Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population

OBJECTIVES: Fear of dentistry is a common obstacle to obtaining dental care in Turkey. The aim of this study was to assess the reliability, validity and psychometric characteristics of the Turkish translation of the Modified Dental Anxiety Scale (MDAS) and compare it to the Dental Fear Survey (DFS) scores obtained in the same population. METHODS: The Turkish translated version of the MDAS was administered to 115 dental patients; 21 subjects who suffered from dental phobia, requiring general anesthesia for dental procedures, and 94 who did not have dental anxiety, in addition to 442 subjects from the general population. RESULTS: The Turkish translated version of the MDAS was internally consistent and reproducible. The patients with dentist phobia had the highest score. The Turkish MDAS correlated with the DFS (r = 0.80, P < 0.001). The MDAS scale correlated inversely (r = -0.14, P < 0.005) with level of education; however, it did not correlate with economic status. Women scored higher than men on the scale (mean = 12.3, SD = 5.2 vs. mean = 10.9, SD = 4.5, P < 0.005). At a cut-off point > or = 15, sensitivity was 0.80, specificity 0.74, positive predictive value 0.41 and negative predictive value 0.94. CONCLUSION: Although the specificity values were low, the Turkish MDAS demonstrated acceptable sensitivity, positive and negative predictive values. Thus, high reliability and validity of the MDAS supports its cross-cultural validity and indicated that it may be a valuable tool in quantifying fear of dentistry among Turks.     

Evaluating a single dental anxiety question in Finnish adults

OBJECTIVE: To evaluate the psychometric properties (criterion validity, construct validity, sensitivity, and specificity) of a single-item question screening for dental anxiety in a Finnish adult population. MATERIAL AND METHODS: A total of 823 subjects, ranging in age from 18 to 87 years, answered a questionnaire comprising sections assessing the respondents' demographic profile and dental attendance patterns. A single dental anxiety question and the Modified Dental Anxiety Scale (MDAS) were included. The final response rate was 85%. RESULTS: Eight percent of the sample was highly dentally anxious using the MDAS cut-off point of 19 or above. Twelve percent of the respondents rated themselves as "very scared" on the single-item question. The percentage agreement between the single-item question and the MDAS was 93; the Kappa coefficient was 0.63. Specificity of the single question was 0.95 while sensitivity was 0.80 using the MDAS dichotomous classification. The single-item question related to age (p<0.001), gender (p<0.001), and dental attendance (p<0.001), as predicted. CONCLUSIONS: The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.     

Dental anxiety among adults in Turkey

AIM: This aim of this study was to investigate the prevalence of dental anxiety and related factors in a Turkish population. METHODS AND MATERIALS: The Turkish translation of the Dental Fear Scale (DFS) and the Modified Dental Anxiety Scale (MDAS) were administered to 115 dental patients consisting of 21 subjects who had dental phobia and of 94 patients who did not. The scales were also administered to a non-clinical general population (N=183). RESULTS: The Turkish version of the DFS was internally consistent and reproducible. The scale had strong correlations (r=0.80, p<0.001 ) with the MDAS. Female participants scored higher (45.2+/-18.1) on the scale than men (38.2+/-15.7). The DFS had a negative correlation (r=-0.25, p<0.001) with education level. There was a statistically significant difference between dental phobics and the remaining groups on the DFS total score. At a cut-off point 55, the sensitivity of the scale was 0.80, specificity 0.80, positive predictive value 0.48, and negative predictive value 0.95. Thirty-nine subjects (21.3%) in the general population had total scores above this cut-off point. CONCLUSION: Dental fear is common in clinical and non-clinical settings in Turkey. The good psychometric characteristics of the DFS among Turkish participants supports its cross-cultural validity.     

