Dental anxiety and dental attendance among 25-year-olds in Norway: time trends from 1997 to 2007

Effects of dental anxiety and anesthesia on vital signs during tooth extraction

BACKGROUND

Anxiety is common preceding tooth extraction; hence, it is crucial to identify patients with dental anxiety (DA) and to manage DA. This study assessed the level of DA and influencing factors in tooth extraction patients in a dental hospital in China and changes in their blood pressure (BP) and heart rate (HR) during the tooth-extraction procedure.

METHODS

The study was a cohort study. The Dental Anxiety Scale (DAS) was used to assess the level of DA of 120 patients before tooth extraction. A Demographics and Oral Health Self-Assessment Form was used to assess factors influencing DA. The correlations of DAS scores with HR and BP were measured. The effects of local anesthesia and general anesthesia on HR and BP were also compared using a Datex-Ohmeda anesthesia monitor to detect HR and BP continuously before and after anesthesia. Independent sample t-tests, OLS multiple regression model and one-way analysis of variance were applied to analysis the results.

RESULTS

Based on the DAS score, 12.5% of the participants were identified as suffering from DA. DA was related to age, gender, and the self-assessment of oral health. The DAS score was correlated with increased BP (P < 0.05). BP showed an overall upward trend after local anesthesia, while it was generally stable after general anesthesia. The systolic BP at 4 and 5 min and the HR at 2 and 4 min increased remarkably (P < 0.05) after local anesthesia compared with those before anesthesia. The HR and BP of patients under local anesthesia were generally higher than those of patients under general anesthesia were during the operation.

CONCLUSIONS

The prevalence of DA in adults was 12.5% in this study population. DA was related to gender, age, and the self-assessment of oral health. The score of DAS was correlated with BP. Compare to local anesthesia, general anesthesia can make the vital signs of tooth extraction patients more stable.

Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies

AIM

To systematically review longitudinal studies investigating the impact of dental visiting patterns on oral health across the life course.

METHODS

Five databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL) were searched up to March 2023. Results were screened based on eligibility criteria in a two-stage process: title and abstract, and full-text review. A backward search of reference lists and a forward search of citations of the included papers was also conducted. The quality of the included papers was assessed using the Newcastle-Ottawa Scale. Key study information was extracted and a narrative synthesis of the findings was performed.

RESULTS

Eleven papers from five longitudinal studies in five countries (Australia, Brazil, China, New Zealand, Sweden) met the inclusion criteria. Studies of moderate to high quality consistently reported that regular dental attendance was associated with having less dental caries experience, fewer missing teeth and better oral health-related quality of life. Inconsistent findings were observed for decayed teeth, and no association was found for periodontal condition.

CONCLUSIONS

This review highlights an association between regular dental visiting pattern and improved oral health, notably less dental caries experience and better oral health-related quality of life. Dental attendance emerges as an important predictor of oral health across the life course, underscoring the importance of routine dental care.

REGISTRATION INFORMATION

The PROSPERO registration number is CRD42023396380.

Exploring avoidance of dental care due to dental fear and economic burden -A cross-sectional study in a national sample of younger adults in Norway

AIM

To assess the prevalence of dental avoidance due to dental fear and economic burden and its distribution by utilization of dental care and socio-behavioural characteristics.

METHOD

A sample of 9052 Norwegian adults aged 25-35 years was invited to participate, and 2551 completed electronic questionnaires regarding lifetime prevalence of dental avoidance due to fear and last year prevalence of dental avoidance due to economic burden.

RESULTS

Cancelled- and avoided ordering appointments due to fear amounted to 14.7% and 30.5%, respectively. Avoidance of dental visits due to cost was 37.7%. Frequency of cancelled appointments due to fear was 30% and 16.6% among participants attending dental care several times annually and seldom, respectively. Multiple logistic regression revealed that avoiding dental visits due to cost was less likely among participants with higher household income (OR 0.4, 95% CI 0.3-0.5) and more likely among participants with dental care need (OR 1.8, 95% CI 1.2-2.7). Cancelled and avoided appointments due to fear was most likely among those with need for dental care and lower education. Early unpleasant experience with dental care remained a covariate of avoidance behaviour due to fear.

CONCLUSION

14.7%, 30.5%, and 37.7% confirmed cancelled appointments due to fear, avoided ordering appointments due to fear, and avoided visiting the dentist due to cost. Avoiding dental care due to fear and economic burden was more and less common among participants with respectively, frequent and seldom use of dental care. Dental avoidance behaviours were highest among socially disadvantaged groups, indicating a hole in the welfare state model that needs political consideration.

Self‐reported factors for improving patient's dental care: A pilot study

Objectives

Patient‐centered approach can offer valuable information in improving dental care, but literature is scarce. This study aimed to evaluate self‐reported factors beneficial for attendance in dental care.

