Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

The Association of Social Media Videos and Patients' Preoperative Anxiety

BACKGROUND

Impacted tooth extraction is regarded as one of the dental procedures that induces the highest levels of dental anxiety.

PURPOSE

The study purpose was to measure and compare anxiety levels in patients undergoing 3rd molar extraction between those who did or did not view videos related to 3rd molar operations.

STUDY DESIGN, SETTING, AND SAMPLE

This prospective cohort study was conducted on patients who presented to the Department of Oral and Maxillofacial Surgery. The study included patients without any systemic comorbidities who had a indication for the extraction of impacted mandibular third molars. Patients who had previously undergone impacted tooth extractions were excluded from the study.

PREDICTOR VARIABLES

The predictor variable was exposure to 3rd molar operation videos on social media. The subjects were grouped into categories; group 1, patients who watched videos and group 2, patients who did not watch videos.

OUTCOME VARIABLES

The main outcome variables are state anxiety (S-anxiety) scores and trait anxiety (T-anxiety) scores. Anxiety scores were measured 1 week before the surgery and on the day of the surgery.

COVARIATES

Age, sex, education level, and whether the video contained animated or real surgical images were used as covariates.

ANALYSES

For normally distributed continuous variables, group means were compared using Student's t-test, while nonnormally distributed variables were compared using the Mann-Whitney U test. A P value of <.05 was considered statistically significant.

RESULTS

The sample consisted of 60 patients, with 68.3% female and 31.7% male. In group 1, S-anxiety scores on the surgery day (44.8 ± 10.38) were higher than 1 week before (37.76 ± 8.92), and T-anxiety scores on the surgery day (78.23 ± 5.25) were higher than 1 week before (74.8 ± 5.54). In group 2, S-anxiety scores on the surgery day (35.9 ± 11.27) were higher than 1 week before (32.3 ± 9.53), and T-anxiety scores on the surgery day (79.16 ± 6.32) were higher than 1 week before (75.76 ± 5.55). S-anxiety scores of group 1 were statistically higher than group 2 in both conditions (P < .05), but there was no statistically significant difference between the groups in terms of T-anxiety scores (P > .05).

CONCLUSION AND RELEVANCE

Watching videos before the operation may be associated with patients' anxiety levels.

AGGREGATIBACTER ENDOPHTHALMITIS IN A PATIENT WITH DENTOPHOBIA

PURPOSE

To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia.

METHODS

Case report.

PATIENTS

A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation.

RESULTS

Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis.

CONCLUSION

Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.

Associations between the perception of dental pain and pain anxiety, mental pain, and dental anxiety in Iranian sample

OBJECTIVE

This study examined the perception of dental pain and its relationship to pain anxiety, dental anxiety, and mental pain.

METHODS

This cross-sectional study was conducted on 328 patients referred to dental clinics in Kermanshah (Iran) from 2020 to 2021. The instruments used in this study included scales assessing pain anxiety, dental anxiety, mental pain, and pain perception.

RESULTS

There was a significant relationship (p = .001) between pain perception with dental anxiety (r = .38), pain anxiety (r = .45), and mental pain (r = .25).

CONCLUSION

Psychological factors are associated with the perception of dental pain. Given the importance of dental care to overall health, psychological interventions may help to reduce the perception of dental pain and fear of seeing dentists in Iran.

Exploring dental students' attitudes toward patient-centered management of dental fear

PURPOSE/OBJECTIVES

A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior.

METHODS

In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims.

RESULTS

Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists.

CONCLUSION(S)

Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.

Anxiety sensitivity and disgust sensitivity predict blood-injection-injury fears in individuals with dental anxiety

BACKGROUND

Anxiety sensitivity (AS) and disgust sensitivity (DS) are transdiagnostic vulnerability factors for anxiety. Both correlate with blood-injection-injury (BII) phobia symptoms in several studies; however, there is ambiguity about their relative contributions, and studies investigating this have relied on unselected samples. Furthermore, although DS reliably predicts BII in studies that do not account for AS, this may be limited to domain-specific DS rather than DS more broadly.

AIMS

The aims of this study were to examine AS and DS as separate and simultaneous predictors of BII fears in a sample with a wide range of BII symptoms, and with attention to the specificity of DS to BII-relevant domains.

METHOD

Fifty-three participants who scored above a clinical threshold on a validated measure of dental anxiety, and who represented a wide range of BII severity, completed measures of AS, DS and BII symptoms.

RESULTS

AS and DS were moderately to strongly correlated with BII severity (r = .40 and .47, p = .004 and <.001), and both independently predicted BII severity when entered as simultaneous predictors (β = .32 and .35, p = .045 and .015). Furthermore, after omitting DS about injections and blood draws, domain-general DS was still moderately correlated with BII severity (r = .33, p = .017). However, domain-general DS did not significantly predict BII severity after accounting for AS (β = .20, p = .164).

CONCLUSIONS

AS and DS both predict BII symptoms, and prospective research is warranted to examine them as potential vulnerability factors.

The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Management strategies of dental anxiety and uncooperative behaviors in children with Autism spectrum disorder

BACKGROUND

Children with Autism spectrum disorder (ASD) was frequently experienced dental anxiety and uncooperative behaviors during dental treatment. Oral health care was necessary because of the poor oral hygiene and prevalent dental diseases in this population.

AIM

In this systematic review, we evaluated the effectiveness and feasibility for pediatric dentist to manage the dental anxiety in children with ASD.

DESIGN

PubMed, Embase, and Cochrane Library were systematically performed on the literature search. The date of eligible publications was from inception to January 2023. After that, the quality of eligible studies was assessed by the Newcastle Ottawa Scale (NOS). Review findings were summarized using the PRISMA Statement for reporting.

RESULTS

A total of six studies were systematically evaluated according to the inclusion and exclusion criteria. Five studies were conducted to evaluate ASD Children's anxiety and uncooperative performance in the progressive oral examination, oral disease prophylaxis and fluoride application. The other one study evaluated the success rate of treatment in decayed permanent tooth treatment. In the included studies, four studies indicated that it was extremely necessary to reduce dental anxiety of ASD children to increase the cooperation in sensory-adapted dental environment (SADE).

CONCLUSION

It is not always effective and feasible for pediatric dentist to manage the dental anxiety in children with autism during routine oral examination. Meanwhile, it is necessary for ASD children to conduct preoperative psychological assessment, to investigate parents' expectations and cooperation, and to determine whether to start corresponding dental treatment.

The effect of sequential dental visits on dental anxiety levels of paediatric patients

AIM

The aim of the present study is to evaluate the relationship between sequential visits in dental caries treatments and dental anxiety levels of paediatric patients through the use of anxiety scales and physiological measurements.

METHODS

A total of 224 children aged 5-8 years who needed at least two bilateral restorative dental caries treatments of the mandibular first primary molar was included in the study. The treatment duration was approximately 20 minutes and time span between the two appointments was a maximum of two weeks. The Wong-Baker FACES Pain Rating Scale (WBFPS) and The Modified Dental Anxiety Scale (MDAS) were used for subjective measurements and the objective measurement of dental anxiety was performed by measuring the heart rate using a portable pulse oximeter. Statistical analysis was carried out using the Statistical Package for the Social Sciences version 22 (IBM corp. Armonk, NY, USA).