Evaluating a single dental anxiety question in Finnish adults

Objective. To evaluate the psychometric properties (criterion validity, construct validity, sensitivity, and specificity) of a single-item question screening for dental anxiety in a Finnish adult population. Material and methods. A total of 823 subjects, ranging in age from 18 to 87 years, answered a questionnaire comprising sections assessing the respondents’ demographic profile and dental attendance patterns. A single dental anxiety question and the Modified Dental Anxiety Scale (MDAS) were included. The final response rate was 85%. Results. Eight percent of the sample was highly dentally anxious using the MDAS cut-off point of 19 or above. Twelve percent of the respondents rated themselves as “very scared” on the single-item question. The percentage agreement between the single-item question and the MDAS was 93; the Kappa coefficient was 0.63. Specificity of the single question was 0.95 while sensitivity was 0.80 using the MDAS dichotomous classification. The single-item question related to age (p<0.001), gender (p<0.001), and dental attendance (p<0.001), as predicted. Conclusions. The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.     

Evaluation of in-office dental unit waterline testing

In-office dental unit waterline (DUWL) testing systems are commercially available for monitoring DUWL bacteria. The current study compared Aquasafe, Petrifilm, and Heterotrophic Plate Count Sampler (HPCS) with R2A plating methodology, considered the gold standard for enumerating heterotrophic bacteria in potable water. Samples were collected from 20 dental units. Heterotrophic bacterial counts of ≤500 CFUs/mL were used as the cut-off for assessing in-office testing compared to R2A laboratory plating. Validity was assessed using sensitivity and specificity, along with positive and negative predictive values. Results were also compared using concordance and kappa statistics. All in-office tests demonstrated 100% specificity and positive predictive values, while sensitivity and negative predictive values were low (Petrifilm, 57%/50%; HPCS, 50%/46%; Aquasafe, 21%/35%). Concordance and kappa values for agreement with R2A plating were as follows: Petrifilm 70% (κ = 0.44), HPCS 65% (κ = 0.38), and Aquasafe 45% (κ = 0.14). In-office DUWL testing with Aquasafe, Petrifilm, and HPCS agreed poorly with R2A plating methodology and is not valid or reliable as a means of accurately monitoring bacterial density in DUWL. These in-office test systems should not be used for assessing compliance with the ADA and CDC standard for acceptable heterotrophic bacterial counts in DUWLs (≤500 CFUs/mL).     

Employing dmft score as a risk predictor for caries development in the permanent teeth in Japanese primary school girls

The aim of this study was to examine the significance of evaluating dmft for predicting the incidence of permanent teeth caries in Japanese girls. The subjects were two birth cohorts in a Primary girls' school: cohort I composed of 45 girls born in 1981 and 1982 and cohort II composed of 53 girls born in 1989 and 1990. In both cohorts, there was a significant correlation between the dmft score in the first grade and the DMFT score in the sixth grade. The validity of employing dmft score was examined by receiver operating characteristic (ROC) curve and risk ratios. The shape of the curve and areas under the curve were similar in the two cohorts. In cohort II, sensitivity and specificity for the optimal cut-off level (dmft >or= 5) were 0.519 and 0.923, respectively. The positive and negative predictive values for that level were 0.875 and 0.649, respectively. In cohort I, sensitivity and specificity were 0.741 and 0.722 for that level and positive and negative predictive values were 0.800 and 0.650, respectively. In both cohorts, the risk ratio for permanent teeth caries was significant for many cut-off levels of dmft. The results indicated that the dmft score is a useful predictor of the permanent teeth caries in Japanese primary school girls.     

Dental anxiety, optimism–pessimism, and dental experience from childhood to adolescence

Abstract 94 adolescents, 58% of the original study group, participated in a 5-yr follow-up questionnaire study to assess the predictive power of self-reported dental anxiety, optimism–pessimism dimension, and previous dental experience on dental anxiety level over the 5-yr period. The mean values on Corah's Dental Anxiety Scale (DAS) and Dental Anxiety Question (DAQ) had increased for the girls and remained stable for the boys. The predictive power of DAS and DAQ on anxiety levels as measured by these same scales 5 yr later was weak to moderate, although statistically significant. The optimism–pessimism dimension and dental treatment experiences did not have any effect on dental anxiety changes from childhood to adolescence. DAS had an independent, weak, but statistically significant negative effect on optimistic disposition over the period. The internal reliability of DAS was high and highly similar results using DAS and DAQ were found. Except for significantly more dental experience in the drop-out group (n= 69) than in the current study group in the first study, there were no satistically significant differences in mean scores between the groups with respect to self-reported and clinical dental anxiety, and optimism. Methodological complications are discussed.     

