Dental caries and changes in dental anxiety in late adolescence

The level of dental fear and anxiety is higher in children with both severe Molar-Incisor Hypomineralisation and active dental caries lesions compared to children without these conditions

PURPOSE

To assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions.

METHODS

In this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children's Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%.

RESULTS

The mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0-25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8-13.3; p value = 0.027).

CONCLUSION

Children with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH.

Systems mapping of multilevel factors contributing to dental caries in adolescents

Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.

Conclusions

Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.

Predictors of Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis

Background: Understanding predictors of pain associated with paediatric dental procedures could play an important role in preventing loss of cooperation, which often leads to the procedure having to be performed under general anaesthesia. Aim: We aimed to identify predictors of intra-operative and post-operative pain associated with routine dental procedures in children. Materials and Methods: A systematic review of observational studies was performed using electronic searches on MEDLINE, EMBASE, PsycINFO, Global Health via OVID, PubMed, Scopus, and SciELO. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate the quality of the included studies, which were meta-analysed to estimate the impact of dental procedures and anxiety on children's pain perception. A meta-regression analysis was also performed to determine the relative effect of predictors on children's pain perception measured as mean differences on a visual analogue scale (VAS). Results: The search identified 532 articles; 53 were retrieved for full-text screening; 6 studies were included in the review; and 4 were eligible for the meta-analysis. The meta-analysis showed the types of procedures that predicted intra-operative pain, with dental extractions being the most painful (Mean VAS Difference [MD] 46.51 mm, 95% confidence interval [CI] 40.40 to 52.62 mm). The meta-regression showed that pain scores for dental extractions were significantly higher than polishing (the least painful procedure (reference category)) by VAS MD = 23.80 mm (95% CI 5.13-42.46 mm, p-value = 0.012). It also showed that highly anxious children reported significantly higher pain scores during dental procedures by a 12.31 mm MD VAS score (95% CI 5.23-19.40 mm, p-value = 0.001) compared to those with low anxiety levels. Conclusions: This systematic review demonstrates that the strongest predictors of intra-operative pain associated with paediatric dental procedures are dental extractions followed by drilling. Children with high anxiety also reported more pain for similar procedures. Tailoring interventions to reduce pain associated with paediatric dental procedures should be a priority for future research, as reducing pain can impact compliance and could reduce the need for general anaesthesia in dental treatment.

The Prevalence of Dental Fear and Its Relationship to Dental Caries and Gingival Diseases Among School Children in Wardha

Background Children who are afraid of the dentist have terrible behavioral effects, and one of those effects is that they have a preconceived concept that getting treatment would be unpleasant. Such fear and anxiety can lead to avoidance of dental care. These patients must be recognized and their concerns addressed as soon as possible. It is, therefore, important to highlight the connection between the constructs that target the development of dental fear and anxiety, including its outcome in children concerning the prevalence of dental diseases. Aims and objectives To assess the prevalence of dental anxiety and its correlation to dental caries and gingivitis in students in Wardha aged six to 12 years old. Methods Two hundred schoolchildren between the ages of six and 12 were chosen at random, with 100 boys and 100 girls. Children had an oral examination utilizing the decayed, missing, and filled teeth (DMFT) Index as well as the Loe and Silness gingival index (GI), as well as a modified version of the dental fear survey questionnaire. Results In the study population, the prevalence of low to moderate "general dental fear" was 47%, whereas the frequency of high dental fear was 14%. The mean DMFT (1.80 ± 1.76) and GI (1.04 ± 0.52) of boys did not differ substantially from the DMFT (1.94 ± 81.02) and GI (0.97 ± 0.53) of girls (P > 0.05). Conclusion In terms of DMFT and gingival scores, there was not any obvious distinction between male and female children. Additionally, there was no connection found between "general dental fear" and either the DMFT or GI scores. Dental fear scores decreased with increasing age.

The Associations among Dental Anxiety, Self-Esteem, and Oral Health-Related Quality of Life in Children: A Cross-Sectional Study

BACKGROUND

The current evidence on the relationships among child oral health-related quality of life, dental anxiety, and self-esteem indicates that we need to investigate these relationships to improve our understanding of the associations. Therefore, the current research aimed to enhance this evidence and provide an overview of the participating children's oral-health-related quality of life (as measured by the CPQ_8-10), self-esteem (as measured by the Coopersmith SEI-SF), and dental anxiety (as measured by the CFSS_DS) and how these child-related outcome measures interacted and were related to one another.

METHOD

A cross-sectional survey was conducted on a random sample of school children (n = 1900) aged 8 to 10 years. The questionnaire was collected through validated self-report measures: dental anxiety, COHRQoL, and self-esteem. Structural equation modelling (SEM) was used to test the strength of the association of our model to explore the relationships among these three psychological constructs. The moderating effects of age, gender, location, and the educational board were analysed for their possible influence on these relationships.

RESULTS

Significant relationships between COHRQoL and child dental anxiety and between COHRQoL and SE were detected. The relationship subscale between COHRQoL and child dental anxiety was 0.24, (p < 0.001). A stronger correlation between COHRQoL, and SE was found, with B = -0.77, (p < 0.001). Although the association between CDA and SE was small, it was statistically significant (p = 0.03). These findings provide some important background information for designing effective educational programs for children.

Evaluation of Change in Quality of Life, Dental Fear and Dental Anxiety in Young Children Following Full-mouth Dental Rehabilitation under General Anesthesia for Early Childhood Caries

AIM

To evaluate the change in quality of life, dental fear, and dental anxiety in young children following full-mouth dental rehabilitation under general anesthesia for early childhood caries.

MATERIALS AND METHODS

About 200 children who were diagnosed with early childhood caries requiring full-mouth rehabilitation under general anesthesia were recruited after obtaining parental consent. Oral health-related quality of life (OHRQoL) was measured using the Early Childhood Oral Health Impact Scale (ECOHIS). Dental fear was evaluated using Children's Fear Survey Schedule-Dental Subscale and dental anxiety was evaluated using the Facial Image Scale. Scores were taken on the day of intervention, and after 14 days when the child reported for posttreatment follow-up.

