Is there a relation between dental anxiety, fear and general psychological status?

Adverse childhood experiences and dental anxiety among Chinese adults in Hong Kong: a cross-sectional study

Introduction

This study aimed to investigate the relationship between adverse childhood experiences (ACEs) and dental anxiety among Chinese adults in Hong Kong.

Methods

A cross-sectional survey was conducted at a university in Hong Kong. The recruiting period and data collection started in January 2023 and ended in June 2023. Participants completed an online questionnaire that assessed ACEs (using the Adverse Childhood Experiences International Questionnaire - ACE-IQ) and dental anxiety (using the Modified Dental Anxiety Scale - MDAS and Dental Fear Survey - DFS). The study examined the impacts of both cumulative (i.e., total number) and independent ACE components on dental anxiety. To explore the relationships between cumulative ACEs, individual ACE components and dental anxiety (MDAS and DFS score), Pearson correlations, linear regression and logistic regression were conducted.

Results

Significant associations were observed between ACEs and dental anxiety among 171 subjects. Cumulative ACEs were positively correlated with MDAS scores (r = 0.169, p = 0.027) and DFS scores (r = 0.253, p < 0.001). The odds of an individual having high dental anxiety increased by 26-43% for every additional increase in the number of ACEs. Individual types of ACEs, such as emotional and physical neglect, sexual abuse, and household substance abuse, significantly influenced the likelihood of having high dental anxiety.

Discussion

The results showed a positive association between ACEs and dental anxiety, highlighting the impact of ACEs on dental anxiety. Dental practitioners should consider inquiring about a patient's ACE history to develop personalized treatment plans.

Retrospective Study Regarding the Correlation between Dental Anxiety and Color Preferences in Children with Severe Early Childhood Caries

BACKGROUND

Severe early childhood caries (S-ECC) is recognized as a significant chronic disease which affects the quality of life starting at very young ages and has a very rapid evolution towards pulp complication and loss of dental tissue. Children with a high caries index DMFT are more likely to develop high levels of dental anxiety, which will influence the degree of cooperation during dental procedures. Emotions play an important role in the psychosomatic development of children, and all the factors that contribute to the modeling of these emotional states must be known and taken into consideration.

AIM

The aim of this study was to assess the association between dental anxiety in children with S-ECC and the color preferences for the components of the dental environment to reduce the levels of dental anxiety during medical visits.

MATERIAL AND METHOD

For this study, 91 children between 3 and 6 years of age diagnosed with S-ECC were selected from the Pediatric Dentistry Department of UMFST from Targu Mures and from a private dental office. The level of dental anxiety was determined by measuring the pulse rate, and a questionnaire was completed to establish the color preferences for the dental office environment and the dentist's attire. For this purpose, six different colors and their variants with three shades less intensity were chosen by using RGB (Red, Green, and Blue) identification codes for each color.

RESULT

The results showed that there was a statistically significant difference between the age of the subjects and dental anxiety levels, but there was no significant correlation between the DMFT score and dental anxiety. Also, the results showed that there was no significant difference between girls and boys when choosing the colors preferred by them for the dental office, but when comparing the colors that represented happiness, significant statistical difference was found between the girls' and boys' groups (p = 0.0039). For all the subjects, the colors associated with happiness were light yellow and pink, while the colors associated with anxiety were red and dark blue.

CONCLUSION

The data obtained showed that dental anxiety is strongly influenced by age, and an important role in inducing positive emotions is played by the dental environment if dressed in specific colors in order to reduce dental anxiety and create familiar conditions, especially for young children with S-ECC.

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.

Children's Dental Fear: Occurrence Mechanism and Prevention Guidance

Children's dental fear (CDF) has become one of the main reasons affecting the quality of dental treatment. In order to reduce the incidence of CDF in China before and after children's dental visits, this review applies literature analysis and empirical summary methods to analyze and summarize academic discussions on this topic, including occurrence mechanism, prevention guidance, and the conclusion that the occurrence and prevention of CDF is closely related with children's internal characteristics and external influences. In the end, we propose a breakthrough of combining the CFSS-DS scale and three-grade prevention theory together in the future to provide new ideas and hypotheses for the prevention of CDF.

