition (12.24 ± 5.67) (P = 0.008). The study also found a statistically significant correlation between maternal dental anxiety and untreated decay in the primary dentition (Pearson's r =0.171, P = 0.015).

Conclusion

Dental anxiety was highly prevalent among mothers in the present study. There was a significant relationship between maternal dental anxiety and untreated decay in the primary dentition. Awareness should be raised among dentally anxious mothers to reduce the burden of dental caries in their children.

Dental Fear and Patient Preference for Emergency Dental Treatment Among Adults in COVID-19 Quarantine Centers in Dammam, Saudi Arabia

PURPOSE

Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.

MATERIALS AND METHODS

Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June-July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.

RESULTS

The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.

CONCLUSION

Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.

A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

Health psychology is multidisciplinary, with researchers, practitioners, and policy makers finding themselves needing at least some level of competency in a variety of areas from psychology to physiology, public health, and others. Given this multidisciplinary ontology, prior attempts have been made to establish a framework for understanding the role of biological, psychological, and socio-environmental constructs in disease development, maintenance, and treatment. Other models, however, do not explain how factors may interact and develop over time. The aim here was to apply and adapt the 3P model, originally developed and used in the treatment of insomnia, to couch the biopsychosocial model in a way that explains how diseases develop, are maintained, and can be treated. This paper outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions (the 3Ps) and provides examples of how this model may be adapted and applied to a number of health-related diseases or disorders including chronic pain, gastrointestinal disorders, oral disease, and heart disease. The 3P framework can aid in facilitating a multidisciplinary, theoretical approach and way of conceptualizing the study and treatment of diseases in the future.

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

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

Facilitating Green Supply Chain in Dental Care through Kansei Healthscape of Positive Emotions

Dentistry is highly energy- and resource-intensive with a significant environmental impact. To consolidate green dentistry supply chains, delivering the care of highest quality that meets client value should not be neglected. This study emphasized the importance of client-centered healthscape design for facilitating a green dentistry supply chain. A client-centered healthscape design, which promotes clients' positive emotions and increases willingness to revisit the dentist, plays a critical role in realizing green dentistry supply chains in the long run. For this purpose, the relationship among dental healthscape design elements, client emotions, and revisit intentions was investigated using a Kansei engineering-based approach. The effects of dental healthscape elements on clients' positive emotions and the effects of positive emotions on clients' revisit intentions were holistically examined on the basis of the stimulus-organism-response model. Through this approach, 17 elements of design, ambience, and social interaction factors that comprise the dental healthscape and 20 Kansei words used to express clients' positive emotions regarding dental service were identified. A questionnaire survey was used to assess Kansei and revisit intention in healthscape scenarios, composed of varied design elements. Primary data were collected from 600 individuals from 2017 to 2018 throughout Taiwan. Partial least squares was applied to holistically analyze the effects of dental healthscape elements on clients' positive emotions and the effects of positive emotions on clients' revisit intention to generate a Kansei model for the dental healthscape. All 20 Kansei words had significant positive effects on the dental revisit intention of clients. The five positive emotions most associated with increased revisit intention were thoughtful, hopeful, tender, comfortable, and cozy. The Kansei model of the dental healthscape provides references for healthscape design that maintains positive client emotions during the dental service and results in high revisit intention. This approach can realize an emotion-centered design for dental healthscapes that promotes preventive dental care, early treatment, and effective use of medical resources, and consequently contributes to green dentistry supply chains.

INFLUENCE OF THE SEROTONERGIC SYSTEM POLYMORPHISM ON THE EXPRESSION OF DENTAL ANXIETY

- The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah's Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by ?χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.

Dental fear among transgender individuals - a cross-sectional survey

AIMS

The aims of this study were to: (1) evaluate the level of dental fear among transgender individuals and (2) investigate specific predictors of dental fear in individuals who identify as transgender.

METHOD AND RESULTS

An anonymous survey among transgender adults was conducted using both a web-based and paper survey. The survey included the Dental Fear Survey (DFS), history of hormonal interventions, perceived gender roles, and demographic information. The bivariate analyses did not show a significant difference in DFS between sex assigned at birth (p = 0.628) or among gender identities (p = 0.109). A regression model analysis for the level of DFS by using participants' demographic information as independent variables indicated the fear and experience of discrimination/maltreatment were significant predictors of dental fear; standardized beta coefficients (p-value) were 0.35 (p = 0.017) and 0.28 (p = 0.041), respectively.

CONCLUSION

The fear and experiences of discrimination/maltreatment were significantly positively associated with their level of dental fear.

Precision Dentistry in Early Childhood: The Central Role of Genomics

Pediatric oral health is determined by the interaction of environmental factors and genetic influences. This is the case for early childhood caries, the most common disease of childhood. The complexity of exogenous-environmental factors interacting with innate biological predispositions results in a continuum of normal variation, as well as oral health and disease outcomes. Optimal oral health and care or precision dentistry warrants comprehensive understanding of these influences and tools enabling intervention on modifiable factors. This article reviews the current knowledge of the genomic basis of pediatric oral health and highlights known and postulated mechanistic pathways of action relevant to early childhood caries.

A Preliminary Genome-Wide Association Study of Pain-Related Fear: Implications for Orofacial Pain

Background

Acute and chronic orofacial pain can significantly impact overall health and functioning. Associations between fear of pain and the experience of orofacial pain are well-documented, and environmental, behavioral, and cognitive components of fear of pain have been elucidated. Little is known, however, regarding the specific genes contributing to fear of pain.

Methods

A genome-wide association study (GWAS; N = 990) was performed to identify plausible genes that may predispose individuals to various levels of fear of pain. The total score and three subscales (fear of minor, severe, and medical/dental pain) of the Fear of Pain Questionnaire-9 (FPQ-9) were modeled in a variance components modeling framework to test for genetic association with 8.5 M genetic variants across the genome, while adjusting for sex, age, education, and income.

Results

Three genetic loci were significantly associated with fear of minor pain (8q24.13, 8p21.2, and 6q26; p < 5 × 10⁻⁸ for all) near the genes TMEM65, NEFM, NEFL, AGPAT4, and PARK2. Other suggestive loci were found for the fear of pain total score and each of the FPQ-9 subscales.

Conclusions

Multiple genes were identified as possible candidates contributing to fear of pain. The findings may have implications for understanding and treating chronic orofacial pain.