Dental fear: one single clinical question for measurement

The effect of parental presence on the anxiety during first dental treatment in children

OBJECTIVE

The aim of this study was to evaluate the effect of parental presence on dental anxiety in children during dental treatments.

MATERIALS AND METHODS

The study was conducted with 194 children between January-April, 2020. The children were randomly divided into two subgroups. Children in group-I were treated in parent's presence (pp), and in group-II in parent's absence (pa). The Wong-Baker FACES Pain Rating Scale (WBFPS) and The Modified Dental Anxiety Scale (MDAS) were used for subjective measurements, whereas the objective measurement was performed by measuring the heart rate.

RESULTS

The mean age of 194 children was 6.26 ± 1.15 years, ranging from 5-8 years of age. The mean MDAS score of all children was 15.1 ± 4.72. No significant correlations were found in terms of dental anxiety between the children's gender and age with heart rate, WBFPS and MDAS scores. Preoperative WBFPSscores (6.83 ± 1.04 pp and 7.01 ± 0.93 pa) were higher than postoperative scores (5.34 ± 2.11 pp and 5.74 ± 2.04 pa), with no statistically significant difference. Although there was no statistically significant results, the paediatric dentist observed a deterioration in the children's behavior throughout the sessions in group-II compared to children in group-I.

CONCLUSIONS

Parental presence has no statistically significant effect on dental anxiety in children during dental treatments.

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.

Service design in healthcare: a segmentation-based approach

Purpose

The study aims to explore how segmentation as a methodology can be adapted to the healthcare context to provide a more nuanced understanding of the served population and to facilitate the design of patient-centric services.

Design/methodology/approach

The study was based on a collaborative project with a national healthcare organization following the principles of action design research. The study describes the quantitative segmentation performed during the project, followed by a qualitative interview study of how segments correspond with patient behaviors in an actual healthcare setting, and service design workshops facilitated by segments. A number of design principles are outlined based on the learnings of the project.

Findings

The segmentation approach increased understanding of patient variability within the service provider organization and was considered an effective foundation for modular service design. Patient characteristics and life circumstances were related to specific patterns of health behaviors, such as avoidance or passivity, or a persistent proactivity. These patterns influenced the patients' preferred value co-creation role and what type of support patients sought from the care provider.

Practical implications

The proposed segmentation approach is immediately generalizable to further healthcare contexts and similar services: improved understanding of patients, vulnerable patients in particular, improves the fit and inclusivity of services.

Originality/value

The segmentation approach to service design was demonstrated to be effective in a large-scale context. The approach allows service providers to design service options that improve the fit with individual patients' needs for support and autonomy. The results illuminate how patient characteristics influence health and value co-creation behaviors.

Participant Observation to Apply an Empirical Method of Codesign with Children

Dental anxiety in children is a well-documented problem in the scientific literature. Tools mediated by Information Technology have been shown to positively influence children’s mood based on distraction as well as relaxing activities. We propose an empirical method of codesign with children to generate app content for reducing dental anxiety. The results are embedded in text through a thick description as an ethnographic technique. The method was applied to 163 children (6–8 years old) from a summer school and a primary school, obtaining multimedia products that were integrated into an app prototype. Finally, although this use case of the presented method is applied to the health field, it can be transferred to any other field of application of codesign to children by using material that is specific to new scenarios.

Impact of maternal and child dental anxiety on oral health-related quality of life of 5-6-year-old preschool children

BACKGROUND

There is a lack of evidence with regards to the association between both maternal and child dental anxiety and the mother's perception of her child's oral health-related quality of life (COHRQoL). The aim of this study was to investigate the association of maternal and child dental anxiety with COHRQoL and the effect of demographic factors as moderators in this relationship. In addition, the association between child's dental caries experience and the COHRQoL was also assessed.

METHODS

A cross-sectional study was conducted involving 1150, 5-6 year-old preschool children in Selangor, Malaysia. Mothers answered a questionnaire on socio-economic status, the Malay-Modified Dental Anxiety Scale to assess maternal dental anxiety, and the Malay-Early Childhood Oral Health Impact Scale to assess COHRQoL. Child's dental anxiety was assessed using the Malay-Modified Child Dental Anxiety Scale via a face-to-face interview prior to oral examination to assess dental caries. Data were analysed using structural equation modelling to assess the relationship between maternal and child dental anxiety and COHRQoL.

