Fear of dentistry

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.

Efficacy of aromatherapy on dental anxiety: A systematic review of randomised and quasi-randomised controlled trials

OBJECTIVES

To evaluate the efficacy of aromatherapy on dental anxiety.

METHODS

A detailed protocol was registered a priori (PROSPERO: CRD42019141093). PubMed, EMBASE, CDSR, CENTRAL, CNKI and grey literature databases were searched from inception to 10 January 2020. Randomised controlled trials (RCTs) and quasi-randomised controlled trials (CCTs) that examined the effects of aromatherapy on dental anxiety, compare to either negative control (i.e. no aromatherapy) or other positive control approaches (e.g. music), were included. The risk of bias of the selected studies was evaluated using the Cochrane Collaboration's tool and ROBINS-I, while the certainty of evidence was assessed using GRADE. A narrative synthesis was performed, rather than meta-analysis, due to the high level of heterogeneity across studies.

RESULTS

Eleven RCTs and six CCTs were included. The risk of bias was identified as either high or unclear in RCTs, and moderate to serious in CCTs. Performance bias and detection bias were the most prevalent in RCTs, followed by selection bias and reporting bias. As to CCTs, greater risk of bias was found in the selection of participants into the study and in the measurement of outcomes. Based on the selected studies, the most commonly used aromatherapy for dental anxiety management was lavender fragrance, followed by orange. Compared to the negative control condition, aromatherapy might reduce the anxiety-related physiological parameters and psychometric rating, pain, and mood, alertness, and calmness compared to the negative control condition; and there might be no intergroup difference in such outcomes between aromatherapy and music. However, GRADEs of the relevant evidence were judged as low to very low.

CONCLUSIONS

Compared to the negative control condition, aromatherapy is more effective to reduce dental anxiety and has comparable effects on dental anxiety compared to music intervention; however, the certainty of evidence is relatively limited. Further high-quality randomised trials with robust study design and large sample size are warranted to confirm our findings and to confirm the role of aromatherapy in relieving dental anxiety.

Dental Anxiety among Israeli Postgraduate Pediatric Dental Students and their Instructors

Objective: To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety. Study design: Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on sociodemographic information, dental anxiety scale (DAS) and dental fear survey (DFS). Results: The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentist's office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar. Conclusions: Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.

Dental Anxiety Among Israeli Postgraduate Pediatric Dental Students and their Instructors

OBJECTIVE

To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety.

STUDY DESIGN

Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on socio demographic information, dental anxiety scale (DAS) and dental fear survey (DFS).

RESULTS

The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentist's office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar.

CONCLUSIONS

Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.

The role of memory on the dentally anxious patient's response to dental treatment

The aetiology of dental anxiety is multifactorial. Psychologically traumatising events associated with dental treatment have been shown to be of particular importance. The present investigation examines the role of memory in relation to these traumatic episodes and investigates their influence on the patient's response to dental treatment.

The study has shown that patients with dental anxiety have had more experience of “traumatic dental events” (p<0.001), relate the cause of their dental anxiety to specific dental procedures and report more fear of dental treatment than controls. The memories of such traumatic dental events are important indicators of anxiety in the clinical setting, with dentally anxious patients having significantly higher scores for dental anxiety (p<0.001) compared with controls. Furthermore, the memories of these events have a special relevance to the patient's subjective experience of dental anxiety in the here and now. The past event sensitises the susceptible patient and maintains and intensifies the anxiety through a feed-back mechanism, resulting in a vicious circle of anticipatory dental fear.

Current sedation practice among general dental practitioners and dental specialists in Jordan: an example of a developing country

Purpose

The study reported here aimed to identify current sedation practice among general dental practitioners (GDPs) and specialist dental practitioners (SDPs) in Jordan in 2010.

Methods

Questionnaires were sent by email to 1683 GDPs and SDPs who were working in Jordan at the time of the study. The contact details of these dental practitioners were obtained from a Jordan Dental Association list. Details on personal status, use of, and training in, conscious sedation techniques were sought by the questionnaires.