RESULTS

Out of the 224 children, 117 were girls (mean age 6.4 ± 1.1 years) and 107 were boys (mean age 6.1 ± 1.2 years). The mean age of the patients was 6.26 ± 1.147 years, ranging from 5 to 8. There were no statistical significant differences between children’s age and genders with dental anxiety. However, there were statistical significant differences for the variables regarding the sequential visits. When comparing the MDAS scores statistically significant differences were observed between the first and second visits (p<0.001). Both preoperative and postoperative WBFPS scores were significantly higher at the first visit than at the second visit. Statistically significant differences were observed in the heart rate scores between the treatment sessions (p<0.001).

CONCLUSION

The results of this study show a significant reduction in dental anxiety after sequental dental visits in children aged 5-8 years, which highlights the importance of the sequental visits in paediatric dentistry.

Dental anxiety, a one-year evaluation

Dental anxiety is the second most common reason for patients to forgo treatment in France. Based on this observation, the odontology and psychiatry departments of Henri Mondor hospital proposed a collaborative approach to help these patients. The aim of this study is to evaluate the results of this pilot project over one year. The patients appreciated the consultation, considering it a tool to help them be able to receive care. This consultation also resulted in 17 percent of patients being offered psychological care in order to treat other problems related to dental anxiety. The idea of a network of practitioners specialized in the treatment of these anxious patients is therefore proposed, the patients having emphasized that not having to re-explain their anxieties would be a relief.

Patient perceptions and experiences of dental fear of different dental specialties: a mixed-method study

OBJECTIVE

The primary objective of this study was to validate an Urdu translation of Kleinknecht's Dental Fear Survey (DFS) for use in Pakistan and to explore which items contribute the most to the variance in dental fear scores based on patient perceptions and lived experiences during dental care.

METHODOLOGY

This mixed-method study was conducted at Dow Dental Hospital from February 2022 to June 2022. For quantitative analysis, a total of 273 participants were enrolled through convenience sampling. After obtaining signed consent, participants were asked to self-report their dental fear. In-depth interviews with 25 patients displaying moderate to high dental fear were conducted to clarify the elements of dental fear scores through the lens of individual perceptions and experiences.

RESULTS

The prevalence of moderate dental fear was significantly higher among female participants than males. The mean dental fear score was higher among females (39.47 ± 14.23) as compared to males (30.83 ± 10.50). Most of the female participants reported an increase in breathing rate and heartbeat during dental treatment. The highest mean fear score was reported by participants who underwent oral surgical treatment (42.98 ± 14.21), followed by participants who received restorative care (36.20 ± 12.60). Approaching the dentist's office was the significant factor that contributed the most to the variance in dental fear scores. Four themes were generated through the content analysis of the interviews: physical reactions to dental procedures, perceptions and fears about surgical and restorative procedures, and gender and environmental factors in dental fear and interaction with dentists.

CONCLUSION

The Urdu translation of DFS is a reliable and valid instrument for assessing dental fears in Pakistan based on the findings of this study. Patients perceive surgical and restorative procedures as unpleasant and threatening. It was noted that "the heart beats faster" and "the breathing rate increases." were the top two physiological responses.

Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health

BACKGROUND

Dentists often use sedative medications such as nitrous oxide inhaled sedation and general anesthesia (GA) to help decrease patient fear and manage paediatric patients' behavior during treatment.

AIM

The goal of this study was to examine factors associated with dental fear changes after restorative dental treatment under nitrous oxide or GA in children 4-12 years old.

DESIGN

A prospective cohort study of 124 children examined changes in dental fear, number of treatment visits, and parental factors among children receiving restorative dental treatment under nitrous oxide (n = 68) or GA (n = 56) sedation. Data were collected at pretreatment (T1), 16 weeks post-treatment (T2), and at 29-month follow-up (T3).

RESULTS

Dental fear increased slightly, but not significantly, under both forms of sedation between T1 and T3. Children's dental fear was associated with parents' poor dental experiences and oral health, but not with number of treatment visits.

CONCLUSIONS

Progression of children's dental fear seems not dependent solely on the type of sedation used but is likely predicted by factors including pretreatment dental fear and dental needs. Dentists recommending sedation for children's dental care may consider pretreatment dental need, fear levels, and parental factors when determining which type of sedation to use.

Smile Restoration of a Dental Anxiety Patient Using Same-Day Chairside CAD/CAM and Esthetic Zirconia

This clinical case study describes the smile restoration of a 33-year-old female patient who exhibited severe dental anxiety, multiple cavities, discoloration, and a fractured tooth. The patient's complex dental history and anxiety-driven treatment preferences posed challenges that were met with a minimally invasive strategy. The case involved meticulous diagnosis, leveraging advanced diagnostic wax-ups, and a comprehensive treatment plan. Esthetic zirconia material was utilized to enable the preservation of tooth structure while achieving visually appealing and functional outcomes, and CAD/CAM technology facilitated same-day restorations with superior marginal fit, aided by the precision of a digital intraoral scanner. The patient's dental anxiety strongly influenced the treatment approach, leading to the integration of smile enhancement alongside caries treatment. The use of a single cement and bond product simplified the final cementation process, while the versatility of the zirconia CAD/CAM material allowed for fabrication of various restoration types with minimal tooth reduction. This streamlined workflow expedited treatment, which was especially crucial for the anxious patient undergoing sedation.

The effect of orthodontic pain on dental anxiety: a review

Dental Anxiety constitutes a series of signs of sympathetic hyperfunction that arises during a dental visit. Orthodontic pain is a common reaction in children and adults that can increase dental anxiety and affect orthodontic outcomes. Both malocclusion and orthodontic pain negatively affect quality of life. Dental anxiety and orthodontic pain have different contributing factors, and the prevalence of malocclusion and dental anxiety varies. Different methods have been proposed for the classification of the dental anxiety scales and orthodontic pain as a first approach in the treatment process. The objective of this literature review was to discuss the effect of orthodontic pain on dental anxietyand to explore ways to address dental anxietyin children and adultsto reduce negative effects on quality of life. This review not only analyses the prevalence and etiology of dental anxiety, the characteristics and influencing factors of orthodontic pain; but also introduces how dental anxiety and orthodontic pain are diagnosed, and proposes some treatment options. The occurrence of malocclusion has recently risen in children and adults, and the negative effects of orthodontic pain and dental anxiety have been explored in literature. Therefore, this review attempts to provide a critical analysis of dental anxiety and orthodontic pain, to attract the attention of orthodontists and provide a framework for further exploration of effective treatment solutions.

Psychometric evaluation of the Japanese version of the fear of pain questionnaire-III and its association with dental anxiety: a cross-sectional study

BACKGROUND

Fear of pain is a significant concern related to chronic pain and its impact on daily functioning. It is also associated with dental anxiety, highlighting its relevance in dental practice. This study aimed to validate the Japanese version of the Fear of Pain Questionnaire-III (FPQ-III) and explore its relationship with dental anxiety.