Material and Methods

Survey data were collected during the summer of 2020 comprising both structured questionnaires and an open question on factors considered beneficial for dental attendance. Voluntary patients over 15 years of age (n = 196, 98%) agreed to fill the questionnaires, and n = 112 of them (57%) also gave open commentary in an urgent dental care clinic, City of Oulu, Finland, comprising the study population. Dental fear was assessed by Modified Dental Anxiety Scale (MDAS) sum scores (min 5, max 25). All utterances (n = 181) on an open question were evaluated by inductive content analysis to create sub‐ and main categories. Covid‐19 pandemic case counts in Finland were low at the time of the survey, but their effect on seeking dental care was asked. The distribution of patients was evaluated by cross‐tabulation, considering their age, gender, and dental fear status; the significance level was p < .05.

Results

Females dominated slightly the study population (57%). The mean age of the respondents was 44 years. Half (50%) had moderate (MDAS score 10−18), and 10% had severe dental fear (≥19). The open responses could be categorized into four main categories. The largest main category by patient count concerned factors related to personnel (29%), followed by the patient (28%) and treatment (25%) related, and administrative factors (19%). Males chose factors falling into categories of administration and treatment while females chose patient and personnel‐related factors (p = .048). Compared to the rest, fearful persons (MDAS > 9) reported more often factors related to personnel and treatment (p = .03). Of all participants, 17% reported seeking less dental care during the pandemic.

Conclusions

Patients value dental personnel and treatment‐related factors, specifically those with fear.

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.

Treatment of Dental Anxiety and Phobia-Diagnostic Criteria and Conceptual Model of Behavioural Treatment

Dental anxiety and dental phobia are still prevalent among adult individuals and should be considered a dental public health issue. Dental anxiety/phobia is often described as a vicious cycle where avoidance of dental care, poor oral health, and psychosocial effects are common features, often escalating over time. Treatment should include therapy for dental anxiety/phobia and oral diseases. This paper discusses aetiology, prevalence, and diagnosis of dental anxiety/phobia and, in detail, presents a conceptual treatment model at the Dental Fears Research and Treatment Center in Gothenburg, Sweden. In addition, based on systematic reviews, evidence-based treatment for dental anxiety is revealed including the interdisciplinary approach between psychology and dentistry.

10-year follow-up study on attendance pattern after dental treatment in primary oral health care clinic for fearful patients

Background

Dental fear may lead to avoidance of regular dental treatment. The scope of this long-term practe-based study was to monitor the dental attendance of patients who received chair-side dental and fear treatment.

Methods

In 2000–2006, patients in the City of Oulu, Finland, received treatment for dental fear in the Clinic for Fearful Dental Patients (CFDP) from primary health care dentists trained on this subject. Of the originally treated patients (n = 163), 152 (93%) with sufficient information in dental records made up the study population. Information on their age and sex was available. The number of dental examinations, emergency visits and missed appointments was collected covering the follow-up period of 10 years 2006–2016. For analyses, data were dichotomized according to age at baseline and preliminary outcome baseline condition of dental fear treatment evaluated in 2006. To investigate association further, Poisson regression as well as binary logistic regression models were conducted. As register keeper, the City of Oulu gave permission for this retrospective data-based study.

Results

Patients receiving dental fear treatment at younger age (2–10 y) had significantly more dental examinations than those treated at > 10 years. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. Sex was not a significant factor in later dental attendance. There was an association between few dental examinations and dental emergency care need with unsuccessful baseline outcome of dental fear treatment.

Conclusions

Successful dental fear treatment especially at an early age is beneficial for future dental attendance measured by the number of examinations and consequently, less need for emergency care than in the opposite case. Successful fear treatment has positive impact on later dental care and regular dental attendance.

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.

Oral health related quality of life and reasons for non-dental attendance among patients with substance use disorders in withdrawal rehabilitation

No study has assessed the socio‐behavioral distribution of oral health related quality of life (OHRQoL) among patients with substance use disorders receiving medically assisted rehabilitation therapy (MAR) in Norway.

Behaviour and Anxiety Management of Paediatric Dental Patients through Virtual Reality: A Randomised Clinical Trial

Clinicians should appreciate the effectiveness of virtual reality (VR) headsets for managing both the anxiety and the behaviour of non-cooperative paediatric patients who require treatment over several dental appointments. The aim of this study was to assess the effectiveness of using a VR headset as a distraction for managing the anxiety and behaviour of paediatric patients during their dental treatment. Eighty patients, aged between five and ten years old and who required dental treatment over three or more appointments, were randomly allocated into two groups. One group used a VR headset during all their appointments, and the other one did not use any distraction technique. The patients were asked to take a Facial Image Scale Test during their first and last appointments to assess their level of anxiety. Additionally, the dentist completed the Frankl Test to quantify the child's behaviour at the beginning and the end of their treatment. The results obtained, both from the group using the VR headset and from the control group, were compared using the chi-square test. The use of a VR headset during dental treatment significantly reduced anxiety (95% of the children were happy) and improved behaviour (100% positive behaviour) as compared with the control group (40% and 57.5%, respectively). A VR headset can effectively distract a paediatric patient, helping to reduce anxiety and manage behaviour during dental treatment.

