Dental fear and adult oral health in Australia

Bibliometric analysis of pediatric dental sedation research from 1993 to 2022

Statement of problem

Bibliometric analysis methods were used to evaluate pediatric dental sedation research and to identify topical hotspots using quantitative and qualitative methodologies.

Purpose

To conduct bibliometric analysis on the retrieved data and to foresee the development of trends and hotspots in this research area.

Material and methods

We retrieved appropriate research articles from the Web of Science Core Collection on January 1, 2023. VOSviewer, Citespace and the Bibliometrics website were used to conduct bibliometric analysis on the retrieved data. GraphPad Prism 10.0 (GraphPad, San Diego, CA, USA) was used to conduct the statistical analysis.

Results

A total of 396 publications on pediatric sedation in dentistry, published between 1993 and 2022, were retrieved from online databases. The USA published most papers. Furthermore, the most frequent countries who cooperated were the USA and Canada. Six of the top ten publishing establishments were USA based. Papers on the research have appeared primarily in the journals of Dentistry and Anesthesiology. Keyword co-occurrence and co-citation cluster analysis revealed that the most common topics mainly were: dental anxiety; conscious sedation; dental caries; midazolam; propofol; hypoxemia.

Conclusions

During the three decades, the focus of pediatric sedation research has been on drugs, dental anxiety and procedural sedation. Keyword burst detection indicated that procedural sedation; adverse event; respiratory depression is an emerging research hotspot.

Psychosocial factors, dentist-patient relationships, and oral health-related quality of life: a structural equation modelling

BACKGROUND

Psychosocial factors and dentist-patient relationships (DPR) have been suggested to be associated with oral health outcomes. This study aimed to test a conceptual model which hypothesised relationships among psychosocial factors, DPR variables, and oral health-related quality of life (OHRQoL) in the 'distal-to-proximal' framework.

METHODS

A total of 12,245 adults aged 18 years or over living in South Australia were randomly sampled for the study. Data were collected from self-complete questionnaires in 2015-2016. The outcome variable of Oral Health Impact Profile was used to measure OHRQoL. Psychosocial domain consisted of psychological well-being, social support, and health self-efficacy. DPR domain included trust in dentists, satisfaction with dental care, and dental fear. The hypothesised model was tested using the two-step approach in structural equation modelling.

RESULTS

Data were analysed from 3767 respondents after the screening/preparing process (adjusted valid response rate 37.4%). In the first step of the analysis, confirmatory factor analyses produced acceptable measurement models for each of the six latent variables (GFI = 0.95, CFI = 0.98, RMSEA = 0.04). The final structural model indicated that better well-being, higher self-efficacy, and more satisfaction were associated with lower oral health impact (β = - 0.12, - 0.07, - 0.14, respectively) whereas fear was positively associated (β = 0.19). Among intermediates, support was positively associated with satisfaction within a small effect size (β = 0.06) as compared to self-efficacy with trust (β = 0.22). The invariance of the final model was also confirmed on participants' SES and dental service characteristics except the variable of 'last dental visit'.

CONCLUSIONS

Psychosocial factors and DPR variables were associated with oral health impact in both direct and indirect paths. The framework of 'distal-to-proximal' actions is empirically supported from psychosocial factors via DPR variables to OHRQoL.

Associations between maternal mental health, child dental anxiety, and oral health of 6- to 12-year-olds in Nigeria

Maternal mental health affects their children's oral health. This study assessed the associations between maternal mental health and dental anxiety level, dental caries experience, oral hygiene, and gingival status among 6- to 12-year-old children in Nigeria. This was a cross-sectional study that recruited mother-child dyad participants through a household survey conducted in Ile-Ife, Nigeria. Data collected included the independent (maternal mental health risk, depressive symptoms, and child's dental anxiety), and dependent (caries experience, oral hygiene status, and gingival health status) variables. Multivariate logistic regression analysis was conducted to determine the associations between dependent and independent variables after adjusting for confounders (mothers' age, child's age, sex, and socioeconomic status). Statistical significance was set at p < 0.05. Of the 1411 mothers recruited, 1248 (88.4%) had low mental health risk, and 896 (63.5%) had mild depressive symptoms. As for the children, 53 (3.8%) had caries, 745 (52.8%) had moderate to high dental anxiety, 953 (63.0%) had gingivitis and 36 (2.6%) had poor oral hygiene. The maternal mental health risk was not significantly associated with the child's caries experience (AOR: 1.012; 95%CI: 0.860-1.190; p = 0.886), poor oral hygiene (AOR:1.037; 95%CI: 0.975-1.104; p=0.250), and moderate/severe gingivitis (AOR:0.887; 95%CI: 0.764-1.030; p = 0.115). Maternal depression status was not significantly associated with the child's caries experience (AOR: 0.910; 95%CI: 0.802-1.033; p = 0.145), poor oral hygiene (AOR: 1.016; 95%CI: 0.976-1.057; p = 0.439), and moderate/severe gingivitis (AOR: 0.963; 95%CI: 0.861-1.077; p = 0.509). Maternal mental health risk and depression do not seem to be risk factors for schoolchildren's oral health in Nigeria. Further studies are needed to understand these findings.

Impact of Dental Anxiety on Dental Care Routine and Oral-Health-Related Quality of Life in a German Adult Population-A Cross-Sectional Study

The interaction between dental anxiety and the establishment of a consistent dental care routine has been an ongoing challenge. Unfortunately, there is limited available data concerning the detailed dental care practices of individuals with dental anxiety. Therefore, this study aims to explore how dental anxiety influences dental care habits and oral-health-related quality of life within an adult population. By utilizing the Dental Anxiety Scale (DAS) and the German Oral Health Impact Profile (OHIP-G5), we assessed their extent. To evaluate the differences, we performed analyses of variance (Anova), an independent t-test and rank correlation. The findings of this study unveil a significant correlation between elevated DAS scores and reduced frequency of tooth brushing; calculus removal and appointments for professional teeth cleaning. Interestingly; the use of dental floss and mouthwash solution as well as toothbrush hardness appeared to be not significantly affected by dental fear. Moreover, individuals with dental anxiety demonstrated a preference for manual toothbrushes over electric ones. In addition, higher DAS scores were found to be strongly associated with greater OHIP-G5 scores, thus leading to a substantial decline in overall oral health-related quality of life.

