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Steenen SA, Linke F, van Westrhenen R, de Jongh A. Interventions to reduce adult state anxiety, dental trait anxiety, and dental phobia: A systematic review and meta-analyses of randomized controlled trials. J Anxiety Disord 2024; 105:102891. [PMID: 38945067 DOI: 10.1016/j.janxdis.2024.102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
This review evaluates randomized controlled trials (RCTs) intervening on adult state anxiety (fear and emotional distress during dental treatment), chronic dental (trait) anxiety or dental phobia (disproportionately high trait anxiety; meeting diagnostic criteria for specific phobia). Seven online databases were systematically searched. 173 RCTs met inclusion criteria, of which 67 qualified for 14 pooled analyses. To alleviate state anxiety during oral surgery, moderate-certainty evidence supports employing hypnosis (SMD=-0.31, 95 %CI[-0.56,-0.05]), and low-certainty evidence supports prescribing benzodiazepines (SMD=-0.43, [-0.74,-0.12]). Evidence for reducing state anxiety is inconclusive regarding psychotherapy, and does not support virtual reality exposure therapy (VRET), virtual reality distraction, music, aromatherapy, video information and acupuncture. To reduce trait anxiety, moderate-certainty evidence supports using Cognitive Behavioral Therapy (CBT; SMD=-0.65, [-1.06, -0.24]). Regarding dental phobia, evidence with low-to-moderate certainty supports employing psychotherapy (SMD=-0.48, [-0.72,-0.24]), and CBT specifically (SMD=-0.43, [-0.68,-0.17]), but not VRET. These results show that dental anxieties are manageable and treatable. Clinicians should ensure that interventions match their purpose-managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies. Existing research gaps underscore the necessity for future trials to minimize bias and follow CONSORT reporting guidelines.
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Affiliation(s)
- Serge A Steenen
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands, Amsterdam University Medical Centers, Meibergdreef 5, Room D2-214, 1105 AZ, Amsterdam, the Netherlands; Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands.
| | - Fabiënne Linke
- Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
| | - Roos van Westrhenen
- Parnassia Psychiatric Institute, Overschiestraat 55, 1062 HN Amsterdam, the Netherlands; The Institute of Psychiatry, Psychology & Neuroscience, IoPPN, King's College London, United Kingdom; St. John's National Academy of Health Sciences, Bangalore, India
| | - Ad de Jongh
- Department of Department of Oral Public Health, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands; The Institute of Health and Society, University of Worcester, Worcester, United Kingdom; The School of Psychology, Queen's University, Belfast, Northern Ireland, UK
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Auerbacher M, Gebetsberger L, Hickel R, Kaisarly D. Chairside oral prophylaxis for people with profound intellectual or multiple disabilities-a retrospective feasibility study. Clin Oral Investig 2023; 27:6747-6756. [PMID: 37878069 PMCID: PMC10630219 DOI: 10.1007/s00784-023-05287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES People with severe intellectual or multiple disabilities (PIMD) have been receiving dental care in a specialized unit offering special care dentistry. For most of these adult patients, the initial consultation is complaint driven. In addition, the limited ability to cooperate due to their disabilities often means that dental treatment for these patients is usually carried out under general anesthesia (GA). Chairside treatment attempts are the exception rather than the rule. This retrospective study evaluated whether consistent practice of behavioral management principles and techniques embedded in a specific dental environment enables successful dental treatment of PIMD. MATERIALS AND METHODS The feasibility of chairside dental prophylaxis in PIMD (n=36) was analyzed: specific behavioral management techniques were applied, and professional tooth cleaning (PTC) was performed in the dental chair. Clinical data obtained from medical records and a questionnaire were analyzed. RESULTS All patients had severe intellectual or multiple disabilities and had previously undergone at least one dental treatment under GA. Of these patients, 55.6% never had their teeth professionally cleaned before. Applying different behavioral techniques, all patients were compliant with receiving PTC in the dental chair. CONCLUSIONS An individualized and disability-specific treatment strategy using various noninvasive and nonpharmacological behavioral guidance techniques resulted in a higher compliance rate in PIMD, which allowed chairside PTC and reduced the need for treatment under GA. CLINICAL RELEVANCE Consistent implementation of various behavioral guidance techniques and communication strategies in a supportive environment enabled all patients to receive chairside PTC and be involved in a lifelong recall program.
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Affiliation(s)
- Marc Auerbacher
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany.
| | - Lydia Gebetsberger
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Dalia Kaisarly
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany.
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Alalawi H, Alhumaily H. Professional assessment compared to patients' attitudes toward tooth replacement: a cross-sectional study. BMC Oral Health 2023; 23:634. [PMID: 37670303 PMCID: PMC10478269 DOI: 10.1186/s12903-023-03355-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND There is a difference between patient self-assessment and professional assessment of oral health needs; therefore, the aim of the study was to investigate patients' individual needs and awareness of replacing missing teeth with prostheses and then to compare this information with professionally assessed clinical prosthetic needs in the Eastern Province of Saudi Arabia. METHODS This was a cross-sectional study conducted in the Eastern Province of Saudi Arabia. The study subjects were recruited from Imam Abdulrahman bin Faisal University in Dammam City, Primary Health Care Centers in Alhasa City and from health education campaigns in the same area. All the patients were provided with a questionnaire related to the effect of missing teeth and replacement options, then underwent a clinical examination performed by a well-trained investigator. Statistical analyses were performed using JMP data analysis software (JMP®, Version 16. SAS Institute Inc., Cary, NC, 1989-2021.) RESULTS: A total of 102 participants were included. Most of the participants (94.2%) reported their need to replace missing teeth. Most of the participants stated that losing teeth (teeth) affected their ability to chew food and their appearance (82.6% and 61.6%, respectively). Dental caries was the main reason behind teeth extraction in 77.9% of the study sample. Fixed partial prosthesis was the first treatment option preferred by 33.7%, followed by implant-supported prosthesis with 25.6% to replace the missing teeth. Only 3.5% of participants preferred not to restore the missing teeth. Professional screening showed that 48.8% of the participants had one missing anterior tooth or more, which dictates the need for esthetic restoration, and 58.1% of the participants had three missing posterior teeth or more, which dictates the need for functional restoration. CONCLUSIONS Patient knowledge and attitudes toward replacing missing teeth in terms of their functional and esthetic needs were variable among the population in comparison to the professional assessment of patient needs. Dentists plays a major role in raising the level of awareness about missing teeth replacement. The results of this study serve as baseline data for any related future studies.
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Affiliation(s)
- Haidar Alalawi
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P. O. Box 1982, Dammam, 31441, Saudi Arabia.
| | - Hasan Alhumaily
- Consultant, Prosthodontic Department, AlAhsa Dental Center, Ministry of Health, AlAhsa, Saudi Arabia
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Hauge MS, Willumsen T, Stora B. Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety. BMC Oral Health 2023; 23:415. [PMID: 37349747 PMCID: PMC10288821 DOI: 10.1186/s12903-023-03061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Educating dentists in treatment methods for dental anxiety would increase the patients' access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD. METHODS A two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique "The Four Habits Model" (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52). RESULTS An Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found. CONCLUSIONS The study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators. TRIAL REGISTRATION The trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.
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Affiliation(s)
- Mariann Saanum Hauge
- Faculty of Dentistry, University of Oslo, Oslo, Norway.
- Oral Health Centre of Expertise, Rogaland, Stavanger, Norway.
| | | | - Bent Stora
- Oral Health Services Agder, Kristiansand, Norway
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Hotton M, Cropper J, Rundle J, Crawford R. The role of the clinical psychologist within a cleft service. Br Dent J 2023; 234:887-891. [PMID: 37349436 DOI: 10.1038/s41415-023-5952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
Clinical psychologists are core members of UK cleft services. This paper outlines the variety of ways in which clinical psychologists work across the lifespan to promote the psychological wellbeing of those born with a cleft and their families. In the context of dental or orthodontic treatment, this involves a combination of early intervention and advice, psychological assessment or specialist psychological therapy for individuals experiencing dental anxiety or anxiety regarding the appearance of their teeth. This paper therefore aims to highlight the varying roles which clinical psychologists play in the provision of cleft-related dental care, often alongside multidisciplinary colleagues.
