Assessment of a dental anxiety scale

Etiology of Dental Anxiety and Dental Phobia: Review

This article examines the etiology of dental anxiety, a common yet often overlooked condition in dental practice. Ranging from mild discomfort to severe dental phobia, dental anxiety significantly affects a patient's ability to receive necessary care. Despite its prevalence, it remains underexplored in scientific research, leading to inadequate treatment and insufficient attention. Understanding the factors behind dental anxiety is crucial for prevention and for providing effective psychotherapeutic and pharmacological interventions.The review was based on a comprehensive search of several scientific databases, including PubMed, Cochrane Database, and Dentistry & Oral Sciences Source. Predefined keywords, such as "Dental Anxiety," "Dental Phobia," and "Etiology," were used to ensure broad coverage of relevant studies. The factors contributing to dental anxiety are multifactorial and involve both internal and external influences. Internal factors, such as genetic predispositions and central nervous system dysfunctions, interact with external influences, including personal experiences, negative past dental encounters, and environmental stimuli. Demographic factors, such as age, gender, and socioeconomic status, along with personal characteristics like temperament and coping mechanisms, further contribute to the development of anxiety.Previous negative dental experiences and self-reported poor oral health exacerbate anxiety, increasing the likelihood of developing dental phobia, which often results in care avoidance. This avoidance worsens oral health, resulting in conditions such as caries and periodontal disease, and significantly diminishes the quality of life. Addressing dental anxiety is critical for improving patient cooperation and ensuring better long-term oral health outcomes. A more comprehensive understanding of dental anxiety will help identify at-risk patients early, prevent severe forms of dental phobia, and ensure dental care is accessible to all individuals.In conclusion, dental anxiety is a multifactorial issue that impacts access to dental care and overall oral health. The most significant factor contributing to dental anxiety is trauma associated with previous dental procedures. Expanding the understanding of its causes enables dental professionals to identify at-risk patients and develop tailored interventions. By addressing anxiety early and adopting evidence-based strategies, dental professionals can reduce the prevalence of dental anxiety and improve patient care.

Validity and Reliability of the Dental Neglect Scale in German

Background/Objectives: The Dental Neglect Scale (DNS) is known and used to evaluate and assess adult behaviors and attitudes related to oral self-care and oral-health. In English-speaking countries, the DNS has been used in many studies. At the moment, there is no validated version of the DNS that is available in the German language. The aim of this study is to validate a German version of the DNS to evaluate and assess the oral health and behavior among the German population. Methods: The study population consisted of N = 311 German adults (180 female, 130 male, 1 diverse) aged from 18 to 90 years from a dental clinic in Germany. The participants answered a questionnaire. In addition to questions on their socio-demographic background and the DNS, the survey included more standardized instruments relating to preventive behavior, dental anxiety, and oral health. Results: The DNS was translated into German. An explanatory factor analysis was conducted, which supported the unifactorial structure of the scale. The following results were obtained for the reliability of the resulting DNS: Cronbach's Alpha = 0.710, McDonald's Omega = 0.711, and Mean = 25.63 (SD = 4.02, Range 12-30). Convergent and divergent validity were demonstrated through associations between the DNS and various oral health scales, and by differences between genders and age groups. Conclusions: This study confirms the quality of the criteria of the DNS for German adults. The DNS is a convincing instrument that is used for epidemiological studies in the field of dentistry and psychology. Further validation with other samples should be conducted.

Exploring the Levels of Dental Anxiety in Greek Patients

INTRODUCTION

Dental anxiety is the apprehension experienced by an individual when confronted with matters related to dentistry, it impacts individuals' dental experiences and the dental healthcare providers' professional lives, contributing to increased tension and potentially compromising performance. Levels of dental anxiety differ across cultures.

OBJECTIVE

To collect normative data on levels of dental anxiety in Greece from a representative sample of people attending their usual dentist for a routine dental appointment.

METHODS

A cross-sectional study was applied. 1313 Adults were recruited, as they attended 1 of 6 different dental settings and were scheduled for a routine dental appointment involving any of the following routine procedures: Check-up, hygiene, restoration, extraction, and pain relief. Their anxiety levels were assessed by applying the Modified Dental Anxiety Scale (MDAS), and by using the cut-off scores of 12 and 19 for assessing moderate and extreme anxiety, respectively.

RESULTS

32.6% per cent of the respondents were found to be dentally anxious, out of which 8.2 % experienced high levels of dental anxiety. The mean MDAS score for the total study population was 10.36 (SD= 4.639). The findings indicated that females and first-time dental patients reported significantly higher levels of dental anxiety than males and repeat attendees. However, dental anxiety levels did not vary significantly across different dental procedures, age groups and dental settings. These results are in line with those reported by White in the U.S. population, demonstrating comparable levels of dental anxiety across both populations.

CLINICAL SIGNIFICANCE

One in 3 patients visiting the dentist in Greece experience some level of dental anxiety. This finding underscores that dental anxiety is a prevalent public health concern in Greece. Dentists and healthcare providers should consider screening for dental anxiety that could lead to early identification and management.

A Cross-Sectional Study on the Impact of Dental Fear and Anxiety on the Quality of Life of Romanian Dental Students

Background and Objectives: Dental anxiety influences quality of life, causing emotional and physical discomfort. The aim of this study was to identify the prevalence of dental anxiety among young adults and how it influences the dimensions of quality of life, especially in terms of physical and psychological health. Material and Methods: This study was conducted between March and July 2024, within the Community Dentistry Discipline at the "Grigore T. Popa" University of Medicine and Pharmacy in Iași, on a group of 180 students to assess dental anxiety and its impact on their quality of life. Participants completed questionnaires using scales such as the IDAF, DAS-R CORAH, and WHOQOL-BREF. Results: Most participants presented a moderate level of dental anxiety, with 59.4% without anxiety and 6.1% with severe anxiety. Significant correlations were established between dental anxiety and physical and psychological dimensions of quality of life. In contrast, there were no significant correlations between dental anxiety and social relationships or the environment. Anxiety and fear were negatively correlated with perceived physical well-being, but positive correlations were also identified between sensitivity to dental stimuli and more favorable perceptions of physical and psychological health. Discussion: Dental anxiety has a significant impact on patients' physical and psychological health, especially on their perception of their well-being. This study confirms previous research showing that dental anxiety is related to certain dental procedures. Conclusions: Dental anxiety has a significant impact on psychological and physical perception but does not significantly affect social interactions.

Dental anxiety and empathy among undergraduate oral health students in Norway, South Africa and Namibia

PURPOSE/OBJECTIVES

Dental anxiety is a common type of fear that can complicate dental treatment. The dental practitioner is crucial in both treating dental fear and anxiety as well as prevent it from arising. The ability to feel empathy is important in that matter. The dental practitioner's own level of dental anxiety can possibly affect his or her ability to treat patients in an empathetic manner. The aim of this study was to assess and examine the relationship between level of empathy and dental anxiety in undergraduate oral healthcare students from Namibia, South Africa and Norway.