Dentist-administered cognitive behavioural therapy versus four habits/midazolam: An RCT study of dental anxiety treatment in primary dental care

The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: -6.6 (SD = 0.5); IDAF-4C scores: -1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.

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.

Dental health care workers' attitude towards patients with substance use disorders in medically assisted rehabilitation (MAR)

OBJECTIVE

To assess knowledge, beliefs and attitudes related to treatment of MAR patients among dentists and dental hygienists. Secondly, to investigate to what extent dental health care professionals' attitudes associate with their treatment experience and beliefs regarding MAR patients.

MATERIAL AND METHOD

We conducted a cross-sectional study, involving a census of dental hygienists and dentists in the public dental health care services in Hordaland and Rogaland counties in Norway. Data were collected by electronically administered questionnaires.

RESULTS

The response rate was 187/344, 54% (26% dental hygienists and 74% dentists). A majority of both professional groups did not find it difficult to understand information on oral health and drug use. Although they confirmed familiarity with guidelines on good dental practice, they had received little information about oral health aspects of substance use. Both groups had slightly negative attitudes towards treatment of MAR patients. Beliefs that completion of treatment is often unsuccessful and that information on drug use and oral health is difficult to interpret associated with negative attitudes towards treatment.

CONCLUSIONS

The findings suggest that promotion of information to dental care personnel to extend their knowledge and improve their skills regarding oral health aspects of substance use might contribute to positive attitudes and improved utilisation of the free dental care offered to MAR patients.

Does preoperative dental anxiety play a role in postoperative pain perception after third molar surgery?

Background

Surgical removal of the impacted third molar is associated with inflammatory morbidities which include swelling, trismus, and pain. Pain is the most common postsurgical morbidity associated with third molar surgery. It remains an important factor in patients' perception of recovery after third molar surgery with dental anxiety reported to exert influence on its threshold.

Objective

The aim of the study was to determine if preoperative dental anxiety has any significant role on postoperative pain perception after third molar surgery.

Materials and Methods

This was a cohort study involving sixty consecutive adult patients requiring extraction of impacted mandibular third molars under local anesthesia. Modified Dental Anxiety Scale Questionnaire was administered to each participant in the waiting area before the surgery. The visual analog scale was also given to each participant to be completed once daily at approximately the same time as the surgery time until day 7 after the surgery. Data collected were analyzed using SPSS version 23.

Results

Sixty participants who consented to third molar surgery took part in this study. Five participants were lost to follow-up. There were slightly more males (50.9%) than females (49.1%). Nineteen participants in this study had moderate dental anxiety (34.5%) and 6 participants (11%) had severe dental anxiety with more females having moderate-to-severe dental anxiety. The correlation between pain perception at different days and dental anxiety was not significant (P > 0.05).

Conclusion

Preoperative dental anxiety may not significantly influence pain perception after third molar surgery.

Early-life course factors and oral health among young Norwegian adults

OBJECTIVE

Using a national sample of young Norwegian adults, we examined whether unpleasant experience with dental care during childhood is associated with tooth loss and oral health-related quality of life in adulthood after accounting for early- and later-life socio-behavioural circumstances and dental avoidance behaviour.

METHODS

2433 individuals aged 25-35 years participated in an electronic survey. Oral quality of life was measured using the oral impact of daily performance (OIDP) inventory. Generalized linear models and negative binomial regression models were used to estimate the association of early unpleasant experiences with dental care and tooth loss and OIDP scores. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were used to estimate the relative differences in prevalence of tooth loss and OIDP scores.

RESULTS

Adjusting for early-life characteristics only, the prevalence of tooth loss was 1.42 (IRR = 1.42, 95% CI: 1.24-1.64) and 1.96 (IRR = 1.96, 95% CI: 1.70-2.26) times higher among individuals who reported unpleasant experiences a few times or several times, than in individuals who did not report unpleasant experiences with dental care in childhood. Adjusting further for educational level, smoking and tooth brushing attenuated the relative differences (IRR = 1.40, 95% CI: 1.22-1.62 and IRR = 1.88, 95% CI: 1.62-2.17, respectively). Lastly, when adjusting for dental avoidance behaviour, the prevalence of tooth loss was 1.29 (IRR = 1.29, 95% CI: 1.11-1.50) and 1.58 (IRR = 1.58, 95% CI: 1.32-1.88) times higher among individuals who reported unpleasant experiences a few times or several times than in those who did not. Corresponding associations of early unpleasant experience with OIDP were (IRR = 1.41 95% CI: 1.22-1.63) and (IRR = 1.69, 95% CI: 1.42-2.01) when adjusting for early-life characteristics, and (IRR = 1.39, 95% CI: 1.20-1.60) and (IRR = 1.51, 95% CI: 1.27-1.80) when adjusting for education, smoking and tooth brushing. When adjusting for dental avoidance behaviour, the association of early unpleasant experience with OIDP became nonsignificant.