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Affiliation(s)
| | - Jenny Cropper
- Clinical Psychologist, Spires Cleft Centre, Oxford, UK
| | - Jen Rundle
- Clinical Psychologist, Evelina London Cleft Service, UK
| | - Rebecca Crawford
- Clinical Psychologist, National Cleft Surgical Service for Scotland, UK
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6
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Hasanoğlu Erbasar GN, Tutunculer Sancak K. Should Preoperative Information Before Impacted Third Molar Extraction Be Visual, Verbal, or Both? J Oral Maxillofac Surg 2023; 81:632-640. [PMID: 36774965 DOI: 10.1016/j.joms.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Offering preoperative information is one option to help patients cope with the anxiety associated with oral and maxillofacial surgical procedures. Although this information is commonly delivered verbally, written information, audio recordings, and videos are also recommended. This study aimed to evaluate the effects of different preoperative information techniques on patients' anxiety levels before and after third molar tooth extraction. MATERIALS AND METHODS A single-blind randomized controlled clinical trial with parallel groups was performed. 92 patients who fulfilled the inclusion criteria were randomly assigned to one of four groups. Group 1 was provided information via a silent video with subtitles. Group 2 was informed via a video with background audio. Group 3 was provided a written information brochure. Group 4, designated as the control group, was informed verbally. The Spielberger state anxiety inventory (STAI-S), dental fear scale (DFS), modified dental anxiety scale (MDAS), and visual analog scale (VAS) were used pre- and postoperatively to evaluate the dental anxiety of patients. The primary predictor variable was the preoperative information method. The primary outcome variables were the scores of STAI-S, DFS, MDAS, and VAS. Gender was also set as a covariate variable. Data analysis was performed with the IBM SPSS Statistics 25.0 software program. Unless otherwise stated, P < .05 was considered statistically significant. RESULTS A total of 86 patients scheduled for impacted third molar extractions under local anesthesia were included in the study. There was no statistically significant difference among the groups in the mean age (P = .275) or distribution of gender (P = .070). Compared to preoperative values, the postoperative scores of MDAS and VAS were decreased significantly in group 1 (P = .002, P = .003, respectively) and group 3 (P = .007; P = .009, respectively). No statistically significant differences were found between the preoperative and postoperative scores of STAI-S, DFS, MDAS, and VAS in group 2 (P = .300, P = .028, P = .063, P = .038, respectively) and group 4 (P = .127, P = .587, P = .072, P = .016, respectively). CONCLUSIONS The findings indicate that visual or written material, without audio or oral delivery, substantially reduced the anxiety associated with oral and maxillofacial surgery. Therefore, clinicians should preferentially provide information via written methods to control patients' anxiety before impacted third molar surgery.
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Affiliation(s)
- Güzin Neda Hasanoğlu Erbasar
- Associate professor, Ankara Yıldırım Beyazıt University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Kevser Tutunculer Sancak
- Assistant professor, Yıldırım Beyazıt University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey.
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Marshman Z, Rodd H, Fairhurst C, Porritt J, Dawett B, Day P, Innes N, Vernazza C, Newton T, Ronaldson S, Cross L, Ross J, Baker SR, Hewitt C, Torgerson D, Ainsworth H. The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children. Trials 2023; 24:15. [PMID: 36609355 PMCID: PMC9817252 DOI: 10.1186/s13063-022-07046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care. METHODS This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model. DISCUSSION Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group. TRIAL REGISTRATION This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).
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Affiliation(s)
- Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Helen Rodd
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Caroline Fairhurst
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Jenny Porritt
- grid.5884.10000 0001 0303 540XCentre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Bhupinder Dawett
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Peter Day
- grid.9909.90000 0004 1936 8403 Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Nicola Innes
- grid.5600.30000 0001 0807 5670School of Dentistry, Cardiff University, Cardiff, UK
| | - Christopher Vernazza
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Newton
- grid.13097.3c0000 0001 2322 6764Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Sarah Ronaldson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Liz Cross
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Jennie Ross
- Richmond Dental Care, 427-429 Richmond Road, Sheffield, UK
| | - Sarah R. Baker
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Catherine Hewitt
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Hannah Ainsworth
- grid.5685.e0000 0004 1936 9668York Trials Unit, Department of Health Sciences, University of York, York, UK
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Management of fear and anxiety in dental treatments: a systematic review and meta-analysis of randomized controlled trials. Odontology 2023; 111:20-32. [PMID: 35536282 DOI: 10.1007/s10266-022-00711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES This systematic review was to compare the effects of interventions for the management of fear and anxiety for dental treatments. METHODS This research project was applied to PubMed, CENTRAL, Web of Science, Cochrane library databases. The last search was run on March 31st, 2021. A list of references of relevant articles and previous reviews were checked. Qualitative and quantitative analyses were performed. RESULTS A total of 20 eligible randomized controlled trials were included, and 969 participations in experimental group and 892 participations in the control group were involved. Anxiety levels decreased more in intervention groups than in control groups (Z = 3.47, P = 0.0005, SMD = - 0.62, 95% CI - 0.98 to - 0.27). For adults, there was statistical difference between experimental and control groups [Z = 2.14, P = 0.03, 95% CI - 0.54 (- 1.03, - 0.04)], while there was not no such statistical difference in children and adolescents [Z = 1.62, P = 0.11, 95% CI - 0.60 (- 1.32, 0.13)]. Patients experienced a significant decrease in anxiety level using sedation drugs [Z = 2.44, P = 0.01, 95% CI - 0.61 (- 1.10, - 0.12)] and audio-visual distractions [Z = 3.1, P = 0.002, 95% CI - 0.86 (- 1.40, - 0.32)]. For the informative intervention groups, patients did not show significant difference than control groups [Z = 1.22, P = 0.22, 95% CI - 0.55 (- 1.43, 0. 33)]. There was no statistical difference in vital signs [Z = 1.39, P = 0.16, 95% CI - 0.25 (- 0.61, 0.10)] and pain levels [Z = 0.69, P = 0.49; SMD = - 0.06, 95% CI (0.27, 0.11)] between intervention and control groups. CONCLUSIONS Interventions should be used in managing anxiety and fear for dental treatment. It might be effective for anxiety alleviating for adults, but there was a low certainty of evidence that interventions could reduce anxiety level in children and adolescents. Sedation drugs and audio-visual distractions might be useful for managing dental fear and anxiety. Pain levels and vital signs could not be improved form our study. High-quality randomized clinical trials are required for further study.
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Wong NSM, Yeung AWK, Li KY, McGrath CP, Leung YY. Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811162. [PMID: 36141435 PMCID: PMC9517611 DOI: 10.3390/ijerph191811162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 05/17/2023]
Abstract
This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. In November 2020, multiple electronic databases (Cochrane, EMBASE, MEDLINE, PsycInfo, PsycArticles, PubMed, and Web of Science) were searched for articles published in English. Inclusion criteria were randomized-controlled trials reporting the effectiveness of any non-pharmacological interventions in reducing fear or anxiety levels in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After screening, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. The anxiety levels after intervention in each study were pooled and meta-analyzed by the random-effect model. A significant reduction in anxiety level was observed in non-pharmacological intervention groups (SMD = -0.32; 95% CI -0.57 to -0.07; p = 0.01). Subgroup analyses showed that a significant anxiety reduction by non-pharmacological interventions could be demonstrated by pooled data from studies using psychometric assessments, but not from studies using physiological assessments. Non-pharmacological interventions appear to reduce fear and anxiety levels in patients undergoing third molar extraction under local anesthesia.
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Affiliation(s)
- Natalie Sui Miu Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Andy Wai Kan Yeung
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Colman Patrick McGrath
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
- Correspondence:
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Arslan I, Aydinoglu S. Child and parent preferences for the appearance of dentists with respect to personal protective equipment in paediatric dentistry. Int J Paediatr Dent 2022; 32:702-713. [PMID: 34908204 DOI: 10.1111/ipd.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/19/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) gained particular importance during the COVID-19 pandemic. AIM To assess child and parent preferences for dentists' appearance concerning their PPE and to determine the relationship between the child and parent preferences. DESIGN A total of 250 children aged 6-12 years and their parents were enrolled in the study. Standardized pictures with different sexes, attires, eye protectors, hair protectors, masks, and gloves were shown to children and their parents separately, and they were asked to choose their preferences. The dental anxiety of the children and their parents was determined using the MCDASf and MDAS, respectively. Decayed, missing, and filled tooth (DMFT) indices were employed for the children. RESULTS Children and parents preferred a dentist of the same sex as themselves (p < .05). Anxious children preferred cartoon-printed attire, and children with low anxiety mostly preferred white coats (p = .001). Children who preferred colored coats had higher DMFT (p < .001). Statistically significant differences were found in the attire and glove preferences between children and parents (p < .001). CONCLUSIONS The production of white and child-friendly fluid-resistant disposable gowns should be considered. PPE with colored or cartoon print was preferred under the influence of factors that could positively affect anxiety.