RESULTS

Overall, complete data on 842 mother-child dyads were analysed. The mean scores of total ECOHIS, the child impacts section (CIS), and the family impacts section (FIS) were 17.7 (SD = 4.9), 12.6 (SD = 3.7), and 5.1 (SD = 1.9), respectively. The mean dental anxiety scores for mothers and children were 11.8 (SD = 4.5) and 16.9 (SD = 4.3), respectively. Maternal dental anxiety was associated with the CIS (b = 0.08, p < 0.001), the FIS (b = 0.01, p = 0.001), and the total ECOHIS (b = 0.14, p < 0.001). Maternal education level, income, urban/rural location, and kindergarten type were moderators to the relationship. In addition, there was also a significant relationship between child's dental caries experience and COHRQoL (p < 0.001).

CONCLUSIONS

Maternal dental anxiety and child's dental caries experience have significantly impacted the COHRQoL, the CIS, and the FIS domains. Demographic factors such as maternal education, income, urban/rural location, and kindergarten type acted as moderators that can strengthen or weaken the relationship between maternal dental anxiety and COHRQoL of 5-6-year-old preschool children.

Stimuli involved in dental anxiety: What are patients afraid of?: A descriptive study

BACKGROUND

Dental anxiety is a psychological response inducing aversion following a dental ill-defined stimulus, non-imminent and perceived as potentially dangerous. It is better to intervene during childhood than to resolve in adulthood when dental anxiety is more settled.

AIM

The purpose of this study is to determine the nature of dental anxiety-provoking stimuli in young patients.

DESIGN

A questionnaire was submitted to 566 children between 3 to 18 years in health institutions and schools in Brussels, Belgium. The items were divided into 3 groups: environment (ENV), local anaesthesia (LA), and intervention (INT) and summarized through averaging per group. Descriptive analysis and non-parametric testing were combined with logistic regression after discretization, above mild, for the group averages.

RESULTS

About 7.2% of the respondents expressed high to severe dental anxiety. Several items presented a clear bimodal distribution dividing the population in fearless and fearing patients, for example, sight and feel of the syringe, sight and taste of blood and extraction. Others presented with a gradually lower incidence with increasing fear level. Fear for the environment was generally low. Gender and ethnic origin contribute significantly to the prediction of fear caused by LA. For fear caused by INT, first the place of questioning enters the models, thereafter follow: negative experience, frequency of dental visit, and gender (P < .05).

CONCLUSIONS

While the dental environment is in general not causing fear, the invasive part of the anaesthesia and the invasive dental procedures are involved. Fear seems to be related to culture, previous experience, and gender.

Effect of Verbal and Written Information and Previous Surgical Experience on Anxiety During Third Molar Extraction

PURPOSE

Third molar extraction is a quite common surgical procedure that causes dental anxiety. This procedure affects patients physiologically and mentally. The type of information provided to patients is important to determine the level of their anxiety regarding the surgical procedure. Patients' experience is also a major determinant of dental anxiety. It is subjective and perceived only by the patient. Questionnaires are tools used to determine and assess patient anxiety. The present study evaluated the effect of verbal and written information and the previous surgical experience of patients on their anxiety before and after third molar extraction.

PATIENTS AND METHODS

A total of 66 patients who had been admitted for third molar extraction under local anesthesia were included. The patients were divided into 3 groups: group 1 was given verbal information, group 2 was given written information, and group 3 had had previous surgical experience. The Spielberger State Anxiety Inventory (STAI-S), Dental Fear Scale (DFS), Modified Dental Anxiety Scale (MDAS), and visual analog scale (VAS) were used pre- and postoperatively to evaluate dental anxiety.

