Optimism-pessimism dimension and dental anxiety in children aged 10-12 years

Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance

Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.

A new measure for dispositional optimism and pessimism in young children

We describe here a new test for dispositional optimism and pessimism in young children, the Parent‐rated Life Orientation Test of children (the PLOT) and assess its psychometric properties. Two hundred and twenty one mother–father pairs rated their children's (mean age = 8.1, SD = 0.3 years) dispositional optimism and pessimism using a new scale, the PLOT, including four optimism and four pessimism items. We associated the PLOT with parent‐rated self‐esteem (Behavioral Rating Scale of Presented Self‐Esteem in Young Children), social competence (Social Competence and Behaviour Evaluation Scale, the SCBE‐30), psychiatric symptoms (Child Behaviour Checklist, the CBCL) and temperament (Children's Behaviour Questionnaire, the CBQ) of the child. A confirmatory factor analysis (CFA) of the mother‐ and father‐rated PLOT revealed a significantly better fit for a two‐ over a one‐factor solution (p < 0.001). The optimism and pessimism subscales displayed good reliabilities, inter‐parental agreement and modest to moderate associations, in the expected direction, with the measures of self‐esteem, social competence, temperament and behaviour problems. To conclude, the PLOT shows good construct and convergent validity and reliability. The findings encourage its use to assess early emerging generalized expectancies of positive and negative outcomes in young children. Copyright © 2009 John Wiley & Sons, Ltd.

Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review

OBJECTIVE

Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry.

STUDY DESIGN

A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children.

RESULTS

104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia.

CONCLUSION

The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.

Association between Optimism, Psychosocial Well Being and Oral Health: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to assess the association of optimism and psychosocial well being of school going children on their oral health status.

STUDY DESIGN

The study included 12- to 15-year-old school going children (N = 2014) from Tamilnadu, India. Optimism was measured using the revised version of the Life Orientation Test (LOT-R). A questionnaire was sent to the parents regarding their child's psychosocial behavior which included shyness, feeling inferiority, unhappiness and friendliness. Clinical examination for each child was done to assess the DMFT score and OHI-S score. The data obtained were statistically analyzed using Pearson Chi-Square test, Mann-Whitney test and Kruskal-Wallis test with the aid of SPSS software (version 17). Odds Ratio (OR) was calculated with 95% Confidence Interval (CI). The p value ≤ 0.05 was considered statistically significant.

RESULTS

Boys with high optimism had significantly lesser DMFT score than the boys with low optimism (p=0.001). Girls with high optimism had significantly higher DMFT score (p=0.001). In psychosocial outcomes, inferiority (p=0.002) and friendliness (p=0.001) showed significant association with DMFT score. Among the boys, children who felt less inferior (p=0.001), less unhappy (p=0.029) and more friendly (p=0.001) had lesser DMFT score.

CONCLUSION

Among the psychosocial outcomes assessed, inferiority and friendliness had significant association with oral health of the children and hence, can be used as a proxy measures oral health.

Effect of 'Perceived control' in management of anxious patients undergoing endodontic therapy by use of an electronic communication system

BACKGROUND

From time immemorial, fear and anxiety have been associated with dental treatment. Coping with this fear and anxiety has been one of the most vexing problems with which the individual dentist, as well as the profession has had to contend. Hence this study was undertaken to evaluate a new technique for management of such anxious patients.

AIM

The aim of this study is to evaluate the efficacy of using 'Perceived control' for the management of anxious patients undergoing endodontic therapy.

SETTINGS AND DESIGN

'A communication device designed by the author and named as "Touch N' Tell" (Patent no: 234291, Government of India) was installed on the dental chair which helps to create an effective communiqué between the patient and dentist during the dental procedure.

MATERIALS AND METHODS

Sixty anxious patients were selected using Modified Dental Anxiety Scale (MDAS), and were divided into two groups. For group A, the patients were treated along with the use of 'communication system' installed on the dental chair, whereas the patients were managed in a routine manner for Group B. The post operative MDAS scores were recorded for both the groups.

STATISTICAL ANALYSIS

The mean change in anxiety levels was calculated for both the groups. Statistical analysis was done using unpaired t-test.

RESULT AND CONCLUSION

A significant decrease in the mean anxiety levels was observed in the group where 'communication system' was used as a measure of perceived control.

