父母牙科焦虑诱导儿童牙科畏惧症行为的影响

目的:观察父母牙科焦虑(parental dental anxiety,PDA)在对儿童牙科畏惧症(child dentalfear,CDF)行为诱导中的作用。方法:240例同时伴有CDF和PDA的家庭,按照儿童年龄进行分层随机分组。实验组CDF在实施诱导前首先进行家长PDA的行为诱导。对照组仅对CDF实施行为诱导。结果:对PDA的诱导可有效促进CDF的行为诱导效果,与对照组相比具有统计学意义(P<0.05)。结论:对伴随家长PDA的CDF诱导过程中,父母(家长)PDA的行为诱导具有重要作用。     

A test of Berggren's model of dental fear and anxiety

Berggren's (1984) model of dental fear and anxiety predicts that dentally anxious individuals postpone treatment, leading to a deteriorating dental state and subsequently to fear of negative evaluations in relation to their oral condition. The present study aimed to test one of the core assumptions of this model, namely that deterioration of dental health status would mediate the effects of avoidance of dental care on self-reported fear of negative evaluation. Participants were 73 patients (mean age 38.5 yr) meeting the diagnostic and statistical manual of mental disorders - 4th edn - Text Revision (DSM-IV-TR) criteria of dental phobia. Variables in the theoretical model were operationalized with multiple measures. A series of Sobel tests indicated that mediation was present for the relationship between years of avoidance and fear of negative self-evaluation when dental health status was based on the assessment of dentists or patients' opinion of their own dental state, but not when dental health status was operationalized as decayed, missing or filled surfaces (DMFS). Although the findings are supportive of Berggren's model, other causal pathways that contribute to the perpetuation of anxiety and fear still need to be tested. The results suggest that individuals with high levels of dental anxiety would particularly benefit from interventions specifically designed to break their avoidance pattern.     

大学生牙科焦虑症及对选择种植修复选择的影响分析

目的了解大学生的牙科焦虑症情况和牙科焦虑症对种植修复选择的影响。方法用改良牙科焦虑量表对126名大学生进行问卷调查。根据性别分析牙科焦虑症情况,并按问卷得分将研究对象分成两组:牙科焦虑症患者和非牙科焦虑症患者。对两组的种植修复的选择情况进行分析,并按组统计不选择种植修复的原因。结果大学生中女性牙科焦虑症发病率较男性高。牙科焦虑症患者对种植修复选择相对较少。不选择种植修复的原因以害怕手术和害怕疼痛为主。结论提高对种植牙的认识,减轻对种植牙的焦虑,可以让更多人选择种植。     

Exploring the associations between somatization and dental fear and dental visiting

While somatization has been investigated as an important variable in relation to excessive health-service utilization, its role in relation to dental visiting and dental fear has received limited attention. It was hypothesized that an excessive focus on physical symptoms might lead somatizers to experience dental treatment as more traumatic, resulting in greater dental fear. The aims of this study were to determine whether somatization was associated with dental fear, reduced dental visiting, and symptomatic visiting. Questionnaire data were collected from 5,806 dentate Finnish adults, with somatization measured using 12 items from the Symptom Check List (SCL-90). Dental fear was measured using a single-item question and dental visiting was assessed by questions relating to time since last dental visit and the usual reason for dental visiting. Multinomial logistic regression analyses indicated that somatization has a statistically significant positive association with both dental fear and symptomatic dental visiting after controlling for age, gender, and education. However, the association between dental-visiting frequency and somatization was not statistically significant. The results were consistent with the hypothesized role of somatization in the development of dental fear. Further investigation of how somatization is related to dental fear and dental-service utilization appears warranted.     

Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts

Abstract — The present study was undertaken in order to evaluate whether electrodermal activity was a useful tool with which to measure dental anxiety in a group of drug addicts. Electrodermal activity was compared to the subjects' self-reported feelings during ordinary dental treatment sessions. In the first part of the study the level of electrodermal activity during treatment sessions was videotaped and recorded on paper by means of a polygraph. The patients were interviewed using a semi-structured questionnaire dealing with the addicts' dental anxiety and fear. In connection with the interviews the addicts completed Corah's Dental Anxiety Scale (CDAS). There was no recognizable pattern in electrodermal activity when this was compared with the patients' feelings during the treatments. Median CDAS was 9.5. In the second part of the study, electrodermal activity was recorded on the polygraph only. This group also completed a CDAS questionnaire. No correlation between the patients' self-reported highest level of anxiety and level of electrodermal activity, number of fluctuations or amplitude in relation to specific dental stimuli was found; agreement was found in two, three and none of 10 cases respectively. Median CDAS was 10.0. It could be concluded that, although the study revealed apprehension and situational anxiety among the addicts, no correlation to electrodermal activity was found. This discrepancy between the physiological and cognitive data probably reflects the uncertainty of these measures under the given circumstances.     

Towards a better understanding of dental anxiety and fear: cognitions vs. experiences

Armfield JM. Towards a better understanding of dental anxiety and fear: cognitions vs. experiences. Eur J Oral Sci 2010; 118: 259–264. © 2010 The Author. Journal compilation © 2010 Eur J Oral Sci Traumatic dental experiences are associated with dental anxiety and fear. However, many people with no dental fear have had negative dental experiences, and some people with considerable fear fail to recall any traumatic incidents. This study aimed to determine whether dental fear was better explained by experiences or by cognitive perceptions of going to the dentist as being uncontrollable, unpredictable, dangerous, and disgusting. A random sample of 1,084 Australian adults (response rate = 71.7%) completed a mailed questionnaire with measures of dental fear, perceptions of going to the dentist, and dental experiences. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness had strong bivariate associations with scores on the Index of Dental Anxiety and Fear (IDAF‐4C). Vulnerability‐related perceptions accounted for 46.3% of the variance in IDAF‐4C scores beyond that accounted for by demographic variables and five possible dental experiences comprising intense pain, considerable discomfort, gagging, fainting, and having a personal problem with the dentist. In contrast, dental experiences accounted for < 1% of the variance in IDAF‐4C scores beyond that accounted for by the four cognitive perceptions. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness were superior predictors of dental fear compared with negative dental experiences.     

Cognitive ability and dental fear and anxiety

Dental fear and anxiety (DFA), as well as dental behavior management problems, are common in children and adolescents. Several psychological factors in the child, and parental DFA, have been studied and found to correlate to the child's DFA. The aim of this study was to investigate the relationship between cognitive ability and DFA in a population‐based group of children with identified behavior and learning problems. In conjunction with a dental examination at 11 yr of age, 70 children were assessed with regard to DFA using the Children's Fear Survey Schedule Dental Subscale (CFSS‐DS), and their cognitive ability was assessed using the Wechsler Intelligence Scale for Children. In addition, parental DFA was measured using the Corah Dental Anxiety Scale. The results revealed that DFA was significantly correlated to verbal intelligence quotient (IQ) but not to any other cognitive index. A significant correlation was found between parental DFA and child DFA. The results indicate that the child's verbal capacity may be one factor of importance in explaining dental fear in children.     

Changes in dental fear and its relations to anxiety and depression in the FinnBrain Birth Cohort Study

This study aimed to: (i) evaluate short-term changes in dental fear during a 9-month period among women and men, and (ii) evaluate whether the course and magnitude of changes in dental fear were associated with changes in depression and anxiety. The longitudinal data of the FinnBrain Birth Cohort Study were used. Out of 3808 women and 2623 men, 1984 women and 1082 men filled in the Modified Dental Anxiety Scale (MDAS) at gestational weeks 14 and 34, and 3 months after childbirth. Other questionnaires used were the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Symptom Checklist-90. All scales were analyzed as sum scores. The MDAS was also trichotomized to assess the stability of dental fear. Statistical significances of the changes in dental fear, depression, and general anxiety were evaluated using repeated-measures Friedman tests. Correlation coefficients were used to describe the associations between measures (Spearman) and their changes (Pearson). Dental fear more often increased than decreased, but for the majority it was stable. On average, dental fear, depression, and anxiety symptoms correlated throughout the study. The correlations tended to be stronger with depressive symptoms. However, the relationships between changes in dental fear, depression, and anxiety were not systematic.     

