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Gomes HDS, Anabuki AA, Viana KA, Abreu LG, Batista AC, Hosey MT, Costa LR. Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE. Braz Oral Res 2022; 36:e067. [PMID: 36507754 DOI: 10.1590/1807-3107bor-2022.vol36.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 02/18/2022] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Heloisa de Sousa Gomes
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Anna Alice Anabuki
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Karoline Alves Viana
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte, MG, Brasil
| | - Aline Carvalho Batista
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
| | - Marie Therese Hosey
- King's College London, Centre for Oral Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial, London, United Kingdom
| | - Luciane Rezende Costa
- Universidade Federal de Goiás - UFG, School of Dentistry, Postgraduate Program in Dentistry, Goiânia, GO, Brasil
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Nalci G, Alaçam T, Altunkaynak B. Evaluation of the effectiveness of a mobile application in the management of dental anxiety: a randomized controlled trial. J Oral Rehabil 2022; 49:535-540. [PMID: 35148428 DOI: 10.1111/joor.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a specially designed mobile application developed to provide patients with a sense of anxiety control during the various stages of endodontic treatment. The patients' anxiety was assessed by measuring their salivary cortisol levels. METHODS A total of 46 patients requiring endodontic treatment were recruited. The patients were randomly assigned to two groups. The experimental group used the special communication application, while the control group did not. Salivary samples were collected from all patients preoperatively, postanesthesia, and postoperatively. The samples were analyzed with an enzyme-linked immunosorbent assay to measure the cortisol levels. RESULTS A significant difference in cortisol levels was observed between the experimental and the control group (Mann-Whitney U test, P < .05). This difference was significant in the experimental group in each step (P < .01). No difference was found in the control group steps (P > .05). CONCLUSIONS Perceived control of anxiety using the specially designed software was effective in reducing salivary cortisol levels.
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Affiliation(s)
- Gamze Nalci
- Department of Endodontics, Faculty of Dentistry, Bezmialem Vakıf University, İstanbul, Turkey
| | - Tayfun Alaçam
- Department of Endodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Bülent Altunkaynak
- Department of Statistics, Faculty of Science, Gazi University, Ankara, Turkey
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Salas Huamani JR, Barbosa TDS, de Freitas CN, de Sousa KG, Gavião MBD, Leal SC, Mialhe FL, Castelo PM. Assessment of anxiety and stress markers in children submitted to educational strategies and ART-restoration: A randomized clinical trial. Arch Oral Biol 2019; 97:191-197. [DOI: 10.1016/j.archoralbio.2018.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/11/2018] [Accepted: 10/26/2018] [Indexed: 12/28/2022]
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Quantitative evaluation of dental anxiety indicators in the serum and saliva samples of children treated under general anesthesia. Clin Oral Investig 2018; 22:2373-2380. [PMID: 29354884 DOI: 10.1007/s00784-018-2340-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/10/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Dental anxiety level has been previously associated with oral health status. Since general anesthesia (GA) allows dental treatments to be performed in anxious children with a high number of caries, we aimed to evaluate the dental anxiety levels of these children before and after dental treatments performed under GA. MATERIALS AND METHODS Thirty-eight children with high anxiety aged between 35 and 72 months who required multiple dental treatments to be performed under GA were included in the study. Frankl's Behavior Rating Scale, sitting patterns, Facial Image Scale, and Children's Fear Survey Schedule-Dental Subscale (completed by the children's parents) were recorded before and after the dental treatments performed under GA. Pre-treatment and post-treatment biochemical parameters, including cortisol, alpha-amylase, and chromogranin A levels, in saliva and serum samples were also evaluated. RESULTS The psychometric scales showed a statistically significant reduction in the post-treatment dental anxiety levels of the children compared with the pre-treatment anxiety levels. Additionally, the biochemical parameters measured in the serum and whole saliva samples showed a decrease after treatments performed under GA. CONCLUSIONS Our study results suggest that performing dental treatments under GA can reduce the dental anxiety levels of children with a high number of caries.