METHODS

400 participants completed the Japanese version of the FPQ-III, with 100 participants re-evaluated after one month. Convergent validity was tested against dental anxiety and pain catastrophizing, while discriminant validity was assessed by examining general anxiety and depression correlations. Confirmatory factor analysis was used to examine the factorial validity of the FPQ-III and a shortened version of the FPQ-III (FPQ-9). Item response theory was applied for each subscale to estimate the discriminative power of each item and draw a test information curve. Structural equation modeling (SEM) was used to investigate the relationship between fear of pain and dental anxiety.

RESULTS

Data from 400 participants (200 women, 44.9 ± 14.5 years) were analyzed. The FPQ-III showed good internal validity, intra-examiner reliability, discriminant validity, and convergent validity. Confirmatory factor analysis results supported a three-factor structure, and the FPQ-9 showed a good fit. Test information curves demonstrated that the FPQ-9 maintained high accuracy over a similarly wide range as the FPQ-III. SEM revealed that fear of minor pain was associated with dental anxiety via fear of medical pain even in individuals without painful medical or dental experiences (indirect effect 0.48 [95% CI: 0.32-0.81]). Fear of severe pain tended to be higher in individuals with chronic pain compared to those without (latent mean values 0 vs. 0.27, p = 0.002) and was also associated with dental anxiety via fear of medical pain in women (indirect effect 0.15 [95% CI: 0.01-0.34]).

CONCLUSION

The Japanese version of the FPQ-9 demonstrated high reliability and validity, making it a valuable tool in dental clinical and research settings. It provides insights into the fear of pain among individuals with chronic pain and dental anxiety, informing potential intervention strategies.

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

BACKGROUND

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Pedia tricks - Out-of-the-box thinking in paediatric dentistry

Noncooperative behaviour faced by a paediatric dentist is the most common attribution towards behavioural manifestations of anxiety in children, and it had been observed that these relationships are long-deterministic and form part of the aforementioned belief system of the child. Forehead and Long in their study found that most uncooperative behaviour of the child is due to their strong will and these children are generally confident, persistent and independent. A fruitful method to deal with strong willed children is to violate the causal relationship by some magic tricks from preventive via curative to his/her follow ups visits. Tricks can be applied at three levels of their visit. Level 1 is preoperative tricks, which includes the preventive measures that teach and educate children for good oral health. Level 2 is operative tricks, which involves child preparedness for successful dental procedures. Level 3 is postoperative tricks, which involve positive reinforcement for regular follow ups. The purpose of this review is to make paediatric dentists think like magicians by using the science behind the magic and applying it in their practice for creating a positive attitude of a child toward dentistry and better procedural experience.

Dental Fear and Anxiety of Chinese Preschool Children in a School-Based Outreach Service Using Silver Diamine Fluoride for Caries Control: A Cross-Sectional Study

Limited data are available regarding the patient-based outcomes of SDF therapy in the kindergarten setting. This study aims to evaluate the dental fear and anxiety (DFA) of preschool children after participating in a school-based outreach service using SDF to arrest early childhood caries (ECC). The study recruited 3- to 5-year-old children with untreated ECC. A trained dentist performed a dental examination and applied SDF therapy to the carious lesions. ECC experience was measured using the dmft index. Questionnaires for parents were used to collect the children's demographic information and their dental treatment experiences. The children's DFA before and immediately after SDF therapy was assessed using the self-reported Facial Image Scale (FIS) on a Likert scale of 1 (very happy) to 5 (very distressed). The association between the children's DFA after SDF therapy and the potentially related factors, including demographic background, caries experience, and DFA before SDF therapy, were analysed using bivariate analysis. Three hundred and forty children (187 boys, 55%) joined this study. Their mean (SD) age and dmft scores were 4.8 (0.9) and 4.6 (3.6), respectively. Most of them (269/340, 79%) never had a dental visit. After SDF therapy, 86% (294/340) of the children exhibited no or low DFA (FIS ≤ 3), whereas 14% (46/340) reported high DFA (FIS > 3). No factor was associated with children's DFA after SDF therapy (p > 0.05). This study showed most preschool children with ECC exhibited no or low DFA after SDF therapy in a school setting.

Web-Based Interventions Reduced Dental Anxiety among Adults in Lithuania and Norway: A Pilot Study

Dental anxiety (DA) is a prevalent public health issue. However, there is a lack of self-administered DA interventions. The aim of this study was to evaluate the short-term effects of web-based interventions aiming to reduce DA in adults in two European countries. A pretest posttest design was used. Tailor-made websites were developed in Lithuania and Norway. Volunteers who self-reported DA were invited to participate. DA levels measured by the Modified Dental Anxiety Scale (MDAS) were assessed at baseline and after two weeks via online questionnaires. The interventions were completed by 34 participants in Lithuania and 35 participants in Norway. In Lithuania, the median posttest MDAS score (9.5, IQR 5.25) decreased compared to the median pretest MDAS score (14.5, IQR 8; Z value = -4.246, p < 0.001). The same was found in Norway-the median posttest MDAS score (12, IQR 9) was lower compared to the median pretest MDAS score (15, IQR 7; Z value = -3.818, p < 0.001). The present study demonstrated that two tailor-made web-based interventions had the potential to reduce dental anxiety levels when assessed in the short term in Lithuania and Norway. Studies with more controlled designs assessing long-term outcomes are needed to validate the results of this pilot study also in other cultures.

Effect of the Case for Carpule as a Visual Passive Distraction Tool on Dental Fear and Anxiety: A Pilot Study

The present cross-over study aimed to evaluate the effect of a visual passive distraction tool, a case for carpule, in the management of fear and anxiety during invasive dental treatment. Children between the ages of 4 and 8 years that need at least two treatments with inferior alveolar nerve block were selected. All the included children received two treatments at different moments: in one treatment, local anesthesia was performed with a visual passive distraction tool, the crocodile case, for carpule (experimental); in the other treatment, local anesthesia was performed without the device (control). An evaluation of the anxiety levels was performed by measuring the heart rate and salivary cortisol levels. Wilcoxon's nonparametric test was used for a data analysis (p < 0.05). The mean heart rate with the visual passive distraction device fell from 81.8 to 78.1, while the control rose from 91.4 to 100 (p < 0.05). The mean salivary cortisol levels with the visual passive distraction device fell from 2.0 to 1.6, while in the control, they rose from 2.1 to 2.4 (p < 0.05). In conclusion, the crocodile case for carpule as a visual passive distraction device contributed positively to the management of fear and anxiety during inferior alveolar nerve block in children.

[Dental anxiety and alexithymia; research on anxiety acquisition]

People with alexithymia have difficulty identifying and describing feelings, have little imagination and mental processes largely orientated towards facts and less towards inner experience. It occurs in about 1 in 10 people and therefore in the dental office, too. A positive association has been found between alexithymia and the development of dental anxiety. With the help of an anxiety-conditioning experiment, the acquisition and the extinction of anxiety can be studied. To gain more knowledge about these processes of acquisition in people with alexithymia, such an experiment was conducted among 32 people with severe dental anxiety, 13 of whom with (possible) alexithymia. Relatively little anxiety conditioning occurred during the experiment. This may be explained by the aversive stimulus and the context in which the experiment was conducted. However, it emerged that for people with alexithymia, a physical outcome measure may be a better indicator of anxiety than a subjective score on a visual analogue scale.