Results

A total of 1003 (60%) questionnaires were returned, with 748 (86.9%) GDPs and 113 (13.1%) SDPs responding. Only ten (1.3%) GDPs and 63 (55.8%) SDPs provided information on the different types of treatments related to their specialties undertaken under some form of sedation performed by specialist and/or assistant anesthetists. Approximately 0.075% of the Jordanian population received some form of sedation during the year 2010, with approximately 0.054% having been treated by oral and maxillofacial surgeons. The main reason for the majority of GDPs (55.0%) and many SDPs (40%) not to perform sedation was lack of training in this field. While some SDPs (26.0%) indicated they did not use sedation because of the inadequacy of sedative facilities.

Conclusion

Within the limitations of the present study, it can be concluded that the provision of conscious sedation services in general and specialist dental practices in Jordan is inconsistent and inadequate. This stresses the great need to train practitioners and dental assistants in Jordan to enable them to safely and effectively perform all forms of sedation.

Effectiveness of music interventions on dental anxiety in paediatric and adult patients: a systematic review

BACKGROUND

Dental anxiety has been identified as a significant and common problem in both children and adults and is considered an obstacle for dental care providers in the delivery of quality oral care. Patients with dental anxiety tend to avoid professional dental care which poses a problem for dentists and patients alike.There are various treatment options for reducing dental anxiety. Music has been used in different medical fields to meet physiological, psychological, and spiritual needs of patients. Music interventions can either be passive (music listening) or active music (therapy).There was a significant gap in the literature on the effectiveness of music therapy and music listening in reducing dental anxiety in patients undergoing various dental treatments/procedures. This systematic review specifically examined the effectiveness of music interventions in reducing dental anxiety in both paediatric and adult patients.

OBJECTIVE

The objective of this systematic review was to critically appraise, synthesise and present the best available evidence related to the effectiveness of music interventions on dental anxiety in paediatric and adult patients.

DATA SOURCES

A comprehensive search was undertaken on major electronic databases from their inception to October 2010. The search was restricted to English language and other languages where a translation was available from colleagues (for e.g. Chinese, Japanese, and Italian).

REVIEW METHODS

Randomised controlled trials, quasi-randomised controlled trials and quasi-experimental studies were included in the review. Critical appraisal and data extraction were undertaken using the Joanna Briggs Institute critical appraisal instrument and the standard data extraction form for evidence of effectiveness.

RESULTS

Seven studies with a combined total of 598 patients were included. Two out of the seven studies were RCTs, four quasi-randomised and one quasi-experimental study. There were 513 adult patients as participants from five studies and 85 paediatric patients from two studies. The results were classified into two categories.Two studies had paediatric patients as population group. One study found that music listening did not result in any reduction of anxiety during dental procedures on young patients; therefore the authors concluded that music alone is ineffective as a distraction during dental procedures. However, another study found that music reduced anxiety to some extent, although it was not significant.Five studies included in this review had adult patients as population group. Two studies concluded that relaxation when compared to music is an effective method of reducing patient's anxiety. One study concluded that music listening significantly lowered levels of anxiety and stress of females during dental procedures. Authors of the study concluded that there was a strong physiological (increased secretory immunoglobulins level) response to music by females. Two other studies provided conclusive evidence on effectiveness of music in reducing dental anxiety in this population group.

CONCLUSIONS

This systematic review concluded that there was enough evidence to suggest that adult patients may benefit from a procedural music-listening program. There was inconclusive evidence on the effectiveness of music in reducing dental anxiety in children.

IMPLICATIONS FOR PRACTICE

It is recommended that pre-recorded music be offered through headphones during the dental procedure to adult patients to reduce their dental anxiety. The evidence on the effectiveness of music in reducing dental anxiety in children is inconclusive.

IMPLICATIONS FOR RESEARCH

More research needs to be performed before it is possible to show, with a higher degree of certainty, that music listening does have a significant effect on the reduction of dental anxiety. Future studies, most likely randomised controlled trials should evaluate music therapy as an intervention for managing dental anxiety.