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Affiliation(s)
- Ipek Arslan
- Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Sema Aydinoglu
- Department of Pediatric Dentistry, Faculty of Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
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Hauge MS, Stora B, Willumsen T. Dental anxiety treatment by a dentist in primary care: A 1-year follow-up study. Eur J Oral Sci 2022; 130:e12872. [PMID: 35569119 PMCID: PMC9540184 DOI: 10.1111/eos.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
In an earlier randomized controlled trial of dental anxiety treatments (n = 96) we compared the effects of dentist‐administered cognitive behavioural therapy (D‐CBT) and dental treatment supplemented with the Four Habits communication model plus midazolam sedation. Both treatments, applied in a general dental practice, were associated with a clinically relevant decrease in dental anxiety. In this follow‐up study, 52 of the 82 treatment completers responded to an online questionnaire 1 year post‐treatment. Reduction in dental anxiety persisted for both treatment groups. From baseline to 1 year post‐treatment the Modified Dental Anxiety Scale was reduced by 7.8 [SD: 4.4; Cohen's d effect size: 1.2 (CI: 0.8–1.7)] and 7.8 [SD: 4.2; Cohen's d: 1.4 (0.9–1.8)] in the D‐CBT and Four Habits/midazolam groups, respectively. Most patients (74% for D‐CBT, 80% for Four Habits/midazolam) continued with dental treatment. Nine patients in the D‐CBT and seven in the Four Habits/midazolam groups received additional CBT treatment from a psychologist/dentist team. Both methods tested should be accessible to interested dentists who receive adequate training. Effective first‐line treatments for dental anxiety in general dental practice can generate more accessible care pathways for patients with dental anxiety. Evidence‐based dental anxiety treatment programmes should be included in the dental curriculum and established as best practice for dentists.
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Affiliation(s)
- Mariann Saanum Hauge
- Faculty of Dentistry, University, of Oslo, Oslo, Norway.,Oral Health Centre of Expertise, Rogaland, Stavanger, Norway
| | - Bent Stora
- Oral Health Services Agder, Kristiansand, Norway
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Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042380. [PMID: 35206566 PMCID: PMC8872083 DOI: 10.3390/ijerph19042380] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 01/28/2023]
Abstract
Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.
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Affiliation(s)
- Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
- Correspondence:
| | | | - Willa Giffin
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
| | - Natasha Hikita
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (W.G.); (N.H.)
| | - José C. Polido
- Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
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13
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Treatment of Dental Anxiety and Phobia-Diagnostic Criteria and Conceptual Model of Behavioural Treatment. Dent J (Basel) 2021; 9:dj9120153. [PMID: 34940050 PMCID: PMC8700242 DOI: 10.3390/dj9120153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Dental anxiety and dental phobia are still prevalent among adult individuals and should be considered a dental public health issue. Dental anxiety/phobia is often described as a vicious cycle where avoidance of dental care, poor oral health, and psychosocial effects are common features, often escalating over time. Treatment should include therapy for dental anxiety/phobia and oral diseases. This paper discusses aetiology, prevalence, and diagnosis of dental anxiety/phobia and, in detail, presents a conceptual treatment model at the Dental Fears Research and Treatment Center in Gothenburg, Sweden. In addition, based on systematic reviews, evidence-based treatment for dental anxiety is revealed including the interdisciplinary approach between psychology and dentistry.
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14
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Patients' Perception of Recovery after Dental Implant Placement. MEDICINA-LITHUANIA 2021; 57:medicina57101111. [PMID: 34684148 PMCID: PMC8538387 DOI: 10.3390/medicina57101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Background and Objectives: The success rates of surgical dental implant insertions are high. However, knowledge of patients’ recovery is still lacking. “Health-related quality of life” (HRQOL) questionnaires are gaining popularity in all fields of medicine. The present survey assessed the perception of recovery after the surgical placement of dental implants. Materials and Methods: Forty individuals (26 women and 14 men; mean age, 55 ± 12 years) filled a questionnaire evaluating patients’ perception of recovery for 7 consecutive days post-surgery. Confounding factors included age, gender, oral habits, smoking, bruxism, bone quality (tactile evaluation) and quantity, implant location, number of implants, implant type, length and diameter, one-stage vs. two-stage, and the need for bone grafting. Results: The most serious difficulties were found in swelling, which became minimal after 5 days, followed by eating everyday food, ability to enjoy everyday food, maximal pain and average pain (3 days); analgesics consumption (2.5 days); limitations in daily routine, mouth opening, and speech (2 days); swallowing and sleep (1.5 days); and, within 1 day, all other measures attained minimal levels. Gender, and implant location (anterior vs. posterior) were significant predictor variables exerting their different characteristic delayed recoveries. Conclusions: (1) Patients should expect, in general, recovery within 4 days after dental implant placement; (2) women will experience a delayed recovery, (3) implants placed in the intercanine area will result in postoperative eating difficulties for nearly one week, and (4) the number of implants placed during the same appointment has no effect on post treatment recovery.
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15
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Kankaala T, Laine H, Laitala ML, Rajavaara P, Vähänikkilä H, Pesonen P, Anttonen V. 10-year follow-up study on attendance pattern after dental treatment in primary oral health care clinic for fearful patients. BMC Oral Health 2021; 21:522. [PMID: 34645419 PMCID: PMC8513357 DOI: 10.1186/s12903-021-01869-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/30/2021] [Indexed: 12/16/2022] Open
Abstract
Background Dental fear may lead to avoidance of regular dental treatment. The scope of this long-term practe-based study was to monitor the dental attendance of patients who received chair-side dental and fear treatment. Methods In 2000–2006, patients in the City of Oulu, Finland, received treatment for dental fear in the Clinic for Fearful Dental Patients (CFDP) from primary health care dentists trained on this subject. Of the originally treated patients (n = 163), 152 (93%) with sufficient information in dental records made up the study population. Information on their age and sex was available. The number of dental examinations, emergency visits and missed appointments was collected covering the follow-up period of 10 years 2006–2016. For analyses, data were dichotomized according to age at baseline and preliminary outcome baseline condition of dental fear treatment evaluated in 2006. To investigate association further, Poisson regression as well as binary logistic regression models were conducted. As register keeper, the City of Oulu gave permission for this retrospective data-based study. Results Patients receiving dental fear treatment at younger age (2–10 y) had significantly more dental examinations than those treated at > 10 years. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. Sex was not a significant factor in later dental attendance. There was an association between few dental examinations and dental emergency care need with unsuccessful baseline outcome of dental fear treatment.
Conclusions Successful dental fear treatment especially at an early age is beneficial for future dental attendance measured by the number of examinations and consequently, less need for emergency care than in the opposite case. Successful fear treatment has positive impact on later dental care and regular dental attendance.