Effect of Culturally Adapted Dental Visual Aids on Anxiety Levels in Children with Autism Spectrum Disorder: A Randomized Clinical Trial

Autism spectrum disorder (ASD) prevalence has risen dramatically in recent decades; it is now common for children with ASD to seek dental care. Because their distinct behavioral patterns prevent them from receiving dental care in a traditional dental clinic, structured dental visual aids are required to help prepare them for their dental appointment. This study aimed to test the effect of "culturally adapted dental visual aids" in decreasing anxiety levels during dental visits in children with autism spectrum disorder (ASD). A randomized, controlled, blinded clinical trial was performed. Sixty-four children with ASD ages 6-12 years were assigned randomly into test and control groups based on the type of dental visual aids they received. The test group received "culturally adapted dental visual aids" created especially for the study, and the control group received "regular dental visual aids". Anxiety levels were assessed before and after using both dental visual aids. All data were processed using SPSS version 25.0. The test group had a significant decrease in anxiety levels compared to the control group (p < 0.001). The "culturally adapted dental visual aids" have effectively reduced anxiety levels in children with ASD during dental visits.

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.

Relationship between Children's Lifestyle and Fear during Dental Visits: A Cross-Sectional Study

The purpose was to analyze the relationship between new family and social patterns and child emotions in the dental clinic. The sample consisted of 174 children between the ages of four and nine. Parents completed 20 questions that referred to social, family, cultural, and economic factors. The Wong−Baker scale was completed by the children after the end of the treatment. A total of 129 of the children were found to be extremely happy (45.4%) or happy (28.7%) with the dental care received. There were statistically significant differences (p < 0.05) between younger children and sad and incredibly sad faces on the Wong−Baker test with a strong association (V > 0.3). Regarding children who practiced team sports, the chi-square test revealed a very significant association with happy and incredibly happy faces (p < 0.001) and the Cramer statistic evidenced a strong relationship between team sports and less dental fear (V > 0.3). Considering the limitations, small children (4−6 years) would be more fearful. In addition, stable environments in the family life of children (appropriate routines, adequate time spent with videogames, sport activities) could be interesting factors for improved control of fear and emotions in children. Further research is needed in this field.

Generalized Anxiety Disorder and Its Relationship with Dental Anxiety among Pregnant Women in Dammam, Saudi Arabia

Objective

To assess the relationship between generalized anxiety disorder (GAD), dental anxiety (DA), and other factors among pregnant women.

Methods

The Generalized Anxiety Disorder (GAD-7) scale and the Modified Dental Anxiety Scale (MDAS) were used to evaluate GAD and DA, respectively. Hard copies of self-administered questionnaires were distributed among 780 pregnant women attending hospitals/health centers in Dammam, Saudi Arabia.

Results

About 31.7% of the participants demonstrated minimal anxiety, 37.9% mild anxiety, 19.7% moderate anxiety, and 10.6% severe anxiety. The mean GAD score of the sample was 7.53 ± 5.16 which differed significantly among women in the first (7.74 ± 5.47), second (6.82 ± 4.64), and third trimesters (8.13 ± 5.37) (P=0.029). Pregnant women who performed routine dental visits demonstrated lower GAD (6.98 ± 5.23) than those who visited dentists for consultation, pain, or treatment (7.58 ± 5.07). The mean GAD score was significantly higher among participants with dental pain or discomfort during the last 12 months (8.12 ± 5.05) than among those without pain or discomfort (7.02 ± 5.2) (P 0.003). Similarly, the participants with DA showed a significantly higher mean GAD score (7.69 ± 5.17) than those without DA (5.93 ± 4.71) (P 0.006). Multivariate linear regression showed that GAD significantly correlated with DA (B = 0.225, P < 0.001).