Optimismus und Pessimismus bei Vorschulkindern

Zusammenfassung. Ziel der vorliegenden Studie ist die Untersuchung der psychometrischen Eigenschaften, faktoriellen Struktur und konvergenten Validität der deutschsprachigen Version des Parent Rated Life Orientation Test of Children (PLOT) zur Messung von Optimismus und Pessimismus bei 4 bis 6-jährigen Vorschulkindern. Eltern von 145 Kindergartenkindern (77 Mädchen; Alter: M = 5.0, SD = 0.6 Jahre) schätzten Optimismus und Pessimismus sowie Emotionsregulation der Kinder ein. Außerdem wurde das Problemverhalten der Kinder (Eltern- und Erzieherinneneinschätzung) erfasst. Konsistent zu Studien mit Schulkindern und Jugendlichen zeigte sich eine zweidimensionale Faktorenstruktur mit einem Optimismus- und einem Pessimismusfaktor. Die Ergebnisse ergaben theoriekonforme Zusammenhänge mit Problemverhalten und Emotionsregulation der Kinder. Insgesamt weisen die gefundenen Reliabilitäts- und Validitätswerte auf eine gute Verwendbarkeit des PLOT bei Vorschulkindern hin. Das neue Messverfahren kann einen Beitrag zum besseren Verständnis von Zukunftserwartungen bei Vorschulkindern leisten und als Screening-Instrument zur Identifikation von Kindern mit einem Entwicklungsrisiko dienen.

Are people with dental fear under-represented in oral epidemiological surveys?

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.

Italian version of Corah's Dental Anxiety Scale: normative data in patients undergoing oral surgery and relationship with the ASA physical status classification

To test the Italian translation of Corah's Dental Anxiety Scale (DAS) and to check the relationship between dental anxiety and the American Society of Anesthesiologists (ASA) physical status classification (ASA-PS), the DAS was translated into Italian and administered to 1072 Italian patients (620 male and 452 female patients, ages 14-85 years) undergoing oral surgery. Patients' conditions were checked and rated according to the ASA-PS. The DAS ranged from 4 to 20 (modus=8, median=10); 59.5% of patients had a DAS of 7-12, 26.1% had a DAS>2, and 10.3% had a DAS>15. The mean DAS was 10.29 (95% confidence limit=0.19); female patients were more anxious than male patients (P< .001), while patients older than 60 years showed a significant decrease in the level of anxiety. Five hundred two patients were rated as ASA-PS class P1, 502 as ASA-PS class P2, and 68 as ASA-PS class P3, with a mean DAS score of 9.69, 10.78, and 11.09, respectively: the DAS difference between groups was significant (P< .001).

Psychometric properties of Spanish-language adult dental fear measures

Background

It would be useful to have psychometrically-sound measures of dental fear for Hispanics, who comprise the largest ethnic minority in the United States. We report on the psychometric properties of Spanish-language versions of two common adult measures of dental fear (Modified Dental Anxiety Scale, MDAS; Dental Fear Survey, DFS), as well as a measure of fear of dental injections (Needle Survey, NS).

Methods

Spanish versions of the measures were administered to 213 adults attending Hispanic cultural festivals, 31 students (who took the questionnaire twice, for test-retest reliability), and 100 patients at a dental clinic. We also administered the questionnaire to 136 English-speaking adults at the Hispanic festivals and 58 English-speaking students at the same college where we recruited the Spanish-speaking students, to compare the performance of the English and Spanish measures in the same populations.

Results

The internal reliabilities of the Spanish MDAS ranged from 0.80 to 0.85. Values for the DFS ranged from 0.92 to 0.96, and values for the NS ranged from 0.92 to 0.94. The test-retest reliabilities (intra-class correlations) for the three measures were 0.69, 0.86, and 0.94 for the MDAS, DFS, and NS, respectively. The three measures showed moderate correlations with one another in all three samples, providing evidence for construct validity. Patients with higher scores on the measures were rated as being more anxious during dental procedures. Similar internal reliabilities and correlations were found in the English-version analyses. The test-retest values were also similar in the English students for the DFS and NS; however, the English test-retest value for the MDAS was better than that found in the Spanish students.

Conclusion

We found evidence for the internal reliability, construct validity, and criterion validity for the Spanish versions of the three measures, and evidence for the test-retest reliability of the Spanish versions of the DFS and NS.

Do dispositional pessimism and optimism predict ambulatory blood pressure during school days and nights in adolescents?

We tested the hypotheses that (1) high pessimism and low optimism (LOT-R overall and subscale scores) would predict high ambulatory blood pressure (ABP) level and 24-hour load (percentage of ABP values exceeding the pediatric 95th percentile) among healthy Black and White adolescents (n=201; 14-16 yrs) across 2 consecutive school days and (2) that the relationships for the pessimism and optimism subscales would show nonlinear effects. The hypotheses were confirmed for pessimism but not for optimism. The results suggest that high pessimism may have different effects than low optimism on ABP and that even moderate levels of pessimism may effect blood pressure regulation. These results suggest that optimism and pessimism are not the opposite poles on a single continuum but ought to be treated as separate constructs.