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Affiliation(s)
- Taina Kankaala
- Department of Cariology, Endodontology, and Pediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Dental Teaching Unit, City of Oulu, Finland
| | - Heikki Laine
- Department of Cariology, Endodontology, and Pediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Marja-Liisa Laitala
- Department of Cariology, Endodontology, and Pediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Päivi Rajavaara
- Department of Cariology, Endodontology, and Pediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Dental Teaching Unit, City of Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Hannu Vähänikkilä
- Biostatistician Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Paula Pesonen
- Biostatistician Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Endodontology, and Pediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland. .,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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16
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Townsend JA, Randall CL. Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance. Dent Clin North Am 2021; 65:731-751. [PMID: 34503664 DOI: 10.1016/j.cden.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Janice A Townsend
- Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, LA Suite 5A, Columbus, OH 43205, USA; Division of Pediatric Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA
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17
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Thayumanavan B, Krithika C, Mohideen K, R Ranjalitha AV, Sacred Twinkle CM, Pravda C, Prabhu S. Assessment of Salivary Cortisol Concentrations as a Level of Stress Indicator among Individuals Undergoing Dental Extraction Procedure. J Pharm Bioallied Sci 2021; 13:S735-S740. [PMID: 34447192 PMCID: PMC8375931 DOI: 10.4103/jpbs.jpbs_557_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Anxious patients tend to exaggerate the aversive events before the actual dental therapy. The anxiety and fear are the major factors that regulate cortisol levels. Aim: Our study aims to estimate the salivary cortisol among patients subjected to dental extraction and correlate any existence between pre- and post-extraction cortisol levels and vital parameters compared to the control group. Methodology: The study sample included sixty individuals, thirty patients indicated for a dental extraction, and thirty healthy patients between the ages of 18 and 60 years. We collected saliva samples from the control group and pre- and post-extraction samples from the study group participants and vital parameters. We used quantitative ELISA Kit, Diagnostics Biochem Canada Inc. (DBC), to estimate the salivary cortisol level. We evaluated the values using the Chi-square test, Pearson correlation test, and paired t-test using the JMP 15; JMP Pro, Version 15 (SAS) Microsoft® Windows® for × 64. Results: The mean value of cortisol concentration of saliva was significantly greater in the preextraction group (6.13 ± 0.53 μg/dl) than after extraction group (3.17 ± 0.14 μg/dl) (P < 0.001). There were no significant associations between hemodynamic parameters and salivary cortisol concentration except for the postextraction systolic blood pressure (BP). A comparison of hemodynamic parameters between the study and control group revealed substantial differences in systolic BP. Conclusion: The patient's anticipation and anxiety toward dental therapy elevate the cortisol level. Dental surgeons should treat the patients more conveniently and effectively without any strains and provide a comfortable atmosphere to avoid stress-related consequences.
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Affiliation(s)
- Balakrishnan Thayumanavan
- Department of Oral Pathology and Microbiology, Sathyabama Institute of Science and Technology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - C Krithika
- Department of Oral Medicine and Radiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Khadijah Mohideen
- Department of Oral Pathology and Microbiology, Sathyabama Institute of Science and Technology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | | | | | - C Pravda
- Department of Oral Medicine and Radiology, Sathyabama Institute of Science and Technology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
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18
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Sivrikaya EC, Yilmaz O, Sivrikaya P. Dentist-patient communication on dental anxiety using the social media: A randomized controlled trial. Scand J Psychol 2021; 62:780-786. [PMID: 34333783 DOI: 10.1111/sjop.12769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 07/02/2021] [Indexed: 12/13/2022]
Abstract
The purpose of the present study was to assess the effects of dentist-patient communication via social media on dental anxiety and to determine the appropriate timing of such communications. In this randomized, double-blinded and controlled trial, we used Instagram's quick replies system to answer patients' questions to alleviate dental anxiety for patients undergoing impacted teeth extraction under local anesthesia. Patients were assigned randomly into four groups according to the timing of such communications: only after (group 1, n = 36), only before (group 2, n = 35), before and after the operation (group 3, n = 36), and a control group who received no communication on social media (group 4, n = 36). Dental anxiety was evaluated one week before (pre-op) and after the operation (post-op) using recognized assessment scales -the Spielberger's State-Trait Anxiety Inventory, Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS). The results showed that the post-op values of group 4 had higher anxiety scores than the groups 2 and 3 according to VAS (p < 0.05). Within the groups, the anxiety levels showed a decreasing trend after surgery according to MDAS and VAS scores (p < 0.05). The results of this study suggest that communication with patients before the operation is sufficient to reduce their dental anxiety.
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Affiliation(s)
- Efe Can Sivrikaya
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Teknik University, Trabzon, 61080, Turkey
| | - Onur Yilmaz
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Karadeniz Teknik University, Trabzon, 61080, Turkey
| | - Pinar Sivrikaya
- Department of Psychiatry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
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19
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Hauge MS, Stora B, Vassend O, Hoffart A, Willumsen T. Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care. Eur J Oral Sci 2021; 129:e12794. [PMID: 33960536 DOI: 10.1111/eos.12794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 01/07/2023]
Abstract
The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: -6.6 (SD = 0.5); IDAF-4C scores: -1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.
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Affiliation(s)
- Mariann Saanum Hauge
- Faculty of Dentistry, University of Oslo, Oslo, Norway.,Oral Health Centre of Expertise, Stavanger, Norway
| | - Bent Stora
- Oral Health Services Agder, Kristiansand, Norway
| | - Olav Vassend
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway.,Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
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20
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Tulsani MG, Ganapathy D, Rupawat D, Devi S. Effectiveness of Antianxiety Drugs on Postoperative Pain Perception After Implant Placement: An In Vivo Study. JOURNAL OF ADVANCED ORAL RESEARCH 2021. [DOI: 10.1177/2320206820981485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: To evaluate the effectiveness of midazolam and zolpidem on postoperative pain perception in patients undergoing implant placement. Materials and Methods: In the present in vivo study 60 patients undergoing implant placement were selected based on the inclusion criteria framed and were randomly allocated using sequentially numbered, opaque, and sealed envelope (SNOSE) method into 3 groups with 20 patients each after obtaining informed consent. Group A was the control group, Group B received midazolam 7.5 mg 30 minutes before the procedure. Group C received zolpidem 5 mg 30 minutes before the procedure. The anxiety level of patients was recorded using the Corah scale and postoperative pain was recorded after 2 hours of implant placement using the VAS scale. Statistical analysis was done using analysis of variance (ANOVA), one-way multivariate analysis of variance (one-way MANOVA), and then Tukey’s Honestly Significant Difference (HSD) test for comparison among groups at the 0.05 level of significance. Results: Group A had a mean anxiety level of 16 ± 1.451, Group B had a mean anxiety level of 11.2 ± 2.858, and Group C had a mean anxiety level of 13 ± 2.9019 and a statistically significant difference between the groups was observed ( P < .05). The mean for the postoperative pain perception for Group A was 6.8 ± 1.1965, for Group B was 3.8 ± 1.3611, and Group C was 5 ± 1.451 and a statistically significant difference between the groups was observed ( P < .05). Conclusion: This study concluded that both midazolam and zolpidem significantly reduced anxiety levels and postoperative pain in patients undergoing implant placement.
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Affiliation(s)
- Minal Gopal Tulsani
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Dhanraj Ganapathy
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Divya Rupawat
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Sanjana Devi
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
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21
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Minimum intervention oral healthcare for people with dental phobia: a patient management pathway. Br Dent J 2020; 229:417-424. [PMID: 33037361 PMCID: PMC7546148 DOI: 10.1038/s41415-020-2178-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL). Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting. People with dental phobia often present with a poorer oral health status which compromises their oral health-related quality of life. An outline of the application of the minimum intervention oral healthcare (MIOC) framework for patients with dental phobia is described, which has the potential to be particularly beneficial for the oral healthcare of this group of patients. An assessment tool is presented which provides an overview of important points for a practitioner to consider when assessing patients with dental phobia using MIOC.
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22
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Tabrizi R, Mohajerani H, Nabtieh A, Shafiei S. Do Patients have the Same Experience of Pain Following Tooth Extraction and Dental Implants? Ann Maxillofac Surg 2020; 10:88-90. [PMID: 32855921 PMCID: PMC7433966 DOI: 10.4103/ams.ams_281_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/01/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: Postoperative pain is an important concern for patients who need dental implants. This study aims to compare the experience of pain in patients who undergo tooth removal and dental implant surgery. Materials and Methods: This is a crossover study. Patients who underwent a simple tooth extraction and dental implant surgery were studied. The pain severity was assessed using a visual analog scale at 12, 24, 48, and 72 h after procedures. The repeated measure test was used to compare pain severity between two treatment sessions. Results: Forty patients were studied. Patients reported higher pain levels in a tooth extraction at study times than implant surgery (P = 0.001). Conclusion: It seems patients who had experience of tooth extraction and a dental implant placement reported significantly lower pain in implant surgery.
