Children's dental fear and anxiety: exploring family related factors

BACKGROUND

Dental fear and anxiety (DFA) is a major issue affecting children's oral health and clinical management. This study investigates the association between children's DFA and family related factors, including parents' DFA, parenting styles, family structure (nuclear or single-parent family), and presence of siblings.

METHODS

A total of 405 children (9-13 years old) and their parents were recruited from 3 elementary schools in Hong Kong. Child's demographic and family-related information was collected through a questionnaire. Parents' and child's DFA were measured by using the Corah Dental Anxiety Scale (CDAS) and Children Fear Survey Schedule-Dental Subscale (CFSS-DS), respectively. Parenting styles were gauged by using the Parent Authority Questionnaire (PAQ).

RESULTS

DFA was reported by 33.1% of children. The mean (SD) CFSS-DS score was 29.1 (11.0). Children with siblings tended to report DFA (37.0% vs. 24.1%; p = 0.034) and had a higher CFSS-DS score (29.9 vs. 27.4; p = 0.025) as compared with their counterpart. Children from single-parent families had lower CFSS-DS score as compared with children from nuclear families (β = - 9.177; p = 0.029). Subgroup analysis showed a higher CFSS-DS score among boys with siblings (β = 7.130; p = 0.010) as compared with their counterpart; girls' from single-parent families had a lower CFSS-DS score (β = - 13.933; p = 0.015) as compared with girls from nuclear families. Children's DFA was not associated with parents' DFA or parenting styles (p > 0.05).

CONCLUSIONS

Family structure (nuclear or single-parent family) and presence of siblings are significant determinants for children's DFA. Parental DFA and parenting style do not affect children's DFA significantly.

Do children's previous dental experience and fear affect their perceived oral health-related quality of life (OHRQoL)?

Background

Oral health-related quality of life (OHRQoL) has been used to describe the consequences of oral health conditions and treatments in children. A better understanding of OHRQoL and its relationship with dental fear and previous dental experience is necessary to improve children’s oral health status. The aim of this study was to investigate the association of dental history and experience with dental fear and the OHRQoL of children aged 11 to 14 years.

Methods

A cross-sectional study was conducted using a multi-stage stratified sample of 1,312 middle school children. Information regarding OHRQoL was collected from the children using the Child Perceptions Questionnaire (CPQ_11–14), and information regarding dental fear was collected using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS). Information on past dental experiences and sociodemographic data were collected from the parents using self-administered questionnaires. Dental examinations were performed to assess caries experience.

Results

The multivariable model indicated that dental fear was the strongest predictor of OHRQoL as the fearful children had on average CPQ_11–14 scores that were 10 units higher than those of the non-fearful children. Regarding past dental experience, pain as the reason for the most recent dental visit was associated with poor OHRQoL, while receiving a filling during the previous dental visits was significantly associated with better OHRQoL. In addition, a larger number of siblings, a lower family income, a lower paternal education level, health problems and prior hospitalization were significantly associated with poor OHRQoL.

Conclusion

This study identified that dental fear and some factors related to previous dental experience are associated with OHRQoL. In dental practice, children with dental fear should be identified, guided and treated early to avoid deterioration of their OHRQoL.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0338-9) contains supplementary material, which is available to authorized users.

A controlled trial on the effect of hypnosis on dental anxiety in tooth removal patients

OBJECTIVE

Empirical evidence concerning the efficacy of hypnosis to reduce anxiety in dental patients is limited. Hence we conducted a controlled trial in patients undergoing tooth removal. The study aims at assessing patient's attitude toward hypnosis and comparing the course of dental anxiety before, during and subsequent to tooth removal in patients with treatment as usual (TAU) and patients with treatment as usual and hypnosis (TAU+HYP).

METHODS

102 patients in a dental practice were assigned to TAU or TAU+HYP. Dental anxiety was assessed before, during and after treatment. All patients were asked about their experiences and attitudes toward hypnosis.