MATERIAL AND METHODS

A cross-sectional study was performed. Questionnaires were distributed, and responses were analyzed anonymously. Dental anxiety was assessed using Modified Dental Anxiety Scale (MDAS), and empathy level was assessed using Toronto Empathy Questionnaire (TEQ). Data were presented as means or medians and analyzed using a linear regression model in STATA with a 5% level of significance.

RESULTS

The response rate was 16.0%, and 298 completed questionnaires were received. MDAS was low in all groups (medians 7-10), however, significantly lower in Norway compared to Namibia and South Africa. The mean TEQ score was 46.8 in Namibia, 47.5 in South Africa and 50.4 in Norway, all above average empathy levels but significantly higher in Norway than in Namibia and South Africa.

CONCLUSIONS

Oral healthcare students in Africa and Norway showed high empathy and low dental anxiety, which is reassuring for future oral health care professionals.

Parental Anxiety Disorders and Their Impact on Dental Treatment in Children Aged 4 to 13 Years: A Cross-Sectional Observational Study

Introduction: Children with dental fear and/or anxiety will use all available means to avoid or delay dental treatment, which can cause a deterioration in their oral health. A close relationship has been demonstrated between parents' fear and/or anxiety about the dentist and the development of dental anxiety in children. Objective: Our aim is to evaluate the anxiety of children's parents and the factors that influence the prediction of anxiety and children's behavior, as well as its impact on the risk of caries. Method: This is a descriptive cross-sectional study. For data collection, scientifically validated questionnaires were used for parents (n = 101) and children (n = 101). Statistical analysis was performed using the Chi2 test, the independent sample t test, and the Mann-Whitney test. Results: A direct relationship (p = 0.095) was found between the Corah test and the Venham test, as well as statistical significance (p = 0.035) between the STAI-Trait and the Venham test. The type of treatment the child is going to undergo is a determining factor in parental anxiety. A total of 85% of the patients exhibited positive behavior regardless of the degree of parental anxiety. Conclusions: The relationship between the anxiety of the parent and the child was very limited and restricted to specific cases; direct associations were found between the oral state of the child and the anxiety of the parents.

Exploring the Variations in the Use of Modified Dental Anxiety Scale (MDAS) in Literature: A Survey of Studies Published from 2014 to 2023

OBJECTIVES

Modified Dental Anxiety Scale (MDAS) is a frequently used psychometric tool to evaluate the dental anxiety level of dental patients or the general population. However, it was largely unclear if MDAS was consistently administered in the original format in the academic literature. This work aimed to survey the literature published in the last 10 years to reveal the current usage of MDAS.

METHODS

Web of Science and Scopus were queried to identify papers that mentioned the use of MDAS.

RESULTS

Among a total of 260 analyzed papers, 101 papers included comprehensive information regarding both the questions posed and the response format employed. Two papers only used an explicitly renamed MDAS with modified contents. Among the 258 papers that used MDAS that were supposed to be standardized, many discrepancies from the original version were discovered. There were only 39 papers that strictly followed the recommended scoring scheme: if a participant had a score of ≥ 19, he or she might be highly dentally anxious. Notable modifications included the use of a cut-off score different from the original recommendation, the use of multiple cut-off scores, modifications of the response format or descriptors, and modifications to the question items especially adding extra questions.

CONCLUSIONS

These modifications would create confusion when researchers and clinicians tried to compare data across studies. Researchers are recommended to administer MDAS in its original format.

Patient-related predictors of post-operative pain following root canal treatment: A structural model analysis

AIM

The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment.

METHODOLOGY

A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%).

RESULTS

Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety.

CONCLUSIONS

Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

Changes of Dental Implant Surgery-Related Anxiety and Pain with Respect to ASA-Physical Status

Background/Objectives: Rehabilitation of missing teeth with dental implants is a strong trigger of dental anxiety. The sympathetic response caused by anxiety can lead to cardiovascular and cerebrovascular incidents, especially in patients at systemic risk (ASA Physical Status-II and ASA Physical Status-III). Dental anxiety can affect physical health by activating the sympathetic response, and the patient's physical health status may also affect dental anxiety. The aim of this study was to analyze the factors that may reduce anxiety and pain, considering the patient's physical health status according to American Society of Anesthesiologists (ASA-PS). Methods: A total of 562 implants were placed under local anesthesia in 201 patients with ASA PS-I (healthy) and ASA PS-II and III (comorbid). The effect of patient-, dentist-, and surgery-related variables on dental anxiety and pain perception were evaluated. Modified Corah Dental Anxiety Scale and Numerical Rating Scale for Pain scores were measured and recorded preoperatively (T0) and 1 week postoperatively (T1). The effects of the associated variables were analyzed using binary logistic regression and non-parametric tests (p < 0.05). Results: Age (OR = 1.089), gender (OR = 6.493), ASA-PS (OR = 13.912), and the number of placed implants (OR = 0.807) were significantly associated with reduction in dental anxiety. There were statistically significant differences between the study groups in terms of mDAS score reduction (p = 0.028). Conclusions: ASA-PS, gender and the number of placed implants affected the anxiety of the patients. Age and number of implants seem to be variables with a relative influence that depends on other factors.

Dental anxiety and dental care - a comparison between Albania and Germany

BACKGROUND

The present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients.

METHODS

This study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used.

RESULTS

The questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p < 0,000). Germans were more susceptible to signs of Anxiety (p < 0,000), Depression and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index (p < 0,000) than Albanian patients. Additionally Albanian patients scored significantly lower on the preventive care index (p < 0,000). Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients.

CONCLUSION

The results showed that between both populations differences in dental anxiety, psychological distress and oral health exists. Patients from Germany report more psychological distress and described more dental anxiety compared to Albanian patients. Albanian patients reported not utilization on oral health care.The implementation of educational programs and preventive measures, would contribute to raising awareness about the importance of oral health and increased use of dental services.

Excessive Gag Reflex, Dental Anxiety, and Phobia of Vomiting in Dental Care

BACKGROUND

The most known and commonly studied behavioral obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).

OBJECTIVE

The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office.

METHODS

A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI).

RESULTS

In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found amongst all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants' gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001).

CONCLUSIONS

The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.

A novel brief questionnaire using a face rating scale to assess dental anxiety and fear

PURPOSE

This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF).

MATERIALS AND METHODS

Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day).

RESULTS

The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days.

CONCLUSION

The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care.