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Affiliation(s)
- Reza Tabrizi
- Associate Professor of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Mohajerani
- Professor of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Nabtieh
- Dentistry student, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shervin Shafiei
- Resident of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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23
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Vanhee T, Mourali S, Bottenberg P, Jacquet W, Vanden Abbeele A. Stimuli involved in dental anxiety: What are patients afraid of?: A descriptive study. Int J Paediatr Dent 2020; 30:276-285. [PMID: 31724773 DOI: 10.1111/ipd.12595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/21/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dental anxiety is a psychological response inducing aversion following a dental ill-defined stimulus, non-imminent and perceived as potentially dangerous. It is better to intervene during childhood than to resolve in adulthood when dental anxiety is more settled. AIM The purpose of this study is to determine the nature of dental anxiety-provoking stimuli in young patients. DESIGN A questionnaire was submitted to 566 children between 3 to 18 years in health institutions and schools in Brussels, Belgium. The items were divided into 3 groups: environment (ENV), local anaesthesia (LA), and intervention (INT) and summarized through averaging per group. Descriptive analysis and non-parametric testing were combined with logistic regression after discretization, above mild, for the group averages. RESULTS About 7.2% of the respondents expressed high to severe dental anxiety. Several items presented a clear bimodal distribution dividing the population in fearless and fearing patients, for example, sight and feel of the syringe, sight and taste of blood and extraction. Others presented with a gradually lower incidence with increasing fear level. Fear for the environment was generally low. Gender and ethnic origin contribute significantly to the prediction of fear caused by LA. For fear caused by INT, first the place of questioning enters the models, thereafter follow: negative experience, frequency of dental visit, and gender (P < .05). CONCLUSIONS While the dental environment is in general not causing fear, the invasive part of the anaesthesia and the invasive dental procedures are involved. Fear seems to be related to culture, previous experience, and gender.
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Affiliation(s)
- Tania Vanhee
- Department of Paediatric Dentistry, Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Mourali
- Department of Paediatric Dentistry, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Astrid Vanden Abbeele
- Department of Paediatric Dentistry, Université Libre de Bruxelles, Brussels, Belgium
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24
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Coxon JD, Hosey MT, Newton JT. The oral health of dentally phobic 12- and 15-year-olds: a descriptive analysis of the 2013 Child Dental Health Survey. Br Dent J 2019; 226:595-599. [PMID: 31028328 DOI: 10.1038/s41415-019-0196-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Dental anxiety has been shown to be related to poorer oral health. Limited data exist exploring the relationship between oral health status and dental anxiety in non-clinical populations in children.Aim To compare the oral health of phobic and non-phobic children aged 12 and 15 years.Design Secondary analysis of data from 12-year-old and 15-year-old children in the Child Dental Health Survey 2013.Materials and methods Participants were grouped into non-phobic and phobic groups, depending on their self-reported dental anxiety (MDAS). Descriptive analyses compared the two groups on social demographic factors, clinical status, self-reported oral health status, oral health-related behaviours and oral health impact.Results A total of 601 children were classed as dentally phobic with 4,144 classed as non-phobic. Dental phobic children were more likely to be female, had more active decay and untreated dental disease, and rated their dental health as poorer. Phobic children were more likely to report that their oral health had a negative effect on their everyday life. This group were less likely to brush their teeth regularly or attend the dentist for check-ups.Conclusions Dentally phobic children have more dental disease and express greater impact on their everyday life.
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Affiliation(s)
- James D Coxon
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK.
| | - Marie-Therese Hosey
- Paediatric Dentistry Centre of Oral Clinical and Translational Science Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
| | - J Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences King's College London, London, UK
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25
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Kranstad V, Søftestad S, Fredriksen TV, Willumsen T. Being considerate every step of the way: a qualitative study analysing trauma-sensitive dental treatment for childhood sexual abuse survivors. Eur J Oral Sci 2019; 127:539-546. [PMID: 31731327 DOI: 10.1111/eos.12661] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
This qualitative study aimed to obtain a deeper understanding of what makes adult dentistry possible for child sexual abuse survivors. Sixteen adult informants were recruited from four Centres against Sexual Abuse and interviewed. Qualitative analysis of the transcribed interviews was conducted consecutively until thematic saturation was reached at 16 informants. A conceptual framework was generated, and informants' experiences of what makes dental treatment achievable were summed as the dentist working in a trauma-sensitive way, captured by the core category: Being considerate every step of the way. The underlying categories are: (i) offering a good start; (ii) being competent; (iii) being aware of the influence of staff behaviour; (iv) building a safe relationship; (v) arranging a secure treatment situation; and (vi) exploring individual triggers. The findings revealed that dental staff should have adequate competence to build secure relationships and explore individual triggers in dental treatment situations when treating child sexual abuse survivors. Dentists should have a trauma-sensitive approach to all patients. When treating child sexual abuse survivors, dentists should demonstrate utmost consideration every step of the way, building long-term solid relationships, and discussing and testing coping strategies individually adapted to the specific needs of the child sexual abuse survivors, in a safe environment.
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Affiliation(s)
- Vibeke Kranstad
- Oral Health Centre of Expertise in Southern Norway, Arendal, Norway
| | - Siri Søftestad
- Oral Health Centre of Expertise in Southern Norway, Arendal, Norway
| | | | - Tiril Willumsen
- Oral Health Centre of Expertise in Southern Norway, Arendal, Norway.,Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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Calik Koseler B, Yilanci H, Ramoglu SI. Does audiovisual information affect anxiety and perceived pain levels in miniscrew application? - a within-person randomized controlled trial. Prog Orthod 2019; 20:29. [PMID: 31367995 PMCID: PMC6669226 DOI: 10.1186/s40510-019-0281-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety can cause difficulties during surgical procedures. The main objective of this study was to evaluate changes in patients' anxiety and perceived pain levels after receiving audiovisual and verbal information about miniscrew application. MATERIALS AND METHODS Eighty-eight patients (30 males and 58 females) with a mean age of 18.18 ± 5.39 years who had fixed orthodontic treatment and required miniscrew anchorage took part in this questionnaire-based randomized controlled trial. The participants were randomly allocated to two groups and either watched a video depicting miniscrew application (study group, 44 patients) or were informed verbally about the procedure (control group, 44 patients) before miniscrew placement. The audiovisual information was given via a video containing footage of local anesthesia injection, topical antiseptic application, and miniscrew insertion. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure anxiety immediately before miniscrew application. Self-drilling miniscrews (8 mm length, 1.5 mm diameter; Aarhus System Miniscrews, American Orthodontics, Washington, USA) were placed in posterior buccal interdental region. Each patient received only one miniscrew. Postoperative pain (PP) was determined using a 100-mm horizontal visual analog scale (VAS). RESULTS State and total anxiety scores were significantly higher in the study group than in the control group (p = 0.009 and p = 0.011 respectively). The mean PP scores (SD) for control and study groups were 12.86 (14.22) and 12.8 (16.22), respectively. The results of Mann-Whitney U test showed no significant difference (p > 0.05). Participants' PP scores did not have a significant effect on state, trait, or total anxiety scores. There was a weak but significant positive correlation between trait anxiety and state anxiety scores in both groups. CONCLUSION Using an audiovisual method to inform patients about miniscrew placement increased anxiety levels but did not affect pain perception.
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Affiliation(s)
| | - Hilal Yilanci
- Department of Orthodontics, Faculty of Dentistry, Medipol University, Bağcılar, 34214, Istanbul, Turkey.
| | - Sabri Ilhan Ramoglu
- Department of Orthodontics, Faculty of Dentistry, Altınbaş University, Istanbul, Turkey
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Outcome of Chair-Side Dental Fear Treatment: Long-Term Follow-Up in Public Health Setting. Int J Dent 2019; 2019:5825067. [PMID: 31281361 PMCID: PMC6589249 DOI: 10.1155/2019/5825067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022] Open
Abstract
Aim Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000–2005. Methods A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. Results The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. Conclusions A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.
