Oral health and its influence on cognitive behavioral therapy in patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for intra-oral injection phobia

Needle phobia among adult Jordanians: General awareness, prevalence; and exploring microneedles as a promising solution

Needle phobia remains a major drawback of conventional injectable medications, leading to avoidance and low adherence among a reasonable portion of patients. Despite this, there is a limited number of studies investigating needle phobia prevalence and symptoms. In this survey, we studied the knowledge and prevalence of needle phobia and its manifestations among 1182 adult Jordanians. Moreover, we assessed the feasibility of microneedles delivery systems as an alternative approach to conventional injectable methods. The results revealed that 28.5% of the participants identified themselves with needle phobia, with a notably higher prevalence among females compared to males (p-value < 0.001). The overall prevalence of needle phobia based on its measured manifestations was found to be 27.4%. The survey also found that 68% of the population were unfamiliar with the concept of microneedles despite the reasonable proportion of the population who were aware of the disadvantages of conventional injectable medications. Furthermore, the survey identified four significant predictors of needle phobia through hierarchical linear regression analysis. Gender, occupation, and negative past experiences with needle injections accounted for 3%, 1%, and 1% of the variance in needle phobia, respectively. In addition, the participants' preference for microneedles over conventional injectables medications appeared as another significant predictor, contributing 5% of the variance. Overall, the model explained 10% of the variance in needle phobia. Collectively, this study provides an insight into needle phobia prevalence and manifestations in Jordan, while also exploring microneedles as an alternative drug delivery system for patients with needle phobia.

Dental Procedures, Oral Practices, and Associated Anxiety: A Study on Late-teenagers

Objectives

The study aims to determine the degree of anxiety pertaining to dental procedures and various oral hygiene practices among college teenagers.

Methods

Corah's Modified Dental Anxiety Scale was administered on a randomly chosen sample of 100 Indian college students (50 males and 50 females) of Delhi University, belonging to the age group of 17–20 years.

Results

Descriptive statistical computations revealed 12.14 years as the mean age of first dental visit, with moderately high levels of anxiety (60.75%) for various dental procedures among the Indian teenagers and 5% lying in the “phobic or extremely anxious” category. With merely 4.16% people going for regular consultations, general check-ups evoked 78.3% anxiety and having an injection or a tooth removed was perceived as the most threatening. The sample subgroup not using mouthwash and mouthspray, smokers, and alcohol drinkers with improper oral hygiene practices experienced much higher anxiety towards routine dental procedures.

Conclusion

The majority of the Indian youngsters had an evasive attitude of delaying dental treatment. The core problems lay in deficient health care knowledge, lack of patient-sensitive pedagogy to train dental professionals, inaccessibility of services, and a dismissive attitude towards medical help. The feelings of fear and anxiety prevalent among the Indian youth offer significant insights into causes and preventive measures for future research and practice. Methods of education and motivation could be developed to dissipate the anxiety amongst Indian teenagers that prevent routine dental visits and maintenance of adequate oral hygiene.

Nine Session Treatment of a Blood–Injection–Injury Phobia With Manualized Cognitive Behavioral Therapy

The treatment of blood-injection-injury (BII) phobia has a unique treatment component as compared with other types of specific phobias. In particular, many patients with a BII phobia distinctively experience an increased susceptibility to fainting when exposed to feared medical-related stimuli due to a diphasic physiological response. Moreover, effective treatment protocols must not only include therapeutic techniques to ameliorate the patient’s fear response but also teach strategies that will allow the patient to remain conscious during exposure to feared stimuli. The current case study describes a manualized, cognitive behavioral therapy that utilized applied muscle tension techniques to comprehensively address the multifaceted components of an adult male’s BII phobia. Treatment included a combination of psychoeducation and cognitive restructuring that provided the patient with an empirically based understanding of BII phobia, practiced using applied muscle tension techniques to better manage his physiological processes during exposure followed by the utilization of in vivo graduated exposure to reduce distress and avoidance of feared stimuli. After completing nine sessions, the patient demonstrated considerable improvement as evidenced by reductions in anxiety and the willful seeking of medical care following treatment. Further implications and future directions for research are discussed.

Salivary cortisol, salivary alpha amylase, and the dental anxiety scale

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.

Computerized dental injection fear treatment: a randomized clinical trial

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists' lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection.

Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia

OBJECTIVE

To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health.

MATERIALS AND METHODS

Subjects were 55 patients (mean age 35.5 ± 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison.

RESULTS

Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL.

CONCLUSIONS

Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.