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

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

Dental Anxiety as a Risk Factor for Facebook Intrusion

OBJECTIVE

To investigate the relationships between dental anxiety, Facebook intrusion, and shame.

METHODS

A sample of 498 adults aged 16-69 years completed an online questionnaire comprising the Modified Dental Anxiety Scale, the Facebook Intrusion Scale, and the Shame scale from the Test of Self-Conscious Affect.

RESULTS

Dental anxiety was positively associated with Facebook intrusion. There were also indirect effects of dental anxiety on Facebook intrusion through shame.

CONCLUSIONS

The results highlight the problem of dental anxiety in the context of Facebook intrusion risk. The findings may be applicable in Internet dependency prevention and treatment, focused on help in coping with the anxiety related to doctors' appointments.

Experience of using a smartphone WeChat applet for dental anxiety assessment and preoperative evaluation: A nationwide multicenter study

Introduction

Dental anxiety is a multivariate phenomenon that regularly occurs during a dental procedure. Although it may lead to patients' safety concerns and adverse events in routine treatment, it is often ignored. The purpose of this research is to develop a novel WeChat Applet for dental anxiety (WADA) with the following features and aims: (1) to help patients with dental anxiety management; (2) provide patient with a physical status self-evaluation; and(3) provide a platform for online assessment and tele-consultancy by dentists. We aimed to test and verify whether such an applet could play a beneficial role before and after a dental procedure and facilitate management of high-risk patients during the COVID-19 pandemic.

Materials and methods

During the 12-month survey period (August 2020 to July 2021), a total of 180 patients aged 3–74 years from eight different cities (n = 180 at the end of treatment, n = 25 for the System Usability Scale (SUS) and follow-up interview) and 20 medical staff from eight different cities (n =20 for follow-up interview) were evaluated by WADA. At the end of the survey period, the results of the interviews were analyzed thematically.

Results

WADA assessment results from 180 patients and follow-up interview results from 45 participants were analyzed. In this study with a male to female ratio of 2:3, 75% were found to be suffering from dental anxiety, 86% were found with postoperative complications, and 11 cases were found to have contraindications to surgery. The total SUS score for WADA is 72.25 above the mean score, proving that WADA is a relevant and useful tool before and after dental treatment. Based on the results of the interviews, the following themes were identified: patient satisfaction; dentists' effectiveness; multi-center data integration; and increase its frequency of usage.

Conclusions

The WADA was developed for dental procedures and is effective for reducing treatment risks, improving patients' satisfaction and dentists' convenience, especially in terms of facilitating management of high-risk patient during the COVID-19 pandemic.

Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review

PURPOSE

Molar Incisor Hypomineralization (MIH) are first molars with developmental enamel defects and are common findings in many child populations. The porous nature of MIH enamel and the presence of post-eruptive enamel breakdown leads to the presence of hypersensitivity and pain, which is often the patient's main complaint and can result in dental fear and affect the quality of life. The present review aims to summarise the evidence for the ability of MIH to cause problems, such as dental fear and anxiety (DFA) and to summarise the evidence for a possibly negative impact on the oral health-related quality of life (OHRQoL) of MIH affected children and adolescents, in a systematic review.

METHOD

Two searches, (1) MIH AND dental anxiety and (2) MIH AND Quality of life, were performed in MEDLINE/PubMed and Scopus. Selection demands were fulfilling the MIH diagnosis criteria using validated instruments and questionnaires for assessing DFA and OHRQoL, respectively.

RESULTS

After removing duplicates and articles not fulfilling the selection demands, 6 studies concerning MIH and DFA and 8 studies concerning MIH and OHRQoL remained.

CONCLUSION

Children and adolescents with diagnosed MIH did not seem to suffer from increased dental fear and anxiety, but indicated an impaired oral health-related quality of life.

Automated Dental Cavity Detection System Using Deep Learning and Explainable AI

Impacting over 3.9 billion people, dental cavities requires a trained dentist for diagnosis. Unfortunately, barriers such as dentophobia, limited dentist availability, and lack of dental insurance prevent millions from receiving care. To address this, an Artificial Intelligence system was developed that detects cavity presence on photographs and visually explains the rationale behind each diagnosis. While previous systems only detected cavities on one extracted tooth showing one tooth surface, this study's system detects cavities on photographs showing multiple teeth and four tooth surfaces. For training, 506 de-identified images from online sources and consenting human participants were collected. Using curriculum learning, a ResNet-27 architecture proved to be most optimal after achieving 82.8% accuracy and 1.0 in sensitivity. Visual explanations for the system's diagnoses were also generated using Local Interpretable Model Agnostic Explanation. This system can explain its diagnoses to users in an understandable manner, which is a crucial skill employed by dentists.

Effects of Preoperative Anxiety Status on Haemodynamic Changes during and after Tooth Extraction in Middle-aged and Elderly Patients with Hypertension: a Prospective Repeated-Measures Cohort Study

OBJECTIVE

To investigate the effects of dental anxiety on fluctuations in blood pressure (BP) and heart rate (HR) during tooth extraction in hypertensive patients under local anaesthesia, and how they are influenced by various confounding variables.

METHODS

This is a prospective repeated-measures cohort study involving 600 patients successively recruited from Peking University School and Hospital of Stomatology, Beijing, China. BP and HR were repeatedly measured at rest (T0), before anaesthesia (T1), during tooth extraction (T2) and after tooth extraction (T3). Anxiety status was measured prior to local anaesthesia using a modified dental anxiety scale (MDAS). Three groups were assigned: mild anxiety (Corah DAS score of 4 to 8), moderate anxiety (score of 9 to 12) and severe anxiety (score of 13 to 20). We used a generalised linear mixed model (GLMM) to analyse the effects of dental anxiety on fluctuations in BP and HR. Interaction analysis was used to further explore the correlationship between these interactive factors.

RESULTS

The mean anxiety scale score was 9.63 ± 2.88. Severe preoperative anxiety (score of 14 to 20) was associated with significantly increased HR during administration of anaesthesia. Patients with severe anxiety also displayed a significantly greater increase in HR during anaesthetic administration (P < 0.001). When analysing the joint effects of different anxiety statuses over time, blood pressure was significantly elevated in all patients with moderate and severe anxiety during tooth extraction at T2 (β = 1.25, 95% CI 0.24 to 2.27). We also observed a significant decrease in HR in the moderate anxiety group at T3 (β = -1.51, 95% CI -2.38 to -0.63) and a significant increase in HR in the severe anxiety group at T1, T2 and T3 (β = 2.52, 95% CI 1.12 to 3.93; β = 3.84, 95% CI 2.30 to 5.38; β = 4.57, 95% CI 3.03 to 6.11, respectively).

CONCLUSION

This study indicates that the effects of dental anxiety on BP and HR in middle-aged and elderly patients with hypertension during local anaesthesia and tooth extraction were influenced by various confounding variables.