Feasibility of minimum intervention oral healthcare delivery for individuals with dental phobia

BACKGROUND

People with dental phobia often present with more active dental caries and fewer teeth. Minimally Intervention oral Healthcare offers a possible solution to address the high care needs of this group. The aim was to determine this patient group's eligibility and willingness to participate and the effect of MIOC, compared to treatment as usual (TAU), on their oral health outcomes for planning a future randomised controlled trial (RCT). Minimum intervention oral healthcare (MIOC) comprises of four interlinked domains. In the first domain, we identified and diagnosed the disease status and participants' anxiety status (≥ 19 MDAS). In the second domain, an individualised prevention-based personalised care plan was designed. During this process, patients with dental phobia were exposed to the dental environment in a stepped manner ('graded exposure') and had their urgent care provided with conscious sedation. In the 3^rd domain, we took a minimally invasive operative approach to restore teeth while preserving tooth substance and limiting the use of fear-provoking stimuli (e.g., rotary instruments) when possible. At the review and the recall appointment(s) (4^th domain), the patients' oral health care behaviours, disease risk/susceptibility and fear levels were re-assessed.

METHODS

This two-arm randomised feasibility trial (N = 44) allocated participants to the experimental arm (MIOC) or the control arm (treatment as usual [TAU]). The primary outcomes were the eligibility and willingness to participate and feasibility to conduct a trial of MIOC for people with dental phobia. The secondary outcomes were oral health status, oral health related quality of life and care completion. A written and verbal consent for participation and dental care provision were obtained.

RESULTS

Forty-four people diagnosed with dental phobia were allocated randomly to the two study arms. At the six-month recall after completed care, the outcome of each study arm was assessed. It was feasible to conduct a clinical trial (eligibility rate [56%], completion rate [81%], declined to participate [12%]). The intervention group showed improvements in all health care outcomes, and oral health related quality of life.

CONCLUSION

A clinical trial of MIOC vs TAU in people with dental phobia is feasible. Preliminary findings suggest that patients in the MIOC arm are more likely to successfully complete their course of treatment. The study was 'retrospectively registered' on 02/05/2018 (ISRCT15294714) with the International Standard Randomised Controlled Trial (ISRCT).

Factors Associated with Patients' Rejection of Root Canal Treatment in a Tertiary Hospital, Southwest Nigeria: A Pilot Survey

Objective

Root canal treatment (RCT) is a major procedure in dentistry. It aims to relieve the pain of pulpal origin and maintain the affected tooth as a functional unit on the arch. Despite these achievable goals, RCT is sometimes rejected by patients. This study, therefore, sought to assess the reasons for rejection in patients planned for endodontic/RCT.

Materials and Methods

This was a cross-sectional pilot survey of patients planned for RCT using a self-administered questionnaire. The questionnaire included sociodemographics, the Index for Dental Anxiety and Fear (IDAF-4C), and questions to assess the reasons for rejection of endodontic treatment. Data collected were analysed with IBM Statistical Package for the Social Sciences software program, version 23.0. Descriptive statistics were used; chi-square was used to test the association between categorical variables. Statistical significance was set at P ≤ 0.05.

Result

Thirty-one patients between the age range of 16 and 81 years, with a mean age of 38.16 ± 17.87, participated in the survey. Only nine (29.03%) of the participants declined to have the treatment. The majority 6(66.7%), and 7(77.8%) of those that refused the treatment did so, due to fear of drilling (P = 0.014) and cost of treatment (P = 0.001), respectively. Mean IDAF-4C was 1.86 ± 0.9 (standard deviation).The rejection was, however, not affected by past experience, the risk of taking multiple radiographs, and the number of hours or visits for the procedure.

Conclusion

The cost of treatment and fear of drilling were the major reasons for the rejection of RCT in this study. Therefore, there is a need to further look into making endodontic treatment a more comfortable, less costly, and less fear-provoking procedure for patients.

Evaluating the stress of root canal treatment in patients and dentists compared to other dental treatments: A systematic review and meta-analysis

This systematic review aimed to investigate whether root canal treatment caused greater stress than other dental treatments for patients and dentists. All peer-reviewed literature published in English between January 1990 and January 2023 was included. This included randomized/non-randomized control trials, cohort studies, case-control studies, and cross-sectional studies. An electronic search used PubMed, Scopus, Medline, Cochrane Collaboration, and Embase. Hand searching supplemented the screening pool. Studies examining physiological or psychological stress measures within patients or providers of dental treatment (dentists, dental specialists, and dental students) were eligible. The study must have reported on the stress outcome for root canal treatment and at least one other dental procedure. After screening 3639 eligible records, there were 23 studies included, varying from very-low to low certainty of evidence. This review found that root canal treatment was more psychologically stressful for patients than routine restorative or cleaning procedures. However, the stress of root canal treatment relative to other dental procedures, especially extractions, was inconclusive for both dental patients and providers. Since patients regard root canal treatment as more stress-evoking than other routine dental procedures, providers should endeavour to minimise their own bias toward root canal treatment when providing adequate information for an informed treatment choice.

Relationship between dental anxiety levels and oral health among dental patients in Turkey: a cross-sectional study

BACKGROUND

This study aimed to determine the relationship between dental anxiety and oral health in adult patients who applied to the Department of Restorative Dentistry at the Faculty of Dentistry at Suleyman Demirel University.

METHODS

The study included 500 subjects. The dental anxiety levels of the patients were determined using a modified dental anxiety scale (MDAS). Information on sociodemographic details, oral hygiene and nutritional habits were recorded. Intraoral examinations of the subjects were performed. Caries prevalence of individuals was determined using the decayed, missing or filled teeth (DMFT) and decayed, missing, or filled surfaces (DMFS) indices. Gingival health was evaluated using the gingival index (GI). Statistical analyses were performed using the Mann-Whitney U, Kruskal-Wallis and Chi-square tests and Spearman correlation analysis.

RESULTS

The ages of the 276 female and 224 male participants ranged from 18-84 years. The median MDAS value was 9.00. The median DMFT and DMFS values were 10.00 and 23.00, respectively. The median MDAS values ​​of women were higher than those of men. Individuals who postponed their appointment had a higher MDAS median value than those who did not (Mann-Whitney U test, p < 0.05). No statistically significant correlation was found between dental anxiety level (MDAS) and GI, DMFT and DMFS index scores (Spearman correlation analysis, p > 0.05).

CONCLUSION

The MDAS values of individuals who did not remember the reason for their dental visit were higher than those who visited the dentist for routine control. Based on the findings of this study, further research on the relationship between dental anxiety and oral health is necessary to determine the factors that pose a risk for dental anxiety and to ensure the regular benefits of dental services.