RESULTS

All 200 participants returned for a follow-up visit after 2 weeks. The child impact section was reduced from 15.7 ± 4.1 to 7.7 ± 1.9 after treatment. The family impact section was reduced from 9.6 ± 2.7 to 3.5 ± 2.6 after treatment. A statistically significant difference was seen in both sections when pre-and posttreatment values were compared (p < 0.001). The total ECOHIS showed statistically significant improvement as the pretreatment score of 21.6 ± 9.5 reduced to 11.2 ± 4.2 showing 51.9% improvement in OHRQoL after full-mouth rehabilitation under general anesthesia was done (p < 0.001). Dental fear and anxiety among the participants showed a statistically significant reduction after treatment was done and most participants were found to be less fearful of doctors, dentists, and injections after treatment.

CONCLUSION

Full-mouth rehabilitation was found to be a reliable treatment modality to improve the OHRQoL of children suffering from early childhood caries.

CLINICAL SIGNIFICANCE

Significant improvement was seen in the OHRQoL within 2 weeks after treatment and most participants were found to be less anxious and fearful toward dentists and dental treatment. Comprehensive dental rehabilitation under general anesthesia has been proven to be an effective treatment modality for early childhood caries and a productive treatment technique to reduce dental fear and anxiety.

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

BACKGROUND

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Dental fear in school children and young adults attending public dental health care: prevalence and relationship to gender, oral disease and dental treatment; trends over 40 years

Purpose

To study prevalence of dental fear and the relationship to gender, oral disease and dental treatment between 1973 and 2013 in school children and young adults attending public dental health care.

Methods

Every ten years from 1973 to 2013 random samples of about 100 individuals in each of the age groups 10, 15 and 20 years took part in a repeated cross-sectional study based on clinical parameters and a questionnaire. Dental fear was estimated by the question: “What do you feel at the prospect of an appointment with a dentist?”. 75–99% of the samples answered the question. Agreement to at least one of the alternative answers: ill at ease, frightened and sick defined dental fear. Frightened and/or sick indicated severe dental fear. The prevalence of caries, gingivitis and number of filled tooth surfaces were calculated. Chi-square tests were used to show differences in proportions between groups and linear regression to show trends over time.

Results

Prevalence of dental fear declined in all age groups over time. In the 20-year olds dental fear was found in 29% of the sample and severe dental fear in 12% of girls and 5% of boys in 2013. Individuals with dental fear had higher mean caries prevalence and number of filled tooth surfaces compared with individuals without dental fear.

Conclusions

This 40-year time trend study showed a reduction in dental fear prevalence in school children and young adults offered regular public dental health care based on prevention and a psychological approach. The prevalence of dental fear was still high in 2013 despite a significant decline in caries during the study period. Further improvements in the psychological approach when treating children are thus needed.

New Method of Avoiding Underestimation of Caries Incidence and Its Association with Possible Risk Factors in Japanese University Students: A Prospective Cohort Study

The objective of this three-year prospective cohort study was to investigate the association between a new definition of an increase in dental caries and risk factors in Japanese young adults. Data of Okayama University students who volunteered to undergo oral examinations and answer questionnaires in 2015 and 2018 were analyzed. The status of filled teeth and the status of occlusal/proximal surfaces of filled or decayed teeth were recorded. An increase in dental caries was defined as a change in the status of filled teeth and/or an increase in dental caries of occlusal and proximal surfaces. A total of 393 participants (18.2 ± 0.8 years) were analyzed. First and second molars showed a high prevalence of dental caries. Of the participants, 144 (36.6%) showed an increase in dental caries. In all the participants and in the females, the decayed, missing, and filled teeth (DMFT) score and history of orthodontic treatment at baseline were significantly associated with an increase in dental caries (p < 0.05) in logistic regression analyses. In the males, the DMFT score and the daily frequency of snacking (≥2) at baseline were significantly associated with an increase in dental caries (p = 0.04). The DMFT score and history of orthodontic treatment at baseline can be risk factors for an increase in dental caries using the new definition in young adults.

Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach’s alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.

Prevalence of Dental Fear and Anxiety and Its Triggering Factors in the Dental Office among School-going Children in Al Ahsa

Aims and objectives

Materials and methods

A cross-sectional questionnaire-based study was conducted. Eight hundred and sixteen, 7–12-year-old children studying in government and private schools spread across the city of Al-Ahsa, Saudi Arabia, participated in the study. A self-reported questionnaire with 15 close-ended questions pertaining to DFA in logical order was distributed to all the participants. Each question had three options as responses with images. The children were asked to choose the option that best fitted their response.

Results and Conclusion

The prevalence of DFA among boys and girls was found to be 50.4 and 71.28%, respectively. The majority of the boys studying in government schools reported DFA when informed about the treatment in advance, while most of those studying in private schools reported DFA at the sight of the dental chair and dental injections, while walking into the clinic, in the waiting room, when informed about the treatment in advance and their tooth being drilled. On the contrary, the responses were very similar among girls irrespective of their school. Most of the boys and girls did not experience any DFA when their parents were allowed to accompany them. Hence, a tailor-made approach for the management of the child in the dental office is warranted.

Clinical significance

A tailor-made approach for the management of DFA in the dental office plays a significant role in successful treatment.

How to cite this article

Alshuaibi AF, Aldarwish M, Almulhim AN, et al. Prevalence of Dental Fear and Anxiety and Its Triggering Factors in the Dental Office among School-going Children in Al Ahsa. Int J Clin Pediatr Dent 2021;14(2):286–292.