CONCLUSION

Unpleasant dental care experiences during childhood are associated with poor oral health in adulthood, independent of later-life socio-behavioural characteristics including negative dental care seeking. This highlights the importance of tailoring regular contacts with dental healthcare services in childhood to build confidence in children and thus has implications for healthcare policy.

What sensitivities matter in dental anxiety? Investigating sensitivity to anxiety, pain, and disgust

Dental anxiety affects many people worldwide and interferes with oral health. Beyond emotional distress, avoidance of dental care visits can lead to serious dental and health consequences. Although emerging research implicates anxiety, pain, and disgust sensitivities in the etiology and maintenance of dental anxiety, no studies to date have concurrently investigated the unique contribution of these vulnerabilities in dental anxiety. As a step toward elucidating salient mechanisms of dental anxiety, the present study investigated the aggregate contribution of anxiety, pain, and disgust sensitivities in dental anxiety, after controlling for relevant covariates. In this study, participants (N = 717; 71.3% female) included an unselected sample of undergraduate students who completed a battery of online questionnaires. Consistent with community rates, 12% of this sample reported high levels of dental anxiety. The hierarchical regression model revealed anxiety and disgust sensitivities were positively associated with dental anxiety symptoms when adjusting for other model variables. Results highlight the roles of anxiety and disgust sensitivities in dental anxiety and indicate the potential benefit of targeting these emotional sensitivities through routine screenings and treatments for dentally anxious patients.

Influence of the previous dental visit experience in seeking dental care among young adults

Introduction:

Dental fear is one of the highly prevalent types of fear which deters patients from seeking dental cares.

Aim:

This study aims to assess the influence of a previous dental visit experience for seeking dental care among adults.

Methodology:

Young adults (n = 150, 15–26 years) with previous dental visit for care were selected randomly among outpatients’ visit in tertiary dental teaching hospital. To assess the influence of previous experience of dental visit in seeking care, we self-administered a Post-traumatic Check List-Civilian Version [posttraumatic stress disorder (PTSD)], an Autobiographical Memory Questionnaire (AMQ), and a Dental Fear Survey (DFS). The relationship of negative and positive experience of previous dental treatment, dental fear, and symptoms of PTSD was assessed using Pearson's correlations. Spearman's rho was used to find out the correlation between the DFS and PCL-C and history of dental treatment undergone.

Results:

The mean score of the DFS and PCL-C was found to be 69.57 and 40.17, respectively. The characteristics of the most negative experience including physical reactions (P = 0.936), emotional intensity (P = 0.935), sight (P = 0.941), smell (P = 0.917), and sound (P = 0.911) of dental treatment showed a significant relationship with dental fear, whereas the characteristics of the most positive memory of dental treatment showed only a few statistically significant associations with dental fear. Most of the symptoms of PTSD also show significant associations (P < 0.05) with characteristics of the most negative memory. Spearman's correlation between the DFS and the PCL-C was also statistically significant, r (150) =0.365, indicating that dental fear is indeed associated with symptoms of PTSD.

Conclusion:

There is a significant association between the characteristics of the most negative experiences of dental treatment and increased dental fear in young adults, while positive experiences did not show the inverse relationship with dental fear.

Virtual Reality Relaxation to Decrease Dental Anxiety: Immediate Effect Randomized Clinical Trial

Introduction:

Dental anxiety is common and causes symptomatic use of oral health services.

Objectives:

The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety.

Methods:

A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking.

Results:

Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001).

Conclusion:

Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080).

Knowledge Transfer Statement:

Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

Dental anxiety in 18-year-old Norwegians in 1996 and 2016

Objective: To estimate the prevalence of dental anxiety, and to explore factors that may increase the risk of reporting dental anxiety among 18-year-old Norwegians in 2016. A further objective was to report changes in dental anxiety since 1996.Material and methods: An anonymous survey from a strategic sample of upper secondary students (n = 351) in 2016 with high response rate (93%) was compared with the results of an investigation of a similar population conducted in 1996.Results: The prevalence of dental anxiety and dental distrust was reduced from 1996 to 2016. Dental Fear Survey (DFS) from 19 to 8% (p < .001), and Dental Belief Survey (DBS) from 15 to 6% (p < .001). Geer Fear Scale (GFS) which measure phobic anxiety did not show a similar reduction (17 versus 15%, p = .37). Phobic anxiety, avoidance behaviour, self-reported poor oral health and previous experiences of pain were all associated with dental anxiety.Conclusion: The prevalence of dental anxiety was reduced from 1996 to 2016, but 8% still report dental anxiety. Proper pain management and use of behavioural management techniques still needs to be highlighted to prevent development of dental anxiety, avoidance behaviour and poor oral health.

Impact of audiovisual information on anxiety and fear in patients undergoing dental implant treatment

BACKGROUND

Few studies have reported the impact of audiovisual implant surgery information on anxiety and fear.

PURPOSE

To investigate the impact of audiovisual information on anxiety and fear in patients undergoing dental implant treatment.