Dental Anxiety Among Physicians: Relationship with Oral Problems, Dental Visits, and Socio-Demographic Factors

Purpose

The purpose of study was to investigate dental anxiety (DA) and its relationship with oral health problems, dental visits, and socio-demographic factors among physicians.

Patients and Methods

This cross-sectional study was conducted on physicians working in Dhahran, Khobar, Dammam, and Qatif cities of the kingdom of Saudi Arabia. The study included physicians (general practitioners, residents, specialists, and consultants) working in the public and private sectors. Modified Dental Anxiety Scale and World Health Organization's Oral Health Questionnaire for Adults were used to evaluate DA, oral health problems, and dental attendance.

Results

The study included data from 355 participants with a mean age of 40.13 ± 10.45 years. There were 57.2% of non-Saudi and 42.8% of Saudi participants in the study. Bad dental experience in the previous dental visit was reported by 40% of participants, which was significantly related to DA (P = 0.002). Only 9.60% of participants had no DA, whereas 41.10% demonstrated low DA, 23.4% moderate DA, 18.9% high DA, and 7% extreme DA. Common oral problems included tooth sensitivity (65.40%), tooth cavities (45.90%), bleeding gums (43.10%), and bad breath (36.90%). More than half of participants (58.3%) visited the dentist during the last year and dental pain was the most common reason for dental visits (31.3%). Saudi participants demonstrated significantly increased DA than non-Saudis (P = 0.019). DA was significantly related to tooth sensitivity (P = 0.001), tooth cavities (P = 0.002), dry mouth (P = 0.044), and bad breath (P = 0.005). The participants with difficulty in biting foods (P > 0.001) and feeling embarrassed due to the appearance of teeth (P < 0.001) demonstrated significantly higher DA.

Conclusion

This sample of physicians showed a high prevalence of DA, oral problems, and dental visits due to pain. DA was significantly related to physicians' negative dental experience, tooth sensitivity, dental decay, dry mouth, and bad breath.

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

BACKGROUND

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

DESIGN

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

RESULTS

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

CONCLUSION

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

The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery

Excessive levels of anxiety may negatively influence treatment outcomes and likely increase patient suffering. We designed a prospective observational study to assess whether preoperative patient-reported anxiety affects major general surgery outcomes. We prospectively administered the State-Trait Anxiety Inventory (STAI) to measure preoperative anxiety in patients awaiting major general surgical procedures. Patients were grouped by STAI scores according to established cutoffs: no anxiety (STAI < 40) and anxiety (STAI ≥ 40). Four hundred patients completed the questionnaires and underwent surgery, with an average interval from questionnaire completion to surgery of 4 days. Applying a state anxiety (STAI-S) score ≥ 40 as a reference point, the prevalence of patient-reported anxiety was 60.5% (241 of 400). The mean STAI-S score for these patients was 50.48 ± 7.77. The mean age of the entire cohort was 58.5 ± 14.12 years. The majority of participants were male (53.8%). The distribution of sex by anxiety status showed that 53.5% of women and 46.5% of men had anxiety (p = 0.003). In the entire cohort, postoperative complications occurred in 23.9% and 28.6% of the no anxiety and anxiety groups, respectively. The difference was nonsignificant. In a subgroup of patients who underwent high-risk complex procedures (N = 221), however, postoperative complications occurred in 31.4% and 45.2% of the no anxiety and anxiety groups, respectively. This difference was significant at p = 0.004. Of the patients who were anxious, 3.3% (8 of 241) died during hospitalization following surgery, compared with 4.4% of the patients (7 of 159) who were not anxious (p = 0.577). In the multivariable analysis adjusted for covariates and based on the results of subgroup analysis, preoperative anxiety assessed by the STAIS score was associated with morbidity (OR 2.12, CI 1.14–3.96; p = 0.018) but not mortality. The majority of enrolled patients in this study were classified as having high- to very high-level preoperative clinical anxiety, and we found a significant quantitative effect of patient-reported anxiety on morbidity but not mortality after surgery.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

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.

Dental Anxiety Screening and Management Practices in Dental Practice in Eastern Province, Saudi Arabia

PURPOSE

The purpose of the study was to investigate dental anxiety (DA) screening and management practices among dental professionals in Saudi Arabia. The study also evaluated correlation between patients' self-reported DA and dentists' ratings of patients' DA.

PARTICIPANTS AND METHODS

This cross-sectional observational study included dentist/patient pairs (N = 279) from the Eastern Province of Saudi Arabia. The dentists responded to a questionnaire about their DA screening and management practices and they evaluated patients' DA using the visual analogue scale (VAS). In addition, patients responded to the Modified Dental Anxiety Scale (MDAS) to measure their DA.

RESULTS

About 15.1% of dentists reported using a published scale for screening DA in dental practice and Corah's Dental Anxiety Scale and Dental Fear Survey were their main scales. However, 69.2% reported directly asking their patients about DA. The use of DA management technique was reported by 89.6% of the dentists. Approximately half of the participants (53%) reported receiving DA training in their undergraduate dentistry programs and 65.2% expressed their interest in continuing education courses related to DA. In multiple logistic regression analysis, statistically significant factors associated with DA screening practice included gender (AOR = 0.46, P = 0.037), place of work (AOR = 3.68, P = 0.039), and interest in continuing education courses (AOR = 3.21, P = 0.015). Monthly income (AOR = 0.20, P = 0.029) and directly asking patient about DA (AOR = 6.15, P = 0.025) were significant factors associated with management of patients with DA. The study also showed a significant but weak correlation between DA evaluated by the dentists and DA reported by the patients (rho = 0.185, P = 0.002).

CONCLUSION

The present study showed a low prevalence of DA screening practices among dentists. Dentists' rating of patients' DA weakly correlated with patients' self-reported DA.

How Can We Reduce Dental Fear in Children? The Importance of the First Dental Visit

Dental fear is a common problem amongst children. It can affect children’s psychological well-being, quality of life, and oral and systemic health. The aim of this study was to identify whether the patients’ age at which visits to the paediatric dentist begin as well as the periodicity of these visits are factors that can prevent dental fear. This observational transversal study was conducted on 575 school children (average age 6.85 ± 0.78) and their mother/father/guardian. Parents completed a survey on the characteristics of dental visits and the child completed the index of dental anxiety and fear (IDAF-4C) to assess dental fear. The correlation between dental fear and age at first visit (r = −0.36 p < 0.01) and dental fear and frequency of visit (r = −0.65 p < 0.01) were statistically significant. The regression analysis performed showed that both variables predicted 44.4% of the dental fear in the child. In conclusion, the age of initiation to the paediatric dentist (before 2 years) and the periodic revisions (every 6 months or every year) could protect the child from dental fear.