Memory of pain and anxiety associated with tooth extraction

Concerns regarding pain constitute a large component of dental anxiety, and patients with high dental anxiety are likely to have exaggerated memory and prediction of dental pain. It remains to be investigated, however, if memory of anxiety is exaggerated in a manner similar to that of pain, and if anxiety and pain assimilate in memory over time. A sample of 79 patients presenting for emergency extraction rated their anxiety and pain before, during, and two weeks after the procedure. Measures of trait dental anxiety and fear of pain also were collected. All patients exaggerated their recall of procedure pain, but only those high in trait dental anxiety exaggerated their recall of anxiety. Highly anxious patients reported more pain prior to the procedure and expected more pain; ratings of anxiety and pain for all participants assimilated over time.

Treatment of Dental Fear: Systematic Desensitization or Coping?

Thirty-two extremely anxious dental patients were given a modified form of systematic desensitization. In order to evaluate the importance of cognitive factors, a procedure of cognitive coping was added to the therapy program for half of the patients. Results show that treatment outcome was significantly better for the group without the addition of coping elements. It is suggested that the adverse effect observed may reflect an interference by the cognitively-oriented therapeutic activities with an otherwise effective therapeutic process.

Factors affecting dental anxiety and beliefs in an Indian population

The purpose of this study was to describe the possible factors that may affect dental anxiety and beliefs and to validate and test the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and a Modified Dental Beliefs Scale (MDBS) among the patients attending a university dental clinic in India. A cross-sectional study design was used. A total of 482 general dental patients attending a university dental clinic returned completed forms of the Indian translations of the MDAS and MDBS. General information about the age, sex, occupation and educational qualifications of the respondents as well as information about past dental experiences was also collected. All the statistical analysis was carried out by the spss (version 10) statistical software package. The Indian translations of the MDAS and the MDBS were found to be internally reliable with a Cronbach's alpha of 0.78 and 0.85, respectively. Validity was demonstrated by a statistically significant correlation between the MDAS and the MDBS scores with the correlation coefficient of 0.47. Age was also inversely related to dental anxiety. Anxiety scores were higher among the less educated patients. Those who had a prior unpleasant dental experience showed higher dental anxiety and more negative dental beliefs. The data obtained in this study provided strong evidence for the psychometric properties of the Indian version of the MDAS and the MDBS.

What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.

Current state of sedation/analgesia care in dentistry

PURPOSE OF REVIEW

Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field.

RECENT FINDINGS

The literature in the last 12 months falls into four main categories: dental anxiety and its influence on patient care, dental sedation for children, sedation with benzodiazepines for dentistry, and intravenous propofol sedation for dentistry.

SUMMARY

Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.

Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A two-wave panel study

OBJECTIVE

To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire.

BASIC RESEARCH DESIGN

Patients were initially screened to include only those who were dentally anxious. A pre- and post-test was planned with the completion of the Modified Dental Anxiety Scale (MDAS) questionnaire as the intervention.

CLINICAL SETTING

Two dental access centres in the North West of England.

PARTICIPANTS

Initially, 583 patients were screened. Of these, 182 (31%) were found to be dentally anxious and were recruited into the study.

MAIN OUTCOME MEASURES

State-Trait Anxiety Inventory Scale Short Form.

RESULTS

State anxiety did not change with the completion of the MDAS questionnaire in either designated dental phobics (MDAS >or=19) or those classified as non-phobics (MDAS <19).

CONCLUSIONS

The MDAS can be used to assess dental anxiety without raising anxiety in patients with or without self-reported dental phobia.

Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population

OBJECTIVES

Fear of dentistry is a common obstacle to obtaining dental care in Turkey. The aim of this study was to assess the reliability, validity and psychometric characteristics of the Turkish translation of the Modified Dental Anxiety Scale (MDAS) and compare it to the Dental Fear Survey (DFS) scores obtained in the same population.

METHODS

The Turkish translated version of the MDAS was administered to 115 dental patients; 21 subjects who suffered from dental phobia, requiring general anesthesia for dental procedures, and 94 who did not have dental anxiety, in addition to 442 subjects from the general population.