Anxiety and dental fear in a group of parenteral drug addicts

Abstract — The aim of the study was to evaluate whether general anxiety and dental anxiety were more common in a group of parenteral drug addicts. 41 drug addicts =27.4 yr) attending a dental clinic in Aarhus in Denmark participated. A randomly sampled reference group comprising 350 individuals living in Aarhus and with similar age distribution was selected from the Central Person Register. Questionnaires with social and educational data and three self-report rating scales, namely Corah's dental anxiety scale (CDAS) and Spielberger's State-Trait anxiety inventory's two scales (STAI-State and STAI-Trait) were completed by the participants. Response rates were 95.6% and 89.3% for drug addicts and controls, respectively. Median CDAS, STAI-State, and STAI-Trait were 10, 46 and 44 in the addicts which was statistically significantly higher than in the general population. These differences were still present when the addicts were compared to a subsample from the reference group with a better matching of educational and social background factors. Spearman's correlation coefficient between CDAS and STAI-State, CDAS and STAI-Trait, and STAI-State and STAI-Trait were 0,57, 0.49 and 0.50, respectively, which were significant and moderately high correlations. Finally, anxiety levels were similar irrespective of caries experience.     

Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study

OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.     

Psychosocial consequences of dental fear and anxiety

OBJECTIVES: The aim of this study was to examine the negative psychosocial impacts of dental anxiety in a sample of dentally fearful and anxious individuals recruited from the general population. The associations between psychosocial impacts, dental anxiety scale (DAS) scores and other severe fears were explored. METHODS: One hundred and thirty-five subjects who were anxious or fearful about dental treatment were divided into low and high general fear groups based on the number of other severe fears they reported. Negative psychosocial impacts were assessed using a modified form of the scale developed by Kent et al. (1996). This consisted of three dimensions: psychological reactions, social relationships and avoidance/inhibition. Other measures included self-ratings of oral, general and emotional health and scales to assess self-esteem and morale. RESULTS: Overall, 93.1% of subjects reported one or more impacts. Those in the high-fear group had higher psychosocial impact scores than those in the low-fear group (means of 4.19 vs. 2.85; P < 0.05). Differences were most marked with respect to psychological consequences and avoidance/inhibition. The high-fear group had scores indicative of lower self-esteem and lower morale. Forward stepwise linear and logistic regression analyses indicated that both dental anxiety and general fearfulness contributed to these negative outcomes. However, the latter was a more consistent predictor in that it entered six of seven models generated while the former entered only four. CONCLUSION: The study indicated that dental fear and anxiety have pervasive psychosocial consequences, and that these are more marked among subjects with high levels of general fearfulness. It also provided evidence of the validity of a modified form of the psychosocial impact scale developed by Kent et al. (1996).     

Prevalence of dental anxiety in the Netherlands

The main purpose of this study was to investigate the prevalence of dental anxiety in the Netherlands by means of both a nationwide representative sample and a valid measurement instrument. The secondary aim was to discriminate between patients with high and low levels of dental anxiety on the basis of socioeconomic and oral health variables. Results showed that about 40% of the Dutch population experience a considerable degree of anxiety about dental treatment, and more than half of them can be considered as highly anxious. Dental anxiety is related to sex, age, and oral health status. Individual most prone to experience dental anxiety are women between 26 and 35 yr of age who do not visit a dentist regularly, live in one of the big cities, have a moderate or high educational level, are Public Health Insurance (Ziekenfonds) patients with a minimum income, judge their oral health as bad, and do not attach much importance to the preservation of their teeth.     