RESULTS

The MDAS and VAS scores of all patients had decreased postoperatively (P = .012 and P < .001, respectively). The postoperative MDAS and VAS scores were lower than the preoperative scores in women (P = .007 and P < .001, respectively). The postoperative MDAS (P = .014 and P = .004, respectively) and VAS (P < .001 and P = .002) scores had decreased compared with the preoperative scores in groups 2 and 3. The preoperative and postoperative MDAS and VAS scores were similar in group 1. In addition, the preoperative and postoperative STAI-S and DFS scores were similar in all groups.

CONCLUSIONS

All patients should be adequately informed about the third molar extraction procedure, even if they have previous experience. Providing detailed information reduced the postoperative anxiety of the patients.

Adolescent with caries and experienced interaction with dental staff

BACKGROUND

There is a lack of studies about how adolescents experience the interaction during dental visits. The experienced interaction during dental visits will influence how adolescents take care of their oro-dental health, and how they attend at the dentist's office.

AIM

To explore the interaction experiences during dental visits of 18-year-olds with or without a history of caries.

DESIGN

The dental health status at age 15 years was used as a predictor of subsequent interaction experiences with the dental staff. The dental health status was assessed by the Decayed Missed Filled Teeth index and interaction experiences by the Patient Dental Staff Interaction Questionnaire.

RESULTS

Adolescents with a history of caries experienced the interaction at dental visits significantly more often negatively than adolescents with healthy teeth. The association was significant after adjustment for potential confounding factors (sense of coherence, gender, and duration of maternal basic education).

CONCLUSIONS

Understanding, encouraging, and appropriate interaction with adolescents with caries may make patients more positive and receptive for treatment and self-care.

Influence of negative dental experiences in childhood on the development of dental fear in adulthood: a case-control study

The aim of this study was to evaluate the factors associated with high dental fear among Brazilian university students, especially the effect of a negative dental experience in childhood. This paired case-control study was conducted at the Universidade Federal de Minas Gerais in Brazil. Dental, psychology and mathematics students were divided into cases (high fear) and controls (low fear), defined by cluster analysis, according to the items of the Dental Fear Survey (DFS). Cases (n = 65) and controls (n = 260) participants were paired (1:4) by gender, undergraduate course and social vulnerability. The students self-reported the DFS and a questionnaire about oral health. Descriptive analysis, bivariate and multivariate conditional logistic regression were used as statistical tests with a significance level of 5%. The multivariate model showed that students who reported negative dental experiences in childhood (OR = 2·97; 95% CI: 1·44-6·14), toothache in the last 12 months (OR = 11·31; 95% CI: 4·79-26·68), discomfort during dental treatment (OR = 5·36; 95% CI: 2·53-11·36) and poor self-evaluation of oral health (OR = 3·82; 95% CI: 1·61-8·11) were more likely to have high dental fear. Negative dental experiences in childhood influence dental fear in adulthood. Oral health education should be addressed among university students to reduce dental fear.

Prevalence of Dental Anxiety among Dental Patients in Saudi Arabia

OBJECTIVE

Anxiety towards dental procedures are common difficulties that may be experienced by dental patients all over the world. This study focused on evaluating the dental anxiety frequency and its relationship with age, gender, educational level, and past dental visits among patients attending the outpatient clinics of College of Dentistry, Al Jouf University, Saudi Arabia.

MATERIAL AND METHODS

A total of 221 patients, aged 21-50 years were selected for the study. A questionnaire comprising the Modified Dental Anxiety Scale (MDAS) was used to measure the level of dental anxiety. Data was analyzed using SPSS version 20.

RESULTS

The mean anxiety score of the 221 patients was 11.39 (SD ± 2.7). Independent t-test showed a significant variation between the age groups with regards to their mean overall anxiety score (P < 0.05), which reduced with increasing age. A significant difference was found by independent t-test in the mean total score between male and female groups and regarding previous dental visit (P < 0.05). Regarding education level, there was no significant difference between the groups (P > 0.05).

CONCLUSION

Younger patients, female, and patients with previous unpleasant dental experience were associated with increased MDAS score.

CLINICAL SIGNIFICANCE

The present study was done for better patient management and proper treatment plan development for dentally anxious patients.