Conclusion

In the present study, GAD was common among pregnant women which significantly correlated with DA. Pregnant women with DA and dental pain demonstrated high GAD. Preventive and therapeutic measures should be taken to reduce GAD and DA during pregnancy.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

An Assessment of Various Challenges Perceived by Dental Students amidst the COVID-19 Pandemic: A Digital Questionnaire Study

The objective of our study was to evaluate dental students’ perception of the challenges faced during the COVID-19 pandemic related to their clinical work, education, performance, online examinations, psychological health, and teamwork. A validated online questionnaire consisting of closed ended questions was sent to all the undergraduate dental students at our institute. Data were collected and analyzed statistically using a chi-square test to compare responses of male with female and junior with senior students. A total of 317 undergraduate dental students (N = 317) participated in this cross-sectional study. The most common challenges perceived by the participants were related to their exam duration (77.3%), patient availability (66.9%), difficulty in understanding online lectures (58.4%), and a fear of losing grades (57.4%). Participants reported that the COVID-19 pandemic affected their performance in the courses (75.4%), teamwork (72.2%), educational aspects (67.5%), and psychological health (51.1%). A significantly greater proportion of female students reported the adverse effects of COVID-19 on their psychological health than male students (p = 0.031). Senior students perceived the negative impact of COVID-19 on teamwork significantly more than the junior students (p = 0.004). The majority of students reported challenges during the COVID-19 pandemic. Female students and senior students perceived more challenges than their counterparts. Future studies from other institutes of this region are recommended to establish a clearer picture of COVID-19 related challenges faced by dental students.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test-retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Prevalence of depression, anxiety and associated factors among patients with dental disease attending outpatient department in Addis Ababa public hospitals, Addis Ababa, Ethiopia: a multicenter cross-sectional study

BACKGROUND

Anxiety and depression are widespread mental health problems in many populations. These problems can be major barriers to dental care and may be led to poor oral health.

OBJECTIVES

To assess prevalence of depression, anxiety and associated factors among patients with dental disease in Addis Ababa public hospitals outpatient department, Addis Ababa, Ethiopia, 2019.

METHODS

An institution based cross sectional study was conducted from May 06 to June 06, 2019 among patients with dental disease attending outpatient department in Addis Ababa city administration public hospitals. Multistage sampling method was used to select study participants. Hospital Anxiety and Depression scale was used to assess anxiety and depression. Face to face interview was used to collect data and the collected data was entered into EPI data version 3.1 and analysis was done using SPSS (Statistical Package Software for Social Sciences) version 20. Bi-variable and multivariable binary logistic regression was carried out. Strength of association was determined using odds ratio with 95% CI (Confidence Interval) and p value less than 0.05 was considered as statistically significant association in the final model.

RESULTS

From the total of 845 participants, 833 were studied with response rate of 98.6%. The median age of the respondent was 32 years with interquartile range (26-41 years). The prevalence of anxiety and depression were found to be 33.9% and 29.2% respectively. Being female [AOR (Adjusted Odds Ratio) 2.70 (95% CI 1.86, 3.89)], tooth extraction [AOR 3.24 (95% CI 2.11, 4.97)], history of repeat visit to dental clinic [AOR 3.21 (95% CI 2.25, 4.58)], chronic disease [AOR 2.95 (95% CI 1.98, 4.38)] and current alcohol use [AOR 3.40 (95% CI 2.28, 5.09)] were significantly associated with anxiety among patients with dental disease. Being female [AOR 2.22 (95% CI 1.53, 3.23)], Elementary educational status [AOR 2.15 (95% CI 1.28, 3.58)], periodontitis [AOR 1.74 (95% CI 1.18, 2.72)],history of repeated visit to dental clinic [AOR 4.07 (95% CI 2.84, 5.84)], current use of alcohol [AOR 4.01 (95% CI 2.68, 6.00)], current cigarette use [AOR 3.15 (95% CI 1.42, 7.00] and irregular tooth brushing [AOR 2.22 (95% CI 1.53, 3.23]were significantly associated with depression among patients with dental disease.