Psychopathologies and socioeconomic status as risk indicators for periodontitis: a survey-based investigation in German dental practices

OBJECTIVES

Periodontitis is a highly prevalent multifactorial disease associated with various mental disorders. However, study results about this association are still contradictory. One methodological reason could be the neglect of potential confounders, such as socioeconomic factors or mental comorbidity. Our study examined a wide range of potential psychosocial risk indicators to identify those with relevant associations to periodontitis.

MATERIALS AND METHODS

In a cross-sectional study, 111 patients with periodontitis (PERIO) (> 30% teeth with approximal attachment loss ≥ 5 mm) and 110 patients without periodontitis (NON-PERIO) were recruited in four dental practices in Germany. Clinical attachment loss, pocket depth, plaque, bleeding on probing, and DMFT were measured. Psychopathologic symptoms and socioeconomic status were recorded using self-report questionnaires (DAS, PHQ-8, GAD-7, CTS, SCOFF, AUDIT, FTND, SSS-8, SES).

RESULTS

The PERIO group reported significantly lower socioeconomic status (Cohen's d = 0.49) and higher psychopathological symptom burden than the NON-PERIO regarding dental anxiety (d = 0.86) and avoidance behavior, nicotine dependency (d = 0.84), depressiveness (d = 0.46), general anxiety (d = 0.45), somatic symptoms (d = 0.42), and childhood traumatization (d = 0.34). No significant group differences existed for alcohol abuse and eating disorders. Dental anxiety was the strongest predictor of periodontitis and showed significant correlations with other psychopathologies and social status.

CONCLUSIONS

Out of all psychosocial factors, socioeconomic status and dental anxiety showed the greatest association with periodontitis.

CLINICAL RELEVANCE

Dentists should encourage socially disadvantaged and dentally anxious patients in the utilization of prevention and dental care. Furthermore, physicians and psychotherapists can contribute to the early detection of dental anxiety, oral diseases, and avoidance behavior.

Using an mHealth App (iGAM) to Reduce Gingivitis Remotely (Part 2): Prospective Observational Study

BACKGROUND

Gingivitis is a nonpainful, inflammatory condition that can be managed at home. Left untreated, gingivitis can lead to tooth loss. Periodic dental examinations are important for early diagnosis and treatment of gum diseases. To contain the spread of the coronavirus, governments, including in Israel, have restricted movements of their citizens which might have caused routine dental checkups to be postponed.

OBJECTIVE

This study aimed to examine the ability of a mobile health app, iGAM, to reduce gingivitis, and to determine the most effective interval between photograph submissions.

METHODS

A prospective observational cohort study with 160 unpaid participants divided into 2 equal groups using the iGAM app was performed. The intervention group photographed their gums weekly for 8 weeks. The wait-list control group photographed their gums at the time of recruitment and 8 weeks later. After photo submission, the participants received the same message "we recommended that you read the information in the app regarding oral hygiene habits." A single-blinded researcher examined all the images and scored them according to the Modified Gingival Index (MGI).

RESULTS

The average age of the intervention group was 26.77 (SD 7.43) and 28.53 (SD 10.44) for the wait-list control group. Most participants were male (intervention group: 56/75,74.7%; wait-list control group: 34/51, 66.7%) and described themselves as "secular"; most were "single" non-smokers (intervention group: 56/75, 74.7%; wait-list control group: 40/51, 78.4%), and did not take medications (intervention group: 64/75, 85.3%; wait-list control group: 40/51, 78.4%). A total of 126 subjects completed the study. A statistically significant difference (P<.001) was found in the dependent variable (MGI). Improvements in gingival health were noted over time, and the average gingivitis scores were significantly lower in the intervention group (mean 1.16, SD 1.18) than in the wait-list control group (mean 2.16, SD 1.49) after 8 weeks. Those with more recent dental visits had a lower MGI (P=.04). No association was found between knowledge and behavior. Most participants were familiar with the recommendations for maintaining oral health, yet they only performed some of them.

CONCLUSIONS

A dental selfie taken once a week using an mobile health app (iGAM) reduced the signs of gingivitis and promoted oral health. Selfies taken less frequently yielded poorer results. During the current pandemic, where social distancing recommendations may be causing people to avoid dental clinics, this app can remotely promote gum health.

Oral health and oral health behavior in young adults with caries disease

Objective

The aim of this study was to describe and analyze oral health, oral health behaviors, and oral health-related quality of life (OHRQoL) in relation to the level of caries disease among caries-active young adults.

Material and methods

This study presents data from a sample of young adults (n = 135) with active caries disease who were enrolled in a clinical, randomized controlled trial. The independent variables of sociodemographics, oral health (gingivitis, plaque), oral health behaviors (such as toothbrushing, dental attendance, sugar-containing sweets and drinks), dental anxiety, self-rated oral health, and OHRQoL were collected. Multinomial logistic regression was used to simultaneously evaluate the associations between the independent variables and caries severity.

Results

Multinominal logistic regression showed that poor OHRQoL and gingivitis were associated with caries severity in a gradient fashion in accordance with caries disease activity. Also, irregular dental care and frequent consumption of sugary soda were significantly associated with very high caries severity.

Conclusions

The risk factors related to caries severity among young adults were poor OHRQoL, gingivitis, consumption of sugary soda and irregular dental care attendance, indicating the need for a combination of different interventions specifically health behavior change. Furthermore, these findings may contribute to identifying high caries-risk individuals.

Estimated prevalence of dental fear in adults: A systematic review and meta-analysis

OBJECTIVES

To systematically review the literature about: 'What is the global estimated prevalence of dental fear in adults?'.

DATA/SOURCES

Inclusion criteria were observational population-based studies reporting the prevalence or raw data of dental fear in adults (>18 years). Five electronic databases (Embase, PubMed, Scopus, Virtual Health Library and Web of Science) were searched without language restrictions up to March 2020. Two researchers independently performed the study selection, data extraction and quality assessment of the included studies. Risk of bias was performed using the Joanna Briggs Critical Appraisal Checklist for Prevalence and Incidence studies. The prevalence pooled estimates of dental fear were calculated using fixed- and random-effect models. Subgroup analyses were performed.