Cerebral activation caused by dental sounds: a functional magnetic resonance imaging study

Dental drilling sounds can induce anxiety in some patients. This study aimed to use functional magnetic resonance imaging (fMRI) to assess the relationship between dental fear and auditory stimuli. Thirty-four right-handed individuals (21 women and 13 men; average age, 31.2 years) were selected. The level of dental fear was assessed using the dental fear survey (DFS). Based on a threshold DFS score > 52, participants were categorized into two groups: dental fear (DF) group (n = 12) and control group (n = 22). Two types of stimuli were presented in a single session: dental and neutral sounds. Cerebral activation during the presentation of these sounds was evaluated using contrast-enhanced blood oxygenation level-dependent fMRI. In the DF group, dental sounds induced significantly stronger activation in the left inferior frontal gyrus and left caudate nucleus (one-sample t test, P < 0.001). In contrast, in the control group, significantly stronger activation was observed in the bilateral Heschl's gyri and left middle frontal gyrus (one-sample t test, P < 0.001). Additionally, a two-sample t test revealed that dental sounds induced a significantly stronger activation in the left caudate nucleus in the DF group than in the control group (P < 0.005). These findings suggest that the cerebral activation pattern in individuals with DF differs from that in controls. Increased activation of subcortical regions may be associated with sound memory during dental treatment.

Interventions to reduce adult state anxiety, dental trait anxiety, and dental phobia: A systematic review and meta-analyses of randomized controlled trials

This review evaluates randomized controlled trials (RCTs) intervening on adult state anxiety (fear and emotional distress during dental treatment), chronic dental (trait) anxiety or dental phobia (disproportionately high trait anxiety; meeting diagnostic criteria for specific phobia). Seven online databases were systematically searched. 173 RCTs met inclusion criteria, of which 67 qualified for 14 pooled analyses. To alleviate state anxiety during oral surgery, moderate-certainty evidence supports employing hypnosis (SMD=-0.31, 95 %CI[-0.56,-0.05]), and low-certainty evidence supports prescribing benzodiazepines (SMD=-0.43, [-0.74,-0.12]). Evidence for reducing state anxiety is inconclusive regarding psychotherapy, and does not support virtual reality exposure therapy (VRET), virtual reality distraction, music, aromatherapy, video information and acupuncture. To reduce trait anxiety, moderate-certainty evidence supports using Cognitive Behavioral Therapy (CBT; SMD=-0.65, [-1.06, -0.24]). Regarding dental phobia, evidence with low-to-moderate certainty supports employing psychotherapy (SMD=-0.48, [-0.72,-0.24]), and CBT specifically (SMD=-0.43, [-0.68,-0.17]), but not VRET. These results show that dental anxieties are manageable and treatable. Clinicians should ensure that interventions match their purpose-managing acute emotions during treatment, or alleviating chronic anxiety and avoidance tendencies. Existing research gaps underscore the necessity for future trials to minimize bias and follow CONSORT reporting guidelines.

Pain Reduction of Ibuprofen Sodium Dihydrate Alone and in Combination with Acetaminophen in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation

INTRODUCTION

Most pain studies have been based on a postsurgical, third molar model using ibuprofen (IBU)/acetaminophen (APAP). Studies have found quicker onset of pain relief with a newer formulation of IBU - ibuprofen sodium dihydrate (ISD). The purpose of this study was to compare pain reduction of ISD/APAP to ISD in an acute endodontic pain model of untreated patients experiencing moderate to severe pain with symptomatic apical periodontitis.

METHODS AND MATERIALS

In this double-blind randomized study, 64 adult emergency patients in acute moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and symptomatic apical periodontitis participated. Each patient randomly received either one dose of 768 mg ISD/1000 mg APAP or one dose of 768 mg ISD. Pain intensity scores were recorded every 15 minutes over 240 minutes using the Heft-Parker VAS along with time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief also recorded. The data were analyzed statistically.

RESULTS

Both ISD and ISD/APAP groups showed a progressive decrease in pain from baseline to 120 minutes after medication administration. Afterward, a relative plateau was seen in the patients' pain. There was no difference in the VAS scores between the ISD and ISD/APAP at any given time point, time to first sign of pain relief, time to meaningful pain relief, and time to 50% pain relief.

CONCLUSIONS

The addition of APAP to ISD for pain control in an untreated endodontic pain model did not differ significantly from ISD alone.

Scenting serenity: influence of essential-oil vaporization on dental anxiety - a cluster-randomized, controlled, single-blinded study (AROMA_dent)

Dental fear and anxiety (DFA) is known as an immense challenge in oral healthcare, which can result in compromised oral health, pain, and uncomfortable treatment. The objective of this study was to analyze the effect of essential-oil vaporization on acute anxiety of patients in dental practices. Four dental practices used five weekly cycles of vaporization with each scent: Orange (Citrus sinensis), Swiss Pine (Pinus cembra), Good Mood (blended essential oils: Citrus sinensis, Citrus aurantifolia, Citrus limon, Osmanthus fragrance (5%)), Forest Walk (blended essential oils: Abies grandis, Pinus cembra, Myrtus communis c. t. 1,8-cineol, Abies alba, Citrus paradisi, Abies sibirica, Pseudotsuga menziesii, Vetiveria zizanoides), and water. Acute anxiety was the primary outcome (state-trait-anxiety inventory (STAI-S)). Secondary outcomes were trait anxiety (STAI-T), dental anxiety (Kleinknecht dental fear survey), and pain perception in treatment (numeric rating scale). Across all patients (n = 486), STAI-S was slightly higher in the control group (40.7 ± 11.6) than in the intervention groups (38.4 ± 10.5). Post-hoc analyses revealed that the effect is only robust for the subgroup of female patients (n = 296, p = 0.044). We also conducted a post-hoc additional analysis on a subpopulation with an increased level of STAI-T ≥ 42 (n = 131 patients). For this group the difference in acute anxiety between the control group (51.1 ± 11.9, n = 30) vs. the intervention groups (46.8 ± 9.6, n = 118) was significant (T = 4.39, p = 0.0379). The results of the study indicate a promising potential of essential-oil vaporization to alleviate dental anxiety, particularly in the subgroups of patients with a high level of trait anxiety, and particularly in female patients. The calming effects of the essential-oil vaporization were also highlighted by the anecdotical statements of the dental-practice staff. The anxiety-reducing role of essential-oil vaporization alone and as one part of combined techniques to counter DFA should be further explored using multi-perspective methodological approaches in research.

The Influence of Anxiety on Postoperative Quality of Life Regarding Implant Treatments: An Epidemiological Study

Dental treatment anxiety is highly prevalent worldwide. This is particularly important in the field of implantology since, in daily clinical practice, it translates into an increase in the difficulty of treatments, extending surgical times and having repercussions in the postoperative period. The aim of this multicentre, cross-sectional, epidemiological study was to determine the influence of anxiety levels in the postoperative period of an implant treatment on patients treated at two dental departments in Extremadura (Spain). To analyse anxiety levels, the modified Corah's Dental Anxiety Scale questionnaire was administered before surgical treatment. To analyse the postoperative period, another questionnaire was provided 7 days after surgery. The study was conducted on a total of 102 patients (55 men and 47 women), with a mean age of 47.99 years. The results indicated that patients with a high and severe degree of anxiety had a poorer quality of life in general. Patients with a higher degree of anxiety perceived greater swelling at 24, 48, 72 h and one week after surgery.