RESULTS

More than 90% of patients had positive attitudes toward hypnosis. Dental anxiety was highest before treatment, and was decreasing across the three assessment points in both groups. The TAU+HYP group reported significantly lower levels of anxiety during treatment, but not after treatment compared with TAU group.

CONCLUSION

Our findings confirm that hypnosis is beneficial as an adjunct intervention to reduce anxiety in patients undergoing tooth removal, particularly with regard to its no-invasive nature.

PRACTICAL IMPLICATION

The findings underline that hypnosis is not only beneficial, but also highly accepted by the patients. Implementation of hypnosis in routine dental care should be forwarded.

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

Background

Dental anxiety is a widespread problem in many populations. This problem can be a barrier to dental care and may lead to poor oral health. Dental anxiety may be related to psychological status.

Aims

The aim of the present study was to assess the levels of dental anxiety, dental fear, Beck Depression, and state-trait anxiety according to age, gender and education level in patients at the periodontology clinic in the Diyarbakır Mouth and Dental Health Center.

Study Design

A total of 231 patients (115 males, 116 females) filled out dental fear scale (DFS), dental anxiety scale (DAS), Beck Depression Inventory (BDI), state-trait anxiety inventory-state (STAI-S), and state-trait anxiety inventory–trait (STAI-T) questionnaires, and evaluations of DFS, DAS, BDI, STAI-S, and STAI-T were conducted according to age, gender, and education level.

Results

The mean DFS, DAS, BDI, STAI-T, and STAI –S were 45.64, 9.15, 13.16, 38.90, and 40.18, respectively. There was a significant association among DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05). These surveys scores were significantly higher in females than males (p < 0.05). The results of this study indicated that gender age and education level have important effects on DFS, DAS, BDI, STAI-S, and STAI-T (p < 0.05).

Conclusion

Dental anxiety and dental fear were found to be related to psychological status (BDI, STAI-S, and STAI-T) over time. There are some patients with unaddressed psychological distress.

Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p=0.04), and in the MDAS between before and immediately after extraction (p=0.02), and between immediately after and 7 days after extraction (p=<0.001). The DFS also differed between before and immediately after extraction (p=0.002), and between immediately and 7 days after extraction (p<0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.

Effects of child characteristics and dental history on dental fear: cross-sectional study

Background

Dental fear (DF) is a challenging problem in dentistry. It is multifactorial in origin and many contributing factors have been identified. The aim of the study was to assess dental fear among 12–15 years old Arabic speaking children in Jeddah, Saudi Arabia and its relation to demographic variables, previous dental experience, and child behaviour.

Methods

In this cross-sectional study, a total of 1522 boys and girls from middle schools in Jeddah, Saudi Arabia participated in this study during the period of 2014 to 2016. The Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS) was used to assess DF. A parental questionnaire was used to record the children’s previous dental experience. Children were examined for caries and the children’s behaviour was assessed during dental examination using Frankl Behaviour Rating Scale. The associations between different variables and the CFSS-DS scores were analysed using t-tests, ANOVA, and multiple linear regression analysis.

Results

The response rate of the questionnaires was 78.6%. The mean CFSS-DS score was 25.99 ± 9.3 out of a maximum of 75. Bivariate analysis showed that younger children, girls, and public-school students were significantly more fearful than older children, boys, and private school children, respectively (P < 0.001). Children who showed poor behaviour during dental examination were significantly more fearful than those with good behaviour (P < 0.001). Regression analysis showed that children who had significantly higher scores of dental fear were the children who did not visit the dentist in the past year due to dental fear; who never visited the dentist or those who only visited the dentist on pain; who were reported by parents as crying, screaming, or resistant during their previous dental visit; and those who were described to be in pain during previous dental treatment. Dental caries showed no significant association with DF.

Conclusions

This study confirms that DF is low among 12–15 years old Arabic speaking children in Jeddah, Saudi Arabia. DF is associated with age, gender, school type, irregular patterns of dental visits, painful experiences during previous dental visits and negative behaviours during dental examinations.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0496-4) contains supplementary material, which is available to authorized users.