STUDY SELECTION

The search strategy identified 4,486 studies. After removal of duplicates (1,722), title and abstract screening (2,764) and full-text reading (108), 31 publications were deemed eligible for this systematic review. Three studies presented low risk of bias and 28 studies presented high risk of bias. A total of 72,577 individuals 18 years of age or older composed the sample of this systematic review. The global estimated prevalence of dental fear and anxiety (DFA), high DFA and severe DFA in adults were 15.3 % (95 %CI 10.2-21.2), 12.4 % (95 %CI 9.5-15.6) and 3.3 % (95 %CI 0.9-7.1), respectively. Subgroup analyses showed a higher prevalence of DFA, high DFA and severe DFA among women and younger adults. The instruments used to measure dental fear also affected its prevalence.

CONCLUSIONS

Dental fear and high dental fear are prevalent in adults worldwide, being more prevalent among women.

CLINICAL SIGNIFICANCE

Evidence suggests fear negatively impacts dental care pattern, clinical and subjective oral health conditions. A better knowledge of the global prevalence and the factors associated with this problem will allow that prevention or even behavior modulation strategies of the fearful individual's in dental setting being carried out.

Fear of COVID-19 in Madrid. Will patients avoid dental care?

Introduction

The objective of this research is to describe how perceived infectability, germ aversion, and fear of COVID-19 in adults in Madrid have changed from the beginning of the pandemic until the lockdown exit phase and their influence on dental care behaviour.

Materials and Methods

Some 961 participants were monitored in a study in Madrid at 2 time points: before lockdown (T0) and after completion of the total lockdown (T1). A questionnaire that included basic sociodemographic variables, the perceived vulnerability to disease scale (including perceived infectability and germ aversion), the fear of COVID-19 scale, and dental visiting behaviour after confinement for fear of COVID was administered.

Results

The participants had higher scores for infectability and germ aversion at T1 than at T0 (P < 0.01). Of those studied, 24.5% (235) of the participants would not go to the dentist for fear of COVID-19. Those who had a high perceived infectability scale score were at least 5 times more likely to not visit the dentist. Those with high COVID-19 fear were at least 6 times more likely to not visit the dentist, and those older than 60 years were 8 times more likely to not visit.

Conclusions

The population's high levels of vulnerability to infectability and perceived germ aversion associated with fear of COVID-19 and the resultant avoidance behaviour to dental care will remain until an effective drug or vaccine for SARS-CoV2 is found.

Factors Influencing Pain and Anxiety Before Endodontic Treatment: A Cross-Sectional Study Amongst American Individuals

Objective:

The present study aimed to assess preoperative levels of patient anxiety and pain before root canal treatment, and to explore variables that may affect these levels.

Methods:

Ninety-five patients presenting for an endodontic visit were recruited for the study. A questionnaire was administered. Visual analog scales were used to record levels of pain and anxiety. Data was tabulated, and analysis was performed using the Pearson Chi-Squire test with continuity correction, and the level of significance was set at 0.05 (P=0.05).

Results:

Anxiety was detected more frequently in females (60%) than in males (33%) (P=0.016). Sixty-two percent of patients who were waiting for a new treatment were anxious, compared to 39% of those who were returning to continue treatment (P=0.049). Sixty-nine percent of patients in pain reported being anxious (P=0.015). Patients aged 18–30 years reported more pain than those older than 30 years (P=0.023). Forty-three percent of new patients reported being in pain, whereas only 20% of patients returning for a treatment reported pain (P=0.027).

Conclusion:

Anxiety associated with root canal treatment is prevalent, and it was reported primarily by young females who were presenting for a new treatment. Pain and anxiety are highly inter-related, and they are usually reduced after the first endodontic session.

Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach

BACKGROUND

Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis.

OBJECTIVE

This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients.

METHODS

A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections. We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks.

RESULTS

All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) "what's in it for me?" and (2) the need for a take-home message. The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction.

CONCLUSIONS

iGAM is the first mHealth app for monitoring gingivitis using self-photography. iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic).

Psychometric Assessment of the Urdu Version of the Index of Dental Anxiety and Fear

Background

The objective of the current study was to adapt the Index of Dental Anxiety and Fear (IDAF-4C) in the Urdu language and measure its validity and reliability.

Methods

Original English questionnaire of IDAF-4C was translated into Urdu language by a panel of dentists and language experts (Urdu and English) followed by critical evaluation, modification and back translation into English language. A final Urdu questionnaire was distributed among 250 patients visiting the Endodontics section at Margalla Institute of Health Sciences (MIHS), Rawalpindi, Pakistan. Cronbach’s alpha was used to determine the reliability of the Index whereas validity was assessed by exploratory factor analysis (EFA). Mean rank scores of IDAF-4C for male and female participants were evaluated using Mann-Whitney U tests (P < 0.05).

Results

Of 250 questionnaires, 209 were returned with a response rate of 84%. Cronbach’s alpha for the Urdu version of IDAF-4C was 0.88. Exploratory factor analysis of the IDAF-4C revealed one factor explaining 55.55% of the common variance (Eigenvalue = 4.5). The mean rank scores of all eight items of IDAF-4C were greater for female participants as compared to male participants with a statistically significant association (P < 0.05).

Conclusion

The psychometric analysis of the Urdu version of IDAF-4C showed good reliability and consistency compared to the original version as well as other translated versions.

Fear and Anxiety Pathways Associated with Root Canal Treatments Amongst a Population of East Asian Origin

Objective

This study aimed to identify and compare the pathways of endodontic fear and anxiety amongst East Asian origin patients attending Griffith University's Dental Clinics, Gold Coast, Australia.

Methods

East Asian patients who attended the Griffith University dental clinics were included in this study. The "My Endodontic Fear" survey was used. The pathways involved in self-perception of dental fear and anxiety were assessed through 5 different questions. Chi-square test was for statistical analysis and the level of significance was set at P<0.05.

Results

One hundred and forty six participants (n=146) (ages 18-62 years) of East Asian descent met the criteria to participate. 58.2% were females, and 41.8% males. The ethnicities were split into Chinese origin and non-Chinese origin (Korean, Phillipino, Japanese, Vietnamese). Results indicate multiple pathways affect the origin of fear, regardless of ethnicity. The Cognitive Conditioning pathway was the primary pathway selected by the Chinese and non-Chinese sub groups (51.4%, 43.6%) followed by the Informative (38.3%, 38.5%), then Vicarious (27.1%, 33.3%) and Parental (18.7%, 33.3%) pathways respectively.The Verbal Threat pathway was the least selected pathway for both groups, however the non- Chinese group selected this pathway significantly more often than the Chinese group (P<0.001).