RESULTS

The Turkish translated version of the MDAS was internally consistent and reproducible. The patients with dentist phobia had the highest score. The Turkish MDAS correlated with the DFS (r = 0.80, P < 0.001). The MDAS scale correlated inversely (r = -0.14, P < 0.005) with level of education; however, it did not correlate with economic status. Women scored higher than men on the scale (mean = 12.3, SD = 5.2 vs. mean = 10.9, SD = 4.5, P < 0.005). At a cut-off point > or = 15, sensitivity was 0.80, specificity 0.74, positive predictive value 0.41 and negative predictive value 0.94.

CONCLUSION

Although the specificity values were low, the Turkish MDAS demonstrated acceptable sensitivity, positive and negative predictive values. Thus, high reliability and validity of the MDAS supports its cross-cultural validity and indicated that it may be a valuable tool in quantifying fear of dentistry among Turks.

The way forward for dental sedation and primary care?

OBJECTIVES

Firstly to determine the current provision of sedation in primary dental care in an area of Scotland without local secondary care support and secondly, to investigate dental practitioners' desire for formal postgraduate training in sedation techniques.

DESIGN

A prospective postal questionnaire-based study.

SETTING

Grampian Primary Care NHS Trust, UK, 2001.

SUBJECTS

Questionnaires were sent to all NHS dental practitioners and community dental service clinicians (N = 194] employed through Grampian Primary Care NHS Trust, Scotland during March - April 2001. The questionnaires sought details about personal status and the use and perceived need for conscious sedation techniques in practice in addition to the stated desire for postgraduate training in sedation techniques.

RESULTS

One hundred and thirty-six questionnaires were returned (70%). Forty-nine per cent of respondents reported current sedation use, with intravenous sedation the favoured technique (82%), followed by oral sedation (33%) and inhalation sedation (19%). Seventy-four per cent of participants considered that there was a need for sedation in their own practice and 68% were interested in further postgraduate training in sedation techniques.

CONCLUSION

Nearly three-quarters of practitioners who responded felt that there was a need for sedation in their own practice, although less than half were able to offer sedation to their patients. Nearly 70% of practitioners felt there was a need for postgraduate training in sedation techniques.

A clinical evaluation of an Erbium:YAG laser for dental cavity preparation

OBJECTIVE

A randomised controlled trial to determine the acceptability to dentists and patients of cavity preparation with an Erbium:YAG laser as compared with conventional handpieces.

METHODS

Fifteen dentists (9 GDPs, 1 community dentist and 5 hospital dentists) treated 77 patients (age range 3.5-68 years old) who had two matched cavities, in a split mouth, randomised trial. One cavity was prepared conventionally, the other with the laser, with dentist and patient preference determined by questionnaire.

RESULTS

In the majority of cases, where dentists expressed a preference, it was for conventional cavity preparation, and this was significant (P < 0.001). In more than half of the laser appointments, dentists had to use conventional handpieces to complete the cavity. Principle difficulties reported with the laser were access (25 cases) and slow speed of cutting (11 cases). Patients aged > or = 10 years who expressed a preference, preferred laser treatment, and this was significant (P < 0.001). Patients aged < 10 years, assessed using a simplified pictorial questionnaire, did not show a significant preference for either technique.

CONCLUSIONS

Dentists preferred conventional handpieces for cavity preparation while patients aged > or = 10 years old preferred laser treatment. Patients < 10 years old did not express a preference.

Dental anxiety among young adolescent patients in Israel

AIM

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

SAMPLE AND METHOD

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

RESULTS

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

CONCLUSIONS

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

Non-institutionalized elderly dental patients in Israel: socio-demographics, health concerns, and dental anxiety

The purpose of this study was to evaluate which factors might influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non-institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one-year period. Socio-demographic information and information about the subjects' general health and their level of concern about health problems were obtained from self-reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety-nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both unmarried and first-time patients expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.