Dental anxiety and oral health-related quality of life in aggressive periodontitis patients

OBJECTIVES

To measure dental anxiety levels and oral health-related qualities of life (OHRQoL) in patients with aggressive periodontitis (AgP) compared to controls and analyze their association with various demographic and clinical parameters.

METHODS

Sixty consecutive patients with AgP were compared to 80 age- and sex-matched controls with no known history of periodontal disease. Collected data included demographics, smoking habits, numerical rating scale (NRS), Corah's Dental Anxiety Scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), DMFT index (Decayed, Missing and Filled Teeth), Plaque Index (PI), probing depth (PD), bleeding on probing (BOP), and radiographic bone loss.

RESULTS

AgP patients exhibited statistically significant higher scores in the DAS total as well as sub-scores, except from DAS 1st question. Compared to the control group, AgP patients exhibited worse OHIP-14 global as well as in all individual OHIP-14 domains scores. Among both AgP and control patients, the physical pain domain was where the highest impact was recorded, while the lowest impact was recorded in the functional limitation domain.

CONCLUSIONS

AgP patients were positively associated with higher levels of dental anxiety and worse OHRQoL. Self-perception of dental anxiety and OHRQoL should be regarded as an integral element in routine diagnostic work-up process of periodontal diseases.

STATEMENT OF CLINICAL RELEVANCE

Aggressive periodontitis (AgP) patients exhibited higher dental anxiety levels and worse oral health-related quality of life (OHRQoL) compared to controls. Professionals should design strategies that will cope with the dental anxiety associated with the treatment and prevent decreases in OHRQoL.

Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures

OBJECTIVE

To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents.

MATERIALS AND METHODS

We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15-18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah's DAS as a dichotomous dependent variable.

RESULTS

Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, 'external control belief', avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12).

CONCLUSIONS

Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.

Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale

Fear of dental treatment in children has been recognized as a source of serious health problems and it may persist into adolescence, which may lead to a disruptive behavior, during dental treatment. In order to prevent this psychometric method namely the dental subscale of the children's fear survey schedule (CFSS-DS) is a well-known psychometric scale that was developed by Cuthbert and Melamed in 1982 for assessing dental fear in children. The present study was to evaluate dental fear in children during first dental visit using CFSS-DS between three different age group 4 and 6 years, 7 and 9 years, 10 and 14 years children to select fearful and nonfearful children from a larger reference population and to estimate the dental fear children. Total 600 children show CFSS-DS of 27.17 ± 5.3385, 307 were girls (51.17%) and they showed CFSS-DS of 27.50 ± 5.060 and 293 were boys (48.83%) and they show CFSS-DS 26.84 ± 5.617. This shows that there were no significant difference in fear between boys and girls. In 4 to 6 years show total CFSS-DS 28.78 ± 5.742, 7 to 9 years show that mean and standard deviation of CFSS-DS 27.81 ± 4.783, 10 to 14 years show that mean and standard deviation of CFSS-DS 25.93 ± 5.586. Fear scores were highest for ‘injections', ‘choking', ‘noise of dentist drilling', ‘dentist drilling which was not significant between boy's and girl's but item, ‘having somebody look at you’ showed that significant differences in fear scores between boys and girls in present study. The present study concluded that dental fear decreased as age increased. Total fear scores also exhibited no strong overall sex difference or age by sex interaction.

d> Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V. Evaluation of Dental Fear in Children during Dental Visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 2013;6(1):12-15.

The impact of dental treatment and age on salivary cortisol and alpha-amylase levels of patients with varying degrees of dental anxiety

Background

The purpose of this study was to assess the salivary cortisol and salivary alpha-amylase levels in children aged between 6 and 9 years, 3 months and 1 year after the successful completion of dental treatment through either pharmacological or non-pharmacological behavior management techniques.