Conclusion

This study demonstrates that the Cognitive Conditioning pathway was the primary fear and anxiety pathway utilized by both East Asian sub-groups. Understanding how patients develop fear and anxiety can help treating dentists discuss triggering factors for patients and alleviate undue anxiety prior to treatment.

Dentist-patient relationships and oral health impact in Australian adults

OBJECTIVES

Dentist-patient relationships (DPRs) are a key component in clinical encounters with potential benefits for oral health outcomes. This study aimed to investigate whether better DPR variables are associated with higher oral health-related quality of life (OHRQoL).

METHODS

A total of 12 245 adults aged 18 years or over were randomly sampled from South Australia in 2015-2016. Data were collected from self-complete questionnaires and analysed as a cross-sectional design. The outcome variable was the Oral Health Impact Profile (OHIP-14). Explanatory DPR variables included trust in dentists, satisfaction with dental care, and dental fear. Covariates comprising oral health behaviours, dental services, demographics, and socioeconomic status were included as potential confounding variables. Bivariate correlation analyses and multivariable linear regression were performed for the associations among explanatory, outcome variables and other covariates.

RESULTS

Response data were analysed from 4220 participants (response rate = 41.9%). Unadjusted mean total scores of DPR variables and OHIP-14 were associated with most of the study participants' characteristics (P < .05). Bivariate correlations among DPR variables and OHIP-14 showed a diverse range of coefficients (|r| or |ρ|=0.22-0.67). Multivariable regression analyses in both individual/clustered block entry and full model indicated that higher satisfaction and less dental fear (B = -0.039 and 0.316, respectively in the full model) were associated with lower OHIP-14 after adjusting for possible confounders (P < .01).

CONCLUSIONS

This study found that favourable DPR variables, mainly greater satisfaction and less dental fear are positively associated with better OHRQoL. Further studies are warranted to investigate the causality and mediation/moderation of DPR variables on oral health outcomes.

Dental students' and patients' perceived importance and knowledge of dental anxiety

AIM

To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear.

METHODS

Dental students (N = 219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5-9, low fear = 10-18, high fear = 19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis.

RESULTS

Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety.

CONCLUSION

Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

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

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

The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety

Background

The purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years, 3 months and 1 year after the successful completion of dental treatment through either pharmacological or non-pharmacological behavior management techniques.

Methods

A total of 1567 patients aged between 6 and 9 years who had completed dental treatment were screened. A total of 703 patients who were caries free at the end of 3 months were classified based on Frankl behavior score and administered the Arabic version of the Children’s Fear Survey Schedule- Dental Subscale (CFSS-DS) and accordingly allocated to one of three groups; (Phobic Patients, Anxious Patients, Control Group). A total of 183 patients met the inclusion criteria and were followed up for 1 year. A total of 151 patients completed the study. Patients’ heart rate on recall, salivary cortisol and salivary amylase were compared between the groups.

Results

The results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate or extent of dental treatment. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. These findings were replicated on 1-year recall.

Conclusions

Within the limitations of this study we can conclude that salivary amylase is an indicator of of acute stress that can differentiate between anxiety and dental fear; while salivary cortisol appears to be a marker of long-term stress that lacks the sensitivity to differentiate between the two.

Dental anxiety among dental, medical, and nursing students of two major universities in the central region of the Kingdom of Saudi Arabia: a cross-sectional study

Background

Dental anxiety is one of the most common fears that can eventually lead to avoidance of dental care. Knowing how students will respond to dental treatment will aid in increasing their awareness of oral health and overcoming this fear. The present study measured the prevalence of dental anxiety among dental, medical, and nursing students in Riyadh city, Kingdom of Saudi Arabia.

Methods

A cross-sectional study including undergraduate dental, medical, and nursing students at King Saud University and Almajmaa University was conducted to assess dental anxiety using the Modified Dental Anxiety Scale. Descriptive statistics including means, standard deviations, and percentages were calculated. Group comparisons were analyzed using t-tests and analysis of variance. Multiple group comparisons were conducted using Tukey’s post-hoc test. P < 0.05 was considered as the significance level.

Results

Two hundred twenty-four participants completed the questionnaire. Medical students accounted for most of the responses (40.6%), followed by nursing (31.7%), and dental students (27.7%). There was no significant difference in dental anxiety with regard to gender. Dental students exhibited the least dental anxiety. A significant difference was found between students with good dental experiences compared with those who had bad dental experiences.

Conclusion

Dental students had the lowest level of anxiety and anxiety levels were affected by previous dental visits. Increasing awareness and knowledge about oral health, regular dental education, and incorporating dental knowledge into university curriculums can aid in eliminating the fear of dentistry among health sciences students.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Demographic profile, Oral Health Impact Profile and Dental Anxiety Scale in patients with chronic periodontitis: a case-control study

OBJECTIVES

To examine whether dental anxiety (DA) and oral health-related quality of life (OHRQoL) differ between persons with and those without chronic periodontitis.

METHODS

One-hundred patients with chronic periodontitis and 50 age- and- sex-matched controls were included. Data were collected on the following: demographics; smoking habits; Numerical Rating Scale (NRS) for dental pain assessment; Corah's Dental Anxiety Scale (DAS); Oral Health Impact Profile 14 (OHIP-14); Decayed, Missing and Filled Teeth (DMFT) index; Plaque Index (PI); probing depth (PD); bleeding on probing (BOP); and radiographic bone loss.

RESULTS

Patients with chronic periodontitis exhibited a significantly higher percentage of high anxiety and phobia compared with subjects in the control group. Furthermore, patients with chronic periodontitis were statistically significantly more likely to consider themselves as suffering from dental anxiety (68.7% vs. 14.3%, P < 0.001) as well as more likely to have fear of receiving dental injections, hearing the dental drill noise and feeling a foreign object in the mouth. Patients with chronic periodontitis exhibited worse OHIP-14 global scores as well as worse scores in the following individual domains: functional limitation (P = 0.005); physical disability (P = 0.003); psychological disability (P = 0.010); social disability (P = 0.011); and handicap (P = 0.012).

CONCLUSIONS

Compared with controls, patients with chronic periodontitis had higher levels of dental anxiety and worse OHRQoL. It is important to consider dental anxiety and OHRQoL assessment as an integral component of the evaluation of patients with chronic periodontitis. Communication between dental and behavioral health professionals is needed to implement a multidisciplinary team approach involving behavioural and psychological interventions.