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Lindenberger BL, Plag J, Schumacher S, Gaudlitz K, Bischoff S, Bobbert T, Dimeo F, Petzold MB, Kirschbaum C, Dudás Z, Ströhle A. Clinical and neurobiological effects of aerobic exercise in dental phobia: A randomized controlled trial. Depress Anxiety 2017; 34:1040-1048. [PMID: 28556577 DOI: 10.1002/da.22659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity has shown to be effective in anxiety disorders. For specific phobia, no studies are available that systematically examined the effects of an aerobic exercise intervention on phobic fear within a randomized-controlled design. Therefore, we investigated the acute effect of a standardized aerobic training on clinical symptoms of dental phobia as well as on stress-related neurobiological markers. METHODS Within a crossover design, 30 patients with dental phobia (mean age: 34.1 years; mean score of the Dental Anxiety Scale: 18.8) underwent two minor dental interventions separated by 7 days. Dental treatment was performed after 30 min of physical activity at either 20% VO2 max (control) or 70% VO2 max (intervention), respectively. To control for habituation, patients were randomly assigned to one of the two conditions prior to the first intervention. Moreover, saliva samples were collected at five times in order to determine changes in salivary cortisol (sC) and alpha-amylase (sAA) due to treatment. RESULTS In comparison to baseline, aerobic exercise within 70% VO2 max significantly reduced clinical anxiety and sC concentrations before, during, and after the dental treatment. In contrast, the control condition led to decreased sAA levels at different time points of measurement. Habituation occurred at the second study day, independent of the order. CONCLUSIONS Our study provides evidence for an effect of moderate-intense exercise on clinical symptoms and sC in patients with dental phobia. Therefore, acute aerobic exercise might be a simple and low-cost intervention to reduce disorder-specific phobic fear.
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Affiliation(s)
- Brigitt L Lindenberger
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Schumacher
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Gaudlitz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sophie Bischoff
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Bobbert
- Department of Endocrinology, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fernando Dimeo
- Section of Sports Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz B Petzold
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Clemens Kirschbaum
- Department of Biological Psychology, Technische Universität Dresden, Dresden, Germany
| | - Zsuzsa Dudás
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Dušková M, Vašáková J, Dušková J, Kaiferová J, Broukal Z, Stárka L. The role of stress hormones in dental management behavior problems. Physiol Res 2017; 66:S317-S322. [PMID: 28948815 DOI: 10.33549/physiolres.933718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Dental management behavior problems are thought to be both multifactorial and multidimensional, consisting of physiological, behavioral and cognitive components. The stress response to pain or even the anticipation of distress initiates activation of the hypothalamic-pituitary-adrenal axis and causes an increase of cortisol and catecholamines. The literature on the role of hormones in dental management behavior problems comprises about one hundred papers, which have mainly been focused on this activation of the HPA axis in various situations in dental care. They have generally used salivary cortisol as a marker of the activity of the HPA axis, sometimes combined with salivary alpha amylase. Here we summarize the literature data on the role of stress hormones in dental management behavior problems.
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Affiliation(s)
- M Dušková
- Department of Steroids and Proteofactors, Institute of Endocrinology, Prague, Czech Republic.
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Noorani H, Joshi HV, Shivaprakash P. Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment. Int J Clin Pediatr Dent 2014; 7:19-23. [PMID: 25206232 PMCID: PMC4144055 DOI: 10.5005/jp-journals-10005-1227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/02/2013] [Indexed: 11/23/2022] Open
Abstract
Objective: Objectives of our studies were to predict dental fear in a child patient depending on salivary alpha amylase (sAA) level before and after dental treatment and to evaluate correlation of later with behavior of child patient during dental treatment. Materials and methods: Seventy-seven children between age of 5 and 12 years were divided in three groups. Group 1 consisted of 25 school children who did not undergo any dental treatment. Groups 2 and 3 underwent dental treatment without and with local anesthesia respectively. Groups 2 and 3 were administered child fear survey schedule-dental subscale (CFSS-DS) questionnaire before treatment. Salivary samples were collected for sAA estimation in groups 2 and 3 children before and after completion of dental treatment and behavior during treatment was noted using Frankel behavior rating scale. Group 1 acted as control in which salivary sample was collected in absence of dental stress. Results: When groups 2 and 3 were combined, pretreatment sAA level had a statistically significant (p = 0.0094) correlation with CFSS-DS scores. Conclusion: Alpha amylase can be used as a screening tool to predict level of dental fear in a child patient. How to cite this article: Noorani H, Joshi HV, Shivaprakash PK. Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment. Int J Clin Pediatr Dent 2014;7(1):19-23.