Dental caries thresholds among adolescents in England, Wales, and Northern Ireland, 2013 at 12, and 15 years: implications for epidemiology and clinical care

BACKGROUND

Dental caries is the most prevalent condition globally. Despite improvements over the past few decades, there remains a significant disease burden in childhood. Epidemiological surveys provide insight to disease patterns and trends, and have traditionally focused on obvious decay which are inconsistent with contemporary clinical criteria. This study examined the distribution of dental caries in 12- and 15-year-olds in England, Wales and Northern Ireland, by severity threshold, at surface, tooth and child level and explored its association with socioeconomic, psychological and behavioural factors.

METHODS

Data from 12- and 15-year-olds in the 2013 Children's Dental Health Survey (CDHS 2013) were analysed at three levels, taking account of dental caries thresholds which involved recording both clinical decay [visual enamel caries (AV) and above] and obvious decay [non-cavitated dentine lesions (2V) and above]. Negative binomial regression was used to identify factors associated with dental caries experience at both thresholds.

RESULTS

The prevalence and severity of dental caries experience was higher among 15-year-olds at all levels. Visual change in enamel (AV) was by far the most common stage of caries recorded in both ages. The average number of surfaces with obvious decay experience, which has been the traditional epidemiological threshold, in 12- and 15-year-olds was 2.3 and 3.9 respectively. The corresponding values under the clinical decay threshold were higher, at 3.9 and 5.9 respectively. Visualisation of the distribution of dental caries at surface/tooth-level exhibited horizontal symmetry and to a lesser extent vertical symetry. In the adjusted models for both ages, country/region, school type, area deprivation, high frequency sugar consumption and irregular dental attendance were associated with greater caries experience in both groups. Dental anxiety was inversely associated with caries experience among 15-year-olds.

CONCLUSION

This research highlights the importance of recognising dental caries patterns by surface, tooth and child-level amongst adolescents and the value of reporting dental caries distribution by threshold in epidemiological surveys, including its relevance for clinical care. Inclusion of enamel caries reveals the extent of caries management required at a point when non-invasive care is possible, emphasising the importance of prevention through contemporary primary care, which includes supporting self-care.

How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

BACKGROUND

Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12.

METHODS/DESIGN

Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation.

DISCUSSIONS

There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.

Dental anxiety and caries experience from late childhood through adolescence to early adulthood

OBJECTIVE

To assess the association between dental anxiety and caries experience from late childhood through adolescence and into early adulthood (12, 15 and 18 years old, respectively).

METHODS

A prospective cohort study was conducted among a population-representative sample of Chinese in Hong Kong. A baseline survey was conducted at age 12 and follow-up assessments were completed at ages 15 and 18. Caries experience was assessed as the number of decayed, missing and filled teeth (DMFT). Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Participants' socio-economic status and oral health-related behaviours were ascertained using a self-complete questionnaire. Negative binomial regression was used to explore the association between dental anxiety and subsequent caries status, controlling for other factors.

RESULTS

At baseline, 668 children participated; 279 (41.8%, comprising 57.0% females) completed all three phases of data collection. MDAS scores at age 18 were lower than at age 12. Caries experience increased as participants aged. At age 15 and 18, females had higher MDAS and DMFT scores than males. Reported frequency of snacking between meals was associated with MDAS scores at age 18. In regression analyses, dental anxiety at age 12 was not significantly associated with dental caries experience at age 15, controlling for socio-demographic and oral-health behaviour factors at age 12. Likewise, dental anxiety at age 15 was not significantly associated with dental caries experience at age 18, controlling for the same factors at age 15.

CONCLUSION

Dental anxiety assessed by MDAS in late childhood and adolescence appears not to predict dental caries experience later in life in this population.

Dental fear association between mothers and adolescents-a longitudinal study

Aim

To assess the longitudinal association between adolescents’ and their mothers’ dental fear.

Study Design

A longitudinal questionnaire survey study.

Methods

A randomized sample of 12-year-old adolescents were selected from local Hong Kong schools. Adolescents and their mothers self-completed the Modified Dental Anxiety Scale (MDAS). The sociodemographic background of the mothers and the oral health habits of the adolescents were also collected and these measurements were repeated at 15- and 18-years-old. Non-parametric tests (Mann–Whitney U test/Kruskall Wallis test) were used to test associations between MDAS dental fear items and independent variables. Logistic regression (adjusted for family’s sociodemographic background and adolescent’s oral health habits) was performed to evaluate the longitudinal association between adolescents’ and mothers’ dental fear.

Results

A total of 212 mother-child pairs were recruited at baseline (12-year-old adolescents). In the first and second follow-ups (15- and 18-years-old), 195 and 182 mother-child pairs completed the survey. Significant associations between mother’s and child’s scores in “feeling about having their teeth scraped and polished”, “having teeth drilled”, and ‘having an injection in the gum’ were found when adolescents were 12- years-old (P < 0.01) and 18-years-old (P < 0.05), but not at 15-years-old.

Conclusion

Adolescents’ and mothers’ dental fear is associated at 12-years-old and 18-years-old, but not at 15-years-old, which is likely specific to the Hong Kong context but may be extrapolated to other industrialized countries with caution.

The Dunedin Multidisciplinary Health and Development Study: Oral health findings and their implications

Longitudinal research is needed to better understand the natural history of oral conditions and long-term health and social outcomes. Oral health data has been collected periodically in the Dunedin Multidisciplinary Health and Development Study for over 40 years. To date, 70+ peer-review articles on the Study's oral health-related findings have been published, providing insight into the natural history of oral conditions, risk factors, impacts on quality of life, and disparities in oral health. Some of these report new findings, while others build upon the existing body of evidence. This paper provides an overview of these findings and reflects on their public health implications and policy utility in New Zealand.

Caries Progression Rates Revisited: A Systematic Review

Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d₃/D₃), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09–0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures

OBJECTIVE

To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents.

MATERIALS AND METHODS

We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15-18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah's DAS as a dichotomous dependent variable.

RESULTS

Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, 'external control belief', avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12).