Updates on Topical and Local Anesthesia Agents

Use of topical and local anesthesia (LA) is the workhorse of all aspects of dentistry. There was a time in the past when dentistry was performed without any local pain control. Owing to this there are patients with dental anxiety and fear of a dental office. The media portraying dentistry as being painful, or showing a dentist with needles, enlists fear and distrust of dentists. In contrast, pain is what brings the patient to the dental office and with local pain control measures a dentist is able to alleviate the patient's cause of pain.

The roles of disgust sensitivity and anxiety sensitivity in attentional bias in dental anxiety

Individuals with dental anxiety show biased attentional processing of threat- and dental-related information. Disgust sensitivity and anxiety sensitivity are both associated with dental fears and attentional biases. Whereas disgust sensitivity is generally associated with attentional avoidance (Armstrong et al., 2014), anxiety sensitivity may be associated with attentional engagement (Keogh et al., 2001a). Elucidating the role of these constructs in dental anxiety-relevant attentional biases could inform theoretical models and/or intervention recommendations. Participants (N = 51) with high dental anxiety completed a Posner paradigm to assess attentional biases to dental versus neutral stimuli. We examined whether disgust sensitivity and anxiety sensitivity moderated degree of attentional bias. Results indicated that both disgust sensitivity (mutilation subscale) and anxiety sensitivity (physical concerns subscale) statistically moderated degree of attentional bias at trend level, and in opposite directions. Simple effects analyses further indicated that disgust sensitivity regarding mutilation was associated with less attentional bias toward dental relative to neutral stimuli, potentially indicating attentional avoidance, and remained so when adjusting for anxiety sensitivity. In contrast, simple effects analysis indicated that anxiety sensitivity regarding physical concerns was not associated with magnitude of attentional bias. If replicated, findings highlight the potential role of disgust in dental anxiety.

Gagging and cooperation in 4-12-year-old children over a series of dental appointments

PURPOSE

The purposes were to evaluate if gagging can affect children's cooperation with treatment, investigate possible changes in gagging and study factors that can predict children's behaviour over dental treatment.

METHODS

255 children aged 4-12 years, needing at least three consecutive dental appointments, completed the Children's Fear Survey Schedule-Dental Subscale before examination. The Gagging Problem Assessment was performed before the initial examination and after the third/final appointment. Frankl's Behaviour Rating Scale (FBRS) was used to rate children's behaviour. Multivariate Mixed Linear and Logistic Regression Models were used.

RESULTS

Children with definitely positive behaviour were significantly older, less fearful and less likely to gag before treatment. Girls and older children had lower odds of gagging over time, while fearful children had higher odds. There were no statistically significant associations between gagging over time, FBRS and the type of dental treatment at the third appointment. The percentage of children who gagged after the third appointment (27.05%) was significantly lower as compared to the percentage found at the initial appointment (32.54%; p = 0.004).

CONCLUSION

Among the variables studied, age, dental fear, initial GPA and type of treatment were good predictors of children's behaviour during dental treatment.

Impact of Silver Diamine Fluoride Therapy on Oral Health-related Quality of Life of Uncooperative Preschool Children: A Prospective Study

PURPOSE

Preschool children with early childhood caries (ECC) frequently exhibit extreme dental anxiety and fear, posing a considerable challenge to paediatric dentists for their treatment. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative preschool children using an Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS).

MATERIALS AND METHODS

A pre-validated A-ECOHIS was used to assess the sensitivity and responsiveness. Fiftyone children, uncooperative with conventional dental care, underwent SDF treatment; their mothers answered the A-ECOHIS before and 4 weeks after treatment. Based on the global transition rating (GTR), the mothers rated their child's oral health condition following SDF treatment.

RESULTS

SDF effectively arrested caries after 4 weeks in all children. There was a statistically significant reduction in mean scores of the total A-ECOHIS, child impact scale and family impact scores at follow-up (Wilcoxon signedrank test; p ˂ 0.001). There were statistically significant changes in the mean GTR of children's oral health.

CONCLUSIONS

A-ECOHIS was sensitive and responsive to SDF treatment. SDF statistically significantly improved the OHRQoL of uncooperative preschool children.

[Mucoperiodontal lesions: improvement of prosthodontic treatment considering initial indicators of patients' oral health]

OBJECTIVE

To assess the need for prosthodontic treatment and to substantiate the features and perspectives for optimizing prosthodontic treatment in patients with mucoperiodontal manifestations of lichen planus (LP).

MATERIAL AND METHODS

For assessment of the need and identification of problematic aspects of prosthetic treatment 74 patients (48.3% of the primary sample of all patients with oral LP) with oral LP-associated mucoperiodontal lesions (MPL) participated in a multicenter open cohort prospective controlled clinical trial with elements of retrospective analysis. The prospective part of the study summarizes the results of prosthodontic treatment of 41 patients (8 men and 33 women aged 45-70 years) carried out using improved therapeutic and diagnostic algorithms applied to the specifics of the MPL forms and stages.

RESULTS

The use of standard protocols of prosthodontic treatment without taking into account the status of oral mucosa in patients with oral LP was associated with the development of nonspecific (prosthetic stomatitis - 25.8%; contact-allergic stomatitis - 22.6%; focal hyperplasia - 16.1%; decubital ulcers - 12.9%, etc.) and oral LP-associated specific reactions (Kebner's symptom - 35.5%; transformation of the typical form into complicated ones - 22.6%; desquamative gingivitis and gingival lichenization - 19.4% each; gum recession - 16.5%) with the involvement of skin and mucous membranes of other localizations (6.5%) and the appearance of symptoms of carcinophobia/dentophobia (25.8%). Prosthetic treatment according to improved protocols for the management of patients with oral LP indicated a decrease in the frequency of nonspecific oral mucosal reactions (by 70.7%, p<0.001), single (4.8%) specific reactions, improvement of masticatory efficiency by 32.8-55.3% (p<0.01), harmonization of speech function, maintenance of a high level of hygiene of prostheses, a significant reduction in the time of adaptation to removable dentures and increased satisfaction with the results of treatment on the GRS scale (1.06±0.3 points after treatment; 3.8±0.5 points before treatment; p<0.001).

CONCLUSION

The best dynamics of clinical and sociological indicators was noted in persons with prosthetic replacement structures based on implants.

Efficacy, tolerability, and safety of an innovative medical device for improving oral accessibility during oral examination in special-needs patients: A multicentric clinical trial

Background

People with special needs have high unmet oral healthcare needs, partly because dentists find it difficult to access their oral cavity. The Oral Accessibility Spatula aims to improve oral accessibility. This prospective multicenter interventional open-label non-randomized patient-self-controlled trial assessed the ability of the spatula to improve the oral accessibility of special-needs patients during dental examinations.

Methods

The cohort was a convenience sample of minor and adult patients with special needs due to physical, intellectual, and/or behavioral disorders who underwent dental check-up/treatment in five French tertiary hospitals/private clinics in 2016–2018 and evinced some (Venham-Score = 2–4) but not complete (Venham-Score = 5) resistance to oral examination. After inclusion, patients underwent oral examination without the spatula and then immediately thereafter oral examination with the spatula. Primary outcome was Oral Accessibility Score (0–12 points; higher scores indicate visualization and probing of the tooth sectors). Secondary outcomes were patient toleration (change in Venham-Score relative to first examination), safety, and Examiner Satisfaction Score (0–10; low scores indicate unsatisfactory examination).