Oral lesions as predictors of highly active antiretroviral therapy failure in Brazilian HIV-infected children

Objectives:  Evaluate the accuracy of HIV-related oral lesions to predict immune and virologic failure on HIV-infected children in use of highly active antiretroviral therapy (HAART).
Study design:  Data for this cross-sectional analysis come from a longitudinal study being conducted through the HIV-AIDS Outpatient Unit, ENT Division, Hospital das Clinicas, Sao Paulo University Medical School. The study began in January 1990 and is still ongoing. The cut-off point for analyses purposes was December 2004. Subjects were 471 HIV-infected consecutive children attending the outpatient unit during this period, who enrolled regardless of medical or immunological status. The children have undertaken oral cavity examination, serum CD4⁺ T-lymphocyte count, and, 271 of them, viral load measurement. Sensitivity, specificity, positive predictive value, negative predictive value and relative risk were calculated.
Results:  Oral lesions had moderate sensitivity, high specificity and positive predictive value to predict immune failure. It had low sensitivity and positive predictive value, and high specificity to predict virologic failure.
Discussion and conclusions:  Oral manifestations of HIV can be important markers for immune suppression and for virologic failure, in Brazilian children undergoing HAART.     

A comparison of root caries diagnosis based on visual-tactile criteria and DIAGNOdent in vivo

Objectives

This clinical study aimed to evaluate the validity of using DIAGNOdent in diagnosing root caries, and to assess the sensitivity and specificity of different cut-off DIAGNOdent values in assessing root caries with reference to visual-tactile criteria.

Methods

Exposed root surfaces were assessed by one examiner for root caries on 266 subjects using visual-tactile criteria and DIAGNOdent 2095 after dental scaling. Associations between DIAGNOdent values and visual-tactile diagnosis of root caries were determined. The cut-off level for statistical significance was 0.05. The sensitivity and specificity of DIAGNOdent with difference cut-off points were analysed compared to visual-tactile diagnosis of root caries.

Results

There was significant difference between DIAGNOdent values obtained from sound and carious root surfaces (p < 0.001). On carious surfaces, active root caries obtained significantly higher DIAGNOdent values than inactive root caries (p < 0.001). With increasing cut-off point DIAGNOdent values from 5 to 35, sensitivity decreased from 91.4% to 16.2% and specificity increased from 64.4% to 98.2%. A cut-off point of DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity.

Conclusions

There was a significant difference in DIAGNOdent values between sound and carious root surfaces diagnosed by visual-tactile criteria supporting the validity of DIAGNOdent for assessing root caries. A DIAGNOdent value between 5 and 10 produced the highest combined sensitivity and specificity when visual-tactile assessment of root caries was regarded as the criterion. These findings have implications in using and explaining DIAGNOdent values in assessing root caries.     

What is the most fearful intervention in ambulatory oral surgery? Analysis of an outpatient clinic

The aim of this study was to evaluate the levels of fear and anxiety in patients undergoing different types of minor oral surgery procedures by using conventional rating scales adjusted to the population characteristics. A demographic form and translated versions of the Modified Dental Anxiety Scale (MDAS) and Dental Fear Survey (DFS) were completed by 500 patients having hard or soft tissue pathologies, third molar removal, implant placement, tooth extraction procedures and 200 non-clinical participants. MDAS and DFS were highly correlated (r=0.79; P<0.05). The structural properties of the MDAS were similar to the original, but the DFS required substantive changes to achieve comparable measurement properties. Anxiety levels decreased with age and were greater in females, those with higher education and following a previous unpleasant experience (P<0.05 for all). The third molar group scored higher than most of the surgical categories in both questionnaires (P<0.05 for each). DFS showed they tended to avoid surgical procedures and were more susceptible to environmental and chair-side effects (P<0.05 for all). Regarding oral surgery, third molar patients should be targeted to increase overall comfort of the treatment. Assessments should be adjusted to cultural differences.     

A Diagnostic Accuracy Study of Laser Doppler Flowmetry for the Assessment of Pulpal Status in Children’s Permanent Incisor Teeth

Introduction

The aim of this study was to assess whether laser Doppler flowmetry is more accurate than the conventional pulp sensibility tests (electric pulp test and ethyl chloride) in assessing the pulpal status of permanent anterior teeth in children and to identify the laser Doppler flowmetry’s Flux cut-off threshold.