The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear

Background

Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored.

Methods

The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates.

Results

People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear.

Conclusion

Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear.

Dental fear in Australia: who's afraid of the dentist?

BACKGROUND

This study aimed to describe both the prevalence of dental fear in Australia and to explore the relationship between dental fear and a number of demographic, socio-economic, oral health, insurance and service usage variables.

METHODS

A telephone interview survey of a random sample of 7312 Australian residents, aged five years and over, from all states and territories.

RESULTS

The prevalence of high dental fear in the entire sample was 16.1 per cent. A higher percentage of females than males reported high fear (HF). Adults aged 40-64 years old had the highest prevalence of high dental fear with those adults aged 80+ years old having the least. There were also differences between low fear (LF) and HF groups in relation to socioeconomic status (SES), with people from higher SES groups generally having less fear. People with HF were more likely to be dentate, have more missing teeth, be covered by dental insurance and have a longer time since their last visit to a dentist.

CONCLUSIONS

This study found a high prevalence of dental fear within a contemporary Australian population with numerous differences between individuals with HF and LF in terms of socioeconomic, socio-demographic and self-reported oral health status characteristics.

A new measure of children's optimism and pessimism: the youth life orientation test

BACKGROUND

Optimism and pessimism are positive and negative expectations linked with well-being in adults. Research on the importance of optimism and pessimism in children is limited by the lack of a developmentally appropriate measure of children's expectations.

METHOD

Based upon the Life Orientation Test-Revised (Scheier, Carver, & Bridges, 1994), the Youth Life Orientation Test (YLOT) is a sixteen-item self-report measure of children's optimism and pessimism.

RESULTS

Reliability and validity of the YLOT was found with 204 3rd-6th graders. Optimism also predicted fewer child-reported depressive symptoms and parent-reported behavior problems assessed three months later. Pessimism predicted more child-reported anxiety symptoms and parent-reported social and academic deficits.

Psychometric properties of optimism and pessimism: results from the Girls' Health Enrichment Multisite Studies

Background. This study investigated the relationships among optimism, pessimism, physical activity, and dietary behaviors among 8- to 10-year-old African-American girls in the Girls' Health Enrichment Multisite Studies (GEMS). Methods. Ninety-two girls were randomly assigned to a 12-week physical activity and diet intervention or comparison group and completed psychosocial assessments including the Youth Life Orientation Test (YLOT) of optimism and pessimism, physical performance self-concept, physical activity self-efficacy, physical activity outcome expectancies, and physical activity and sedentary preferences. Also, preferences for bottled water and sweetened beverages were assessed. Physical activity and dietary intake were assessed by self-report and parent-report at baseline and follow-up. Also, physical activity was objectively assessed by wearing an accelerometer for 3 days. The psychometric properties of the optimism-pessimism subscales were analyzed. Results. The measures of optimism and pessimism in children were reliable (r = 0.75-0.82). In the multiple regression analyses without the intervention interaction terms, pessimism was positively and significantly related to increases in MET-adjusted usual activity (P = 0.008) and sedentary behaviors (P = 0.0004). Additionally, a negative (P = 0.026) pessimism by intervention interaction term for MET-adjusted usual activity was found such that the intervention group had a lower change in physical activity per unit increase in pessimism compared to the control group.

CONCLUSIONS

Among 8- to 10-year-old African-American girls, pessimism was related to increased sedentary behaviors and usual activity. Previous studies have reported relationships between optimism and health-compromising behaviors. This study found that pessimism may positively or negatively influence efforts to increase health-promoting behaviors. Future research should confirm and clarify the meaning of these findings.

Dental anxiety in a students' paediatric dental clinic: children, parents and students

OBJECTIVE

The purpose of the present study was to investigate the dental anxieties of children, parents and student caregivers in a dental school environment.

METHODS

Eighty-eight children, parents and the dental students who treated the children were included in the study. They were asked to complete questionnaires which gathered information about demographics and dental anxiety using the Dental Anxiety Scale (DAS). Students were also asked to respond to a visual analogue scale (VAS) to assess their anxiety prior to treating children.

RESULTS

Significant differences were observed between the mean DAS of the children compared to the students (8.8 +/- 3.9 and 7.3 +/- 2.7, respectively), and between the scores of the parents and the students (8.3 +/- 2.9 and 7.3 +/- 2.7, respectively). No significance was noted between the mean DAS scores of the children and those of the parents. The number of children in family did not influence the mean DAS of the children. Parents' age, education or place of birth did not influence the mean DAS of the parents or the children. The mean DAS of children who reacted excellently in previous treatments scored significantly lower in DAS compared with children who were fearful. Female dental students demonstrated higher DAS and VAS scores than male students. Students' seniority, type of last treatment that they received, time since last treatment, parenthood or self-ranking in class did not seem to significantly influence their DAS or VAS scores. A strong correlation in DAS scores between parents and children was found (r = 0.41, P = 0.0001). No correlation between children's and students' DAS scores was found.