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Evaluation of Self-Help Cognitive Behavioural Therapy for Children's Dental Anxiety in General Dental Practice. Dent J (Basel) 2019; 7:dj7020036. [PMID: 30939740 PMCID: PMC6631013 DOI: 10.3390/dj7020036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/07/2019] [Accepted: 03/15/2019] [Indexed: 12/27/2022] Open
Abstract
Dental anxiety is very common; however, there is a lack of studies focusing on reducing children’s dental anxiety. One such initiative, the guided self-help cognitive behavioural therapy (CBT) resources ‘Your teeth, you are in control’, reduces dental anxiety in children attending paediatric dentistry clinics. This service evaluation aims to investigate whether such CBT resources reduce children’s dental anxiety when implemented in general dental practice. A convenience sample of children was given the resources by their dental practitioner. There was no control group. Children completed the Children’s Experiences of Dental Anxiety Measure (CEDAM) prior to using the resources and on completion of a course of dental treatment. Overall, 84 children were involved, with a mean age of 10.9 years; 48 were female and 59 were living in the most deprived area of England. At baseline the mean CEDAM score was 20.3, and on receiving the resource and completing treatment the mean CEDAM score was 16.4, showing a significant reduction in dental anxiety (t = 14.6, (df = 83), p < 0.001, 95% CI: 3.4–4.4). The items that improved the most were worry over having dental treatment and dental treatment being painful. The service evaluation indicates a reduction in child dental anxiety following the use of CBT resources in general practice. Further evaluation, preferably a randomised controlled trial, is needed.
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Alsanawi EA, Abusaris R, El-Metwally AA. Cross-cultural adaptation and validation of the Arabic version of the Index of Dental Anxiety and Fear (IDAF-4C). J Oral Sci 2019; 61:229-237. [DOI: 10.2334/josnusd.18-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | - Raghib Abusaris
- College of Public Health and Health Informatic, King Saud Bin Abdulaziz University for Health Sciences
| | - Ashraf A. El-Metwally
- College of Public Health and Health Informatic, King Saud Bin Abdulaziz University for Health Sciences
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Heyman RE, Wojda AK, Eddy JM, Haydt NC, Geiger JF, Slep AMS. Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices. Adv Dent Res 2018; 29:35-41. [PMID: 29355419 DOI: 10.1177/0022034517737023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.
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Affiliation(s)
- R E Heyman
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - A K Wojda
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - J M Eddy
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - N C Haydt
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - J F Geiger
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
| | - A M Smith Slep
- 1 Family Translational Research Group, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY, USA
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Rosted P, Bundgaard M, Gordon S, Pedersen AML. Acupuncture in the Management of Anxiety Related to Dental Treatment: A Case Series. Acupunct Med 2018; 28:3-5. [DOI: 10.1136/aim.2009.001933] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Anxiety related to dental treatment is a common phenomenon that has a significant impact on the provision of appropriate dental care. The aim of this case series was to examine the effect of acupuncture given prior to dental treatment on the level of anxiety. Methods Eight dentists submitted 21 case reports regarding the treatment of dental anxiety. The level of anxiety was assessed by the Beck Anxiety Inventory (BAI). Only patients with moderate to severe anxiety (BAI score ≥16) were included. The remaining 20 patients, 16 women and 4 men, with a mean age of 40.3 years, had a median BAI score of 26.5 at baseline. The BAI score was assessed before and after the acupuncture treatment. All patients received acupuncture treatment for 5 min prior to the planned dental treatment using the points GV20 and EX6. Results There was a significant reduction in median value of BAI scores after treatment with acupuncture (26.5 reduced to 11.5; p<0.01), and it was possible to carry out the planned dental treatment in all 20 cases after acupuncture treatment. Previously this had only been possible in six cases. Conclusion Acupuncture prior to dental treatment has a beneficial effect on the level of anxiety in patients with dental anxiety and may offer a simple and inexpensive method of treatment. However, the present results need to be tested in a larger randomised clinical trial in order to evaluate the effectiveness of the acupuncture treatment in patients with dental anxiety.
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Affiliation(s)
- Palle Rosted
- Department of Oncology, Weston Park Hospital, Sheffield, UK
| | - Mads Bundgaard
- Amager Tandplejecenter, Tårnby Torv 9, 2770 Kastrup, Denmark
| | - Sian Gordon
- Dental Department, Isebrook Hospital, Northamptonshire, UK
| | - Anne Marie Lynge Pedersen
- Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, University of Copenhagen, Copenhagen N, Denmark
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Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness. Am J Prev Med 2018; 55:470-479. [PMID: 30126670 DOI: 10.1016/j.amepre.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/31/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.
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Ihara Y, Fukuda KI, Saita N, Ichinohe T. Male Gender and High Trait Anxiety Are 2 Major Factors Associated With Severe Dental Fear and Avoidance. Anesth Prog 2018; 65:177-180. [PMID: 30235434 DOI: 10.2344/anpr-65-03-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this article is to investigate the association between the background characteristics of patients with severe fear of dental treatment who frequently avoid dental care and the degree of difficulty in treating them. At the time of initial presentation at a dental phobia clinic, each of 321 subjects was asked to complete the State-Trait Anxiety Inventory, the Dental Anxiety Scale, and a health questionnaire related to phobic objects. Subjects who rejected oral examination with a dental mirror were categorized as being severely difficult to treat, whereas those who were able to undergo examination were categorized as being moderately difficult to treat. In the statistical analysis, assessment items that were correlated with difficulty to treat were designated as independent variables for a logistic regression analysis. In the logistic regression analysis, significant correlations were observed for gender (male > female with adjusted odds ratio, 4.121; 95% CI, 1.96-8.65) and level of trait anxiety (2.401; 1.01-5.73). Male gender and a high trait anxiety were identified as major factors associated with severe dental fear and avoidance.
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Affiliation(s)
- Yoshiaki Ihara
- Director of Ihara Dental Clinic, Ihara Dental Clinic, Shizuoka, Japan
| | - Ken-Ichi Fukuda
- Chair and Professor of Oral Health and Clinical Science, Division of Special Needs Dentistry and Orofacial Pain, Department of Oral Health and Clinical Science, Tokyo Dental College, Tokyo, Japan
| | - Naoko Saita
- Director of Saita Dental Clinic, Saita Dental Clinic, Tokyo, Japan
| | - Tatsuya Ichinohe
- Chair and Professor of Dental Anesthesiology, Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan
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A Prosthodontic Treatment Plan for a Saxophone Player: A Conceptual Approach. Dent J (Basel) 2018; 6:dj6030033. [PMID: 30021940 PMCID: PMC6162486 DOI: 10.3390/dj6030033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 01/18/2023] Open
Abstract
Introduction: A wind instrumentalist was diagnosed with a periapical lesion on tooth 21. The prosthetic rehabilitation options were considered with respect to the embouchure mechanism of the saxophonist. The underlying mechanism associated with the embouchure of the saxophone player was observed in this particular case in order to understand if asymmetrical forces were transmitted to the upper central incisors. Periapical lesions can be harmful to the oral health of musicians. The treatment options thus have to be taken into consideration with special focus on the need for oral rehabilitation on the anterior maxilla. Material and Methods: The patient underwent a radiographic examination with a panoramic X-ray. Subsequently, two piezoresistive sensors (FlexiForce™) were placed on the upper surface of the mouthpiece in order to quantify the pressure applied to the central incisors during the embouchure. In order to understand the values involved during this procedure, the saxophone player was required to play three different notes at different pitches: high, medium, and low. This procedure was repeated three times for each pitch in order to obtain a medium value for each note. Signal acquisition was obtained within software developed for this purpose, with the voltage output observed in LabView 2011®. Results: The panoramic X-ray showed a periapical lesion with the characteristics of a radicular cyst on tooth 21. The FlexiForce™ piezoresistive sensors allowed us to find that greater force (kg) was being applied to tooth 11 in comparison to tooth 21 during the embouchure mechanism. Conclusions: The sensors used in this research are acceptable for identifying the tooth where the greatest pressure is applied during the mouthpiece stabilization. In the case of executing an oral rehabilitation procedure for wind instrumentalists, a clinical examination can be complemented with the aid of bioengineering and the inherent development of sensor technology in order to better understand the embouchure mechanism. Likewise, the prosthetic rehabilitation should be taken into consideration in order to provide minimal changes to the musician’s performance.