CONCLUSION

Anxiety and depression were high among people with dental disease. Tooth extraction and having chronic disease were significantly associated with anxiety. Elementary educational status, periodontitis, current cigarette smoking and irregular tooth brushing pattern were significant association with depression. History of repeat visit to dental clinic, current alcohol use and female sex were significantly associated with both depression and anxiety. Based on the finding of this study early screening and treating of anxiety and depression, also identifying those associated factors are important at dental clinic.

The evaluation of psychological state of dental students during the COVID-19 pandemic

The purpose of the present study was to assess anxiety among a sample of dentistry students during the COVID-19 pandemic. A total of 355 dentistry students (165 males and 190 females) completed the Health Anxiety Inventory (HAI), Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory-I (STAI-I), and State-Trait Anxiety Inventory II (STAI-II) questionnaires. and evaluations of HAI, BAI, STAI-I, and STAI-II were based on sex, dental school year, smoking habit, and lifestyle. Female students had higher HAI and BAI scores than male students (p = 0.009 and p = 0.001, respectively). Statistically significant differences in HAI scores existed between preclinical and clinical students (p = 0.048). The only statistical significant differences detected in STAI-I scores involved students with an extended family when compared to students without an extended family (p = 0.039). The HAI scores of students who had close contact were significantly higher than students who had no contact (p = 0.047). There were significant correlations between the four scales (p < 0.05). During the COVID-19 pandemic [was under control in Turkey?], the HAI scores were higher in female, clinical students and students who lived with an extended family.

Restoring and preserving capacity of self-affirmation for well-being in Indian adults with non-clinical depressive tendencies

BACKGROUND

Although self-affirmation has been reported to enhance well-being and other positive life outcomes in normal adults, little is known about its capacity to restore and preserve well-being in adults with depressive tendencies. The current study attempts to expound the restoring and preserving capacity of self-affirmation for well-being in Indian adults with non-clinical depressive tendencies.

PARTICIPANTS AND PROCEDURE

The study used a sequential research design. Eighty participants (22-27 years) with depressive tendencies were chosen through purposive sampling and were randomly assigned equally to the experimental and control conditions. Their depressive tendencies and well-being were measured through standard scales at three intervals: pre-intervention, post-intervention and follow-up.

RESULTS

The results revealed significant restoring and preserving capacity of self-affirmation for the well-being of the experimental group participants as compared to the control group. The main effects of conditions (experimental, control) and treatment intervals (pre, post, follow-up) were significant along with the interaction effects of conditions × treatment intervals. The significant differences in the mean well-being scores for pre-intervention, post-intervention and follow-up points of time showed the restoring and preserving capacity of self-affirmation intervention.

CONCLUSIONS

The findings showed that self-affirmation helps to restore well-being as well as preserve it after a significant gap, which is evident in higher well-being mean scores of the experimental group taken at post-intervention and follow-up intervals. The positive effects of self-affirmation on well-being may have remained active even after the cessation of the intervention due to the underlying mechanisms of enhanced self-worth, positive values, inner strengths, positive attributions and interpersonal relationships.

Barriers Affecting the Oral Health of People Diagnosed with Depression: A Systematic Review

Introduction

The problems of oral health of people diagnosed with depression are not adequately recognized, either in developed or developing countries. Social stigma, lack of self-interest, or even inadequate approaches of dental doctors towards the unique situation of this group of people this lead to excessive oral health problems.

Methods

The bibliographic database PubMed/Medline, Google Scholar, and Whiley online library were searched using the following text and MeSH as separate key terms and in combination: depression and oral health/dental caries/periodontal disease/tooth loss/utilization of oral health services/and barriers. The content of documents was analysed using qualitative methodology.

Results

Twenty-six original studies were included in the review. Level/severity of depression, medication and medical comorbidity are the most important medical barriers influencing the oral health of people diagnosed with depression. Dental fear and anxiety are mostly combined with low oral hygiene and bad oral health. Socioeconomic status, dental insurance, bad habits and education also have important roles in the oral health status of people diagnosed with depression.

Conclusion

Including individuals with depression and oral health problems in national health programs, creating specific prevention programs, or subsidizing the cost of treatment are some of the recommendations suggested as solutions.