MATERIALS AND METHODS

This study included 300 patients due to undergo surgery to place a single implant. An interview topic guide and the Krantz Health Opinion Survey (KHOS) survey were used to assess the information patients already had about treatment and how much information they were seeking. Afterwards were randomized into two groups (n = 150): group 1 (verbal information) and group 2 (audiovisual information). Before surgery, anxiety and fear were assessed using State-Trait Anxiety Inventory (STAI), Modified Corah Dental Anxiety Scale (MDAS), and Dental Fear Scale (DFS) scales. After treatment, all patients described their satisfaction with the information received with a VAS.

RESULTS

Before receiving information, both groups were homogenous in their knowledge of the implant procedure (P = .825) and the quantity of information sought (KHOS; P = .080). After receiving information, group 2 patients presented more anxiety and fear than group 1 (STAI-State, STAI-Treat, MDAS, DFS; P < .001). After surgery, both groups were equally satisfied with the information received and the need for additional information (P = .689; P = .199, respectively).

CONCLUSIONS

Audiovisual information generated greater anxiety and fear than conventional verbal information in patients undergoing implant surgery.

Anxiety In A Dental And Maxillofacial Surgery Consulting Room: Does Previous Experience Matter?

Objectives

To explore the associations between previous dental visits and dental anxiety among patients presenting at the dental and maxillofacial surgery clinic of Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria.

Materials and methods

This study was a cross-sectional study conducted among 172 patients. Study instrument was a 9-item structured questionnaire, which obtained information about the participants regarding their: demographic profile; previous dental experience; and dental anxiety status in a dental and maxillofacial surgery consulting room. Data collected were analyzed using the SPSS Version 20 Software. Associations between variables were evaluated using Chi-square statistics using a p < 0.05 to determine the level of statistical significance.

Results

Roughly, six-tenth (57.6%) of the participants were males. The observed prevalence of dental anxiety among the participants was 47.7%. A history of pain experience during past dental treatment as well as a history of past dental visit were found to have statistically significant relationships with participants’ dental anxiety status (p-values < 0.05). However, the frequency of previous dental visits, a history of past dental treatment, and a history of use of intraoral injections in the course of past dental treatment were found to have no statistically significant relationship with participants’ status of dental anxiety (p-values > 0.05). Finally, the prevalence of dental anxiety among the groups of female folks with “a history of previous visit to a dentist” and “a history of pain experience in the past dental treatment” were found to be significantly higher than that observed among similar groups among the male folks (p-values < 0.05).

Conclusion

Previous experience of pain plays a major role of influence over dental anxiety experience among patients. Hence, dental practitioners need to pay more attention towards dental anxiety management among patients, especially women.

Evaluation of the ability of dental clinicians to rate dental anxiety

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (r_s ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

Dental anxiety in relation to torture experiences and symptoms of post-traumatic stress disorder

Torture victims often show symptoms of dental anxiety when receiving dental care, but little systematic research is available. The purpose of this study was to explore torture experiences, symptoms of post-traumatic stress disorder (PTSD), and dental anxiety in refugees in Norway and to test the hypothesis that refugees with torture experiences are more prone to dental anxiety than refugees with no such experiences. A total of 173 refugees were interviewed shortly after an oral examination. The Modified Dental Anxiety Scale (MDAS) and the Harvard Trauma Questionnaire-PTSS16 were administered verbally through attending interpreters. Among torture victims (47%, n = 81), the prevalence of torture experiences involving mouth or teeth was 35% and 23%, respectively. Harvard Trauma Questionnaire mean sum scores were statistically significantly higher in torture victims (34.3 vs. 24.8). Torture survivors report a larger number of symptoms of PTSD, and dental anxiety shows a higher prevalence in refugees reporting PTSD symptoms than in refugees who do not report such symptoms. When analysed using logistic regression models, the data showed the odds of high levels of dental anxiety being 6.1 times higher in refugees with torture experiences compared with other refugees and 9.3 times higher in torture victims with PTSD symptoms. Oral health professionals should be aware of these associations when providing dental care to refugees. The hypothesis that tortured refugees are more prone to dental anxiety is supported.

Dental attendance after treatment under dental general analgesia (DGA): a data-based follow-up study

AIMS

To investigate dental attendance of patients in different age groups after dental general analgesia (DGA) and procedures performed on these patients during the DGA and in dental care after the DGA during the follow-up period of almost 3 years.

METHODS

The study population consisted of 66 patients who were treated under DGA at a municipal health centre in Oulu, Finland between September 2010 and June 2011. The electronic patient files of the DGA patients were accessible for data collection for the follow-up period of nearly 3 years. The statistical analyses included Chi square tests and logistic regression modelling.

RESULTS

Approximately every sixth (14.9%) dental visit was missed or cancelled and nearly half (43.9%) of the studied subjects had at least one missed or cancelled appointment. The factors increasing the risk of missed or cancelled appointments and dental avoidance were endodontic treatment (OR 3.62), need of more than five dental restorations (OR 3.47), tooth extractions due to caries (OR 2.22), and male gender (OR 1.80). A total of 45.5% of the patients received non-invasive procedures.