Patient-dentist relationship and dental anxiety among young Sudanese adult patients

OBJECTIVE

To evaluate the effects of the patient-dentist relationship on dental anxiety among young adult Sudanese patients.

MATERIALS AND METHODS

In this cross-sectional study, 864 patients attending outpatient dental clinics of the governmental dental hospitals in Khartoum, Sudan were recruited; 51.2% were males and 48.8% were females, with an age range of 18-24 years. The questionnaire used evaluated the socio-demographics, education levels, economic status, patient experience, and also included the Dental Anxiety Scale, Corah (J Dent Res 1969 48: 596).

RESULTS

High dental anxiety was reported by 22.2%, 29.5% reported moderate dental anxiety, and 48.3% reported low or no dental anxiety. There were statistically significant associations between dental anxiety and gender, time lapse since the previous dental visit (P < 0.004) and the reason for the previous visit (P < 0.001). In addition, the dental clinic environment (P < 0.002), the time waiting before seeing the dentist (P < 0.001) and the overhearing of pain expressed by other patients (P < 0.001) were also statistically significant. Negative comments by the treating dentist also had a statistically significant impact (P < 0.032). In contrast, a clear explanation of related dental care (P < 0.008), as well as the allowance of adequate time to discuss oral health (P < 0.006), had significantly positive effects.

CONCLUSION

The study showed that the patient-dentist relationship had a significant association with dental anxiety, and may be an important target for improving the delivery and standards of oral health in dentally anxious patients in this region.

Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern State Medical University, Arkhangelsk, North-West Russia

The objective was to assess the prevalence of and factors associated with dental anxiety (DA) in medical and dental students in North-West Russia. This cross-sectional study included 422 medical and 285 dental undergraduate Russian students aged 18–25 years from the Northern State Medical University in Arkhangelsk. Corah’s Dental Anxiety Scale (DAS) was applied to measure DA. Information on socio-demographic and socioeconomic factors, oral health behaviour and general and oral health was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess caries experience, Simplified Oral Hygiene Index, and Gingival Index. DAS score ≥13 was found in 13.7% and 2.2% of medical and dental students, respectively. Female sex (incidence rate ratio [IRR] = 1.11, p = 0.013), lower education of mother (IRR = 1.13, p = 0.001), and poor self-assessed oral health (IRR = 1.15, p < 0.001) were associated with DA in medical students. Corresponding factors in dental students were female sex (IRR = 1.16, p = 0.001), irregular dental visits (IRR = 1.19, p = 0.001), infrequent tooth-brushing (IRR = 1.17, p = 0.007), pain in mouth (IRR = 1.09, p = 0.031) and number of missing teeth (IRR = 1.13, p = 0.007). The prevalence of high DA was lower in dental students than in medical students. DA was associated with sex, mother’s education, poor oral health behaviour and self-assessed and clinically assessed oral health.

A Cross-sectional Study to assess the Perception of Psychosocial Elements among Pediatric Patients visiting Dental Clinics

INTRODUCTION

Children with high dental fear and perception usually encounter high prevalence of dental caries. Data showed that individuals with dental fear will probably defer dental appointments which may result in the formation of a setup of an endless loop of dental fear. Present study was aimed to assess different psycho-social parameters among pediatric patients visiting dental clinics.

MATERIALS AND METHODS

In the present cross-sectional study, the data of 200 schoolchildren were collected and analyzed by means of a questionnaire. Evaluation of the oral health status was done by experienced pedodontists. All the answers were recorded and analyzed by Statistical Package for the Social Sciences (SPSS) software.

RESULTS

Nearly 120 were regular attendees while remaining 80 were found to be irregular attendees. Significant difference was observed while comparing the decayed, missing, and filled teeth (DMFT) index, decayed teeth, dental fear, cognitive vulnerability, and dental prevention belief between the regular and irregular group. Significant correlation was observed between higher number of decayed teeth and increasing level of dental fear.

CONCLUSION

Various psychosocial parameters, by affecting the dental visits, are associated with outcome of oral health measures.

CLINICAL SIGNIFICANCE

Special attention should be paid to the pediatric patients with such kind of behavior so that their psy-chosocial attitude could be modified in favor of dental treatment.

Dental insurance, service use and health outcomes in Australia: a systematic review

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.

The role of cognitions in short-term temporal changes in dental fear among Australian adults

OBJECTIVES

To determine if temporal changes in dental fear over a 4-month period are predicted by changed cognitive vulnerability-related perceptions of going to the dentist.

METHODS

Australian adults (n = 484) completed mailed questionnaires at baseline and follow-up, containing measures of dental fear, cognitive vulnerability-related perceptions, dental services received, and possible aversive experiences during the study period. Change in dental fear was the main outcome measure, categorized as decreased (Fear^- ), unchanged (Fear⁰ ), and increased (Fear⁺ ).

RESULTS

Across the study period, 15.5 percent of people had Fear^- , 73.4 percent had Fear⁰ , and 11.1 percent had Fear⁺ . In a multinomial logistic regression, after controlling for participant gender, income, time since last dental visit at baseline, dental fear at baseline and experiencing an aversive event, increased vulnerability-related perceptions were significantly associated with Fear⁺ (OR = 2.83, P < 0.001) while decreased vulnerability-related perceptions were associated with Fear^- (OR = 0.17, P < 0.001).

CONCLUSIONS

This study found, across a relatively short 4-month period, that increased vulnerability-related perceptions of visiting the dentist predicted increased dental fear while decreased vulnerability-related perceptions predicted decreased dental fear. More appropriate study designs, such as longitudinal designs, and longer follow-up periods are needed to determine the possible causal nature of these associations.

Individualized intervention to reduce anxiety in adult orthodontic patients based on Q methodology

INTRODUCTION

In this study, we used Q methodology to assess the concerns of adults seeking orthodontic treatment and to determine individualized interventions to reduce their anxiety.

METHODS

Statements of concern were derived by in-depth interviews with 70 adult patients. Q sorting methodology was then used to identify the main factors associated with anxiety in a cohort of 40 adults who had not been involved in the first part of the study. The final stage involved a randomized study in which 160 new adult patients were recruited and randomized into intervention and control groups. Participants in the intervention group sorted the statements, after which individualized interventions were implemented. Participants in the control group received routine treatment. The State-Trait Anxiety Inventory was used to measure changes in participants' anxiety levels before and during treatment.