Evaluating factors associated with fear and anxiety to dental treatment-A systematic review

Introduction

Dental anxiety refers to a set of complex psychological issues bearing a significant impact in individual's lives reflecting in the form of dental visit avoidance, poor dental health status and decreases oral health related quality of life. Hence, it is imperative to consider those factors associated with dental anxiety so as to treat and promote better oral health. The review aimed to assess various factors associated with dental fear and anxiety.

Materials and Methods

Literature search was done from Pubmed and Google scholar search engines to identify publications which explored factors associated with dental fear and anxiety.

Results

Research evidence pointed a significant relationship of age, gender, maternal anxiety, previous dental experience, and number of siblings with dental fear and anxiety (DFA).

Conclusion

Findings of the review clearly suggest that a better understanding of factors causing dental anxiety and phobia will help preventing dental avoidance and providing better care.

Evaluation of knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic

BACKGROUND

The novel coronavirus disease (COVID-19) is a new viral respiratory illness, first identified in Wuhan province, China. Dental professionals and dental students are at an increased risk for these viruses from dental patients, as dental practice involves face-to-face communication with the patients and frequent exposure to saliva, blood, and other body fluids. Dental education can play an important role in the training of dental students, adequate knowledge and adopting attitudes regarding infection control measures. The aim of this study was to evaluate knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic.

METHODS

A total of 355 pre-clinical and clinical dental students (242 and 113, respectively, comprising 190 females and 165 males) at Fırat University Dentistry Faculty, in Elazığ, Turkey answered an online questionnaire about the biosafety procedures for and their attitudes to and knowledge of COVID-19. The study was conducted in March 2020, Turkey. The data gained were analyzed using descriptive statistical methods and chi-square test.

RESULTS

Both the clinical and preclinical students were found to be afraid of infecting themselves and their environment with COVID-19, and the difference between them was statistically significant. Three quarters (74.9%) of the participants responded yes to the question of whether they thought that experiences related to COVID-19 affected them psychologically, with the differences between gender and clinical status were statistically significant. Responses to the question of which clinical rotation worried them more were 29.9% endodontics, 25.1% oral and maxillofacial surgery, 16.3% prosthesis, 15.2% periodontology, 6.8% restorative dentistry, 3.9% oral diagnosis and radiology, 1.7% pedodontics, and 1.1% orthodontics, with a significant difference between the preclinical and clinical students. Regarding the measures applied by the clinical students in their clinical rotation, the responses were 100% gloves and 100% mask (with 11.5% FFP3/N95 mask), 73.6% face protective shield and 37.1% safety glasses, and 49% bonnet and 16.8% disposable box, with 90.2% frequent hand washing, and 86.7% frequent hand antiseptic usage.

CONCLUSIONS

While students gave good responses regarding the standard measures they take to protect against transmission of COVID-19, their knowledge and attitudes about the extra measures they can take should be improved. For students to be least affected by fears associated with the disease, dental faculties should be ready to provide psychological services to those in need.

Dental anxiety and caries experience from late childhood through adolescence to early adulthood

OBJECTIVE

To assess the association between dental anxiety and caries experience from late childhood through adolescence and into early adulthood (12, 15 and 18 years old, respectively).

METHODS

A prospective cohort study was conducted among a population-representative sample of Chinese in Hong Kong. A baseline survey was conducted at age 12 and follow-up assessments were completed at ages 15 and 18. Caries experience was assessed as the number of decayed, missing and filled teeth (DMFT). Dental anxiety was assessed using the Modified Dental Anxiety Scale (MDAS). Participants' socio-economic status and oral health-related behaviours were ascertained using a self-complete questionnaire. Negative binomial regression was used to explore the association between dental anxiety and subsequent caries status, controlling for other factors.

RESULTS

At baseline, 668 children participated; 279 (41.8%, comprising 57.0% females) completed all three phases of data collection. MDAS scores at age 18 were lower than at age 12. Caries experience increased as participants aged. At age 15 and 18, females had higher MDAS and DMFT scores than males. Reported frequency of snacking between meals was associated with MDAS scores at age 18. In regression analyses, dental anxiety at age 12 was not significantly associated with dental caries experience at age 15, controlling for socio-demographic and oral-health behaviour factors at age 12. Likewise, dental anxiety at age 15 was not significantly associated with dental caries experience at age 18, controlling for the same factors at age 15.