Do Subjects from Different Occupational Groups Experience Dental Fear and Anxiety Equally?

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients.

More than fear? Brain activation patterns of dental phobic patients before and after an exposure-based treatment

Hyperactivation of brain networks conferring defensive mobilization is assumed to underlie inappropriate defensive-preparation in patients with Specific Phobia. However, studies targeting Dental Phobia (DP) yielded quite heterogeneous results and research concerning the effects of exposure treatments on phobic brain activation so far is missing. This functional Magnetic Resonance Imaging (fMRI) study aimed to investigate activation patterns in DP patients during exposure to phobia-related stimuli and the effects of an exposure-based fear treatment on phobia-related activation. Seventeen patients with DP and seventeen non-phobic, healthy controls participated in this fMRI experiment presenting dental-related and neutral auditory and visual stimuli. After completing a short exposure-based CBT program, patients were scanned a second time to illustrate treatment-related changes in brain activation patterns. Pre-treatment fMRI results demonstrate enhanced activation in DP-patients mainly in the precuneus and lateral parietal cortex. Moreover, a small activation focus was observed in the amygdala and anterior cingulate cortex (ACC) as parts of classically fear-related structures. Activation in all these clusters decreased significantly from pre- to post-treatment assessment and in the case of the ACC was correlated with dental fear reduction. Activation changes in the precuneus and lateral parietal cortex suggest a pronounced first-person perspective memory processing including a vivid recall of contextual information from an egocentric perspective triggered by exposure to phobia-related stimuli. Besides a treatment-sensitive hyperactivity of fear-sensitive structures, DP may also be characterized by a disturbed memory retrieval that can be reorganized by successful exposure treatment.

Efficacy of the TuttleNumbNow Intraosseous Method for Pulpal Anesthesia in the Mandibular First Molar: A Prospective, Randomized, Crossover Study

INTRODUCTION

Previous studies on intraosseous (IO) anesthesia as a primary injection have shown high success rates. The TuttleNumbNow (TNN; Orem, UT) is a new primary IO injection technique that has not been scientifically evaluated. Therefore, the purpose of this prospective randomized, crossover study was to evaluate the anesthetic efficacy of the TNN IO technique using the Septoject Evolution needle (Septodont, Saint-Maur-des-Fosses, France) compared with buccal infiltration for pulpal anesthesia in mandibular first molars.

METHODS

One hundred four healthy subjects were randomly assigned to 2 treatment groups separated by at least 2 weeks. One set of injections consisted of buccal infiltration of the mandibular first molar using 1.8 mL 4% articaine with 1:100,000 epinephrine followed by a mock TNN injection distal to the mandibular first molar. The other set of injections was a mock buccal infiltration of the mandibular first molar followed by a TNN injection of 1.8 mL 4% articaine with 1:100,000 epinephrine distal to the mandibular first molar. Statistical analyses were performed.

RESULTS

For the mandibular first molar, which had a 42% anesthetic success rate (highest 80 reading) with buccal infiltration compared with 49% with the TNN, no statistically significant difference in success was observed (P = .2115).

CONCLUSIONS

The TNN technique has been advocated as an IO injection. However, the inability to deliver anesthetic solution to the cancellous bone resulted in an anesthetic success rate of 49%. The success was statistically similar to a buccal infiltration (42%) and would not provide adequate pulpal anesthesia as a primary injection.

Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis

BACKGROUND

Non-pharmacological behavioural interventions (NPBIs) have been employed by dentists to alleviate dental fear and anxiety (DFA) among preschool and school children. The aim of this systematic review and meta-analysis was to investigate the effectiveness of different NPBIs in reducing DFA among children aged below 12.

METHOD

A comprehensive search was conducted using four electronic databases to identify randomised controlled trials that assess the effectiveness of NPBIs among preschool and school children. Two reviewers independently screened and selected the relevant studies, evaluated the risk of bias, and extracted relevant data for qualitative and quantitative syntheses.

RESULT

A total of 66 articles were included in the study. Except during more invasive dental procedures, the use of distraction techniques was found to result in significantly lower self-rated anxiety, better cooperation, and lower pulse rate compared to the tell-show-do method. However, inconsistent results were reported regarding the efficacy of virtual reality, modelling, visual pedagogies, tell-show-do and other NPBIs in reducing DFA among children.

CONCLUSIONS

The studies exhibited substantial heterogeneity due to varying age groups, methods of implementing NPBIs, dental treatments performed, and measurement scales employed in the evaluation of DFA.

Assessment of patients' dental anxiety levels in the context of infectious diseases: development and validation of Musa Kazim's Dental Anxiety Scale (MK-DAS)

OBJECTIVES

The study aimed to develop and validate a new scale called Musa Kazim's Dental Anxiety Scale (MK-DAS) to measure dental anxiety in relation to infectious diseases.

METHODS

The study utilized a cross-sectional design and recruited participants from Faculty of Dentistry, Altinbas University. The sample included 289 participants who were seeking dental treatment. The Modified Dental Anxiety Scale (MDAS) was employed for the purpose of assessing levels of dental anxiety. In contrast, the MK-DAS, comprised a series of seven inquiries specifically targeting concerns regarding the treatment procedure and the fear of contagion. The data was analyzed using various statistical methods, including descriptive statistics, exploratory factor analysis, criterion validity, cluster analysis for cut-off points, and test-retest reliability.

RESULTS

The factor analysis revealed that MK-DAS had a two-factor structure. The first factor consisted of five items related to various aspects of the treatment process (α:0.837), while the second factor included two items related to the fear of infectious diseases (α:0.747). The scale showed good reliability, as indicated by high Cronbach's alpha coefficients for both factors. Strong positive correlations were found between MDAS and the first factor of MK-DAS (r = 0.857; p < 0.01), moderate positive correlations between MDAS and the second factor (r = 0.323; p < 0.01), and a strong positive correlation between MDAS and the overall of MK-DAS (r = 0.782; p < 0.01). Additionally, the cluster analysis yielded a cut-off score of 17 based on the k-means analysis. Moreover, test-retest reliability analyses indicated that dimension 1 (ICC: 0.904), dimension 2 (ICC: 0.840), and overall MK-DAS (ICC: 0.944) demonstrated high internal consistency.

CONCLUSION

The MK-DAS is an innovative and modern dental anxiety scale that has been proven to be reliable and valid, surpassing the comprehensiveness of the MDAS.

Evaluation of hemodynamic changes and patient-reported outcome measures in surgical therapy with or without intravenous sedation: a prospective controlled clinical study

OBJECTIVES

To determine whether intravenous (IV) sedation would contribute to the stabilization of patients' hemodynamics during periodontal and oral surgical procedures, and to evaluate the patient-reported outcome measures (PROMs).

MATERIALS AND METHODS

Periodontal or oral surgery patients were recruited and distributed into two groups: (1) sedation group (SG): intravenous sedation plus local anesthesia; (2) control group (CG): local anesthesia only. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SaO2), were monitored at 15-min intervals from sitting in the dental chair (baseline) until the end of the treatment. In addition, a subjective assessment of PROMs was obtained through a post-operative questionnaire.