Dental anxiety among patients prior to different dental treatments

The purpose of the present study was to evaluate dental anxiety among patients anticipating various dental treatments. One hundred and eighty patients who were scheduled for specific dental treatments at the School of Dental Medicine, the Hebrew University--Hadassah, Jerusalem, Israel participated in the study. Patients were anticipating one of the following dental procedures: scaling, filling, root canal therapy, preparation for crown, periodontal surgery or extraction. For each of the six dental treatments, 30 patients were selected at random. Dental Anxiety Scale (DAS) questionnaires were completed by the patients while waiting for their treatments. The results indicated that extraction caused the highest score, followed by scaling (though not significantly). Patients in the 35 to 49 year age group showed the highest total DAS scores. Women demonstrated higher total DAS scores than men. The relative influence of gender, type of treatment and age on the anxiety scores is demonstrated by using logistic regression, which revealed gender to have the strongest impact on the DAS scores, followed by the type of treatment and age.

Dental anxiety among patients undergoing endodontic treatment

The purpose of this study was to evaluate the dental anxiety expressed among patients undergoing endodontic treatment with respect to some social and dental parameters. The dental records of 98 patients, 42 men and 56 women who were referred for root canal treatment to an endodontist, were examined. Patients completed a Dental Anxiety Scale (DAS). Dental experience, time of last visit to the dentist, and symptoms of tooth were recorded. The mean DAS scores were higher than scores reported in other countries (9.4 +/- 3.3). Women demonstrated higher dental anxiety than men. Patients with higher education demonstrated lower dental anxiety. No difference was found between patients experienced in endodontic treatment and those who were not, patients who suffered previous pain in the treated tooth and patients who did not. Women in their mid-thirties to mid-forties and men in their twenties expressed the highest DAS scores.

Dental fear and anxiety in an adult Icelandic population

This study was carried out on a random sample drawn from participants in a population-based survey in Reykjavík, Iceland. The sample consisted of 1548 people, men and women, born in 1914-63 (age range, 25-74 years) who lived in and around Reykjavík and a rural area in southern Iceland. The results from a single, modified Dental Anxiety Question (DAQ), designed to classify fear or anxiety into five different levels or categories, were compared with respect to age, oral status, extent of edentulousness, and education level. Of the whole sample 10% admitted to having considerable or more than considerable fear, while 5% classified their fear as extensive or more than extensive. Only 0.3%, however, said that it prevented dental visits. Fear was influenced by sex, as significantly more women experienced some level of fear (P < 0.001) and described their fear as considerable or extensive (P < 0.001). Fear was more common in the younger age groups among both sexes. A significant correlation was found between the number of decayed teeth and anxiety among the men, and patients of both sexes who admitted to fear had significantly fewer fillings. Fear was significantly more common in the rural than the urban population (P < 0.001). Edentulousness, or number of remaining teeth, did not seem to be significantly reflected in the extent of dental fear. People with higher education levels reported less dental fear.

Liaison psychiatry and psychology in dentistry

Dentists are trained to provide treatment for patients with straightforward problems that respond to routine therapy and do not recur. However, patients may present to dentists and complain solely of physical symptoms such as toothache, headache, and facial pain: only after much inappropriate treatment these symptoms are revealed to be due to emotional disturbance. The dentist may spend hours investigating such patients, in some of whom dental pathology may be present, but the symptoms and ensuing disability cannot be satisfactorily explained as a result. There are other patients who are preoccupied by physical symptoms or by their appearance. In others, anxiety may manifest itself as a phobia, or a dysmorphic concern about certain aspects of their appearance. This article reviews the role of liaison psychiatry and psychology in dentistry.

Dental anxiety among adolescents in St. Petersburg, Russia

This small-size epidemiologic investigation examined the prevalence and etiology of dental fear and anxiety among 288 schoolchildren aged 13-18 years in St. Petersburg, Russia. The adolescent population was collected from a larger sociological investigation performed in Russia during the early period of reforms. The investigation revealed a comparatively elevated anxiety level with an average DAS score of 10.0 and a prevalence of high dental fear of 12.6%. The present study showed that the origin of dental anxiety as reported by adolescent, urban Russians parallels much of previous results from the US and Western Europe. Thus, the etiology of dental anxiety was related to negative dental experiences and this conditional learning seemed to be especially prevalent in the presence of previous oral pain experiences and an existing dental anxiety in the family.

Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state, utilisation of dental services and concomitant factors

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Göteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS > or = 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hällström and Halling in their analysis of data from the first Göteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.

Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale

This study analyzed and assessed dimensions of a questionnaire developed to measure general fears and phobias. A previous factor analysis among 109 dental phobics had revealed a five-factor structure with 22 items and an explained total variance of 54%. The present study analyzed the same material using a multivariate statistical procedure (LISREL) to reveal structural latent variables. The LISREL analysis, based on the correlation matrix, yielded a chi-square of 216.6 with 195 degrees of freedom (P = 0.138) and showed a model with seven latent variables. One was a general fear factor correlated to all 22 items. The other six factors concerned "Illness & Death" (5 items), "Failures & Embarrassment" (5 items), "Social situations" (5 items), "Physical injuries" (4 items), "Animals & Natural phenomena" (4 items). One item (opposite sex) was included in both "Failures & Embarrassment" and "Social situations". The last factor, "Social interaction", combined all the items in "Failures & Embarrassment" and "Social situations" (9 items). In conclusion, this multivariate statistical analysis (LISREL) revealed and confirmed a factor structure similar to our previous study, but added two important dimensions not shown with a traditional factor analysis. This reduced FSS-II version measures general fears and phobias and may be used on a routine clinical basis as well as in dental phobia research.

Dental anxiety in Danish and Chinese adults--a cross-cultural perspective

The aim of this study was to correlate dental anxiety as reported by two different ethnic groups with socio-demographic factors, dental status, and dental behaviour. Two randomly selected populations aged 35-44 years and 65-74 years were interviewed. The populations comprised 214 and 99 Danes and 384 and 497 Hong Kong Chinese respectively. Dental anxiety was assessed by the Corah Dental Anxiety Score (DAS). Mean DAS scores were significantly higher in Chinese than in Danes (8.7-10.3 and 6.7-8.2, respectively) and higher in the younger than in the older groups. Moderate to phobic dental anxiety was reported by 15% of the Danes and 30% of the Chinese, the latter proportion far beyond what is usually reported in Western populations. Only in the Chinese group did women report more anxiety than men. Regression analysis indicated that only a few of the variables selected to explain anxiety determinants had significant explanatory value. Among Chinese, gender was the most predominant in both age groups followed by perceived condition of teeth in the younger age group. Among Danes, perceived condition of teeth had an explanatory value for both age groups and dental visit pattern was the strongest for the younger age group. In spite of statistical significance, all explanatory values were small and indicate that variables not included in this analysis may exert a greater influence on the variation in dental anxiety. DAS, seemingly, was able to highlight variations in dental anxiety in the populations in spite of their differences and made interpretations feasible with regard to contrasting dental care behaviour and dental status.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations in blood pressure and pulse rate in exodontia patients

The measurement of blood pressure and pulse rate prior to, during and after exodontia was conducted on 60 healthy patients. The aims were to first, investigate the changes in blood pressure and pulse rate, and second, to observe the presence of any clinically significant change over time. Thirty patients attending an Oral Medicine Clinic were used as the control group to allow a comparison to be made between the effects of exodontia and non-invasive treatment. The results suggested that exodontia was the most stressful part of the procedure. Bradycardia during local analgesia was also noted. These changes in the cardiovascular parameters may represent a risk to patients with heart diseases especially those previously undiagnosed. Further, the results indicate the effect stress can have on the cardiovascular system and the importance of eliminating pain and minimizing patient anxiety.