CONCLUSIONS

Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.

Changes in dental anxiety among 15- to 21-year-olds. A 2-year longitudinal analysis based on the Tromsø study: Fit futures

OBJECTIVE

Identify predictive variables related to the development and continuation of high dental anxiety among young people over 2 years and assess differences between youth experiencing increased, decreased or unchanged dental anxiety scores over time.

METHODS

An observational panel study of 15- to 21-year-old people in Tromsø and Balsfjord region followed students from their first to their last year of upper secondary school (2010/11-2012/13). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) of possible predictive variables assessed at baseline when using dental anxiety score from the second wave as a dichotomous dependent variable. Variables measured at baseline: Sex, Dental Caries Experiences (DMFS index), Dental Anxiety (Corah's Dental Anxiety Scale/DAS), Psychological Distress (Hopkins Symptom Checklist/HSCL-10), Avoidance of dental treatment, Pain Estimation at the dentist and motivational questions related to tooth brushing and caries (Self and Social Motivation). Wilcoxon signed-rank tests and Kruskal-Wallis tests were used to test whether changes in DAS score between waves were associated with changes in Pain Estimation between waves and HSCL-10 scores at baseline.

RESULTS

Hopkins Symptom Checklist, DMFS and DAS scores at baseline predicted high dental anxiety scores after 2 years. Sex, motivation related to oral hygiene and avoidance due to fear at baseline did not contribute significantly to our model. DMFS and HSCL-10 were higher among young people who reported a substantial change in DAS score (2.0 > Interquartile range/IQR), irrespective of the direction of change. Pain Estimation changed consistently with a change in DAS score.

CONCLUSION

Mental health symptoms, pre-existing dental anxiety and dental health status are important contributors to the development of dental anxiety in youth. Estimations of pain at the dentist are central when it comes to changes in dental anxiety over time in this study.

Sonic and ultrasonic oscillating devices for the management of pain and dental fear in children or adolescents that require caries removal: a systematic review

OBJECTIVES

To evaluate the effectiveness and degree of acceptance by children and adolescents of the use of oscillating tips compared with rotating drills.

DESIGN

Systematic review.

DATA SOURCES

PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library and Web of Science (October 2017).

ELIGIBILITY CRITERIA

Controlled randomised or non-randomised trials that evaluated sonic and ultrasonic oscillating devices versus rotating drill.

DATA EXTRACTION

Eligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed using the Cochrane Method.

RESULTS

Two controlled clinical trials comprising 123 children aged 2-12 years old were identified. Both trials were at high risk of selection bias and unclear risk of detection bias. In one trial, pain due to the use of oscillating drill resulted lower than employing rotating drill (Verbal Hochman Scale: RR 0.64 (95% CI 0.41 to 1.00); Visual Facial Expression Scale: RR 0.64 (95% CI 0.44 to 0.94)). In another study, compared with traditional drill ultrasonic tip was associated with a lower level of patient's discomfort (RR 0.40 (95% CI 0.20 to 0.79)) but not with dental anxiety (RR 1.29 (95% CI 0.97 to 1.71)). The effectiveness of the removal of caries as well as fillings durability were only considered in one study, but no statistically significant differences were found between the two interventions.

CONCLUSIONS

The evidence based on two low-quality studies was insufficient to conclude that the use of oscillating tips for the management of pain and dental fear in children or adolescents compared with rotating drills was more effective.

General anxiety, dental anxiety, digit sucking, caries and oral hygiene status of children resident in a semi-urban population in Nigeria

BACKGROUND

Digit sucking can represent untreated anxiety or other emotional problems. The aim of this study was to determine if digit sucking is a predictor of general anxiety and dental anxiety; and if general and dental anxiety are associated with caries and oral hygiene status of children resident in sub-urban Nigeria.

METHODS

This was a secondary data analysis of a household survey conducted in Ile-Ife, Nigeria. The level of general anxiety and dental anxiety of 450 6 to12 year old children were measured using the Revised Child Manifest Anxiety Scale and Dental Subscale of the Child Fear Survey Schedule respectively. Presence of digit sucking habit, caries and oral hygiene status were determined. General anxiety and dental anxiety scores were dichotomized into low and high levels respectively. Logistic regression was conducted to determine if digit sucking was a predictor of general anxiety and dental anxiety; and if general anxiety and dental anxiety were predictors caries and good oral hygiene status. Adjustments were made for age and sex.

RESULTS

Digit sucking is not a significant predictor of dental anxiety (p = 0.99) and general anxiety (p = 0.79). Children with high general anxiety (AOR: 5.02; 95% CI: 2.9-9.74; p <  0.001) and high dental anxiety (AOR: 1.74; 95% CI: 1.15-2.65; p = 0.009) had higher odds of having caries and good oral hygiene respectively.

CONCLUSION

Digit sucking was not a significant predictor of general anxiety and dental anxiety. General and dental anxiety however, had effects on the likelihood of having caries and good oral hygiene.

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.

Salivary Immunoglobulin Gene Expression in Patients with Caries

BACKGROUND:

Immunoglobulins mediate the host’s humoral immune response are expressed in saliva.

AIM:

To quantify the FcαR, FcγRIIB, and FcαμR gene expression in the saliva of Mexican patients with caries in mixed and permanent dentition.

SUBJECTS AND METHODS:

This was a comparative cross-sectional study. mRNA was isolated from 200 μL of saliva following the RNA III Tissue Fresh-frozen protocol of the MagNA Pure LC Instrument 2.0 (Roche Diagnostics GmbH, Nederland BV) and the FcαR, FcαμR and FcγRIIB were quantified through TaqMan Assays.

RESULTS:

One hundred individuals, 50 with mixed dentition and 50 with permanent dentition, were included in the study. Statistically, it was found a significant difference (p = 0.025) in the IgG (FcγRIIB) expression between the studied groups.