Criteria for trismus in head and neck oncology

The aim of this study was to determine a functional cut-off point for trismus in head and neck oncology. In total, 89 patients (13 dentate, 30 partially dentate and 46 edentulous) treated for cancer of the oral cavity or oropharynx were asked whether they experienced a limited mouth opening. The mandibular function impairment questionnaire (MFIQ) was filled out and mouth opening was measured. The proportion correctly predicted (proportion true positives+proportion true negatives) was calculated. For cut-off points from 25 to 45 mm, differences in MFIQ scores of the restricted and non-restricted groups were analyzed. A receiver operating curve was constructed. The proportion correctly predicted was highest for cut-off point 相似文献   

Psychometric properties of Greek versions of the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS)

Background

A growing body of literature describes the performance of dental fear questionnaires in various countries. We describe the psychometric properties of Greek versions of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS) in adult Greek patients.

Methods

Greek versions of the MDAS and DFS were administered to two samples of adult dental patients. In the first sample, 195 patients attending one of three private practice dental offices in a large city in Greece completed the questionnaires in the waiting room before dental treatment. After treatment, their dentists (who did not know how the patients had answered the questionnaire) rated their anxiety during dental treatment. In the second sample, 41 patients attending a Greek university dental school clinic completed the questionnaire twice at two separate visits, in order to provide test-retest data. Cronbach's alpha was used to compute the internal consistencies, while Spearman's rho was used to compute the test-retest reliabilities. Construct validity was assessed by correlating the responses to the MDAS and DFS by Spearman's rho. Spearman's rho was also used to examine the criterion validities, by comparing the questionnaire responses with the dentists' ratings of anxiety.

Results

The internal consistencies for the MDAS were 0.90 and 0.92 in the two samples; for the DFS, the internal consistencies were 0.96 in both samples. The test-retest reliabilities were 0.94 for the MDAS and 0.95 for the DFS. The correlation between the two questionnaires was 0.89. The patients' responses to both questionnaires were significantly related to the dentists' ratings of their anxiety during dental treatment (both p values <0.001).

Conclusion

The results indicate that the Greek versions of the MDAS and DFS have good internal consistencies and test-retest reliabilities, as well as good construct and criterion validities. The psychometric properties of the Greek versions of these questionnaires appear to be similar to those previously reported in other countries.     

Dental Discomfort Questionnaire: predicting toothache in preverbal children.

AIM: In the present study the value of the Dental Discomfort Questionnaire in predicting toothache in young children is analysed. METHODS: The Dental Discomfort Questionnaire (DDQ-8; Cronbach's alpha 0.75) was completed by parents on behalf of their children (N=99; mean age 47 months). Half of the children were referred to a special dental care centre and the other half were controls from a day care centre. RESULTS: The behaviours from the DDQ-8 appeared to be more often present in those children with decayed teeth and toothache than in those without decayed teeth or toothache. A score of 3 or higher on the DDQ-8 seemed the best cut-off point to predict toothache in children. The receiver operating characteristic curve (ROC) showed that the DDQ-8 has predictive value for toothache. STATISTICS: The validity of the DDQ-8 was expressed as sensitivity, specificity and positive predictive value and negative predictive value. The DDQ's ability to discriminate between patients with and without toothache was estimated by the area under the ROC area of the questionnaire. CONCLUSIONS: The DDQ-8 could be helpful for parents, non-dental healthcare workers and researchers in predicting the existence of toothache in preverbal children.     

Psychometric properties of Spanish-language adult dental fear measures

Background  

It would be useful to have psychometrically-sound measures of dental fear for Hispanics, who comprise the largest ethnic minority in the United States. We report on the psychometric properties of Spanish-language versions of two common adult measures of dental fear (Modified Dental Anxiety Scale, MDAS; Dental Fear Survey, DFS), as well as a measure of fear of dental injections (Needle Survey, NS).     