口服咪达唑仑治疗牙科恐惧症儿童的临床疗效观察

目的对牙科恐惧症儿童实施口服咪达唑仑镇静下的口腔治疗,评估治疗的安全性、有效性及其影响因素。方法选择在口腔科就诊的Frankl量表评分为1的有不良牙科治疗经历的30例患儿为研究对象,共进行了46人次的口服咪达唑仑（0.5～1.0 mg·kg-1）镇静下治疗。治疗时,记录患儿的心率、血氧饱和度、治疗内容及持续时间等。采用Houpt量表评估患儿治疗完成情况,治疗结束24 h后电话回访不良反应。结果46人次治疗中,患儿的生命体征平稳、安全,37人次（80.4％）完成了既定治疗,9人次（19.6％）镇静效果不理想,仅完成部分治疗。烦躁不安是术后最常见的不良反应。3岁以上儿童的治疗成功率高于3岁及以下儿童,性别、剂量和治疗内容与治疗成功率无关。结论口服咪达唑仑治疗牙科恐惧症儿童是一种安全有效的方法,3岁以上儿童的治疗效果较好。     

Appraisal of dental anxiety and fear questionnaires: a review

Abstract –This article reviews and assesses six dental anxiety and fear questionnaires. The construct aimed at by the questionnaires, the data collected, their reliability, validity and normative scores are considered. Some attention is given to the correlations between the questionnaires, their ambiguity, the presence of manuals, and whether the questionnaires tap the three segments distinguishable on theoretical ground in dental anxiety/fear. All questionnaires are open to criticism. In the final assessment Kleinknecht's Dental Fear Survey is preferred to Corah's Dental Anxiety Scale. The latter, however, appears useful in getting a quick impression of anxiety and in evaluative studies. Three recently developed questionnaires, Stouthard's Dental Anxiety Inventory, Weiner's Fear Questionnaire and Morin's Adolescents'Fear of Dental Treatment Cognitive Inventory are considered promising, but for the last two instruments more data, in particular with regard to their validity, are needed. H is concluded that in dental anxiety research more than one questionnaire should be used and that it may be worthwhile to include other, non-anxiety questionnaires as well.     

Prevalence of dental fear and its relationship with primary dental caries in 7-year-old-children

BackgroundChild's dental fear has been reported as one of the reasons that increase, aggravate dental diseases and facilitate other oral diseases. This study is aimed to describe the type and prevalence of dental fear and to assess the relationship between cavities of primary teeth and dental fear in 7-year-old children at Phulam Primary School, Hanoi.MethodsThe sample comprised of 132 children aged 7 years. The questionnaire examined the profile of participants and assessed their dental fear using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Children have “dental fear” when the total CFSS-DS score is greater than or equal to 38. By contrast, those without dental fear gain the total point which is less than 38. After completing the questionnaire, a dental examination was undertaken according to the International Caries Detection and Assessment System (ICDAS).ResultsThe prevalence of dental fear was 34.85%. Fear scores were highest for “Dentist drilling” (2.92 ± 1.47) and “Injections” (2.87 ± 1.53). In the univariate analysis, the odds of girls having dental fear were approximately equal to boys (OR = 0.98, 95% CI = ?0.75-0.70). The odds of only children having dental fear were 1.6 times higher than others, but there were not significant. Dental fear was found to be no associated to sex, birth order and primary dental caries (p > 0.05).ConclusionOur findings demonstrated the status of 7-year-old children's dental fear at Phulam primary school, and found that primary dental caries had no correlation with child dental fear score.     

Dental fear, regularity of dental attendance and subjective evaluation of dental erosion in women with eating disorders

This questionnaire study, with a response rate of 53%, examined self-induced vomiting, erosions and dental attendance in women with eating disorders (EDs) as well as dental fear and its effect on attendance and communication with the dentist. A survey of 371 responding women with EDs, who were recruited from a self-help organization, revealed that dental fear was higher in women with EDs compared to the general population. Dental fear was present in 32.1% of women with EDs, and very high dental fear was present in 16.5% of women with EDs. Of those with very high dental fear, 32.3% had not visited a dental clinic at all in the preceding 2 yr, and 43.5% only initiated contact when they had symptoms. Self-induced vomiting was especially frequent in women with bulimia nervosa (87.9%) and in those with more than one ED (the 'mixed group') (80.6%). Among those with self-induced vomiting, 45.3% thought that they had erosions, although only 28.4% had erosions diagnosed by a dentist. Of women with EDs, 61.4% failed to disclose their condition. High dental fear did not affect willingness to disclose the ED. We conclude that dentists should examine ED patients carefully for dental erosions. Moreover, they should realize that most ED patients avoid disclosing their disorder and that dental fear further complicates dental treatment in these patients.