Methods

A total of 1567 patients aged between 6 and 9 years who had completed dental treatment were screened. A total of 703 patients who were caries free at the end of 3 months were classified based on Frankl behavior score and administered the Arabic version of the Children’s Fear Survey Schedule- Dental Subscale (CFSS-DS) and accordingly allocated to one of three groups; (Phobic Patients, Anxious Patients, Control Group). A total of 183 patients met the inclusion criteria and were followed up for 1 year. A total of 151 patients completed the study. Patients’ heart rate on recall, salivary cortisol and salivary amylase were compared between the groups.

Results

The results of the study showed that amylase and cortisol levels had a significant association with the level of dental fear. The phobic patients had the highest levels of salivary amylase and salivary cortisol levels with no significant associations observed with either heart rate or extent of dental treatment. Control and anxious patients had significantly lower amylase levels when compared to phobic patients. There was no significant difference between the salivary cortisol levels of anxious and phobic patients. These findings were replicated on 1-year recall.

Conclusions

Within the limitations of this study we can conclude that salivary amylase is an indicator of of acute stress that can differentiate between anxiety and dental fear; while salivary cortisol appears to be a marker of long-term stress that lacks the sensitivity to differentiate between the two.

Dental anxiety in patients with borderline intellectual functioning and patients with intellectual disabilities

Background

This study was aimed to investigate the prevalence of dental anxiety in a population of patients with Borderline Intellectual Functioning (BIF) and patients with mild and moderate intellectual disability (ID), and how dental anxiety correlated with their age and gender.

Methods

The sample was made of 700 patients, 287 females and 413 males, 6-to-47 years old, either with borderline intellectual functioning or mild/moderate intellectual disabilities. All patients were administered the Dental Anxiety Scale to assess their level of dental anxiety.

Results

Moderate Anxiety was the most prevalent dental anxiety category for patients with intellectual borderline functioning (15.56 %) and mild intellectual disabilities(18.79 %), while Severe Anxiety was the most prevalent category for patients with moderate intellectual disabilities(21 %). Overall, a statistically significant difference (p < 0.001) between the three groups (BIF, Mild-ID and Moderate-ID) was found. Also, the correlation analysis between participants’ age and dental anxiety was statistically significant (p < 0.001); indeed, dental anxiety turned out to decrease with the increasing of the age. Moreover, the analysis between gender and dental anxiety was found to be significant as well (p < 0.001), where higher prevalence of dental anxiety was found in females.

Conclusions

To our knowledge, this is the first study on dental anxiety carried out in the field of intellectual disability. Results show that the higher the level of intellectual disability – and consequently the lower the cognitive functioning – the higher the percentage and the severity of dental anxiety.

Translation and validation of the Finnish version of index of dental anxiety and fear (IDAF-4C+) among dental students

BACKGROUND

Dental fear accounts for 41% of the non-habitual dental attendance such as visiting only when in pain among adult Finns. Dentists should be able to recognize patients in risk for irregular attendance due to dental fear and measure their fear with valid and reliable instrument that capture the multidimensionality of dental fear. The study's aim was to translate the Index of Dental Anxiety and Fear (IDAF-4C+) into Finnish and test its reliability and validity.

METHODS

The study population consisted of dental students in a Finnish university (n = 202). The IDAF-4C⁺ was back-and forward translated by experts as well as a native English translator, blinded to the original version. Reliability was assessed using Cronbach's alpha. Validity of the IDAF-4C⁺ was assessed against the Modified Dental Anxiety Scale (MDAS) using Spearman correlation coefficients and through the use of Exploratory factor analysis (EFA) and between genders using Mann-Whitney U tests.

RESULTS

The reliability of the IDAF-4C⁺ was good, the Cronbach's alpha being 0.88. The IDAF-4C⁺ and MDAS and their subscales were correlated, with coefficients varying between 0.34 and 0.85. Correlations were stronger with the emotional and physiological components of the IDAF-4C⁺. EFA revealed one factor explaining 51.7% of the common variance (eigenvalue = 4.6). Women tended to have slightly higher mean scores than men (1.49 vs. 1.36, p = 0.247).

CONCLUSIONS

The translation and localization of the Finnish version of the IDAF-4C⁺ can be considered as providing some evidence of the validity and reliability of the scale. It adds to previously used measures as it considers also the behavioral, cognitive and physiological dimension involved in dental fear.

Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment

Objective: Objectives of our studies were to predict dental fear in a child patient depending on salivary alpha amylase (sAA) level before and after dental treatment and to evaluate correla­tion of later with behavior of child patient during dental treatment.

Materials and methods: Seventy-seven children between age of 5 and 12 years were divided in three groups. Group 1 consisted of 25 school children who did not undergo any dental treatment. Groups 2 and 3 underwent dental treatment without and with local anesthesia respectively. Groups 2 and 3 were administered child fear survey schedule-dental subscale (CFSS-DS) questionnaire before treatment. Salivary samples were collected for sAA estimation in groups 2 and 3 children before and after completion of dental treatment and behavior during treatment was noted using Frankel behavior rating scale. Group 1 acted as control in which salivary sample was collected in absence of dental stress.

Results: When groups 2 and 3 were combined, pretreatment sAA level had a statistically significant (p = 0.0094) correlation with CFSS-DS scores.

Conclusion: Alpha amylase can be used as a screening tool to predict level of dental fear in a child patient.

How to cite this article: Noorani H, Joshi HV, Shivaprakash PK. Salivary Alpha Amylase as a Noninvasive Biomarker for Dental Fear and Its Correlation with Behavior of Children during Dental Treatment. Int J Clin Pediatr Dent 2014;7(1):19-23.

Psychophysiological reactivity of currently dental phobic-, remitted dental phobic- and never-dental phobic individuals during exposure to dental-related and other affect-inducing materials

Psychophysiological responses indicating the preparation of defensive behaviour, such as heart rate (HR)-increase and startle-response (SR) potentiation, have often been reported amongst individuals suffering from phobic disorders when exposed to phobia-related information. Although exposure is widely considered the 'gold standard' for treatment of Specific Phobia, it is unclear to what extent psychophysiological defensive response patterns change following treatment, and whether any changes are maintained. We assessed the acoustic SR- and HR-response to neutral, positive, negative and phobia-related pictures and sounds in 41 individuals currently suffering from dental phobia, 22 formerly dental phobic individuals who had remitted following an exposure-based treatment eight months prior to assessment, and 29 control individuals with no history of dental phobia. We observed SR-potentiation to dental-related stimuli in controls combined with HR-deceleration. In contrast, amongst phobic individuals SR-potentiation was accompanied by HR-acceleration to dental pictures. Successfully treated individuals showed inhibited startle reactivity in combination with HR-deceleration to dental related materials of both modalities. Our findings suggest inappropriate fight-flight preparation amongst individuals with dental phobia, reflecting overactivation of the defensive system. However, successful treatment results in inhibited physiological defence preparation, with remitted individuals displaying a response pattern that differed from that of phobic individuals and controls.

Dental fear association between mothers and adolescents-a longitudinal study

Aim

To assess the longitudinal association between adolescents’ and their mothers’ dental fear.

Study Design

A longitudinal questionnaire survey study.

Methods

A randomized sample of 12-year-old adolescents were selected from local Hong Kong schools. Adolescents and their mothers self-completed the Modified Dental Anxiety Scale (MDAS). The sociodemographic background of the mothers and the oral health habits of the adolescents were also collected and these measurements were repeated at 15- and 18-years-old. Non-parametric tests (Mann–Whitney U test/Kruskall Wallis test) were used to test associations between MDAS dental fear items and independent variables. Logistic regression (adjusted for family’s sociodemographic background and adolescent’s oral health habits) was performed to evaluate the longitudinal association between adolescents’ and mothers’ dental fear.

Results

A total of 212 mother-child pairs were recruited at baseline (12-year-old adolescents). In the first and second follow-ups (15- and 18-years-old), 195 and 182 mother-child pairs completed the survey. Significant associations between mother’s and child’s scores in “feeling about having their teeth scraped and polished”, “having teeth drilled”, and ‘having an injection in the gum’ were found when adolescents were 12- years-old (P < 0.01) and 18-years-old (P < 0.05), but not at 15-years-old.