Effect of different diagnostic thresholds on dental caries calibration

OBJECTIVES: (a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values. PARTICIPANTS: A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity. METHODS: Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used. MAIN OUTCOME MEASURES: WHO and WHO+IL diagnostic thresholds according to tooth and dental surface. RESULTS: Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL. CONCLUSION: It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.     

Examining the Sensitivity and Specificity of 2 Screening Instruments: Odontogenic or Temporomandibular Disorder Pain?

Introduction

Two groups of patients with orofacial pains that are clinically important to distinguish from each other are patients with odontogenic pain and temporomandibular disorder (TMD) pain. The aim of this study was to determine the sensitivity and specificity of 2 screening instruments in distinguishing between patients with these types of pain.

Aspartate aminotransferase activity in crevicular fluid from dental implants

BACKGROUND: Aspartate aminotransferase (AST) is an enzyme normally confined to the cytoplasm of cells, but released to the extracellular environment upon cell death. Its levels are associated with the severity of experimental gingivitis and the loss of periodontal attachment. The aim of the present study was to investigate the presence and activity levels of AST in peri-implant crevicular fluid (PCF) from healthy and diseased endosseous implants in order to assess if AST in PCF can be further studied as a possible objective diagnostic aid in oral implantology. METHODS: Eighty-one fixtures from 81 systemically healthy subjects were divided into 3 groups, 27 healthy implants (HI), 27 implants with mucositis (MI) and 27 implants affected by peri-implantitis (PI) according to well-defined clinical and radiographic criteria. PCF was collected by the insertion of a #40 standardized endodontic paper point to the base of the crevice or pocket for 30 seconds. AST activity was determined spectrophotometrically at 25 degrees C. The results were expressed as AST Units/ml in PCF. RESULTS: An AST activity was detected in each sample from HI, MI and PI. The mean AST activity in HI was 0.26 +/- 0.16 U/ml; in MI, 0.38 +/- 0.27 U/ml; in PI, 0.62 +/- 0.29 U/ml. ANOVA showed that the difference among HI, MI, and PI was statistically significant at P <0.01 level. Post-hoc tests demonstrated that a significant difference in AST activity existed between HI/PI (t = 5.14; P<0.01) and MI/PI (t = 3.09; P<0.01). No statistically significant difference was found between HI/MI (t = 1.07; P >0.1) AST activity was significantly (P <0.01) associated with probing depth (r = 0.55), the amount of bone loss (r = 0.60) and bleeding on probing (r = 0.67). When the threshold for a positive AST test was set > or =0.4 U/ml, a sensitivity = 0.81 and a specificity = 0.74 were found in the detection of peri-implantitis; the positive predictive value was 61% and the negative predictive value was 88%. CONCLUSIONS: Within the limits of this study, our results may suggest that PCF analysis could be further investigated in longitudinal studies as a suitable diagnostic strategy in the evaluation of dental implants.     

Self - perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys

BACKGROUND: Clinical (normative) and subjective (self-assessment) evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self-perceived assessment) as compared to clinical examinations (normative assessment) and to evaluate the implications of the results in understanding the public's perception of oral health. METHODS: The investigation was performed on 4920, 21 year-old Israeli adults upon release from compulsory military service between 1996 and 1998. Participants were asked to fill in a questionnaire inquiring how they would rate their personal dental and periodontal health levels. Clinical examinations, employing the DMFT and CPITN indices, were performed to determine normative oral health status. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values and overall proportions using the clinical examinations as a gold standard. RESULTS: The sensitivity (disease perception) for dental status was found to be 0.34, while the specificity (health perception) was found to be 0.83. The positive predictive value for perceived dental status was found to be 0.68, whereas the negative predictive value was found to be 0.54. The sensitivity for perceived periodontal status was found to be 0.28, while the specificity was found to be 0.83. The positive predictive value for perceived periodontal status was found to be 0.05, whereas the negative predictive value was found to be 0.97. Regarding the overall proportions, a large discrepancy was found between self-assessment and professional assessment for both dental and periodontal health status. CONCLUSIONS: Self-assessment questionnaires were of low value in evaluating oral health status both in the individual and public levels, though perception levels of health were higher than that of disease. Findings reflects a low level of awareness of the public that may influence care-seeking behavior and highlight the importance of oral health promotion and the crucial need for public health action.