CONCLUSION

Dental anxiety assessed by MDAS in late childhood and adolescence appears not to predict dental caries experience later in life in this population.

Association of state and trait anxiety with oral health status among adult dental patients

Background:

Dental caries and periodontal diseases are the most prevalent oral health problems worldwide. Behavioral and psychosocial factors along with social, economic and cultural conditions may alter the health balance, favoring the onset of dental diseases. Hence the study was conducted to assess the association of state and trait anxiety with oral health status among adult dental patients.

Methods:

The study was carried out among 456 adult dental patients visiting Panineeya Institute of Dental Sciences and Hospital, Hyderabad. Anxiety levels were measured by State-Trait Anxiety Inventory-short version (STAI-S) consisting subscales State Anxiety (SA) and Trait Anxiety (TA). Clinical examination was done using WHO Basic Oral Health survey assessment form, 2013. The data was analyzed using Statistical Package for Social Sciences Software 21.0. p≤0.05 was considered statistically significant.

Results:

A significant gender difference (p=0.001) was noted for total anxiety with higher mean score observed among males (46.13±5.98) than females (45.32±6.00).Similarly, significant higher mean score was observed among males (23.31±4.08) than females (p=0.03) for State anxiety. Females had higher mean DMFT (3.61±3.21), DT (2.04±2.05), FT (0.49±1.34) and MT (1.08±2.09) components but significant difference was noted only for overall DMFT (p=0.03) and DT (p=0.001) component than males.

Conclusion:

Gender, education and previous dental visits didn’t show any significant association with total anxiety, state and trait anxiety. Likewise, none of the oral parameters showed any significant association except for the Decayed Teeth (DT) component of DMFT with total anxiety levels among study subjects. (www.actabiomedica.it)

Assessing the behavior management problems during the first dental visit of preschool children using a doll placement test

CONTEXT

Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care.

AIM

This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit.

SETTINGS AND DESIGN

This cross-sectional study was conducted between the ages of 3-7 years.

MATERIALS AND METHODS

During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis.

RESULTS

The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively).

CONCLUSIONS

The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.

Validation of Arabic version of the Modified Dental Anxiety Scale (MDAS) and Kleinknecht's Dental Fear Survey Scale (DFS) and combined self-modified version of this two scales as Dental Fear Anxiety Scale (DFAS) among 12 to 15 year Saudi school students in Riyadh city

Aims

The aim of this study was to test the reliability and validity of the Arabic version of Modified Dental Anxiety Scale (MDAS), Dental Anxiety Scale (DAS), and a combined self-modified version of these scales and Dental Fear and Anxiety Scale (DFAS). We also aimed to assess the impact of dental fear and anxiety among Arabic-speaking 12-15-year-old Saudi students on their quality of life by correlating MDAS, DAS, and DFAS scores with other demographic data.

Materials and Methods

A cross-sectional study was conducted among 500 individuals (250 male and 250 female) in Riyadh city using a questionnaire. An unpaired t-test was used to check the mean difference between anxiety score among males and females, and one-way analysis of variance was used to check the mean difference between percentage anxiety score among different visit groups. Scheffe post hoc test was used to check the pairwise difference between the groups, and Cronbach's alpha was used to measure internal consistency of the questionnaire.

Results

Overall mean percentage DAS score was 51.1640 + 6.87358 and 55.2080 + 8.52805 for male and females, respectively. The overall mean percentage MDAS score was 51.6640 + 10.9478 and 58.3200 + 11.62990 for males and females, respectively. The overall mean total score was found to be 64.4080 + 11.80776 and 100.4680 + 12.34840 for males and females, respectively. All the above results were statistically significant by 5% (P < 0.001). Cronbach's alpha score for MDAS and DAS was found to be 0.843 and it was 0.960 for DFAS. It was found that removal of any item would have decreased the overall consistency, which indicated a high level of internal consistency for our scales.