CONCLUSIONS

Patients who need DGA are evidently risk patients considering dental attendance. Nearly half of the patients in this study had non-attended or cancelled appointments. DGA patients' need of treatment after DGA is extensive, even comparable to the amount of procedures generally performed under DGA. The quality or amount of preventive procedures do not appear to be at the required level to reduce the number of non-attended appointments.

Applying the theory of planned behavior to self-report dental attendance in Norwegian adults through structural equation modelling approach

BACKGROUND

Understanding factors that affect dental attendance behavior helps in constructing effective oral health campaigns. A socio-cognitive model that adequately explains variance in regular dental attendance has yet to be validated among younger adults in Norway. Focusing a representative sample of younger Norwegian adults, this cross-sectional study provided an empirical test of the Theory of Planned Behavior (TPB) augmented with descriptive norm and action planning and estimated direct and indirect effects of attitudes, subjective norms, descriptive norms, perceived behavioral control and action planning on intended and self-reported regular dental attendance.

METHOD

Self-administered questionnaires provided by 2551, 25-35 year olds, randomly selected from the Norwegian national population registry were used to assess socio-demographic factors, dental attendance as well as the constructs of the augmented TPB model (attitudes, subjective norms, descriptive norms, intention, action planning). A two-stage process of structural equation modelling (SEM) was used to test the augmented TPB model.

RESULTS

Confirmatory factor analysis, CFA, confirmed the proposed correlated 6-factor measurement model after re-specification. SEM revealed that attitudes, perceived behavioral control, subjective norms and descriptive norms explained intention. The corresponding standardized regression coefficients were respectively (β = 0.70), (β =0.18), (β = - 0.17) and (β =0.11) (p < 0.001). Intention (β =0.46) predicted action planning and action planning (β =0.19) predicted dental attendance behavior (p < 0.001). The model revealed indirect effects of intention and perceived behavioral control on behavior through action planning and through intention and action planning, respectively. The final model explained 64 and 41% of the total variance in intention and dental attendance behavior.

CONCLUSION

The findings support the utility of the TPB, the expanded normative component and action planning in predicting younger adults' intended- and self-reported dental attendance. Interventions targeting young adults' dental attendance might usefully focus on positive consequences following this behavior accompanied with modeling and group performance.

Assessment of pre and postoperative anxiety in patients undergoing ambulatory oral surgery in primary care

Background

To analyze the pre- and postoperative anxiety level in patients undergoing ambulatory oral surgery (AOS) in a primary healthcare center (PHC).

Material and Methods

Prospective and descriptive clinical study on 45 patients who underwent AOS procedures in the dental clinic of a public PHC of Spain between April and September 2015. Anxiety analysis was carried out with pre- and postoperative anxiety-state (STAI-S), anxiety-trait (STAI-T) and dental anxiety (MDAS) questionnaires. A descriptive, inferential and binary logistic regression analysis were performed for the variables age, sex, educational level, previous experience of oral treatment, type of oral surgery, degree of third molar impaction, surgical time, intraoperative complications, postoperative complications, and pain score with a visual analogue scale (VAS).

Results

The majority were female (57.8%) with a mean age of 33.5+9.6 years. The most frequent procedure was the lower third molar removal (82.2%). The mean pain score on the VAS was 1.6+1.8. The incidence of complications was low (7.8%). There was a statistically significant association between post- and preoperative anxiety (r=0.56, p<0.001) and a correlation between pain score and postoperative anxiety (Rho= -0.35, p=0.02). The likelihood of postoperative anxiety was related to preoperative anxiety (OR=1.3, p=0.03).

Conclusions

AOS in a HPC is safe and should be more encouraged in the public primary care. The emotional impact on users was relatively low, highlighting that the preoperative anxiety levels were higher than the postoperative ones. Psychological factors related to pre- and postoperative anxiety should be considered in the AOS carried out in PC.

Key words:Anxiety, oral surgery, ambulatory surgery, primary care, STAI scale, postoperative pain.

Association between dental fear and oral health habits and treatment need among University students in Finland: a national study

BACKGROUND

First-year university students are in a new, independent life situation, which may affect health behaviour, including oral health habits. The aim of this study was to evaluate the association between dental fear and oral health habits, while considering the simultaneous effects of attitude toward food and treatment need at dental check-ups.

METHODS

The data (n = 8514) for this national cross-sectional study were collected from health registers of Finnish Student Health Service. As part of health examination all first-year university students in Finland were sent an electronic questionnaire asking about general, psychological and oral health, and health habits. Dental fear was measured by the question: "How afraid are you of visiting a dentist?" (reply alternatives: "Not at all", "Somewhat" and "Very"). Chi-square tests and Multiple logistic regression analyses were used to determine the associations between dental fear and oral health habits (tooth brushing, tobacco use, frequency of eating and drinking, eating habits and interval between dental check-ups) as well as attitude to food and treatment need at dental check-ups while controlling for age, gender, general mood and feelings in social situations.