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Gomes HS, Viana KA, Batista AC, Costa LR, Hosey MT, Newton T. Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review. Int J Paediatr Dent 2018; 28:422-431. [PMID: 29984460 DOI: 10.1111/ipd.12405] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a paucity of evidence about cognitive behaviour therapy in the management of dentally anxious children. AIM To systematically review evidence of the effectiveness of cognitive behaviour therapy for children with dental anxiety or dental phobia. DESIGN Clinical trial registries, grey literature, and electronic databases, including The Cochrane Library, EMBASE, PubMed, Scopus, Web of Science, LILACS/BBO, and PsycINFO, were searched (April 2018). The reference lists of relevant studies were hand-searched. Randomised controlled trials that evaluated the effects of cognitive behaviour therapy on dental anxiety or on acceptance of dental treatment in dental patients up to 18 years were included. Two trained and calibrated reviewers performed the study selection and risk of bias assessment. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Six studies with a total of 269 patients, aged 41 months to 18 years, were included. Cognitive behaviour therapy decreased level of anxiety compared to control groups and improved cooperation/behaviour, although the quality of the evidence was low. CONCLUSIONS Cognitive behaviour therapy produces better anxiety reduction than diverse behavioural management techniques but the evidence was of low quality and further studies in children are needed.
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Affiliation(s)
| | | | - Aline Carvalho Batista
- Departamento de Estomatologia (Patologia Oral), Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Brazil
| | - Luciane Rezende Costa
- Departamento de Saúde Oral, Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Brazil
| | - Marie Therese Hosey
- Paediatric Dentistry, Division of Population and Patient Health, King's College London Dental institute, London, UK
| | - Tim Newton
- Psychology, Division of Population and Patient Health, King's College London Dental institute, London, UK
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Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Hägglin C. Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective. Acta Odontol Scand 2018; 76:320-330. [PMID: 29560758 DOI: 10.1080/00016357.2018.1453082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.
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Affiliation(s)
- Carl-Otto Brahm
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Sven G. Carlsson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Peter Nilsson
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden
| | - Catharina Hägglin
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Special Care Dentistry and Oral Medicine, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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Yeung A, Goto TK, Leung WK. Brain responses to stimuli mimicking dental treatment among non-phobic individuals: A meta-analysis. Oral Dis 2018; 25:34-43. [PMID: 29250913 DOI: 10.1111/odi.12819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/12/2017] [Accepted: 12/09/2017] [Indexed: 12/14/2022]
Abstract
Numerous neuroimaging studies have attempted to identify how the brain responds to stimuli mimicking dental treatment in normal non-phobic individuals. However, results were sometimes inconsistent due to small sample sizes and methodological variations. This meta-analysis employs standardized procedures to summarize data from previous studies to identify brain regions that were consistently activated across studies, elicited by stimuli such as pictures, sounds, or audiovisual footage mimicking those encountered during dental treatments. A systematic literature search was carried out using PubMed and Scopus. The meta-analysis analyzed data from 120 healthy subjects from seven neuroimaging studies. We assessed the risk of bias among the included studies with the Risk of Bias Assessment Tool for Nonrandomized Studies. One study appeared to have a high risk of selection bias, whereas the others were considered to have a low risk of bias. Results revealed three clusters of activation with cluster sizes ranging from 768 mm3 to 1,424 mm3 . Stimuli mimicking dental treatment consistently activated the bilateral anterior insula; right dorsal anterior cingulate, putamen, and medial prefrontal cortex; and left claustrum. This study confirmed that audio and/or visual stimuli mimicking dental treatment consistently activated the fear-related brain regions among healthy subjects, mostly consistent with activations from general anxiety but without the involvement of the amygdala.
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Affiliation(s)
- Awk Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - T K Goto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College, Tokyo, Japan
| | - W K Leung
- Periodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Burghardt S, Koranyi S, Magnucki G, Strauss B, Rosendahl J. Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis. J Dent 2018; 69:22-31. [DOI: 10.1016/j.jdent.2017.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022] Open
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Shahnavaz S, Hedman-Lagerlöf E, Hasselblad T, Reuterskiöld L, Kaldo V, Dahllöf G. Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial. J Med Internet Res 2018; 20:e12. [PMID: 29358158 PMCID: PMC5799719 DOI: 10.2196/jmir.7803] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/30/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. Objective The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. Methods This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. Results The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. Conclusions ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.
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Affiliation(s)
- Shervin Shahnavaz
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | | | - Tove Hasselblad
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | | | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Göran Dahllöf
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Wang MC, Vinall-Collier K, Csikar J, Douglas G. A qualitative study of patients’ views of techniques to reduce dental anxiety. J Dent 2017; 66:45-51. [DOI: 10.1016/j.jdent.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/20/2017] [Accepted: 08/24/2017] [Indexed: 11/16/2022] Open
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Matsuoka H, Chiba I, Sakano Y, Toyofuku A, Abiko Y. Cognitive behavioral therapy for psychosomatic problems in dental settings. Biopsychosoc Med 2017. [PMID: 28630646 PMCID: PMC5470220 DOI: 10.1186/s13030-017-0102-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cognitive behavioral therapy (CBT) has been applied for various problems, including psychiatric diseases such as depression and anxiety, and for physical symptoms such as pain. It has also been applied for dental problems. Although the effect of CBTs on temporomandibular disorders and dental anxiety are well documented, its effectiveness on other types of oral symptoms remain unclear. Little information comparing the different types of CBTs in the dental setting is currently available. Because dental professionals are often expected to conduct CBTs in the dental setting, it is important to develop proper training programs for dental professionals. In this review article, we demonstrate and discuss the application of CBTs for psychosomatic problems, including temporomandibular disorders, dental anxiety, burning mouth syndrome, and other oral complaints in dental settings.
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Affiliation(s)
- Hirofumi Matsuoka
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Itsuo Chiba
- Division of Disease Control and Molecular Epidemiology, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Yuji Sakano
- School of Psychological Science, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido Japan
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Porritt J, Rodd H, Morgan A, Williams C, Gupta E, Kirby J, Creswell C, Newton T, Stevens K, Baker S, Prasad S, Marshman Z. Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety. JDR Clin Trans Res 2017; 2:23-37. [PMID: 28879243 PMCID: PMC5576043 DOI: 10.1177/2380084416673798] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.
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Affiliation(s)
- J. Porritt
- Department of Psychology, Sociology, and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - H. Rodd
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - A. Morgan
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Sheffield, UK
| | - C. Williams
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
| | - E. Gupta
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - J. Kirby
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - C. Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, Berkshire, UK
| | - T. Newton
- Oral Health Services Research & Dental Public Health, King’s College London, Denmark Hill Campus, Caldecot Road, London, UK
| | - K. Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, UK
| | - S. Baker
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - S. Prasad
- Derbyshire Community Health Services, Long Eaton Dental Clinic, UK
| | - Z. Marshman
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
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Kazancioglu HO, Dahhan AS, Acar AH. How could multimedia information about dental implant surgery effects patients' anxiety level? Med Oral Patol Oral Cir Bucal 2017; 22:e102-e107. [PMID: 27918733 PMCID: PMC5217487 DOI: 10.4317/medoral.21254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/27/2016] [Indexed: 01/09/2023] Open
Abstract
Background To evaluate the effects of different patient education techniques on patients’ anxiety levels before and after dental implant surgery. Material and Methods Sixty patients were randomized into three groups; each contained 20 patients; [group 1, basic information given verbally, with details of operation and recovery; group 2 (study group), basic information given verbally with details of operative procedures and recovery, and by watching a movie on single implant surgery]; and a control group [basic information given verbally “but it was devoid of the details of the operative procedures and recovery”]. Anxiety levels were assessed using the Spielberger’s State-Trait Anxiety Inventory (STAI) and Modified Dental Anxiety Scale (MDAS). Pain was assessed with a visual analog scale (VAS). Results The most significant changes were observed in the movie group (P < 0.05). Patients who were more anxious also used more analgesic medication. Linear regression analysis showed that female patients had higher levels of anxiety (P < 0.05). Conclusions Preoperative multimedia information increases anxiety level. Key words:Implant, anxiety, pain, dental, video and patient knowledge.