CONCLUSIONS

Students' dental anxiety, or their anxiety prior to treating a child, may not be directly associated with the child's dental anxiety. However, a positive correlation exists between parental and children's dental anxiety.

Anxiety and pain measures in dentistry: a guide to their quality and application

BACKGROUND

The authors review measures of anxiety and pain used in recent dental studies. In particular, the study identifies the reliability, validity and usefulness of the measures.

TYPE OF STUDIES REVIEWED

Three computerized databases of published scientific literature were searched over a 10-year period. Only studies that included measures of anxiety or pain were included.

RESULTS

Information on the reliability and validity of 15 measures of dental care anxiety and three measures of pain and pain-related behaviors is provided. Reliability and validity data for most measures are good. Corah's Dental Anxiety Scale is the most widely used measure of anxiety, although it may not be as sensitive as other measures. The McGill Pain Questionnaire is the measure of choice for the assessment of pain.

CLINICAL IMPLICATIONS

The authors have summarized properties of the scales for clinicians and researchers planning to use measures of anxiety, measures of pain, or both.

Dental anxiety among young adolescent patients in Israel

AIM

To evaluate adolescents' dental anxiety using self-reported questionnaires previously given to adults.

SAMPLE AND METHOD

One hundred and four patients (42 boys, 62 girls) aged 12-18 years who attended their paediatric dentist completed a questionnaire in the waiting room. The survey consisted of three sections: sociodemographic information for the children, a dental anxiety scale (DAS), and a dental fear survey (DFS).

RESULTS

The scores of the girls were higher than the boys in every DAS item as well as in the total score. Girls showed higher DFS scores than boys in most items. The most anxiety-provoking stimuli were feeling and seeing the needle. In the most anxiety provoking stimuli, among the boys who reported higher DFS scores (categories 3, 4, 5), the DAS scores were higher than the scores of the girls. As the stimulus became less anxiety-provoking, such as sitting in the dental chair, the DAS scores of the girls in these categories were higher than boys. Significantly more girls' responses were in categories 3, 4 and 5 in the items dealing with the needle and the drill, while no significant difference was observed among the boys and girls regarding sitting in the dental chair.

CONCLUSIONS

It is concluded that individual personality traits may be the final factor to indicate those who will eventually develop higher dental anxiety, and those who will not. The difference could be also in the conditioning process and learned responses (male and female education) that these individuals have experienced in life.

Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence.

The prevalence of dental anxiety in children from low-income families and its relationship to personality traits

The prevalence of dental anxiety and the association between dental anxiety and personality traits were examined in a population-based sample of 895 US urban children, from 5 to 11 years of age, from low-income families. Dental anxiety was reported by the child using the Dental Subscale (DS) of the Children's Fear Survey Schedule, and behavioral problems and personality traits were evaluated by parent report on the Child Behavior Checklist (CBCL). Mean DS scores were 31.1 (SD = 10.3) for boys and 34.3 (SD = 11.0) for girls. CBCL score means were 33.3 (SD = 23.2) for boys and 28.5 (SD = 19.1) for girls. The hypothesized relationship between DS and CBCL scores in this population was not demonstrated.

Dental anxiety, optimism-pessimism, and dental experience from childhood to adolescence

94 adolescents, 58% of the original study group, participated in a 5-yr follow-up questionnaire study to assess the predictive power of self-reported dental anxiety, optimism-pessimism dimension, and previous dental experience on dental anxiety level over the 5-yr period. The mean values on Corah's Dental Anxiety Scale (DAS) and Dental Anxiety Question (DAQ) had increased for the girls and remained stable for the boys. The predictive power of DAS and DAQ on anxiety levels as measured by these same scales 5 yr later was weak to moderate, although statistically significant. The optimism-pessimism dimension and dental treatment experiences did not have any effect on dental anxiety changes from childhood to adolescence. DAS had an independent, weak, but statistically significant negative effect on optimistic disposition over the period. The internal reliability of DAS was high and highly similar results using DAS and DAQ were found. Except for significantly more dental experience in the drop-out group (n = 69) than in the current study group in the first study, there were no statistically significant differences in mean scores between the groups with respect to self-reported and clinical dental anxiety, and optimism. Methodological complications are discussed.

Appraisal of dental anxiety and fear questionnaires: a review

This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents' Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. It is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.