RESULTS

Of the oral health habits, tooth brushing and tobacco use were associated with dental fear. Those who brushed their teeth once a day or less often or used tobacco regularly were more likely to have high dental fear than those who brushed their teeth twice a day or more often or used tobacco occasionally or not at all. Students who reported not having a normal attitude to food were more likely to have high dental fear than were those reporting normal attitude to food, but the frequency of eating and drinking was not associated with dental fear. Students who reported needing treatment frequently or at every dental check-up were more likely to have high dental fear than those who reported rarely or never needing treatment.

CONCLUSION

Those students with high dental fear seem to be at risk of having poor oral health habits and abnormal attitude to food, which may increase the risk of deterioration of oral health and the need for treatment. Dental teams should make efforts in helping fearful patients to find motivation for good oral health habits.

Changes in dental fear among Finnish adults: a national survey

OBJECTIVES

The aim of this study was to evaluate changes in dental fear among adult Finns aged 19 years and over at the beginning of the study in 2000-2011 in a nationally representative sample.

METHODS

The study was based on Health 2000 and 2011 Surveys by the National Institute for Health and Welfare in Finland. The Health 2000 Survey used a stratified two-stage cluster sampling design (N = 9 922). Those who participated in 2000 (n = 7 964) were invited to participate in 2011. The number of participants was 3 961. Dental fear was assessed by a single question: 'How afraid are you of visiting a dentist?' (not at all, somewhat, very much). Background variables included were age (categories 30-34, 35-39, 40-44, 45-54, 55-64, 65-74, 75+ years), gender, marital status (nonsingle, single), and education (basic, secondary, higher). To match the population sizes in different areas and thus forming a nationally representative data, the data were weighted based on age, gender, and area. General linear modeling for repeated measures was used to evaluate changes in dental fear and associations with background variables.

RESULTS

Between 2000 and 2011, dental fear decreased more often than increased among adults in Finland. Change from being very afraid to not at all afraid of visiting a dentist was most common in the oldest group. For most participants, dental fear remained stable; being very afraid of visiting a dentist was more stable among participants from 35 to 54 years of age than among younger or older participants.

CONCLUSIONS

Dental fear is still common among adult Finns and it seems to depend on age. As the most obvious consequence of dental fear is avoidance of dental care, reducing dental fear should be taken into account when planning and reorienting oral healthcare services.

Dentists' use of behavioural management techniques and their attitudes towards treating paediatric patients with dental anxiety

PURPOSE

The purpose of this study was to explore the relationship between dentists' education in treatment of dental anxiety (DA), dentists' attitudes towards patients with DA and dentists' use of BMT.

METHODS

An anonymous questionnaire was sent electronically to 611 dentists in the Public Dental Service in Norway. Statistical evaluation was done using cross tabulation with Chi square and logistic regression analyses.

RESULTS

The response rate was 65 % (n = 391). About half of the respondents (53 %, n = 208) had followed postgraduate courses in treating patients with DA. The following were the most common attitudes towards treating young patients with DA: it feels like making a contribution (72 %, n = 286), it is difficult or tiresome (54 %, n = 215) and it is a positive challenge (51 %, n = 203). Dentists who had taken postgraduate courses in DA more often reported anxious patients as a positive challenge (60 vs. 42 %, p < 0.001) and were less reluctant to treat these patients (5 vs. 15 %, p = 0.002). The most frequently used BMT was tell-show-do (87 %, n = 340), followed by relaxation (35 %, n = 132), distraction (25 %, n = 94), systematic cognitive behaviour therapy (22 %, n = 84) and conscious sedation (18 %, n = 69). Dentists without postgraduate courses in DA used fewer techniques when treating these patients (OR 2.1, 95 % CI 1.3-3.3, p = 0.001) compared with dentists who had taken these courses.

CONCLUSION

Country of graduation and postgraduate courses in DA had a strong relationship with dentists' use of BMT and dentists' attitudes towards young patients with DA.

Dental fear and its possible relationship with periodontal status in Chinese adults: a preliminary study

BACKGROUND

The aim of the present study was to describe the characteristics of dental fear of Chinese adult patients with periodontal disease and provide information for clinical assessment.

METHODS

A total of 1203 dental patients completed questionnaires that included Corach's Dental Anxiety Scales (DAS), Dental Fear Survey (DFS) and the short-form Dental Anxiety Inventory (S-DAI). Among all the patients, 366 cases were self-reported periodontal disease. The general characteristics were described, such as socio-demographics, dental attendances and oral health behaviors. The statistical analysis was performed by t-test, Mann-Whitney U test and linear regression respectively to evaluate correlations between dental fear and general characteristics according to the three scales.