Some problems of dental treatment. Part 2. Treatment avoidance: some differences between regular and irregular patients

Analysis of questionnaire data obtained from 54 irregular patients and 56 regular patients attending the Dental Department of the Lower Hutt Hospital and private practices in Lower Hutt and Wellington, New Zealand indicates that irregular patients are more anxious about dental treatment, value natural teeth less and find dental treatment more unpleasant than do regular patients. These and other survey findings on dental service utilization and dental anxiety suggest that the dental profession has a good deal of control over the way the public utilizes dental services. Most international surveys have found that less than 60 per cent of the population visits the dentist regularly, so there appears to be the potential for a substantial increase in regular use of dental services by the public. But, it is also likely that the longer an individual is remiss in regular dental care and the more teeth are lost, the more difficult conversion to regular visits will be.

Appraisal of dental anxiety and fear questionnaires: a review

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

Some problems of dental treatment. Part 1. Patient anxiety: some correlates and sex differences

An analysis of questionnaire data obtained from 110 adult patients attending the Dental Department of the Lower Hutt Hospital and four private dental practices in Lower Hutt and Wellington, New Zealand indicates that patient treatment anxiety is more severe in women than men and that it is correlated with patients' descriptions of dental treatment. Altogether, survey findings indicate that treatment anxiety has adverse effects and that, with few exceptions, it results directly or indirectly from unpleasant experiences during dental treatment. Two of the most common of such experiences are evidently pain arising from the stimulation of sensitive tissue and oral injections. The eradication of treatment anxiety is therefore heavily dependent on the unobtrusive induction of profound analgesia prior to painful procedures.

What do anxious patients think? An exploratory investigation of anxious dental patients' thoughts

According to BECK's cognitive model of emotional disorders (1976) anxiety is associated with negative and threatening thoughts concerning the likelihood of personal danger. In the present study the content of thoughts of 32 anxious dental patients was investigated. Patients' mean score for the Dental Anxiety Scale was 17.1 (SD = 2.0). The average time period patients had not visited a dentist was 9.1 yr (SD = 8.7). Using semi-structured interviews 132 thoughts were explored. The mean number of thoughts reported per patient was 4.1 (SD = 1.6). Almost all patients reported thoughts in some way related to their fear. All patients except one reported self-verbalizations of a negative or catastrophizing nature. Nine different categories of the content of the thoughts were identified. Nine percent of the thoughts consisted of visual images. The largest category (23%) consisted of catastrophic thoughts about the patient's own functioning during dental treatment, e.g., thoughts about losing control, panicking and dying. Fifty-nine percent of the patients reported thoughts of this type. The findings provide support for BECK's cognitive model of emotional disorders.

Cross validation of a Brazilian version of the Dental Fear Survey

The Dental Fear Survey (DFS), a paper and pencil instrument for assessing dental fear and avoidance, has been widely used and validated in fear studies in the US. However, before such instruments are used in countries and cultures dissimilar to the one in which it was developed, they should be cross-validated in that culture. The present study is an examination of the DFS response characteristics in a group of 374 Brazilian university students. Factor analysis of the DFS revealed three factors essentially identical to those found among university students in the US and in Singapore, as well as among US adult dental patients. Higher DFS scores were significantly associated longer intervals since last dental visit. These results are taken as evidence that the DFS performs in this Brazilian sample very much as it does in other samples; and is thus, a valid indicator of dental fear at least among Brazilian university students.

Anxiety about dental hygienist treatment

Although dental anxiety is a well investigated phenomenon in dental health care, remarkably little is known about anxiety reactions related to treatment carried out by the dental hygienist. In the present study anxiety reactions were measured among 101 patients attending the dental hygienist. General level of anxiety was assessed through the PAQ (Photo Anxiety Questionnaire; STOUTHARD, DE JONGH & HOOGSTRATEN, 1991), whereas an additional questionnaire was used to obtain information about specific stimuli and situations that might provoke anxiety in the dental hygienist situation. The results indicated that during dental hygienist treatment only 15% of the patients experienced no feelings of anxiety. Another 15% of the patients reported that a visit to the dental hygienist was more distressing than dental treatment. The level of anxiety appeared to be strongly related to a number of stimuli and situations, with actual pain (78%) and expected pain (67%) major anxiety provoking factors. The relation between pain and anxiety was highly significant, with highly anxious patients having more fear for pain than their low anxious counterparts. Also feelings and sounds of instruments, patient's helplessness and perceived lack of control over what happens were identified as important contributors to anxiety for the dental hygienist treatment. The results of this study suggests that treatment by the dental hygienist is a distressing event for many patients.