Results

The 201 patients were mostly non-elderly adults (18–64 years, 65%) but also included children (21%), adolescents (11%), and aged patients (3%). One-quarter, half, and one-quarter had Venham-Score = 2, 3, and 4 at inclusion, respectively. The spatula significantly improved Oral Accessibility Score (4.8 to 10.8), Venham-Score (3.1 to 2.6), and Examiner Satisfaction Score (3.4 to 7.2) (all p<0.001). There were no severe spatula-related adverse events.

Conclusion

The spatula significantly improved oral access, was safe and well-tolerated by the patients, and markedly improved oral examination quality.

Reliability and validity in Mexico of the Spanish version of the Children's Fear Survey Schedule - Dental Subsca

AIM

Low attendance and abandonment of dental treatment caused by dental fear varies from 6% to 20%. Various specific scales have been used to evaluate and measure dental fear, like Children´s Fear Survey Schedule - Dental Subscale, which is considered the "gold standard", due to its efficacy and validity. However, not all the studies that have been conducted have performed the Exploratory Factorial and Confirmation Analysis to infer the validity of the scale's content, which is why this study has as its main objective to analyse the confidentiality and validation of this scale.

MATERIALS AND METHODS

In a sample of 163 school age children, from 6 to 12 years old, of both genders, from a public school, a Children's Fear Survey Schedule - Dental Subscale was applied to measure dental fear. The internal consistency of the scale was estimated with the Cronbach's alpha, we also performed the Exploratory Factorial Analysis with the method of the main component with Varimax rotation and the Confirmatory Factorial Analysis to confirm the structure of the factors.

RESULTS

The Cronbach's alpha was obtained with a .837 (p?.05). The adequate coefficients were determined with the Kaiser-Meyer-Olkin (KMO = .843) and the Bartlett's test of specificity (?2 = 565,325, p= .000), in which there was a good adequate data, expressing an appropriate and intercorrelation between items or strongly related. The factorial structure showed four factors extracted, 4 factors explain the 53.57% of the accumulated variation; 14 items were above the .40. The statistics of the second and third model obtained adequate values in the statistics of goodness of fit index.

CONCLUSION

The Mexican version of the CFSS-DS in the present study gives us data about the adaptation and validation of the dental fear scale of CFSSS-DS by the Exploratory Factorial Analysis through a model of structural equations. This means that this instrument is a trusting and valid tool to measure dental fear in the children's population of Mexico.

Effect of Verbal and Visual Information on the Level of Anxiety among Dental Implant Patients

AIM

To compare the effect of visual information and verbal communication on the level of anxiety among patients undergoing dental implant (DI) therapy.

MATERIALS AND METHODS

A total of 270 patients who were undergoing DI treatment were recruited for the study. An equal number of patients (n = 90) were randomly allocated into three study groups which were formed on the basis of the mode of delivery. Subjects in group I received verbal information, whereas patients in group II were shown a video of surgery on manikins. Group III subjects were made to watch a video of surgery on a real patient. Before the surgery, anxiety levels were measured for all patients using the modified Corah dental anxiety scale (MDAS).

RESULTS

Questionnaires were filled by all patients and were later analyzed. The values of Cronbach's α and the behavioral involvement subscale were 0.89 and 0.91, indicating hemogeneous sample. Patients of group I showed significantly reduced anxiety levels (p < 0.01) followed by groups II and III.

CONCLUSION

Verbal information generated less anxiety than visual information on patients undergoing DI therapy.

CLINICAL SIGNIFICANCE

To assess the best method of information delivery to dental implant patients in which their anxiety will be minimal.

Child Life Interventions for Pediatric Dental Patients: A Pilot Study

Purpose: The purpose of this pilot study was to assess whether child life intervention can be an effective alternative to pharmacologic behavior management in uncooperative pediatric dental patients. Methods: Thirty uncooperative four- to eight-year-old patients with no history of a negative invasive dental experience were randomly assigned into two groups: experimental (E) and control (C). Group E was given two 30- minute child life interventions (CLIs) by a certified child life specialist. Group C did not receive CLIs. Both groups then had an invasive restorative dental appointment, which was video recorded, edited, and viewed to assess behavior via the Houpt scale. Results: Group E demonstrated overall better cooperation for the appointment (Group C equals 3.63, and group E equals 4.07.) Conclusions: Child life interventions may be considered an adjunct to other behavior guidance techniques, but further investigations should be conducted to evaluate the effectiveness of CLIs on behavior in the dental setting.

Sedation or General Anaesthetic for Special Care Patients?

When faced with an anxious patient with complex needs who requires dental care, it can be difficult to decide on the most appropriate method to manage their pain and anxiety. There are a range of conscious sedation techniques that may be used, and on some occasions, general anaesthesia may be required. This paper describes the methods available and the factors influencing the decision-making process. The general dental practitioner (GDP) may not be able to offer care in their setting, but knowing more about the decision-making process and the information required to make that decision can help them guide patients and their families.

The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments

OBJECTIVE

Distraction is a highly acceptable technique for diverting a patient's attention from what may be perceived as an unpleasant procedure, reducing anxiety and helping the patient relax. The objective of the present study was to evaluate the effect of watching television during dental treatment on pediatric patients' anxiety and cooperation compared to the commonly used conventional Tell-Show-Do (TSD) behavioral management method.

METHOD AND MATERIALS

Sixty-nine children (mean age 6.8 years) scheduled to undergo restorative dental treatment were randomly divided into two intervention groups: a group that was managed by television distraction and a control group that was managed by TSD. During treatment, anxiety was assessed by the Facial Image Scale and cooperative behavior was assessed by the Frankl scale. Pulse rate and oxygen saturation were also measured during the treatment.

RESULTS

Compared to TSD, television distraction significantly reduced anxiety by 1.27 (95% confidence interval [CI] 0.798 to 1.744, adjusted P < .001), decreased pulse rate by 6.44 beats per minute (bpm) (95% CI 4.60 to 8.28, adjusted P < .001), and significantly increased cooperation by 1.17 (95% CI -1.318 to -1.020, adjusted P < .001). A greater effect of television distraction on reduced anxiety and increased cooperation was observed during administration of the anesthetic injection. No effect of television distraction on saturation levels was noted.

CONCLUSIONS

Television distraction is an effective method for reducing anxiety and improving cooperative behavior in children during dental treatments.

Management of dental anxiety – a cross-sectional survey in private dental practices in the Swiss Romandy

The main aim of the present study was to gain a better understanding of the management of dental anxiety reported by dental practitioners in western Switzerland. In 2013, an 18-item electronic questionnaire was sent to dental practitioners in the Swiss Romandy. A total of 140 (18.6%) questionnaires were included in the analysis. About four out of five practitioners (79.4%) involved with dental emergency service had at least one occurrence with dental phobic patients. The majority of the respondents stated that both dental anxiety and dental phobia increases stress in the dental practice with frequencies of 90.0% and 88.5%, respectively. Among the 119 respondents using anxiety reduction methods (85.0%), an overall of 51 (42.9%) reported using pharmacological methods while 89.9% (n = 107) used psychological methods. Female dentists were using psychological anxiety reduction methods three times more frequently than male dentists reaching borderline statistical significance (OR = 3.0, p = 0.0591). Out of 140 respondents, only 28 (20.1%) received education and training in dental anxiety reduction methods. The majority of these (66.4%; n = 83) stated that their education was inadequate and 55.8% (n = 77) requested further education and training. It can be concluded that more education and training of dental anxiety reduction methods are needed.