RESULTS

The prevalence of dental fear was 74% among 1203 patients, 23.4% of total with high dental fear, while 27.3% in the patients with periodontal disease. The average score of DAS and DFS for patients with periodontal disease was significantly higher than those without periodontal disease. The regression analysis indicated that gender, age, periodontal status, dental attendances and oral health behaviors were correlated with dental fear. Among 366 patients with periodontal disease, gender, dental attendances and oral health behaviors had correlation with dental fear. The analysis of DFS scale exhibited that 'drilling with handpiece' and 'injecting the anesthetic' were the most important factors to contribute to dental fear.

CONCLUSIONS

There was high prevalence of dental fear in Chinese adult patients, particularly in patients with periodontal disease, and high level of dental fear may lead to poor periodontal status.

A randomized controlled trial of the effect of a brief cognitive-behavioral intervention on dental fear

OBJECTIVES

The objective of this study was to examine the effect of a brief cognitive-behavioral intervention for patients with dental fear in a private dental clinic.

METHODS

Patients presenting with subjectively reported dental fear were randomly assigned to either an immediate intervention (n = 53) or a waiting list (n = 51) group. Both groups received an identical intervention, but delayed by 4-6 weeks in the waiting list group. Participants were asked to fill out two self-report questionnaires of dental fear at pre- and post-intervention, and again at a 2-year follow-up assessment.

RESULTS

Analysis of variance showed that dental fear was significantly reduced in the immediate intervention group (d = 1.5-2.2), compared with the waiting list group (d = 0.3-0.4). Additionally, all participants showed a significant reduction of dental fear following the brief intervention, and in the subgroup available for follow-up, this effect was maintained after 2 years.

CONCLUSIONS

This indicates that a brief cognitive-behavioral intervention may be efficacious in helping a significant number of patients with dental fear return to regular dental treatment. Future research should investigate the applicability of a brief cognitive-behavioral intervention in the dental clinic.

The level of dental anxiety and dental status in adult patients

BACKGROUND

The present study aimed to assess potential correlation between dental anxiety and overall dental status in adult patients, in consideration of the frequency of dental appointments and individual dental hygiene practices.

MATERIALS AND METHODS

Individual dental anxiety levels were assessed with the aid of the Corah's dental anxiety scale (DAS). The study embraced 112 patients of the University Dental Clinic, Kraków. Following clinical and X-ray exams, respectively, decayed, missing and filled teeth (DMFT) index and dental treatment index (DTI) were computed for each study subject.

RESULTS

Mean DAS among the 112 subjects under study was 9.41 standard deviation (SD = 3.36). Mean DMFT value was 15.86 (SD = 7.00), whereas DTI value was 0.76 (SD = 0.27). The number of decayed teeth and an individual dental anxiety level were found to be correlated (r = 0.26). Higher dental anxiety correlated with lower DTI value (r = -0.22) and lesser frequency of dental appointments (r = 0.22).

CONCLUSIONS

Individual dental anxiety level appears to impact overall dental status, frequency of dental appointments and everyday oral health practices. Every conceivable effort should therefore be undertaken with a view to effectively diminishing dental anxiety levels in the patients. How to cite the article: Dobros K, Hajto-Bryk J, Wnęk A, Zarzecka J, Rzepka D. The level of dental anxiety and dental status in adult patients. J Int Oral Health 2014;6(3):11-4.

Factors associated with dental and medical care attendance in UK resident Yemeni khat chewers: a cross sectional study

Background

The chewing of khat leaf with tobacco smoking amongst Yemenis, Somalis and Ethiopians is reported to impact oral and general health. The health status and particularly dental and medical care attendance of UK-khat chewers has not received attention. This study aimed to explore health status and dental and medical attendance and its associated factors in UK permanently resident Yemeni khat chewers.

Methods

A cross- sectional study with a purposively selected sample of 204 khat chewers was conducted. Data were collected through face to face interviews. Data analysis included descriptive, Chi-square tests and binary logistic regressions.

Results

The mean age for this study sample was 44.84 (SD = ±19.70) years and 35% were employed. Forty five percent reported symptomatic medical attendance for self reported health conditions in the last two weeks whilst 44% had symptomatic dental attendance. Higher khat chewing dependency levels associated positively with both symptomatic dental and medical attendance (p = 0.004, OR = 1.14, 95%CI = 1.04-1.25; p = 0.003; OR = 1.16, 95%CI = 1.05-1.29, respectively). Higher social participation levels associated negatively with symptomatic dental attendance (p = 0.034, OR = 0.98, 95%CI = 0.96-0.99) whilst increase in age and self-reported health conditions associated positively with symptomatic medical attendance (p = 0.030, OR = 1.03, 95%CI = 1.01-1.06; p = 0.001, OR = 4.51, 95%CI = 2.02-10.08, respectively).

Conclusions

In this study of khat chewers, a significant proportion reported symptomatic dental and medical attendance. Demographic, psychosocial and self reported general health conditions were associated significantly with dental and medical attendance. Strategies to improve the dental and medical care attendance amongst this group should focus on these and other unexplored underlying factors.