Conclusion

Saudi Arabian version of Arabic version of MDAS, DAS and DFAS have shown high validity and reliability, and can be used to assess the dental patient's anxiety and fear.

Effect of audiovisual distraction on the management of dental anxiety in children: A systematic review

BACKGROUND

Audiovisual distraction, a non-pharmacological intervention, has been used to manage dental anxiety in prior clinical trials.

AIM

Synthesize the available evidences to evaluate the efficacy of audiovisual distraction techniques on the management of dental anxiety in children.

DESIGN

Electronic databases (PubMed, Cochrane Central Register of Controlled Trials, and Embase) were searched. We included randomized controlled trials (RCTs), and methodological quality of included trials was assessed using the Cochrane Collaboration's criteria. Information on reported anxiety, pain, behaviors, vital signs (including blood pressure, oxygen saturation, and pulse rate), and children satisfaction was analyzed.

RESULTS

Nine studies were included for a systematic review, and none of them had low risk of bias. Significant differences in anxiety were found. According to the study, a majority of results indicated a significant difference in pain and behavior between the audiovisual and control group. Three studies reported children in the audiovisual group preferred usage of an audiovisual device for future dental visits. No significant differences could be found regarding blood pressure.

CONCLUSIONS

There is some low-quality evidence suggesting that the usage of audiovisual distraction during dental treatment may relieve children's dental anxiety.

The long-term effect of previous dental treatment under general anaesthesia on children's dental fear and anxiety

BACKGROUND

Dental treatment under general anaesthesia (DGA) is deemed to contribute to children's dental fear and anxiety (DFA), both in the short term and long term.

OBJECTIVE

To compare DFA between children who had previous DGA and those who did not.

METHODS

A cross-sectional survey included 5- to 12-year-old children who had undergone DGA (n = 43) and a control group who had not (n = 55). Questionnaires were completed by parents regarding sociodemographic and dental profiles. Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale (faces) (MCDASf) were completed by children.

RESULTS

The mean age of the control group and the DGA group was 9.5 ± 1.7 and 8.8 ± 1.5 years old, respectively (P > 0.05). The time passed since DGA was experienced ranged between 1.2 and 6.9 years ago (mean: 4.2 ± 1.1 years). The mean CFSS-DS and MCDASf scores for the DGA group (34.3 and 20.4, respectively) were significantly greater when compared to the control group (23.6 and 12.7, respectively) (P < 0.001).

CONCLUSION

Children who experienced DGA are a high-risk group for DFA several years after the procedure. The DGA status could be used for identifying anxious children to promote better behaviour management.

Cross-Cultural adaption, validity and reliability of a Hindi version of the Corah's Dental Anxiety Scale

Background: An appropriate scale to assess the dental anxiety of Hindi speaking population is lacking. This study, therefore, aims to evaluate the psychometric properties of Hindi version of one of the oldest dental anxiety scale, Corah’s Dental Anxiety Scale (CDAS) in Hindi speaking Indian adults.

Methods: A total of 348 subjects from the outpatient department of a dental hospital in India participated in this cross-sectional study. The scale was cross-culturally adapted by forward and backward translation, committee review and pretesting method. The construct validity of the translated scale was explored with exploratory factor analysis. The correlation of the Hindi version of CDAS with visual analogue scale (VAS) was used to measure the convergent validity. Reliability was assessed through calculations of Cronbach’s alpha and intra class correlation 48 forms were completed for test-retest.

Results: Prevalence of dental anxiety in the sample within the age range of 18-80 years was 85.63% [95% CI: 0.815-0.891]. The response rate was 100 %. Kaiser-Meyer-Olkin (KMO) test value was 0.776. After factor analysis, a single factor (dental anxiety) was obtained with 4 items.The single factor model explained 61% variance. Pearson correlation coefficient between CDASand VAS was 0.494. Test-retest showed the Cronbach’s alpha value of 0.814. The test-retest intraclass correlation coefficient of the total CDAS score was 0.881 [95% CI: 0.318-0.554].