RESULTS

Forty-nine patients (25 in SG and 24 in CG) were included. The highest SBP and DBP were significantly higher in CG compared to the SG (141.1 ± 18.4 and 133.6 ± 15.1, respectively in SBP; and 85.5 ± 11.0 and 82.9 ± 10.1, respectively in DBP), but no mean significant differences were found between groups (P value of 0.85 and 0.72 for systolic and diastolic BP, respectively). HR and SaO2 did not show statistical intra- and inter-group differences. The overall patient satisfaction score was significantly higher in the SG group compared to CG.

CONCLUSIONS

Intravenous moderate sedation seems to contribute to the stabilization of patient's hemodynamics, especially the systolic blood pressure, although small differences have been found.

CLINICAL RELEVANCE

Intravenous sedation seems to contribute to stabilize the hemodynamic values, and enhances the patient satisfaction after periodontal and oral surgical treatment in the dental office.

Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

Variables associated with oral health-related self-efficacy - results of a cross-sectional study

BACKGROUND

Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions.

METHODS

OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen's d) were calculated.

RESULTS

The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059).

CONCLUSIONS

In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Is Dental Anxiety Associated with Oral Health-Related Quality of Life? Assessment of Statistical Significance and Clinical Meaningfulness in a Sample of Russian Medical and Dental Students

Information about oral health-related quality of life (OHRQoL) and dental anxiety (DA) in Russian young adults is scarce. We investigated how DA is associated with OHRQoL in a group of medical and dental students in North-West Russia. The study had a cross-sectional design and included 807 students aged 18-25 years who attended the Northern State Medical University in Arkhangelsk. OHRQoL and DA were measured by the Oral Health Impact Profile (OHIP-14) and Corah's Dental Anxiety Scale (DAS), respectively. A questionnaire collected information on socio-demographics and self-reported oral health (OH) characteristics. A dental examination was executed to assess dental caries and oral hygiene. We observed differences in the OHIP-14 scores between dentally anxious and non-anxious students: unadjusted incidence rate ratio [IRR] = 1.65, 95% confidence interval [CI]: 1.29-2.12; after adjustment for socio-demographics and clinically assessed OH: IRR = 1.58, 95% CI: 1.23-2.02; after adjustment for socio-demographics, clinically assessed OH, and self-reported OH characteristics: IRR = 1.27, 95% CI: 0.99-1.63. The differences between estimated marginal means for the DAS categories in the models were 2.92, 2.51, and 1.24, respectively. Minimal clinically important differences of OHIP-14 fell between 1.68 and 2.51. We found a negative statistical association between DA and OHRQoL in our study sample, but after adjustment for potential confounders, the association lost its clinical importance.

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

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

The role of neuroticism and pain in dental anxiety: A twin study

OBJECTIVES

Accumulating evidence has revealed that dental anxiety is robustly associated with dental care-related pain and discomfort, but also with the personality trait of neuroticism (i.e. the relatively stable disposition to experience the world as distressing, threatening and unsafe). However, there is a near absence of research on these risk factors in samples for which genetic information is available. With the aim of arriving at a more refined understanding of dental anxiety, this twin cohort study assessed genetic and environmental influences on neuroticism, dental care-related pain and dental anxiety, and the relation between these phenotypes.

METHODS

Participants were recruited from the Norwegian Twin Registry, and data collections were carried out in 1992-98 (Time 1) and 2011 (Time 2). Well-validated questionnaires were used to assess the study variables, including Corah's Dental Anxiety Scale, the Numerical Pain Rating Scale, the NEO Personality Inventory Revised (Time 2) and Eysenck's Personality Questionnaire (Time 1). Pearson correlation analysis and generalized estimating equations (GEE) were used to investigate phenotypic associations. Analyses of genetic and environmental influences were performed using Cholesky modelling.

RESULTS

A total of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 participated in the study. Moderate estimates of heritability for dental anxiety (0.29), treatment-related pain (0.24) and neuroticism (0.45-0.54) were found. Cholesky modelling showed furthermore that neuroticism assessed at Time 1 and Time 2 was related to dental anxiety and pain via both genetic and individual-specific environmental pathways, albeit not very strongly. The particularly high phenotypic correlation observed between dental care-related pain and anxiety (r = .68) was explained by both overlapping genetic and individual-specific environmental influences (the genetic and environmental correlations were .84 and .63 respectively).

CONCLUSIONS

The findings provide deeper insight into the aetiology of dental anxiety and confirm that while it is strongly linked to treatment-related pain experiences, this relation is to a considerable degree independent of general negative affectivity/neuroticism.

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

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

What is the gold standard of the dental anxiety scale?

It is important to understand patients' anxiety and fear about dental treatment. A patient's anxiety can be quantified through a self-report questionnaire, and many related scales have been developed. In this review, I tried to find out which scale is most suitable for the patient's dental anxiety and fear evaluation by examining the contents of previously developed scales and comparing the strengths and weaknesses of each scale.

Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+)

BACKGROUND AND OBJECTIVES

The goal of this study was to assess the validity of the Romanian version of the Index of Dental Anxiety and Fear (IDAF-4C+) questionnaire.

MATERIALS AND METHODS

This study was conducted on a convenience sample of past patients and their acquaintances through an online questionnaire administered on the Google Forms platform between May 2021 and September 2022. The sections of the survey were demographic characteristics, the dental anxiety scale questionnaire, the IDAF-4C+ questionnaire, a single question about dental fear, and previous dental treatments.

RESULTS

In total, 239 participants were included in the study, and the mean age was 37. The IDAF-4C questionnaire had good internal validity (Cronbach alpha was 0.945). The IDAF-4C had good convergent validity, and it was positively correlated with the dental anxiety scale (r = 0.825, p < 0.001) and the question about the fear of going to the dentist (r = 0.738, p < 0.001). The questionnaire had good reliability, and the intraclass correlation was 0.985. Lower levels of dental anxiety were associated with scaling, orthodontic treatment, and dental implants. A confirmatory factor analysis was conducted after the removal of the first question from the phobia module, and residual covariance was added between items four and nine of the stimulus module, showing a good fit for the retained questions of the IDAF-4C+, grouped by module.

CONCLUSIONS

The Romanian version of the IDAF-4C+ showed acceptable psychometric properties.

Are childhood oral health behaviours and experiences associated with dental anxiety in adolescence?

BACKGROUND

Dental anxiety is associated with untreated dental caries. Understanding which childhood behaviours or experiences have the strongest association with later dental anxiety may help focus preventive strategies, subsequently limiting the burden of dental caries and anxiety.

AIM

The aim of this study was to explore whether behaviours and experiences during childhood were associated with adolescent dental anxiety.