Effectiveness of Virtual Reality Glasses as a Distraction for Children During Dental Care

Purpose: The purpose of this review was to investigate the effect of virtual reality (VR) glasses as an audiovisual distraction technique on dental anxiety, pain perception, and behavior triggered during dental treatment in children up to 12 years old. The research question asked was: Can improvement be seen in the child's behavior, pain perception or anxiety when VR eyeglasses are used during dental treatment? Methods: Five databases were searched for studies published until September 2018. Studies were selected by titles and abstracts, followed by full-texts reading. Results: Meta-analysis was performed and combined results were presented as a pooled mean difference for each procedure, using random-effect models. Nine randomized clinical trials assessed the effect of VR glasses on children's behavior during dental care. No differences were observed in anxiety levels during local anesthesia, use of rubber dam, removal of caries and restorative procedures. Similar results were observed in children's behavior when local anesthesia and rubber dam were used. Conclusions: The use of virtual reality glasses is an effective tool for improving behavior and reducing pain perception during the dental treatment of children. Children who used VR eye-glasses behaved better during removal of caries and showed lower pain perception during restoration.

Level of Dental Anxiety and Its Relation to Khat Chewing in Jazan Population: A Cross-sectional Study

AIM

To investigate and compare the levels of dental anxiety (DA) in relation to khat and non-khat chewer subjects of both genders from Jazan subpopulation, Kingdom of Saudi Arabia (KSA).

MATERIALS AND METHODS

A cross-sectional study was conducted to assess DA using the modified dental anxiety scale (MDAS). A total of 352 subjects from the city of Jazan who attended dental clinics for regular treatment were recruited for this study. A questionnaire was used to collect the required information, which consisted of three parts. Descriptive statistics including means, standard deviations, and percentages were calculated. Multiple group comparisons were analyzed using Chi-square tests using the Statistical Package for Social Science (SPSS) program. p < 0.05 was considered as the significance level.

RESULTS

Among the participants, 75.6% was male, while 71.3% khat chewers, and most of them were male (91.2%). The percentage of the overall mean of MDAS was low; 40% to moderate; 38%, while sever anxiety were present in 4% only. Anxiety related to endodontic treatments represents 33.8% in both genders and 34.3% among the khat chewers, while fear was 42.1% among males and 45.4% among khat chewers. The local anesthesia injection in the gum and tooth drilling items of MDAS were represented by 36.6% for both khat and gender groups and resulted in a fairly and extremely anxious situation during dental treatments. All variables were significantly different.

CONCLUSION

The overall DA level was low to moderate among the majority of the assessed subjects. Endodontic treatments were the first type of dental treatments for the subjects, while fear of pain was the most common cause of irregular dental visits. Significant differences were detected between khat and non-khat chewers and between genders in relation to anesthesia injection, and drilling of teeth in the MDAS items.

CLINICAL SIGNIFICANCE

Community programs focusing on the high DA levels caused by khat chewing might be important in order to minimize the fear of dental treatments and improve and regularize the overall dental treatments.

Smartphone-based exposure treatment for dental phobia: a pilot randomized clinical trial

OBJECTIVES

High levels of dental care-related fear/anxiety, as well as phobia, result in delay or avoidance of dental care, which are associated with poorer oral and overall health. Both pharmacotherapeutic and psychosocial methods are available to treat those with high levels of dental fear/anxiety or phobia, but they are infrequently used and not easily accessed. Smartphones are a potential vehicle for delivering exposure therapy (e.g., a treatment involving systematic encounter with fear-evoking stimuli), but there is a need to test the acceptability of this approach in regard to treatment of high levels of dental anxiety/fear and phobia.

METHODS

There were 36 patients with high dental anxiety/fear/phobia randomly assigned to either a treatment or a waitlist condition. Participants completed a pre- and two-week post-multimodal assessment, including a dental behavioral avoidance task. The treatment condition included 2 weeks of self-directed exposure delivered via a personal smartphone in the patients' natural environment.

RESULTS

Participants in the treatment condition utilized the smartphone exposure an average of 1.6 times daily (SD = 0.85), and found the self-directed exposure highly acceptable. Moreover, they had lower self-reported anxiety and decreased cardiac reactivity at the postassessment compared with the preassessment; no change in anxiety was found for the control condition from pre- to postassessment.

CONCLUSIONS

Highly anxious, fearful, and dental phobic participants utilized smartphone-delivered exposure therapy, and found it to be an acceptable treatment method. Results support the utility and promise for further testing of the personal smartphone in delivering self-directed exposure therapy for high dental fear/anxiety and phobia.

Effectiveness of Bubble Breath Play Therapy in the Dental Management of Anxious Children: A Pilot Study

Play is an inseparable part of childhood and can act as a mode through which children can be desensitized toward dental treatment.

AIM

To assess and compare the efficacy of bubble breath play therapy (BBPT) and tell-show-do (TSD) technique in the dental management of anxious/fearful children.

MATERIALS AND METHODS

Forty-eight children aged 6-8 years were randomly divided into group I: BBPT and group II: TSD. The effectiveness of the BBPT and TSD technique in reducing anxiety/fear in children was assessed pretreatment, during, and posttreatment evaluation of the child's anxiety levels using finger pulse oximeter and Venham's anxiety and behavior rating scale. All children underwent rotary restorative treatment.

RESULTS

The mean pulse rate in the BBPT and TSD group was 106.96 mm Hg and 102.25 mm Hg, respectively, at baseline. A decrease in the pulse rate was observed in both the groups after the application of behavior modification strategies. However, after the dental treatment, the mean pulse rate slightly increased in the BBPT group, while it showed a further improvement in the TSD group.

CONCLUSION

The BBPT acts as a distraction and can be considered to enhance rapport between the dentist and children during dental treatment.

CLINICAL SIGNIFICANCE

Application of appropriate strategies to allay dental fear in children is essential to provide quality dental treatment and build a positive attitude toward oral health.

Management of the Dentally Anxious Patient: The Dentist's Perspective

PURPOSE

To evaluate dental anxiety from the dentist's perspective.

MATERIALS AND METHODS

A cross-sectional study was performed on a convenience sample. Data were gathered using questionnaires that included general information and specific questions concerning dentally anxious patients.

RESULTS

Three hundred ten practicing dentists completed the survey. Participants estimated that 27% of their adolescent/adult patients and 35% of their child patients suffer from dental anxiety. Dentists reported devoting about a quarter of their weekly work hours to treating such patients. The most common anxiety management techniques used for adults and children alike were nitrous oxide and/or behavioural techniques (such as distraction, reinforcement, gradual exposure, and relaxation). Dentists generally agreed that it is their responsibility to help dentally anxious patients. Eighty-one percent expressed interest in taking part in dental anxiety management courses. The consensus was that treating dentally anxious patients involves long treatment times, insufficient payment, and frequent appointment cancellations.