CONCLUSION:

Although we confirmed the existence of FcαR, FcγRIIB and FcαμR gene expression in saliva, only a significant difference in the expression of FcγRIIB between the mixed dentition and permanent dentition was found.

Ten years on: Is dental general anaesthesia in childhood a risk factor for caries and anxiety?

Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors.Design Analysis of prospectively obtained data.Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children.Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data.Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale.Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P <0.001]).Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease.

Factors for determining dental anxiety in preschool children with severe dental caries

The aim of this study was to assess the clinical and socioeconomic indicators associated with dental anxiety in preschool children with severe dental caries. A total of 100 children between 3 and 5 years of age were selected during a dental screening procedure. The selection criteria were having at least one tooth with dental caries and a visible pulpal involvement, ulceration, fistula, and abscess (PUFA) index of ≥1 in primary teeth. Before the clinical examination or any treatment procedure was performed, we evaluated the children's dental anxiety using the Facial Image Scale (FIS). Parents completed a questionnaire on socioeconomic conditions, which included the family structure, number of siblings, parental level of education, and family income. A dentist blinded to FIS and socioeconomic data performed the clinical examination. Poisson regressions associate clinical and socioeconomic conditions with the outcome. Most of the children (53%) experienced extensive dental caries (dmf-t ≥ 6), and all children had severe caries lesions, with a PUFA index of ≥1 in 41% and that of ≥2 in 59%. The multivariate adjusted model showed that older children (4-5-year old) experienced lower dental anxiety levels compared with younger children (3-year old) (RR = 0.35; 95%CI: 0.17-0.72 and RR = 0.18; 95%CI: 0.04-0.76, respectively), and children with three or more siblings were associated with higher levels of dental anxiety (RR = 2.27; 95%CI: 1.06-4.87). Older age is associated with low dental anxiety, and more number of siblings is associated with high dental anxiety in preschool children, whereas the severity or extent of dental caries is not associated with dental anxiety.

Prevalence of dental caries based on personality types of 35-44 years old residents in Davangere city

AIM

To assess dental caries experience of different personality types of 35-44 years old residents in Davangere city.

MATERIALS AND METHODS

A cross-sectional survey was conducted in field setting. Based on Jenkins Activity Survey Questionnaire¹¹ used to assess the personality types, a personality questionnaire was designed consisting of 20 items. Questionnaire was used to assess and categorize personality types as Type A, Type B and Type AB. Data were analyzed using SPSS software version 17. Standard descriptive statistics were generated. Evaluation of data was done using chi square test.

RESULTS

Prevalence of dental caries was 96.6% in Type A personality and 95.9% in Type B personality and this difference was not statistically significant (person chi square p value = 0.53).

DISCUSSION

In a cross-sectional survey it is difficult to inspect personality types which is a qualitative variable with some people giving different responses at different occasions. There are chances of social desirability bias. Hence, longitudinal studies should be conducted to ascertain the association between personality types and dental carries.

Integrated oral, mental and sexual health management for adolescents: a call for professional collaboration

BACKGROUND

Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents.

DISCUSSION

Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents.

CONCLUSION

Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents' health needs.

The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis

BACKGROUND

Many psychological disorders are associated with comorbid physical illness. There are less data on dental disease in common psychological disorders such as depression and anxiety in spite of risk factors in this population of diet, lifestyle or antidepressant-induced dry mouth.

METHODS

We undertook a systematic search for studies of the oral health of people with common psychological disorders including depression, anxiety and dental phobia. We searched MEDLINE, PsycInfo, EMBASE and article bibliographies. Results were compared with the general population. Outcomes included partial or total tooth-loss, periodontal disease, and dental decay measured through standardized measures such as the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS).

RESULTS

There were 19 papers on depression and/or anxiety, and seven on dental phobia/anxiety (total n=26). These covered 334,503 subjects. All the psychiatric diagnoses were associated with increased dental decay on both DMFT and DMFS scores, as well as greater tooth loss (OR=1.22; 95%CI=1.14-1.30). There was no association with periodontal disease, except for panic disorder.

LIMITATIONS

Cross-sectional design of included studies, heterogeneity in some results, insufficient studies to test for publication bias.

CONCLUSION

The increased focus on the physical health of psychiatric patients should encompass oral health including closer collaboration between dental and medical practitioners. Possible interventions include oral health assessment using standard checklists that can be completed by non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth, and early dental referral. Mental health clinicians should also be aware of the oral consequences of inappropriate diet and psychotropic medication.

Dental subscale of children's fear survey schedule and dental caries prevalence

Objective:

To assess the level of fear of dental procedures among 6-12 year school children and correlate the prevalence of dental caries with their dental fears scores.

Materials and Methods:

The study sample of 444 school children, comprising of 224 girls and 220 boys in the age group of 6-12 years old from a private English medium school were selected. Each student was asked to independently complete a Children's Fear Survey Schedule – Dental Subscale (CFSS-DS) questionnaire. Children having a score of ≥ 38 were included in the “dental fear” group while those scoring <38 were placed in the “without dental fear” group. All dental examinations were performed in the classroom.

Results:

Fear scores were highest for “Injections,” (3.76 ± 0.68) “Choking,” (3.48 ± 0.63) and “Dentist drilling” (2.88 ± 0.69). The overall mean score of CFSS-DS in our study was 37.0 ± 8.89, mean score of DMFT and DMFS were 0.58 ± 0.74 and 0.73 ± 1.09, respectively. Mean score of deft and defs were 4.40 ± 2.34 and 7.28 ± 5.49, respectively.

Conclusion:

The study showed the prevalence of dental fear in 6-12 year old children and there was no statistically significant co-relation between the level of dental fear and dental caries in these children.

Why are people afraid of the dentist? Observations and explanations

OBJECTIVE

The aim of this review was to explore the peer-reviewed literature to answer the question: 'Why are people afraid of the dentist?'