DESIGN

Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multivariable logistic regression was used to explore associations between adolescent dental anxiety and childhood behaviours and experiences. 1791 participants answered questions about oral health behaviours and experiences at 8 years of age and dental anxiety questions aged 17 years.

RESULTS

Children with experience of invasive dental treatment were more likely to have dental anxiety at 17 years of age than those who had not experienced dental treatment (OR 1.63; 95% CI: 1.12, 2.37; p = .011). Irregular dental attenders in childhood had over three times the odds of dental anxiety by adolescence, compared with regular attenders (OR 3.67 95% CI: 1.52, 8.88; p = .004).

CONCLUSIONS

Adolescent dental anxiety is associated with invasive treatment and irregular dental attendance in childhood. A history of irregular attendance or invasive treatment may serve as a useful predictor when considering dental anxiety in young adult patients. Early preventive care supports good attendance and oral health. These actions may have secondary effects of reducing future dental anxiety.

Prevalence of negative behaviour in the dental setting and association with sociodemographic, oral health-related and psychosocial factors amongst Brazilian preschool children

PURPOSE

To investigate the prevalence of negative behaviour in preschool children attending dental clinics and its association with sociodemographic, oral health-related and parental psychosocial factors.

METHODS

A cross-sectional study was carried out with 145 parents/guardians and their children aged 4-6 years attending paediatric dentistry training programmes in a capital city of Midwest Brazil. Data were obtained from children's dental records, interviews, and questionnaires for parents/guardians. The outcome was negative child behaviour, based on the dentists' use or indication of behavioural control measures during the dental appointments, as registered in the children's dental records. Covariates were sociodemographic, clinical and parent/guardian psychosocial factors religiosity (DUREL index) and Sense of Coherence (SOC-13 scale). Bivariate analyses and Poisson regression with robust variance were performed.

RESULTS

The prevalence of negative behaviour was 24.1% (95% CI = 17.9-31.7). In the bivariate analyses, the variables initially selected for the regression models (p < 0.25) were the parent/guardians' number of children and religiosity, and the children's dental pain and caries status in deciduous teeth. After adjustment, the prevalence of negative behaviour was 2.12 higher in children with teeth extracted due to caries.

CONCLUSION

The prevalence of negative behaviour was high and associated with the presence of missing teeth due to caries, regardless of sociodemographic, psychosocial, and other oral health factors.

A Bibliometric Analysis on the Early Works of Dental Anxiety

Dental anxiety has been a common phenomenon under investigation for decades. This report aimed to identify the historical roots of dental anxiety in the research literature. The literature database Web of Science Core Collection was searched to identify relevant papers on this theme. Cited reference analysis on the collected literature set was performed with CRExplorer, a dedicated bibliometric software. This analysis successfully identified the references dealing with dental anxiety in the late 1800s and early 1900s. They included essays that provided expert opinion on dental anxiety, reported semi-structured interviews to elucidate its underlying reasons, introduced psychometric scales to assess dental anxiety, and proposed theories and arguments from psychoanalytic aspects. Several references dealing with anxiety in general were also identified. To conclude, cited reference analysis was useful in revealing the historical origins of dental anxiety research. These cited references provided a concrete foundation to support subsequent dental anxiety research.

Investigate the role of positive and negative memories from dentistry in the anxiety of dental patients in Kerman, Iran

BACKGROUND AND AIM

Several research works show that anxiety is more common in women, low-income classes, and middle-aged and elderly populations. The present study aimed to investigate the role of positive and negative memories in patients' anxiety referred to the dental clinics, offices, and schools of Kerman, Iran, in 2018-2019.

MATERIALS AND METHODS

In this cross-sectional, descriptive, analytical study, the participants were selected among individuals referred to the dental offices, schools, and clinics of Kerman, Iran. In this study, 500 questionnaires were distributed among the participants (based on census method), and of these, 482 of which were reviewed (response rate = 96.4%). The questionnaire used in this study contained four categories of questions, including demographic information, general questions about dentistry, Corah's Dental Anxiety Scale, and Autobiographical Memory Questionnaire. Analysis of variance, t-test, and Chi-square test were used to analyze.

RESULTS

Overall, 281 participants were female, and 201 were male. Based on the findings, dental visits were enjoyable and pleasant experiences for 154 participants, and 165 patients were anxious while the dentist prepared for a restorative treatment. This study showed that people with negative memories had more anxiety. Anxiety was also significantly associated with positive memories, higher education, and gender (female) (P < 0.05). Also, the most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults (P < 0.05), while positive memories did not have a relationship any with decreased anxiety (P > 0.05).

CONCLUSION

The most negative memories of dental treatments were associated with increased anxiety about dental treatments in adults, while positive memories did not have any expected inverse relationship with anxiety.

Associations between oral habits, dental anxiety, dental service utilization, and maternal mental health status among 6- to 12-year-old children in Ile-Ife, Nigeria

PURPOSE

The current study sought to determine the associations between maternal mental health and oral habits, dental anxiety, and dental service utilization of 6- to 12-year-old children in Ile-Ife, Nigeria.

METHODS

Data were obtained from a household survey involving 1411 mothers and their 6- to 12-year-old children. Data collected were the confounding (maternal age, child's age at last birthday, sex at birth and socioeconomic status), independent (maternal psychological distress, and depression status) and dependent (child's non-nutritive oral habits, dental anxiety level, and most recent dental visit) variables. Bivariate analyses were conducted to test the associations between the dependent and independent variables. After controlling for confounding variables, the associations between the dependent and independent variables were determined using multivariable linear and logistic regression analyses.

RESULTS

Overall, 479 (33.9%) reported one oral habit, 189 (13.4%) reported two and 99 (7.0%) children reported three or more oral habits. Only 25 (1.7%) children reported a dental visit in the year preceding the study. Higher maternal psychological distress was associated with higher dental anxiety in children (AOR: 0.094; 95% CI - 0.080 to - 0.293; p < 0.001). There was no significant association between maternal psychological distress, child's non-nutritive oral habits, and the child's most recent dental visit. There was also no association between maternal depression and the child's non-nutritive oral habits, dental anxiety level, and most recent dental visit.

CONCLUSION

Maternal psychological distress was a significant risk indicator for dental anxiety, but not for dental service utilization or non-nutritive oral habits among children in Ile-Ife, Nigeria. Maternal educational status was also associated with dental anxiety. Further research is needed to elucidate the study's findings.

Relationship between Children's and Parents' Dental Anxiety: A Cross-Sectional Study on the Six European Countries

Background: The purpose of this study is to investigate the relationship between children’s and parents’ dental anxiety. Methods: 731 children of different ages and their parents from six European countries participated in this study. Dental anxiety was investigated through an online questionnaire, which consisted of general questions and the Corah Dental Anxiety Scale (CDAS), which is a questionnaire that measures respondents’ reactions on a 5-point scale for four different situations. Results: CDAS results were calculated for all children and their parents. A total of 12.5% of children from Croatia, 26.67% from Macedonia, 10.94% from Bosnia and Herzegovina, 20.31% from Montenegro, 23.08% from Slovenia and 16.10% from Serbia showed a high level of anxiety. The correlation between dental anxiety of parents and children was 0.4 (p < 0.01). Conclusions: Parents with negative experience from a dental office can have a bad effect on their child’s behaviour, which results in the creation of a non-active patient. Due to the clear and existing cause-and-effect relationship of dental anxiety in children and parents, it is extremely important to educate parents about the proper psychological approach to children in order to promote positive experiences from dental offices, as well as to emphasize the importance of regular visits to the dentist.