Conclusion: Hindi version of CDAS is a valid and reliable scale to assess dental anxiety in Hindi speaking population. Convergent validity is well recognized but discriminant validity is limited and requires further study.

Associations between dental anxiety and postoperative pain following extraction of horizontally impacted wisdom teeth: A prospective observational study

The aim of the study is to identify associations between dental anxiety and postoperative pain in patients undergoing extraction of horizontally impacted wisdom teeth.A total of 119 volunteers provided demographic data, and completed questionnaires, the State-Trait Anxiety Inventory (STAI), Chinese Index of Dental Anxiety and Fear (C-IDAF)-4C, and the Numeric Rating Scale (NRS) for pain.Mean SAI, TAI, and C-IDAF-4C scores were 42.5 ± 8.7, 46.4 ± 10.9, and 16.9 ± 7.2, respectively. Mean postoperative pain level score was 3.0 ± 1.8 (range: 0.3-8.4). SAI scores increased as preoperative pain levels increased (β = 1.30, 95% confidence interval [CI]: 0.62-1.98, P < .001); females had higher SAI scores than males (5.34; 95% CI: 1.74-8.95, P = .004). Multivariable analysis revealed that females, bad exodontic experience, and higher predicted pain levels were associated with higher IDAF-4C scores. SAI scores (γ = 0.611, P < .001) and TAI scores (γ = 0.305, P < .001) increased as C-IDAF-4C scores increased. Higher C-IDAF-4C scores and longer operative time were significantly associated with higher levels of postoperative pain.Specific factors are associated with anxiety and stress, and postoperative pain in patients undergoing wisdom teeth extraction. Addressing these factors preoperatively may reduce stress and anxiety, and lead to more favorable treatment outcomes.

Effects of a combination of non-pharmaceutical psychological interventions on dental anxiety

BACKGROUND

Dental anxiety is a common problem associated with poorer oral health. Managing anxiety is key to improving oral health of patients with dental anxiety. The present pilot study therefore investigated dental anxiety prevalence among patients visiting a university dental clinic. We further examined the effect of combined psychological interventions on anxiety or concern towards dental treatment procedures before treatment, after treatment, and at follow-up.

METHODS

In this prospective pilot study, patients seeking restorative treatment were screened for dental anxiety and dental concern about treatment using the Dental Anxiety Scale-Revised (DAS-R) and Dental Concern Assessment (DCA) questionnaires. Participants with a DAS-R score of 9 or above were randomly assigned to an experimental or control group. The patients in the experimental group received two psycho-logical interventions (psychoeducation and progressive muscular relaxation) prior to dental treatment. Dur-ing treatment, patients received another psychological intervention (music distraction). No psychological interventions were given to control patients. DAS-R and DCA scores were used to assess dental anxiety and concern, respectively, before treatment, after treatment, and at follow-up. Nonparametric tests were used for intergroup and intragroup statistical analyses.

RESULTS

Out of 64 patients surveyed, 33 (51.6%) had experienced dental anxiety. Of those, 2 were exclud-ed, and 31 patients with a mean ± SD age of 41.2 ± 15.9 y completed the study. No intergroup differences in dental anxiety were found in terms of pretreatment, posttreatment, and follow-up treatment. The mean rank value of the dental anxiety score was less in the experimental group (13.53) than the control group (18.31), albeit not significant. More specifically, differences (Kruskal-Wallis %2 = 14.82, P = 0.001, effect size = 0.33) were found in the experimental group for pretreatment, posttreatment, and follow-up treatment levels of dental anxiety for extraction (P = 0.01), injection (P = 0.02), and sound/vibration of the drill (P = 0.00). No significant intragroup differences between pretreatment, posttreatment, and follow-up treatment were found in the control group.

CONCLUSIONS

The combined brief psychological interventions reduced dental anxiety.

RELEVANCE FOR PATIENTS

The psychological interventions of the present study could be applied right before or during dental treatment to reduce the dental anxiety of patients. However, additional research involving larger groups is needed to replicate the results of this pilot study.