Determining Cut-Off Points for the Dental Fear Survey

Objective. To determine a high fear cut-off point score for the Dental Fear Survey (DFS) using a single-item self-report questionnaire. Methods. The DFS, a 20-item questionnaire assessing fear of dental treatment, was completed by 1,256 participants with a mean age of 22.3 years (SD = 5.1). Another self-report questionnaire was used to collect data on previous dental experiences. A high fear cut-off point score was determined by calculating the receiver operating characteristic (ROC) curve for the DFS. Descriptive statistics and multinomial logistic regression were calculated; a significance level of p < 0.05 was used for all tests. Results. The ROC curve indicated that a DFS score ≥53 corresponds to a sensitivity of 88.9% and a specificity of 92.5%. Most participants (n = 895; 71.5%) reported no fear of going to the dentist. There was significant association between DFS score and fear assessed with the question “Are you fearful of going to the dentist?” (p < 0.001). Conclusion. A cut-off point of 53 on the DFS total score represents the best compromise between sensitivity and specificity and can be used to predict high dental fear.

Dental Fear and Delayed Dental Care in Appalachia-West Virginia

PURPOSE

The people of Appalachia-West Virginia are culturally unique and are known to have oral health disparities. The purpose of this study was to evaluate dental fear in relation to delayed dental care as a factor influencing oral health behaviors within this culture.

METHODS

A cross sectional study design was used. Participants were urgent care patients in a university dental clinic. The sample included 140 adults over age 18 years. The Dental Fear Survey was used to determine dental fear level. Self-report of delayed dental care was provided by the participants. The Dental Fear Survey was dichotomized at score 33, with higher scores indicating dental fear.

RESULTS

The prevalence of dental fear was 47.1% (n=66). There was a significant association of dental fear and dental delay. The unadjusted odds ratio was 2.87 (95% CI: 1.17, 7.04; p=0.021). The adjusted odds ratio was 3.83 (95%CI: 1.14, 12.82; p=0.030), controlling for tobacco use, perceived oral health status, pain, and last dental visit. A difference in dental delay between men and women was not present in this sample. The only significant variable in delayed dental care was dental fear.

CONCLUSION

In Appalachia-West Virginia, there remains a high level of dental fear, despite advances in dental care, techniques, and procedures.

The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran

BACKGROUND

Dental anxiety and fear are major complications for both patient and dental care provider. The purpose of this study was to assess the prevalence of dental anxiety and fear in patients who referred to Isfahan Dental School and their relation to their age, gender, educational level, past traumatic experiences and frequency of dental visits.

MATERIALS AND METHODS

In this cross-sectional study, 473 patients were provided with a questionnaire including three sections. First section contained questions concerning their age, gender, educational level, frequency of dental visits, reasons for irregular attendance and existence of past traumatic experiences. Second section comprised a Farsi version of Modified Dental Anxiety Scale (MDAS); and third included a Farsi version of dental fear survey (DFS). Data were analyzed by t-test, ANOVA, Pearson and Spearman correlation tests.

RESULTS

The prevalence of dental anxiety among the study population was 58.8%. No correlation was found between age and MDAS (r = -0.08, P = 0.07) and DFS (r = -0.03, P = 0.53). Women demonstrated higher anxiety (P < 0.001) and fear (P = 0.003). Education had no significant effect on dental anxiety (r = -0.046, P = 0.32) and dental fear (r = -0.017, P = 0.79). Previous traumatic experiences were found to result in elevated anxiety and fear (P < 0.001). There was an inverse relationship between frequency of dental attendance and anxiety (r = -0.128, P = 0.008).

CONCLUSIONS

Within the limitations of this study, anxiety associated with dental treatment was widespread in the study population. Dental fear and anxiety were not affected by age or education level. Dental fear and anxiety were higher in women. In addition, people who visited the dentist more regularly and individuals without previous traumatic dental experiences were less anxious.