Anxiety Rating Scale for Speech and Hearing-impaired Children

Background

It has been observed that children with special healthcare needs exhibit higher dental anxiety levels because of various barriers. In the literature, there is no anxiety assessment scale for speech and hearing-impaired children. A new concept of pictorial representation of common emotions observed during dental treatment was used to design an innovative scale, thereby helping to improve communication and in bringing out positive behavior among the children. This study aimed to assess and validate the efficacy of an anxiety rating scale for speech and hearing-impaired children.

Materials and methods

A total of 36-12-year-old children with speech and hearing impairments from a special school were selected for this study. The pretreatment anxiety score among the children was assessed using the pictorial anxiety rating scale.

Results

The anxiety rating scale was well accepted by speech and hearing-impaired children. It was well-supported by expert opinions and equal distribution of anxiety scores.

Conclusion

The pictorial scale is a valid anxiety assessment scale for measuring dental anxiety among speech and hearing-impaired children. It can be used independently to assess dental anxiety in clinical settings and epidemiological studies as well.

How to cite this article

Shivashankarappa PG, Kaur J, Adimoulame S. Anxiety Rating Scale for Speech and Hearing-impaired Children. Int J Clin Pediatr Dent 2022;15(6):704-706.

Genome-wide Scan of Dental Fear and Anxiety Nominates Novel Genes

Dental care-related fear and anxiety (DFA) is prevalent, affects oral health care utilization, and is related to poor oral health and decreased quality of life. In addition to learned and cultural factors, genetics is hypothesized to contribute to DFA. Therefore, we performed a genome-wide association study to identify genetic variants contributing to DFA. Adult and adolescent participants were from 4 cohorts (3 from the US-based Center for Oral Health Research in Appalachia, n = 1,144, 1,164, and 535, and the UK-based Avon Longitudinal Study of Parents and Children [ALSPAC], n = 2,078). Two self-report instruments were used to assess DFA: the Dental Fear Survey (US cohorts) and Corah's Dental Anxiety Scale (ALSPAC). Genome-wide scans were performed for the DFA total scores and subscale scores (avoidance, physiological arousal, fear of dental treatment-specific stimuli), adjusting for age, sex, educational attainment, recruitment site, and genetic ancestry. Results across cohorts were combined using meta-analysis. Heritability estimates for DFA total and subscale scores were similar across cohorts and ranged from 23% to 59%. The meta-analysis revealed 3 significant (P < 5E-8) associations between genetic loci and 2 DFA subscales: physiological arousal and avoidance. Nearby genes included NTSR1 (P = 3.05E-8), DMRTA1 (P = 4.40E-8), and FAM84A (P = 7.72E-9). Of these, NTSR1, which was associated with the avoidance subscale, mediates neurotensin function, and its deficiency may lead to altered fear memory in mice. Gene enrichment analyses indicated that loci associated with the DFA total score and physiological arousal subscale score were enriched for genes associated with severe and persistent mental health (e.g., schizophrenia) and neurocognitive (e.g., autism) disorders. Heritability analysis indicated that DFA is partly explained by genetic factors, and our association results suggested shared genetic underpinnings with other psychological conditions.

Assessment of Clinical Parameters of Dental Anxiety during Noninvasive Treatments in Dentistry

Dental anxiety is a matter of interest for the dentist since an anxious patient is a potential source of complications in the dental office. The main objectives of this study are to describe the correlation between dental anxiety levels and the values of physiological parameters related to dental anxiety and to study the evolution of blood pressure and heart rate over time during noninvasive dental treatments, i.e., not requiring local anesthesia. A descriptive, longitudinal, and prospective observational study was designed. The study population consisted of 200 patients who attended a university clinic for dental treatment without local anesthesia. The patients were asked to complete the Corah Dental Anxiety Scale. Afterward, blood pressure and heart rate were measured by means of a digital sphygmomanometer. Blood pressure and heart rate were taken throughout the procedure on four occasions. Most of the patients showed mild dental anxiety (5 [IQR: 3] points on Corah Dental Anxiety Scale). Significant but weak correlations were found between the level of dental anxiety and heart rate (Spearman rho: 0.166 and 0.176; p = 0.019 and 0.013; 3 min before and after treatment, respectively), as well as between the level of dental anxiety and the duration of treatment (Spearman rho: 0.191 3 min; p = 0.007). As for the evolution of physiological parameters, all patients showed a progressive decrease in values at different time points during treatment. When the types of treatment were evaluated separately, it was observed that there were statistically significant differences between them with respect to the level of dental anxiety (p = 0.006).

Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption

Preoperative anxiety has an incidence of 11-80% in patients undergoing surgical or interventional procedures. Understanding the role of preoperative anxiety on intraoperative anesthetic requirements and postoperative analgesic consumption would allow personalized anesthesia care. Over- or under-anesthetizing patients can lead to complications such as postoperative cognitive dysfunction in elderly patients, or procedural discomfort, respectively. Our scoping review focuses on the current evidence regarding the association between preoperative anxiety and intraoperative anesthetic and/or postoperative analgesic consumption in patients undergoing elective surgical or interventional procedures. Based on 44 studies that met the inclusion criteria, we found that preoperative anxiety has a significant positive correlation effect on intraoperative propofol and postoperative opioid consumption. The analysis of the literature is limited by the heterogeneity of preoperative anxiety tools used, study designs, data analyses, and outcomes. The use of shorter, validated preoperative anxiety assessment tools may help optimize the intraoperative anesthetic and postoperative analgesic regimen. Further research to determine the most feasible and clinically relevant preoperative anxiety tool and subsequent implementation has the potential to optimize perioperative care and improve patient outcomes.

Patient and Caregiver Perceptions of Animal Assisted Activity in Orthodontics

Dental anxiety affects up to 21% of children and 80% of adults and is associated with lifelong dental avoidance. Animal assisted activity (AAA) is widely used to reduce anxiety and pain in medical settings and has promise in dentistry. The primary objective of this study was to evaluate caregiver and patient perceptions of canine AAA in orthodontics. A cross-sectional survey consisting of pre-tested and validated questions was conducted (n = 800) including orthodontic patients (n = 352 minors, n = 204 adults) and parents/caregivers (n = 244) attending university orthodontic clinics. In this study, AAA and dog therapy were not used or tested for dental anxiety management. More than a third of orthodontic patients (37%) had moderate or greater anxiety related to care. Participants believed that therapy animals would make dental experiences more enjoyable (75%) and reduce anxiety (82%). There was little to no concern expressed regarding cleanliness (83%), allergies (81%), and safety (89%) with a therapy animal in dental settings. Almost half of the participants would preferentially select an orthodontic office offering AAA. In light of the COVID-19 pandemic, we assessed whether perceptions of AAA changed before and after the shutdown of dental offices, with no significant differences. Across patients and caregivers, the responses support the use of AAA in orthodontic settings with minimal concerns.