Conclusion

Adolescents’ and mothers’ dental fear is associated at 12-years-old and 18-years-old, but not at 15-years-old, which is likely specific to the Hong Kong context but may be extrapolated to other industrialized countries with caution.

Sleep quality in patients with dental anxiety

BACKGROUND

Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients.

OBJECTIVES

To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters.

METHODS

67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected.

RESULTS

49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores.

CONCLUSIONS

DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.

Music therapy and aromatherapy on dental anxiety and fear: A randomized controlled trial

Background/purpose

Dental anxiety and fear in children are major public health concerns. This study aimed to determine the effectiveness of music therapy combined with aromatherapy, in reducing the children's dental anxiety and fear.

Materials and methods

A total of 128 school-age children aged 10-12 years were randomly allocated into 4 groups: a control group with 32 volunteers, an experimental group that received music therapy, with 33 volunteers, an aromatherapy experimental group with 31 volunteers, and 32 volunteers in an experimental group with music therapy combined with aromatherapy.

Results

The results found that within-group comparisons before and after the experiment revealed the outcomes with a statistically significant change at the 0.05 level of each group as follows. The control group had increased heart rate. The music therapy group showed decreased dental anxiety and fear and systolic blood pressure. The aromatherapy experimental group exhibited increased oxygen saturation. The experimental group receiving music therapy combined with aromatherapy showed decreased dental anxiety and fear, heart rate, and systolic and diastolic blood pressure as well as increased oxygen saturation values. In addition, it was found that music therapy combined with aromatherapy had a co-influence on dental anxiety and fear (F = 22.22, P < 0.001) and oxygen saturation (F = 17.40, P < 0.001), and the two main treatments also significantly influenced these outcomes at the 0.05 level.

Conclusion

The results showed that music therapy in combination with aromatherapy reduced children's anxiety and fear of dental services better than a single treatment.

Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups.

MATERIALS AND METHODS

Observational studies were retrieved by Cochrane, Embase Search, Portal BVS, Clinical Trials, Ovid, Open Gray, PubMed, Scopus, and Web of Science, and they were manually checked for the inclusion of additional articles of interest. The assessment of quality of studies was performed by the application of three different versions of the Newcastle-Ottawa Scale, for cohort, case-control, and cross-sectional studies. Only studies with low or unclear/moderate risk of bias contributed to meta-analyses, regarding the analysis of random effects of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures.

RESULTS

Of 276 articles initially retrieved, 10 were included in the systematic review, while only 6 studies with unclear/moderate risk of bias were considered in meta-analyses. The mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls (1.20; 95% CI 0.27-2.14; P = 0.01). Additionally, a moderate positive correlation was observed between dental beliefs and dental fear measures (r = 0.54, 95% CI 0.47-0.60;P< 0.001).

CONCLUSIONS

Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias.

CLINICAL RELEVANCE

Dental fear and anxiety is an important obstacle for the access of dental treatment and patient-dentist relationship, leading to inadequate oral health levels.

Child dental fear and past dental experience: comparison of parents' and children's ratings

PURPOSE

To compare the parental and child versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the parental and child evaluations of the Child's Past Dental Experience (CPDE) in 4- to 12-year-old children in a sample from Greece.

METHODS

537 families (652 children) with 4- to 12-year-old children seeking dental care either at a University paediatric dental clinic (UC) (50.8%) or a paediatric private practice (PP) participated. Parents completed a sociodemographic questionnaire and the parental Greek version of the CFSS-DS, and children independently completed the child's Greek version. All family members answered questions about CPDE. Statistical analyses were based on multilevel models (p < 0.05).

RESULTS

Mothers' and fathers' mean CFSS-DS total scores were not significantly different from each other (p = 0.655), but were significantly higher than the scores of their sons and daughters (p < 0.001), regardless of the child's age. There was a negative association between mother's age and CFSS-DS agreement, but not for fathers. There was poor agreement for CPDE ratings between children and both parents, regardless of gender. Parents' ratings of CPDE were not related to their assessment of their children's dental fear, whilst the children's ratings of their CPDE were significantly related to their current dental fear. Location (UC or PP) had no significant influence on CFSS-DS or CPDE parental-child differences.