Attendance pattern of anxiety-treated dental patients: a pilot study

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.

General and specific fears in referred and self-referred adult patients with extreme dental anxiety

The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.

Generalization of effects of dental fear treatment in a self-referred population of odontophobics

Effects of dental fear treatment on general anxiety and mood in 60 dental phobics with high and low general anxiety were compared with "attention" effects in 75 dental phobics on a waiting list using the Dental Anxiety Scale, a State-Trait Anxiety Inventory and a modified Fear Survey Schedule. Positive effects of the treatment were apparent in reduced dental and general fearfulness as well as elevated mood on numerous measures that paralleled dentist ratings of patient behavior. Ss had less fear of going to the next dentist after the program than before, according to a visual analogue measure. Ninety-three percent of Ss started dental treatment with private dentists within 1 year.

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

This study explored the relationships between Previous Dental Experience (PDE), Corah's Dental Anxiety Scale (DAS), the Dental Anxiety Question (DAQ), dispositional optimism as measured by the Life Orientation Test (LOT), and Clinical Behavioral Rating (CBR). The main purpose of the study reported here was to investigate the possible usefulness of the optimism-pessimism dimension in predicting clinical dental anxiety. 163 children aged 10-12 yr participated in the investigation. The results indicate that both self-reported dental anxiety and optimism-pessimism were unique contributers to prediction of behavioral ratings of dental anxiety.

A cross-cultural cross validation of the Dental Fear Survey in South East Asia

This study was designed as a cross-cultural replication and cross validation of the Dental Fear Survey (DFS) in two groups of Singapore adults: university students and military conscripts. Factor analysis of the DFS in each of these dissimilar samples revealed factor structures that were highly comparable to one another as well as to those obtained in the U.S.A. Behavioral and physiological fear assessment during exposure to simulated dental treatment also showed results comparable to those found in Western cultures. Self report measures were more likely to correlate with other self reports than with physiologic or behavioral measures. Among university students, those who had visited a dentist within the past year had significantly lower DFS scores than those who had avoided dentistry. The fear-avoidance relationship did not hold for military subjects who reported less dental fear overall. It was concluded that the DFS was factorially stable; and therefore, generalizable to this South East Asia culture.

Pre-school children with uncooperative behavior in the dental situation. Some characteristics and background factors

One hundred and eighty-six generally healthy pre-school children referred to a pedodontic clinic because of uncooperativeness in the dental situation were surveyed with regard to some characteristics and background factors considered of importance as possible origins of the uncooperative behavior. Information was gained from interviews with the referring dentists and the parents, from a developmental test of the child, and from dental records. In spite of a high prevalence of caries, dental treatment before referral was characterized by few restorative measures. The results also showed that the children constituted a heterogeneous group with regard to the variables studied. Further, the referring dentists represented various resources in terms of self-reported knowledge and time for treating this category of children. The data provide a basis for comparisons with a reference group, to be presented in a subsequent study.

Attitudes of some young female bank employees to dentistry

Structured interviews were undertaken with one hundred 18-30-year-old females, seeking their views on dental care. Almost all regarded their own past experience as affecting their general level of dental anxiety. Over half were anxious about visiting the dentist and almost all of these were anxious before entering the surgery. The Anxious emphasized the negative features in dental care and the practice environment whereas the Non-anxious concentrated on positive features, particularly their relationship with the dentist. Many spontaneously commented that their attitudes had been improved by changing dentists, although some still remained anxious. 'Worst visits' had frequently occurred early in their lives. Appearance was of prime importance; function was ignored. Interviewees believed that visiting the dentist would be eased by lower costs, more convenient hours, better surroundings in the practice and improved techniques to make dentistry more comfortable.