METHOD

Relevant literature was identified by searching the following on-line databases: PubMed, PsycInfo, the Cochrane Library and Google Scholar. Publications were extracted if they explored the causes and consequences of dental fear, dental anxiety or dental phobia.

RESULTS

The research evidence suggests that the causes of dental fear, dental anxiety or dental phobia are related to exogenous factors such as direct learning from traumatic experiences, vicarious learning through significant others and the media, and endogenous factors such as inheritance and personality traits. Each individual aetiological factor is supported by the evidence provided.

CONCLUSIONS

The evidence suggests that the aetiology of dental fear, anxiety or phobia is complex and multifactorial. The findings show that there are clear practical implications indicated by the existing research in this area: a better understanding of dental fear, anxiety and phobia may prevent treatment avoidance.

Prevalence of clinical consequences of untreated dental caries and its relation to dental fear among 12-15-year-old schoolchildren in Bangalore city, India

PURPOSE

To investigate the prevalence of clinical consequences of untreated dental caries and its relation to dental fear among public schoolchildren in India.

METHOD

A cross-sectional study of 1,452 schoolchildren aged 12-15-years in Bangalore city using a three-stage stratified random sample was conducted. Caries was scored by WHO (World Health Organisation) criteria (1997) and clinical consequences of untreated dental caries using the PUFA index. Dental fear was assessed by a single item dental fear questionnaire.

RESULTS

The overall prevalence of caries was 57.9% and of untreated dental caries was 19.4%. Children with high dental fear had 2.05 times the risk of untreated caries as compared to children with low fear.

CONCLUSIONS

This study showed that the prevalence of clinical consequences of untreated dental caries was low, and dental fear was shown to be a significant determinant of clinical consequences of untreated dental caries.

Toward the validation of visual analogue scale for anxiety

Anxiety is a relevant problem in dental practice. The Visual Analogue Scale for Anxiety (VAS-A), introduced in dentistry in 1988, has not yet been validated in large series. The aim of this study is to check VAS-A effectiveness in more than 1000 patients submitted to implantology. The VAS-A and the Dental Anxiety Scale (DAS) were administered preoperatively to 1114 patients (459 males and 655 females, age 54.7 ± 13.1 years). Statistical analysis was conducted with Pearson correlation coefficient, the receiver operating characteristic (ROC) curve, and McNemar tests. A close correlation between DAS and VAS-A was found (r  =  0.57, P < .0001); the VAS-A thresholds of dental anxiety and phobia were 5.1 and 7.0 cm, respectively. Despite a significant concordance of tests in 800 cases (72%), disagreement was found in the remaining 314 cases (28%), and low DAS was associated with high VAS-A (230 cases) or vice versa (84 cases). Our study confirms that VAS-A is a simple, sensitive, fast, and reliable tool in dental anxiety assessment. The rate of disagreement between VAS-A and DAS is probably due to different test sensitivities to different components of dental anxiety. VAS-A can be used effectively in the assessment of dental patients, using the values of 5.1 cm and 7.0 cm as cutoff values for anxiety and phobia, respectively.

Can parents and children evaluate each other's dental fear?

The aim of this study was to determine whether parents and their 11-16-yr-old children can evaluate each other's dental fear. At baseline the participants were 11-12-yr-old children from the Finnish Cities of Pori (n = 1,691) and Rauma (n = 807), and one of their parents. The children and their parents were asked if they or their family members were afraid of dental care. Fears were assessed using single 5-point Likert-scale questions that included a 'do not know' option. Children and parents answered the questionnaire independently of each other. Background variables were the child's and their parent's gender. Parents' and children's knowledge of each other's dental fear was evaluated with kappa statistics and with sensitivity and specificity statistics using dichotomized fear variables. All kappa values were < 0.42. When dental fear among children and parents was evaluated, all sensitivities varied between 0.10 and 0.39, and all specificities varied between 0.93 and 0.99. Evaluating dental fear among fearful children and parents, the sensitivities varied between 0.17 and 0.50 and the specificities varied between 0.85 and 0.94, respectively. Parents and children could not recognize each other's dental fear. Therefore, parents and children cannot be used as reliable proxies for determining each other's dental fear.

Perceived dental anxiety among schoolchildren treated through three caries removal approaches

Objectives:

The aim of the investigation was to test the differences in the perceived level of dental anxiety among children treated restoratively using the Atraumatic Restorative Treatment (ART) approach, the traditional restorative (TRA) approach and ART aided with a chemomechanical caries removal gel (ART plus).

Methods:

The study subjects were 6-7-year-old children. TRA was compared to ART in a clinical setting after children had seen a dentist twice (Group A), ART was compared to 'ART plus' in a clinical setting after children had seen a dentist once (Group B) and ART was applied outside the clinic on school premises (Group C). The treatments were carried out in Class II cavitated dentine lesion in primary molars. Dental anxiety was measured using the Venham Picture Test (VPT). Three-way analysis of variances and interaction was applied to test for treatment approach, gender and operator effects on the mean VPT scores.

Results:

There was no statistically significant difference (p=0.80) observed between the mean VPT scores for the traditional approach and those for the ART approach and between ART with and without a chemomechanical caries removal gel (p=0.07). Children in Group A had lower mean VPT scores than children in Group B (p=0.02) and Group C (p<0.00001) when treated using the ART approach by the same two operators.

Conclusions:

The level of dental anxiety was low. There was no difference in level of dental anxiety observed in children treated with ART in comparison to the traditional restorative approach, and between children treated with ART with and without a chemomechanical caries removal gel. The treatment environment and prepatory visits may be factors determining the level of dental anxiety in children treated through the ART approach only.

A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age

BACKGROUND

The development of dental anxiety in children is poorly understood.

AIMS

The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.

DESIGN

A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.

RESULTS

The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.

CONCLUSIONS

Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.

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).