CONCLUSIONS

Both parents overestimated their sons' and daughters' dental fear. There was poor agreement on CPDE evaluation between parents and children. Parental CFSS-DS and CPDE evaluations are poor indicators of children's dental fear and prior dental experience.

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.

Anxiety and facial self-contacts: possible impact on COVID-19 transmission in dental practice

BACKGROUND

The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact).

METHODS

A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients' movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire.

RESULTS

Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact.

CONCLUSIONS

Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.

Methods Helping Dentists to Detect Dental Fear

OBJECTIVES

Dental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients' self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed.

METHODS

A cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new "traffic light" colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants.

RESULTS

Of the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF "traffic light" system. The association between dentists' and participants' estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen's kappa value = -0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS.

CONCLUSIONS

Colour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.

Association between dental fear and eating disorders and Body Mass Index among Finnish university students: a national survey

Background

Little is known about the association between eating disorders (ED) and dental fear. This study investigated the association between dental fear and EDs through body mass index (BMI), and SCOFF (sick, control, one stone, fat, food) questionnaire among Finnish university students. We hypothesised that dental fear is associated with EDs and BMI.

Methods

We used the latest data from the Finnish University Student Health Survey 2016. This survey targeted undergraduate Finnish students (n = 10,000) of academic universities and universities of applied sciences. We enquired about e.g. age, gender, height, weight, educational sector and perceived mental well-being. We used the SCOFF questionnaire to assess those at risk for developing EDs. The question ‘Do you feel scared about dental care?’ enquired about dental fear. We used the chi-square test and gender-specific logistic regression to analyse the associations between dental fear, EDs and BMI controlling for age, educational sector and mental well-being.

Results

In total, 3110 students participated in the study. Overall 7.2% of the students reported high dental fear and 9.2% scored SCOFF positive; more women than men reported high dental fear (11.2% vs. 3.8%, p < 0.001) and scored positive on SCOFF (14.2% vs. 3.6%, p < 0.001). Gender modified the association between dental fear and EDs and BMI. Among females, when controlling for educational sector and BMI, those with positive SCOFF score were more likely to have high dental fear than those with negative SCOFF score (OR = 1.6; CI = 1.0–2.4). After adding perceived mental well-being to the gender-specific regression analyses, overweight and obese males, BMI ≥ 25 (OR = 2.4; CI 1.3–4.4) and females with poor to moderate mental well-being (OR = 2.1; CI 1.4–2.9) were more likely than their counterparts to have high dental fear.

Conclusions

Among the Finnish university students BMI in males and problems of mental well-being in females were positively associated with high dental fear. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.

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.

Reliability and validity of the Korean version of the Dental Fear Survey

BACKGROUND

Many people experience varying levels of discomfort when confronted with the prospect of dental treatment. Dental treatment can be a traumatic experience, especially for children and adolescents with dental anxiety. In this age group, dental fear causes a significant problem in dental management and has been related to severe dental caries and dental pain. The Dental Fear Survey ( DFS ) is the most widely used measure of dental fear. This study was undertaken to develop the Korean version of the DFS ( K-DFS ) and test its reliability and validity.

METHODS

The K-DFS, which uses projective techniques to measure children's and adolescents' dental fear, was developed. The DFS was translated into Korean and participants were selected via convenience sampling. Reliability and validity were tested using data from a sample of 813 middle school students in Gyeonggi Province, selected from the Self questionnaire survey. The K-DFS was administered twice to 102 adolescents aged 12-15 years.

RESULTS

The K-DFS had high internal consistency reliability (99.1%) but low test-retest reliability.

CONCLUSIONS

The results indicate that the Korean versions of the DFS have good internal consistency reliabilities and test-retest validities. However, we need to further examine the test-retest reliability of the K-DFS and replicate the current study in different samples covering various age groups.