Can Intra-Oral Qualitative Sensory Testing Foretell Postoperative Dental Pain? A Preliminary Report

Pain prevention and management is one of the primary goals of dental care. Postoperative dental pain (PDP) following caries removal and performance of a restorative dental treatment is a common clinical phenomenon, often causing significant discomfort to dental patients. In the present study, a psychophysical non-invasive method, qualitative sensory testing (QualST), was used in an attempt to foretell PDP following dental restorative procedures. Forty-two dental patients underwent an intra-oral cold QualST four times: immediately prior to a restorative dental procedure and at a follow-up meeting 1−3 weeks later, on the treated and on the contralateral oral sides. The QualST measures included subjects’ evaluation of the magnitude of pain and cold sensations experienced (on visual analogue scales) and the duration of the cold sensation (in seconds). Additional measures included age, gender, level of dental anxiety, jaw treated, and type of dental restoration performed (Class I or Class V). Subjects’ PDP was assessed through the phone using numeric rating scales 24, 48, and 72 h postoperatively. The highest level of PDP experienced by subjects occurred 24 h postoperatively (ANOVA with repeated measures). Of the study variables, the QualST pain sensation (B = 0.645, p < 0.001), duration of the cold sensation (B = 0.042, p < 0.05), and an interaction between gender and dental anxiety (B = 0.136, p < 0.05) emerged as possible predictors of the highest PDP experienced by subjects (stepwise regression). The results suggest that subjects’ reaction to an intra-oral cold stimulation of the oral mucosa can serve as a potential tool to foretell postoperative dental pain following restorative dental procedures.

Dental Anxiety and Oral-Health-Related Quality of Life among Rural Community-Dwelling Older Adults

Aim: This study aimed to investigate the association between dental anxiety (DA) and oral-health-related quality of life (OHRQoL) among rural community-dwelling older adults. Methods: A cross-sectional descriptive study was conducted among 390 rural community-dwelling older adults attending outpatient clinics of the Damanhur National Medical Institute during the year 2021. Three instruments were used: a demographic and clinical data structured interview schedule, Modified Dental Anxiety Scale (MDAS), and the Oral Health Impact Profile (OHIP-5) questionnaire. All statistical analyses were considered significant at a p-value of ≤0.001. Results: The main results showed that the prevalence of DA among participants was 90.5%, and 66.9% of the studied elderly population were either extremely (phobic) or very anxious. Moreover, a significant association was found between older adults’ DA and their OHRQoL (p ˂ 0.001). Conclusions: It was concluded that DA represents a common problem among rural community-dwelling older adults and is a predictor for poor OHRQoL. Raising community awareness about the importance of oral health and implementing measures to avoid DA through specialized community campaigns is recommended, particularly in rural areas.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Comparison of Maxillary Lateral Incisor Infiltration Pain Using the Dentapen and a Traditional Syringe: A Prospective Randomized Study

INTRODUCTION

The anterior maxillary infiltration is one of the more painful dental injections. The Dentapen is an electronic syringe that utilizes computer-controlled delivery technology to administer dental local anesthesia at a slow controlled rate. The purpose of this prospective, randomized, single-blind study was to evaluate solution deposition pain of a maxillary lateral incisor infiltration using the Dentapen with the slow flow rate (1.8 mL/162 seconds) and ramp-up setting compared to a traditional syringe infiltration at a flow rate of 1.8 mL/60 seconds.

METHODS

One hundred thirty adults were administered a maxillary lateral incisor infiltration with the Dentapen and a traditional syringe at two separate appointments in a single blind manner. The infiltrations of 2% lidocaine with 1:100,000 epinephrine were given at a rate of 1.8 mL/162 seconds with the ramp-up feature for the Dentapen and 1.8 mL/60 seconds for the traditional infiltration. The pain of solution deposition was recorded on a visual analog scale. At the conclusion of the study, subjects selected their preferred injection technique. The data were analyzed statistically using paired t-tests, a mixed-effect model, and odds ratio.

RESULTS

The pain of solution deposition was significantly less for the Dentapen injection than the traditional injection (p<0.001). With the Dentapen device, 16% experienced moderate pain and for the traditional syringe, 39% experienced moderate pain. Overall, 75% of subjects preferred the Dentapen injection over the traditional injection.

CONCLUSION

The Dentapen, using the slow flow rate and ramp-up mode, significantly reduced the pain of solution deposition for maxillary lateral incisor infiltrations.

Effect of photobiomodulation therapy on patient morbidity and wound healing at donor site after free gingival graft harvesting: a triple-blind randomized-controlled clinical trial

OBJECTIVES

This study aimed to evaluate the effect of photobiomodulation therapy (PBMT) on patient morbidity and donor site healing after free gingival graft (FGG) harvesting.

METHODS

Forty-four patients requiring FGG were selected for this trial. Individuals were randomly assigned to test group (PBMT, n=22) or control group (placebo, n=22) applied immediately after surgery, 24 and 48 hours after. Demographic, surgical-related and psychosocial variables possibly associated with treatment response were collected. The primary outcome was postoperative pain at the donor site evaluated using Visual Analogue Scale (VAS) immediately after surgery and 6, 24, 48 and 72 hours after. Secondary outcomes include medication consumption, patient-reported outcome measures (PROMs) and percentage of wound closure.

RESULTS

Intragroup analysis showed no differences in VASLog means for placebo group throughout the study (p>0.05), whereas a significant difference in PBMT group at 6h, 24h, 48h and 72h (p<0.05) were observed. Postoperative rescue analgesic requirement was significantly higher in the placebo group (p=0.004). The number needed to treat(NNT) was 2.43. PBMT group reported significant better function related to sleeping, going to work/school and daily routine activities, less restriction to mouth opening, chewing and food consumption, less swelling and bleeding (p<0.05), mainly in the first 48hs. PBMT group presented a significantly higher palatal wound closure at 7 days compared to placebo group (33.41 vs 21.20 respectively, p=0.024) after adjustment for confounding. No adverse effects were reported.

CONCLUSIONS

PBMT accelerated the pain resolution time and palatal closure, decreased rescue medication consumption and significantly improved patient satisfaction in the postoperative period.

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial

Purpose

The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes).

Methods

In this randomised controlled parallel arm trial involving 123 children aged 8–12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham’s scale and pain was measured by both self-reporting and observational scales.

Results

No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores.

Conclusion

Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction.

Clinical trial registration

The clinical trial was registered at Clinical Trials Registry–India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00698-7.