Simultaneous interrelationship between the oral health behavior and oral health status of mothers and their children

The purpose of this study was to examine the simultaneous interrelationships of oral health behavior and oral health between mothers and their children using the linear structural relations (LISREL) program. The subjects comprised 117 pairs of mothers and their children aged between 8 and 11 years. Dental status was expressed as DMFT. The Oral Rating Index (ORI) for mothers and ORI for children (ORI-C) were used as measures of gingival health. Hiroshima University Dental Behavioral Inventory (HU-DBI) was used for the assessment of mothers' oral health behavior. HU-DBI had a direct positive relationship to ORI, a direct negative relationship to DFT, and a direct positive association with ORI-C. Toothbrushing had a direct negative relationship to ORI-C. The hypothesized model was found to be closely consistent with the data. These results indicate that the periodontal health status of mothers is directly related to the oral health status of their children, and that toothbrushing by children is directly related to their gingival health.

Oral-health-related quality of life among children with and without dental fear

OBJECTIVES

This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured.

MATERIAL AND METHODS

The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register (n = 51) and schoolchildren (n = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule-Dental Subscale and a single question. ORHQoL was measured with CPQ(11-14). Background variables were gender and the dental care experienced.

RESULTS

The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ(11-14 )total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics.

CONCLUSION

Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.

Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health

Pronounced dental anxiety could lead to avoidance strategies to evade dental visits. The aim of the present epidemiological study was to investigate the prevalence and related oral disease patterns of dental anxiety in young adult male soldiers. Therefore, the intensity and frequency of dental anxiety are presented and the correlation with oral clinical findings are evaluated. Three hundred seventy-four soldiers who underwent a compulsory dental check-up were randomly assigned to this study. Psychological parameters were collected based on a protocol integrating the Dental Anxiety Scale (DAS) and the Gatchell Fear Scale (GaFS). Patient-based measures included D3,4MF-scores for dental status and the Community Periodontal Index of Treatment Need (CPITN) for periodontal status. Thirty-two individuals (8.6%) showed DAS-scores of 13 or 14 (anxious), while 4.6% had a DAS-score > or = 15 (highly anxious/phobic). Highest DAS-values were measured among patients' aged 19-29 (n = 262). DMFS-values of anxious and less anxious patients showed only minor differences. However, anxious patients had significantly more carious lesions (P < 0.001). CPITN periodontal values showed no significant differences between both groups. 89.2% of less anxious individuals and 79.6% of anxious patients went for regular dental check-ups. Thus, every tenth patient was considered to have high dental anxiety. Anxiety results in avoidance behaviour, which can only be discovered upon compulsory examinations and which is associated with higher caries morbidity and need for oral rehabilitation. As anxiety has a direct influence on oral health, it should be detected and accounted for in a treatment concept integrating dental and cognitive-behavioural therapeutic approaches.

Risk factors and risk indicators associated with high caries experience in Swedish 19-year-olds

OBJECTIVE

To study the risk factors and risk indicators associated with high caries experience (DMFS >or= 10) in 19-year-olds.

MATERIAL AND METHODS

The subjects (n=800) lived in seven suburbs of Stockholm and answered a structured questionnaire about their parents' education, occupation, and country of birth, as well as their dietary habits, oral hygiene habits, and attitudes to dental care. Dental caries was assessed by clinical and radiographic examination using the decayed, missing, filled teeth (DMFT), and surfaces (DMFS) indices. Dental plaque (VPI%) and gingival bleeding (GBI%) indices were recorded.

RESULTS

A total of 696 subjects (364 M, 332 F) participated in the study. The mean DMFT and DMFS were 3.9 and 5.1, respectively. In 81% of subjects, the DMFT was >or= 1 and 15% had DMFS >or= 10. In the multivariate analysis, the variables significantly associated with high caries experience were: dental fear (p<0.001, odds ratio (OR) 2.8), GBI >or= 15% (p=0.003, OR 2.1), mother born abroad (p=0.007, OR 2.0) and irregular toothbrushing at night (p=0.008, OR 1.9). When all significant variables in the multivariate analysis were present, the cumulative probability of DMFS >or= 10 was 52%.

CONCLUSIONS

Dental fear, gingival inflammation, a foreign-born mother, and irregular toothbrushing at night are variables that are strongly associated with high caries experience in 19-year olds. The study indicates that foreign-born parents, oral hygiene habits, and behavioral factors still have a strong impact on dental health in late adolescence.

Dental anxiety in children and its relationship to dental caries and gingival condition

The aim of this study was to determine the levels of dental anxiety, dental caries and gingivitis among 12-15-year-old schoolchildren, in Irbid Governorate/northern Jordan, and to evaluate the correlation between these variables. Two schools were selected by a simple random method from each of the five geographic areas in Irbid Governorate. All children (1021), from the 10 selected schools, who participated in this study completed a questionnaire modified from Kleinknecht's Dental Fear Survey (DFS questionnaire). Children underwent oral examination for dental caries and gingival condition, using Decayed, Missing and Filled Teeth (DMFT) Index and Löe and Silness Gingival Index (GI), respectively. Results of this survey showed that the prevalence of low to moderate 'general dental fear' among the study population was 43% while that of 'high dental fear' was 10%. The self-reported 'general fear of dental treatment' was higher among girls than boys. Fear of specific stimuli (pain) was the most common source of dental fear. The sight and sensation of the anaesthetic needle and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. The mean DMFT (2.89) and GI (1.80) of boys was not significantly different from the DMFT (3.37) and GI (1.53) of girls (P > 0.05). Spearman's correlation test demonstrated no association between 'general dental fear' and dental caries (r = 0.06) or gingivitis (r = 0.007).

Dental fear and oral health and family characteristics of Finnish children

OBJECTIVES

Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear.

METHODS

The subject groups were aged 3, 6, 9, 12, and 15 years in two middle-sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors.

RESULTS

Dental fear was higher among 12- and 15-year-old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12-year-olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six- and 12-year-olds who had experienced caries were more likely to report dental fear than were caries-free children. Among 6-year-olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear.