CONCLUSIONS

According to practicing dentists, over one-quarter of their patients suffer from dental anxiety. Most dentists perceive themselves as responsible for treating these patients and are willing to receive appropriate training. Incorporating behavioural and pharmacological management techniques in the undergraduate dental curriculum and expanding postgraduate training programmes in this field are important issues that can improve the well-being of both dentally anxious patients and their dentists.

Dental students' and patients' perceived importance and knowledge of dental anxiety

AIM

To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear.

METHODS

Dental students (N = 219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear = 5-9, low fear = 10-18, high fear = 19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis.

RESULTS

Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P < .001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety.

CONCLUSION

Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

Exposure to Electronic Screens and Children's Anxiety and Behavior During Dental Treatment

Purpose:The purposes of this study were to (1) assess the relationship between exposure time to electronic screens and children's anxiety and behavior manage ment problems during dental treatment; and (2) evaluate the effect of the underlying confounding factors.<br/> Methods:A cross-sectional study of 95 five- to eight-year-old patients was conducted. The study consisted of two sessions, one week apart. During the first visit, the socioeconomic status of the family was assessed, and examination and preventive measures were performed. One of the parents was asked to report screen time use by the child over a one week period using a valid questionnaire. In the second visit, dental anxiety and behavior management problems were assessed using the Clinical Anxiety Rating Scale and Frankl Behavior Scale, respectively.<br/> Results: Anxiety and behavior management problems during a dental visit were significantly correlated with the participant's total exposure hours to electronic screens. Exposure to violent media was significantly different between participants with and without behavior management problems. Boys showed a significant higher exposure to violent media than girls.<br/> Conclusion: Anxiety and behavior problems in a dental visit correlate to total hours of exposure to electronic screens. Therefore, limiting a child's screen exposure should be considered. (J Dent Child 2019;86(3):139-44).

Factors associated with children's perception of pain following dental treatment

PURPOSE

To assess children's perception of pain during routine dental procedures and associated factors.

METHODS

A cross-sectional study was performed including 192 children aged 6-13 years, who visited a university paediatric dental clinic. Mothers were interviewed to obtain information about demographic and socioeconomic data, and psychosocial characteristics. During dental treatment, children's behaviour was assessed using Frankl's Behaviour Scale. Dental procedures were recorded according to complexity of treatment from dental records. Immediately after the dental procedure, perception of pain was assessed using the Faces Pain Scale-Revised. Poisson regression analysis was used to assess the association between potential predictor variables and perception of pain (P  < 0.05 was considered significant).

RESULTS

Overall, the mean pain score was 1.5 (SD 2.4). Higher levels of pain were reported by children who demonstrated non-cooperative behaviour during the treatment (RR = 2.39, 95% CI = 1.23-4.64), who were administered local analgesia (RR = 2.36, 95% CI = 1.31-4.27), and who reported dental pain during the previous 4 weeks (RR = 1.60, 95% CI = 1.04-2.47).

CONCLUSION

Perception of pain may be influenced by pre-operative pain and use of local analgesia, and is associated with non-cooperative behaviour during treatment.

Parasympathetic effect of deep pressure input on third molar extraction in adolescents

BACKGROUD/PURPOSE

Deep pressure input is used to normalize physiological arousal due to stress. Third molar extraction is an invasive dental procedure with high stress for the patient, and an alleviation strategy is rarely applied during tooth extraction. In the present study, we investigated the effects of deep pressure input on autonomic responses during the procedures of third molar extraction in healthy adolescents.

METHODS

A randomized controlled crossover design was used for adolescents who were allocated to experimental and control groups that received intervention with or without deep pressure input, respectively. Autonomic indicators, namely the heart rate, percentage of low-frequency heart rate variability (LF-HRV), percentage of high-frequency heart rate variability (HF-HRV), and low-frequency/high-frequency heart rate variability ratio (LF/HF-HRV), were assessed at the baseline, during molar extraction, and in the posttreatment phase.

RESULTS

The results indicated that third molar extraction caused significant autonomic parameter changes in both groups; however, differential response patterns were observed between two groups. In particular, application of deep pressure input in the experimental group was associated with higher HF-HRV and lower LF/HF-HRV during third molar extraction compared with those in the control group.

CONCLUSION

LF/HF-HRV measurement revealed balanced sympathovagal activation in response to deep pressure application. The present study suggests that the application of deep pressure alters the response of HF-HRV and facilitate maintaining sympathovagal balance during third molar extraction.

The influence of clinical and psychosocial characteristics on children behaviour during sequential dental visits: a longitudinal prospective assessment

PURPOSE

This is the first study to adopt a multilevel approach to assess the impact of the order of dental visits on child's behaviour. The aim was to investigate which factors directly interfere with child's behaviour regardless of the order of sequential dental visits.

METHODS

In this prospective longitudinal study, children aged 7-12 years were invited to participate. Child behaviour was assessed using the Frankl Scale during four sequential dental visits. Chi-square test was used to analyse the effect of dental fear on children's non-cooperative behaviour according to the presence of dental fear. Multilevel mixed logistic regression model was used to assess the association between predictor variables and the outcome (child behaviour) during the sequential dental visits.

RESULTS

Overall, 111 children participated in this study. Maternal dental anxiety, dental pain and complexity of the treatment were associated with the non-cooperative behaviour in children aged 7-12 years. When stratified by dental fear, the complexity of the treatment remained associated with non-cooperative behaviour.

CONCLUSIONS

The results provide evidence that, even with the familiarization of child with the dental environment, maternal dental anxiety, dental pain in the last month, and the complexity of dental treatment negatively affect the children's behaviour aged 7-12 years.

Effects of Familial Characteristics on Dental Fear: A Cross-sectional Study

AIM

Dental fear (DF) in children is a multifactorial problem that may affect the child's dental treatment and behavior at the dental office. This study aimed to evaluate the familial characteristics affecting DF among Arabic-speaking 12- to 15-year-old children in Jeddah, Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study assessing 16 middle schools in Jeddah, Saudi Arabia, was performed through multistage stratified random sampling. DF among children was measured using the children fear survey schedule-dental subscale (CFSS-DS) questionnaire. A parental questionnaire was used to collect information regarding familial socioeconomic status, parental DF, and DF among siblings and friends. The data were analyzed using the t test, one-way analysis of variance (ANOVA), and multiple linear regression analysis.

RESULTS

A total of 1,522 children were included. Socioeconomic variables were not associated with DF among children. Parental DF, parental dental experiences, siblings' DF, and friends' DF were significantly associated with DF in children. In the regression analysis, mothers' anxiety at the last dental visit, siblings' DF, and friends' DF were significant predictors of DF among children.

CONCLUSION

DF in children is associated with mothers' anxiety during their last dental visit and DF in siblings or friends.

CLINICAL SIGNIFICANCE

Obtaining comprehensive dental, family, and social history from patients is as essential as asking about medical history for pediatric dentists to plan the most appropriate and effective behavioral management techniques for their pediatric patients. Understanding the etiology of DF assists clinicians to provide better oral health services for their fearful patients.