Dental Fear Survey: a cross-sectional study evaluating the psychometric properties of the Brazilian Portuguese version

Objective. The aim of this study was to evaluate the psychometric properties of the Brazilian version of the Dental Fear Survey (DFS), previously translated to the Brazilian Portuguese language and validated. Methods. A cross-sectional study with 1,256 undergraduates from the city of Belo Horizonte, Brazil, was carried out. The DFS and a questionnaire about previous dental experiences were self-administered. Data analysis involved descriptive statistics, principal components analysis (PCA), confirmatory factor analysis (CFA), internal consistency and test-retest reliability, and construct, discriminant, and convergent validity. Results. PCA identified a three-factor structure. CFA confirmed the multidimensionality of the Brazilian version of the DFS. A modified model of the Brazilian version of the DFS fits better than the hypothesized model. The Cronbach's alpha coefficient for the total DFS scale was 0.95. Conclusion. The DFS demonstrated acceptable construct validity, convergent validity, and discriminant validity. These results supported the reliability and validity of the DFS among Brazilian undergraduates.

Dental fear and sense of coherence among 18-yr-old adolescents in Finland

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovsky's Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.

Association between childhood dental experiences and dental fear among dental, psychology and mathematics undergraduates in Brazil

The aim of the present study was to evaluate the association between childhood dental experiences and dental fear in adulthood among dentistry, psychology and mathematics undergraduate students. A cross-sectional study of 1,256 students from the city of Belo Horizonte, Brazil, was performed. Students responded to the Brazilian version of the Dental Fear Survey (DFS) and a questionnaire regarding previous dental experiences. Both the DFS and the questionnaire were self-administered. Association was tested using descriptive, bivariate and multivariate linear regression analysis, with a 5% significance level. Dentistry undergraduates reported lower scores than psychology (p < 0.001) and mathematics undergraduates (p < 0.05) for all three dimensions of the DFS. Negative dental experiences in childhood was associated with dimensions of Avoidance (B = 2.70, p < 0.001), Physiological arousal (B = 1.42, p < 0.001) and Fears of specific stimuli/situations (B = 3.44, p < 0.001). The reason for first visit to dentist was associated with dimensions of Physiological arousal (B = 0.76, p < 0.01) and Fears of specific stimuli/situations (B = 1.29, p < 0.01). Dentists should be encouraged to evaluate the dental fear of their patients before treatment. The DFS has been found to be an effective instrument for this purpose.

Self-reported dental fear among dental students and their patients

The aim of the present study was to compare self-reported dental fear among dental students and patients at a School of Dentistry in Belo Horizonte, Brazil. Eighty students ranging in age from 20 to 29 years and 80 patients ranging in age from 18 to 65 years participated in the study. A self-administered pre-tested questionnaire consisting of 13 items was used for data acquisition. The city of Belo Horizonte Social Vulnerability Index (SVI) was employed for socioeconomic classification. The chi-square test and binary and multinomial logistic regression were employed in the statistical analysis, with the significance level set at 0.05. The majority of dental students (76.5%) sought the dentist for the first time for a routine exam, while patients (77.3%) mostly sought a dentist for the treatment of dental pain. Dental fear was more prevalent among the patients (72.5%) than the students (27.5%). A total of 47.1% of the students and 52.9% of the patients reported having had negative dental experiences in childhood. The logistic model revealed an association between dental fear and a pain-related experience (OR: 1.8; 95%CI: 1.3–2.6). Patients were more prone to dental fear (OR: 2.2; 95%CI: 1.0–5.0). Although at different percentages, both students and patients experienced dental fear. Current patient with previous experience of dental pain had more dental fear.

Sense of coherence and health behaviour in adolescence

AIM

To explore associations of Sense of coherence (SOC) with health behaviour and social competence among 15-year-old adolescents.

METHODS

Study population is a prospective cohort of a randomized cluster sample of families and their first-born children from south-western Finland in 1986-1987. In this study, cross-sectional data of the 15-year-olds were used. The present data were based on mailed, pretested questionnaires. The outcome variable, SOC, was based on the 13-item scale of Antonovsky's Orientation to Life Questionnaire (OLQ). The principal explanatory variables were health behaviour, including experienced oral health, and social competence. The statistical analysis was performed using linear regression modelling.

RESULTS

Strong SOC of adolescents associated significantly with lighter use of alcohol, being a non-smoker, better care of oral health and better social competence compared with the others.

CONCLUSION

Sense of coherence is a useful tool for identifying adolescents in need of extra support and motivation for their health behaviour.