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Affiliation(s)
- H-O Kazancioglu
- Bezmialem Vakif University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, 34093, Fatih, Istanbul, Turkey,
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Shahnavaz S, Hedman E, Grindefjord M, Reuterskiöld L, Dahllöf G. Cognitive Behavioral Therapy for Children with Dental Anxiety: A Randomized Controlled Trial. JDR Clin Trans Res 2016; 1:234-243. [PMID: 29417092 PMCID: PMC5772454 DOI: 10.1177/2380084416661473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Dental anxiety affects approximately 9% of children and is associated with poor oral health, pain, and psychosocial problems. The objective of this study was to investigate the efficacy of cognitive behavioral therapy (CBT) for children with dental anxiety in specialist pediatric dentistry. The study used a parallel-group superiority randomized controlled trial design. The primary outcome measure was the behavioral avoidance test; assessors were blind to treatment allocation. Participants were 8 boys and 22 girls 7 to 18 y old (mean ± SD, 10 ± 3.1). Children fulfilling the diagnostic criteria for dental anxiety were randomized to CBT (n = 13) or treatment as usual (n = 17), such as various sedation methods. Psychologists provided 10 h of CBT based on a treatment manual. Treatments were conducted in a naturalistic real-world clinical setting. Assessments were conducted before the treatment, 3 mo after the start of treatment, and at 1-y follow-up. The analyses of the primary outcome measure by repeated-measures analysis of variance and independent t test showed that children receiving CBT made superior, statistically significant improvements at follow-up (16.8 ± 2.4) compared with treatment as usual (11.4 ± 3.1, P < 0.01). A large between-group effect size (Cohen’s d = 1.9) was found. Following treatment, 73% of those in the CBT group managed all stages of the dental procedures included in the behavioral avoidance test compared with 13% in the treatment-as-usual group. Furthermore, 91% in the CBT group compared with 25% in the treatment-as-usual group no longer met the diagnostic criteria for dental anxiety at the 1-y follow-up according to the secondary outcome measure. Measures of dental anxiety and self-efficacy showed larger improvements in the CBT group compared with controls. We conclude that CBT is an efficacious treatment for children and adolescents with dental anxiety and should be made accessible in pediatric dentistry (ClinicalTrials.gov: NCT01798355). Knowledge transfer statement: The results of this study can be used by decision makers and clinicians when planning to implement evidence-based treatment in pediatric dentistry and give children and adolescents access to methods for treating dental anxiety. The results can also be used by parents of children with dental anxiety when asking dentists to cooperate with psychologists using cognitive behavioral therapy.
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Affiliation(s)
- S Shahnavaz
- Department of Dental Medicine, Division of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden
| | - E Hedman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Grindefjord
- Department of Dental Medicine, Division of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Dentistry, Eastman Institutet, Public Dental Service, Stockholm, Sweden
| | - L Reuterskiöld
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - G Dahllöf
- Department of Dental Medicine, Division of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden
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Naumova EA, Faber S, Lindner P, Wannemueller A, Sandulescu T, Joehren P, Arnold WH. Parallel study about the effects of psychotherapy on patients with dental phobia determined by anxiety scores and saliva secretion and composition. BMC Oral Health 2016; 17:32. [PMID: 27485732 PMCID: PMC4970277 DOI: 10.1186/s12903-016-0264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/29/2016] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to determine the success of psychotherapeutic treatment for dental phobia by measurement of anxiety using the dental anxiety score (DAS), the state trait anxiety score (STAI state), salivary cortisol and protein concentrations and the salivary secretion rate. Primary endpoint of the study was the comparison of the data before and after psychotherapeutic treatment. Methods Forty patients were included into the study. Twenty-four were allocated to the phobic group, 16 to the control group. Saliva was collected upon entering the dental clinic and again after three weeks of psychotherapy. The results were compared with those of a control group. The DAS and STAI questionnaires were completed at each visit. Results A reduction in DAS values was found after psychotherapy. However, the values remained significantly higher in the phobic group than in the controls. Similar results were found for STAI scores. A slightly higher salivary cortisol level was found in the phobic group. No changes occurred in cortisol or protein concentrations. The salivary secretion rate increased in the phobic patients after psychotherapy. Conclusions It could be concluded that psychotherapy is effective in the treatment of dental phobic patients. Trial registration This study has been retrospectively registered in the German Clinical Trials Register (# DRKS00009552) on 10/19/15. Electronic supplementary material The online version of this article (doi:10.1186/s12903-016-0264-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E A Naumova
- Department of Biological and Material Sciences in Dentistry, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - S Faber
- Department of Biological and Material Sciences in Dentistry, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - P Lindner
- Dental Clinic Bochum, Bochum, Germany
| | | | - T Sandulescu
- Department of Biological and Material Sciences in Dentistry, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - P Joehren
- Dental Clinic Bochum, Bochum, Germany
| | - W H Arnold
- Department of Biological and Material Sciences in Dentistry, School of Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany.
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Service evaluation of a nurse-led dental anxiety management service for adult patients. Br Dent J 2016; 220:515-20. [DOI: 10.1038/sj.bdj.2016.375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/08/2022]
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Chang H, Noh J, Lee J, Kim S, Koo KT, Kim TI, Seol YJ, Lee YM, Ku Y, Rhyu IC. Relief of Injection Pain During Delivery of Local Anesthesia by Computer-Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial. J Periodontol 2016; 87:783-9. [PMID: 26991489 DOI: 10.1902/jop.2016.150448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pain from local anesthetic injection makes patients anxious when visiting a dental clinic. This study aims to determine differences in pain according to types of local anesthetizing methods and to identify the possible contributing factors (e.g., dental anxiety, stress, and sex). METHODS Thirty-one patients who underwent open-flap debridement in maxillary premolar and molar areas during treatment for chronic periodontitis were evaluated for this study. A randomized, split-mouth, single-masked clinical trial was implemented. The dental anxiety scale (DAS) and perceived stress scale (PSS) were administered before surgery. Two lidocaine ampules for each patient were used for local infiltration anesthesia (supraperiosteal injection). Injection pain was measured immediately after local infiltration anesthesia using the visual analog pain scale (VAS) questionnaire. Results from the questionnaire were used to assess degree of pain patients feel when a conventional local anesthetic technique (CNV) is used compared with a computer-controlled anesthetic delivery system (CNR). RESULTS DAS and PSS did not correlate to injection pain. VAS scores were lower for CNR than for CNV regardless of the order in which anesthetic procedures were applied. VAS score did not differ significantly with sex. Pearson coefficient for correlation between VAS scores for the two procedures was 0.80, also indicating a strong correlation. CONCLUSION Within the limitations of the present study, relief from injection pain is observed using CNR.
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Affiliation(s)
- Hyeyoon Chang
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jiyoung Noh
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jungwon Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yang-Jo Seol
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yong-Moo Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Young Ku
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - In-Chul Rhyu
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016; 8:35-50. [PMID: 27022303 PMCID: PMC4790493 DOI: 10.2147/ccide.s63626] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, “tell-show-do”, and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.
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Affiliation(s)
- Deva Priya Appukuttan
- Department of Periodontics, Sri Ramakrishna Mission Dental College and Hospital, Chennai, India
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Characteristics of patients attending for cognitive behavioural therapy at one UK specialist unit for dental phobia and outcomes of treatment. Br Dent J 2015; 219:501-6; discussion 506. [DOI: 10.1038/sj.bdj.2015.890] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/08/2022]
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50
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Santuchi CC, Cortelli SC, Cortelli JR, Cota LOM, Alencar CO, Costa FO. Pre- and post-treatment experiences of fear, anxiety, and pain among chronic periodontitis patients treated by scaling and root planing per quadrant versus
one-stage full-mouth disinfection: a 6-month randomized controlled clinical trial. J Clin Periodontol 2015; 42:1024-31. [DOI: 10.1111/jcpe.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Camila Carvalho Santuchi
- Department of Dental Clinics, Oral Pathology, and Dental Surgery; Dentistry School; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Sheila Cavalca Cortelli
- Periodontics Research Division; Department of Dentistry; University of Taubaté; Taubaté São Paulo Brazil
| | - José Roberto Cortelli
- Periodontics Research Division; Department of Dentistry; University of Taubaté; Taubaté São Paulo Brazil
| | - Luís Otávio Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Dental Surgery; Dentistry School; Federal University of Minas Gerais; Belo Horizonte Brazil
| | - Camila Oliveira Alencar
- Periodontics Research Division; Department of Dentistry; University of Taubaté; Taubaté São Paulo Brazil
| | - Fernando Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Dental Surgery; Dentistry School; Federal University of Minas Gerais; Belo Horizonte Brazil
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