CONCLUSIONS

Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

Dental caries experience in older people over time: what can the large cohort studies tell us?

BACKGROUND

Little was known of the natural history of dental caries among older adults until recently, but reports from a number of large cohort studies have now enabled better understanding of the nature and determinants of dental caries in older people. The aim of this review is to examine and compare findings from established population-based longitudinal studies of older adults in order to determine their preventive implications.

METHODS

The dental literature was reviewed in order to identify reports on dental caries incidence from large, population-based dental longitudinal studies of older adults (age 50+) with at least 3 years of follow-up.

RESULTS

Reports were identified from four studies (in Iowa, North Carolina, Ontario and South Australia) which met the criteria; four reports dealt with coronal caries, and five with root surface caries. When annualised, coronal and root surface caries increments were combined and compared with those reported for adolescents, the caries experience of older people over time (between 0.8 and 1.2 new surfaces affected per year) exceeded that reported from cohort studies of adolescents (between 0.4 and 1.2 surfaces per year). The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only).

CONCLUSIONS

Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents.

PRACTICE IMPLICATIONS

Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.

Caries prevalence, oral health behavior, and attitudes in children residing in radiation-contaminated and -noncontaminated towns in Ukraine

INTRODUCTION

Several studies investigating the oral health status of children living in Ukraine after the Chernobyl catastrophe revealed an increase of caries in children residing in radionucleotide-contaminated areas.

PURPOSE

(1) To compare prevalence of dental caries in contaminated and noncontaminated towns; and (2) to determine if there is a difference between dental behaviors and attitudes of children residing in contaminated and noncontaminated areas that may have contributed to differences in caries prevalence.

METHODS

Children aged 13-14 were randomly selected in two towns of approximately the same population size (33 000): Ovruch (n = 119) from a contaminated area and Mirgorod (n = 100) from a noncontaminated area. Data on behaviors and attitudes were collected via a self-administered questionnaire having six domains: (i) family background; (ii) dental anxiety; (iii) dental utilization; (iv) oral hygiene; (v) use of fluoride toothpaste; and (vi) sugar consumption. Oral examinations included information on carious lesions, restorations, missing teeth, and soft tissue abnormalities. Caries prevalence was compared using a t-test. Regression analysis was conducted to determine the independent contribution of oral hygiene behaviors and dental utilization.

RESULTS

There was a significant difference in caries prevalence in the contaminated town (mean DMFT = 9.1 +/- 3.5) versus the noncontaminated town (mean DMFT = 5.7 +/- 1.4; P < 0.000). Oral hygiene practices, age, and utilization of dental services were not found to be associated with differences in DMFT score between the two communities.

CONCLUSION

There was a significantly higher caries prevalence in a radiation-contaminated town compared to a noncontaminated town of Ukraine. The difference was not explained by differences in oral health knowledge, attitudes or behaviors.

Factors related to severe untreated tooth decay in rural adolescents: a case-control study for public health planning

OBJECTIVES

In this case-control study of rural adolescents we identified factors to discriminate those who have high levels of tooth decay and receive treatment from those with similar levels who receive no treatment.

METHODS

The sample was drawn from all 12-20-year-olds (n = 439) in a rural high school in Washington State, U.S. The criterion for being included was 5 or more decayed, missing or filled teeth. The questionnaire included structure, history, cognition and expectation variables based on a model by Grembowski, Andersen and Chen.

RESULTS

No structural variable was related to the dependent variable. Two of 10 history variables were related: perceived poor own dental health and perceived poor mother's dental health. Four of eight cognition variables were also predictive: negative beliefs about the dentist, not planning to go to a dentist even if having severe problems, not being in any club or playing on a sports team and not having a best friend. No relationship was found for the expectation variable 'usual source of care'.

CONCLUSIONS

These data are consistent with the hypothesis that untreated tooth decay is associated with avoidance of care and point to the importance of history and cognition variables in planning efforts to improve oral health of rural adolescents.

The relationship between anxiety and dental treatment experience in 5-year-old children

OBJECTIVES

To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences.

METHODS

A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance experience, past extraction and restoration history were using chi-square and t-tests. Multiple logistic regression analyses identify predictors for dental anxiety.

RESULTS

A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8b) judged their child to be dentally anxious. Anxious children had significantly (p<0.001] more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% Cl 2.22, 5.00), have anxious parents (OR 1.60,95% Cl 1.09, 2.36), and to have undergone dental extraction in the past[OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socio-economic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors.

CONCLUSIONS

Dental anxiety is a fairly common condition in 5-year-old children in the North West of England. It is closely associated with asymptomatic, irregular attendance pattern, a history of extraction and having a dentally anxious parent. The cause and effect dynamics of these relationships need to be determined.

Dental fear among a young adult Saudian population

AIMS

To assess the prevalence of dental fear and reasons for irregular dental attendance among young adult university students; to describe the gender distribution of the dentally anxious population according to the perceived origins or sources of fear; to identify the time of fear development and preference for anaesthesia or sedation before dental treatment.

METHOD

A questionnaire incorporating the Dental Fear Scale (DFS) with items related to sources of dental fear stimuli, together with the preference of anaesthesia or sedation before dental treatment and other characteristics. Approximately 500 questionnaires were distributed among Saudian undergraduate students.

RESULTS

368 questionnaires were completed and presented for statistical analysis. The sight and sensation of anaesthetic needles and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. Also, females tended to be more anxious than males. Increased heart rate was the most common reported physiological response to fear resulting from dental treatment. The overall level of fear of dental work among the studied population was found to be about 39%.'Lack of time' and 'no need for treatment' were found to be the main reasons for irregular dental visits. Fear of pain and trauma were the major perceived sources of reported fear reactions and were developed mainly during childhood. About 63% of the subjects preferred to have local anaesthesia before dental treatment to prevent or ameliorate dental fear.