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Affiliation(s)
- Hina Noorani
- Professor and Head, Department of Pediatric and Preventive Dentistry, PM Nadagouda Memorial Dental College and Hospital, Bagalkot Karnataka, India
| | - Hrishikesh V Joshi
- Postgraduate Student, Department of Pediatric and Preventive Dentistry, PM Nadagouda Memorial Dental College and Hospital, Bagalkot Karnataka, India
| | - Pk Shivaprakash
- Professor, Department of Pediatric and Preventive Dentistry, PM Nadagouda Memorial Dental College and Hospital, Bagalkot Karnataka, India
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Sadi H, Finkelman M, Rosenberg M. Salivary cortisol, salivary alpha amylase, and the dental anxiety scale. Anesth Prog 2013; 60:46-53. [PMID: 23763559 DOI: 10.2344/0003-3006-60.2.46] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race, gender, any existing pain, or traumatic dental experience and their effect on dental anxiety. This study followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete the Dental Anxiety Scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence of pain and history of traumatic dental experience. However, no significant correlations were observed between DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation between dental anxiety, cortisol, and sAA levels.
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Affiliation(s)
- Hana Sadi
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA.
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Eitner S, Sokol B, Wichmann M, Bauer J, Engels D. Clinical use of a novel audio pillow with recorded hypnotherapy instructions and music for anxiolysis during dental implant surgery: a prospective study. Int J Clin Exp Hypn 2011; 59:180-97. [PMID: 21390978 DOI: 10.1080/00207144.2011.546196] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A prospective, comparative study of a novel audio pillow with hypnosis text and relaxation music was conducted in 82 dental-implant surgery patients to relieve anxiety over a 6-month period. Visual analogue scales combined with the Aachen Dental Treatment Fear Inventory (AZI) questionnaire were used to quantify patients' subjective feelings of fear. Blood pressure, heart rate, and capillary oxygen partial pressure were measured before, during, and after surgery. The AZI scores decreased in the hypnotherapy group (n = 44) and increased slightly in the control group; scores were significantly different between the groups (p = .000). During surgery, the average diastolic blood pressure and heart rate decreased in the hypnotherapy group and increased in controls. Thus, this audio pillow with relaxation music showed anxiolytic effects in patients during dental implantation procedures.
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Affiliation(s)
- Stephan Eitner
- Friedrich-Alexander-University, Erlangen Nuremberg, Glueckstrasse 11, Erlangen, Germany.
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Kanegane K, Penha SS, Munhoz CD, Rocha RG. Dental anxiety and salivary cortisol levels before urgent dental care. J Oral Sci 2009; 51:515-20. [DOI: 10.2334/josnusd.51.515] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Blomqvist M, Holmberg K, Lindblad F, Fernell E, Ek U, Dahllöf G. Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder. Eur J Oral Sci 2007; 115:1-6. [PMID: 17305710 DOI: 10.1111/j.1600-0722.2007.00423.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The present study tested the hypotheses that children with ADHD, particularly those exhibiting severe hyperactivity and impulsivity, have a different stress reaction (measured by salivary cortisol) during a dental recall visit and are more dentally anxious than children in a control group. Eighteen children with ADHD and a control group of 71 children, all 13 yr of age, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one prior to dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity/impulsivity had statistically significantly lower cortisol levels than the control group 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. There was a significant correlation between CDAS scores and cortisol concentrations prior to the dental examination in both the ADHD and the control group. Behavioral expressions of anxiety in children with ADHD may be different from those in other children, not only due to the characteristics of their disorder, but also because of lower stress reactivity.
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Affiliation(s)
- My Blomqvist
- Department of Pediatric Dentistry, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Zusammenfassung. Ätiologie, Symptomatik und Verlauf von Angststörungen sind multikausal zu erklären. Ein Teilaspekt der psychobiologischen Erklärungsansätze von Angststörungen sind endokrine Auffälligkeiten, anhand derer bestimmte Unterformen pathologischer Angst charakterisiert werden können. Vor allem die Hypothalamus-Hypophysen-Nebennierenrinde-Achse und das sympathiko-adrenomedulläre System werden im Zusammenhang mit Emotionsregulation und pathologischer Angst untersucht. Beide Hormonsysteme spielen bei der Anpassung an individuelle Belastungssituationen eine bedeutende Rolle und beeinflussen die psychobiologische Anpassung an angstauslösende Situationen nachhaltig. In dieser Überblicksarbeit werden endokrine Dysregulationen der o.g. Hormonsysteme für verschiedene Unterformen von Angststörungen aufgezeigt und bzgl. ihrer ätiologischen Bedeutsamkeit, auch unter Berücksichtigung genetischer Befunde, diskutiert. Darüber hinaus werden erste therapeutische Ansätze, bei denen psychoendokrinologische Methoden genutzt werden, aufgezeigt.
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