RESULTS

In total, 41 statements were identified, and participants were classified according to 5 factors. Factor 1 participants were concerned about the lack of treatment information; factor 2 represented concerns about cost and other people's opinions; factor 3 represented concerns about impact on work related to wearing braces; factor 4 encompassed concerns about treatment effects, pain, and dental fears; and factor 5 reflected concerns about side effects and finding a partner. The mean state anxiety inventory scores for both the intervention and control groups were highest 24 hours after bonding (intervention group, 44.63 ± 4.49; control group, 49.43 ± 5.42). The intragroup state anxiety inventory scores differed significantly across the 6 time points (P <0.01), with the state anxiety inventory scores of the intervention group significantly lower than those of the control group (P <0.01) at all time points except baseline. No significant intergroup or intragroup differences were found in relation to trait anxiety.

CONCLUSIONS

Adult orthodontic patients expressed diverse concerns. Individualized interventions based on Q methodology may reduce anxiety in this patient population.

Does the trait anxiety affect the dental fear?

The aims of the present study were to evaluate possible associations between trait anxiety, dental fear and the predictors of these interactions including demographic characteristics and dental history of patients applied to the dental care center in Ankara, Turkey. A sample of 607 participants (mean age: 21.02 ± 2.32) responded to a Turkish version of the Modified Dental Fear Survey (MDFS), the State-Trait Anxiety Inventory (STAI-T) and a questionnaire regarding previous negative dental experience. Multiple logistic regression analysis was used to identify the association between dental fear and the independent variables including trait anxiety, age groups, education level, dental visit frequency, experience and the source of dental knowledge. There was a trend for increasing in trait anxiety scores with greater levels of dental fear in a medium level of the dental fear group (OR = 1.055, 95%CI [1.025-1.086]; p < 0.001) and in a high level of the dental fear group (OR = 1.090 [1.057-1.124]; p < 0.001). Comparing to the low level of dental fear group; participants of medium dental fear level intended more likely to go to the dentist when they have a complaint instead of regularly going (odds ratio; OR = 3.177, 95%CI [1.304-7.741]; p = 0.011). Participants of high dental fear level tended to be less likely to have experienced no problem (OR = 0.476, 95%CI [0.284-0.795]; p = 0.005) than the low level of the dental fear group. We strongly indicate that higher dental fear scores have a predisposition of having high trait anxiety scores. Unpleasant dental experiences increased the risk for high dental fear levels. Patients with dental fear tended only to visit a dentist when necessary, avoiding regular visits.

Periodontal Status and Quality of Life: Impact of Fear of Pain and Dental Fear

Background. Oral health-related quality of life (OHRQoL) is impacted by periodontal disease and orofacial pain. There is a limited research examining the impact of avoidance of care or physiological arousal related to the fear of pain response on periodontal-related OHRQoL. Methods. Data are from the Center for Oral Health Research in Appalachia family-based study focusing on 1,339 adults. Measures included a modified Periodontal Screening and Recording Index across sextants of dentition, dental fear survey, Fear of Pain Questionnaire-9, and Oral Health Impact Profile-14. Structural equation modeling was used to estimate the effects of periodontal disease screening indicators on OHRQoL including the mediating role of dental fear while accounting for fear of pain. Results. A significant total effect was found for the mandibular anterior sextant, components of dental anxiety/fear, and indicators of OHRQoL (pain and discomfort, β = .165, p = .001; psychosocial impact, β = .199, p < .001). The maxillary anterior region was significantly associated with pain discomfort (β = .116, p = .017) and functionality (β = .130, p = .011). Conclusions. Findings provide a granular perspective of periodontal disease indicators and OHRQoL. Dental avoidance/anticipatory fear and physiological arousal mediate OHRQoL in individuals who have indicators of periodontal disease in sextants that may be visible and susceptible to higher pain and psychosocial impact.

Dental Anxiety among Medical and Paramedical Undergraduate Students of Malaysia

Aim. To assess the dental anxiety level among dental, medical, and pharmacy students of MAHSA University, Malaysia. Materials and Methods. A cross-sectional questionnaire study was conducted among 1500 undergraduate students of MAHSA University. The Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety among the study population. The responses were assessed by 5-point likert scale ranging from 1 to 5. The level of anxiety was categorized into lowly anxious (5-11), moderately anxious (12-18), and severely anxious ≥19. Out of 1500 students enrolled, 1024 students (342 males and 682 females) completed and returned the questionnaire having response rate of 68.26%. Results. There was a statistically significant difference (P < 0.001) when the mean dental anxiety scores were compared among the three faculties and dental students had lowest mean score (11.95 ± 4.21). The fifth year (senior) dental students scored significantly (P = 0.02) lower mean anxiety score as compared to the first dental students (junior). The students were anxious mostly about tooth drilling and local anesthetic injection. Conclusions. Dental students have a significantly low level of dental anxiety as compared with medical and pharmacy students. Incorporation of dental health education in preuniversity and other nondental university curriculums may reduce dental anxiety among the students.

Oral health and dental anxiety in a German practice-based sample

OBJECTIVE

Does dental anxiety have an effect on dental and periodontal health?

METHODS

Survey data was collected from n = 200 adults (53 % females, average age 49 years) in a cross-sectional study. Dental anxiety was measured with the modified dental anxiety scale (MDAS, score 1-5, the greater the score, the greater the anxiety). Clinical parameters including probing depth (PD), clinical attachment level (CAL), plaque index (SLI), and bleeding on probing (BoP) as well as the DMFT index were recorded and statistically analyzed.

RESULTS

Rating of dental anxiety was higher in women than in men (65 vs 35 %). Subjects with higher MDAS values visited the dentist less frequently (p = 0.001) and had more decay (DT 6.7 ± 4.2 vs 1.7 ± 2.4; p < 0.001) but fewer filled teeth than subjects with lower ratings of dental anxiety (FT 7.1 ± 4.5 vs 9.8 ± 5.7; p = 0.042). There were no differences in PD or CAL between subjects with or without dental anxiety, while patients with higher MDAS value showed significantly more BoP (50 ± 19 vs 34 ± 20 %; p = 0.002) than patients with low MDAS scores (no or low dental anxiety).

CONCLUSIONS

Patients with higher ratings of dental anxiety had significantly more caries experience and gingivitis. Therefore, dental anxiety is associated with negative effect on dental and periodontal health.

CLINICAL RELEVANCE

Identifying patients with high dental anxiety and helping to manage this anxiety has important implications to improve oral health in adults. The MDAS appears to be an easy and efficient tool that can be used to identify patients with dental anxiety in dental practices.

Parallel study about the effects of psychotherapy on patients with dental phobia determined by anxiety scores and saliva secretion and composition

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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