Gender differences in dental anxiety: is the chair position important?

Dental anxiety in the general population is more prevalent in females than in males. The presence of dental anxiety was studied in a group of 189 females and 176 males using the following scales: the Dental Anxiety Scale (divided into DAS 1 containing 6 items, which explores a patient's dental anxiety and DAS 2 containing 13 items, which looks at dental anxiety concerning dentist-patient relations), the Self-Rating Depression Scale (SDS), and the Quality of Life Index (QL-Index). The results obtained showed significant differences only in relation to dental anxiety regarding the use of instruments (such as needles and handpieces) and the tilted-back position of the chair (DAS 1). No significant gender differences emerged between the two groups in relation to dental anxiety regarding dentist-patient relations (DAS 2), depression (SDS), and the quality of life (QL-Index). The results may explain why women avoid dental care and indicate new designs to make the chair position more comfortable would be useful.     

Catastrophizing, anxiety and pain during dental hygiene treatment

Objectives : This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment. Methods: Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale – Revised, and were asked to rate the degree of pain they experienced during the scaling procedure. Results: Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were signicant predictors of pain, even when controlling for gender, and oral hygiene status. Conclusions: Thendings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.     

拔牙患者牙科焦虑心理研究

目的：研究拔牙患者牙科焦虑心理产生的原因。方法：术前对100例拔牙患者完成问卷，用改良的牙科焦虑量表(corah dental anxiety scale，DAS)和类视力量表(visual anxiety scale，VAS)划界分为高牙科焦虑组和低牙科焦虑组。结果：病人对疼痛的期待存在较大的偏差，高焦虑组更明显。结论：疼痛是病人最恐惧的因素，消除疑虑和减轻疼痛是拔牙术中首要解决的问题。     

The Prevalence and Impact of Dental Anxiety Among Adult New Zealanders

ObjectiveTo describe the prevalence and impact of dental anxiety in the New Zealand adult population.MethodsSecondary analysis of data from the 2009 New Zealand national oral health survey. Dental anxiety was measured using the Dental Anxiety Scale (DAS).ResultsThe prevalence of dental anxiety was 13.3% (95% CI = 11.4, 15.6). On average, DAS scores were higher by 14% among females, lower among those in the oldest age group (55+), higher by 10% among those in the European/Other ethnic category, and higher by 10% among those residing in the most deprived neighbourhoods. Those who were dentally anxious had greater oral disease experience and were less likely to have visited a dentist within the previous 12 months. They also had poorer oral health-related quality of life, with the highest prevalence of OHIP-14 impacts observed in dentally anxious 35- to 54-year-olds.ConclusionsDental anxiety is a dental public health problem. It is an important contributor to poor oral health and care avoidance among New Zealanders. There is a need to develop both clinical and population-level interventions aimed at reducing the condition''s prevalence and impact.Key words: Dental anxiety, New Zealand, Quality of life, Dental utilisation     

Novel Animated Visual Facial Anxiety/Pain Rating Scale-Its reliability and validity in assessing dental pain/anxiety in children

IntroductionDetermining dental anxiety in children is of prime importance in the first dental visit as it leaves an impact and influences future behavior towards dental treatment. For this purpose, subjective assessment measures such as pictorial scales are considered appropriate.AimTo assess the validity and reliability of the novel Animated Visual Facial Anxiety/Pain Rating Scale (AVFP/ARS) for measuring dental anxiety in children during their first dental visit. Also, to compare this new scale with other standard scales like Facial Image Scale (FIS), Venham Picture Test (VPT), Wong-Baker Pain Rating Scale (WBPRS) and Chota Bheem Chutki Scale (CBCS).Methods61 children (4–14 years) comprising of 31 girls and 30 boys, who met inclusion criteria were divided into two groups depending on treatment procedure; Group I (class I restoration) and Group II (IANB). In both, the groups' anxiety was assessed using FIS, VPT, WBPRS, CBCS, and AVFP/ARS before, during and after the dental procedure. The obtained scores were analyzed using Pearson's product-moment coefficient.ResultsA strong correlation (p < 0.05) was found between AVFP/ARS and the other scales in Group I while in Group II a strong correlation (p < 0.05) was found between AVFP/ARS when compared to VPT and WBPRS scales indicating the good validity of AVFP/ARS for both Restoration and IANB groups.ConclusionOur study suggests that AVFP/ARS can be used as a new tool to assess dental anxiety in children.     

Relationship between dental status and Oral Impacts on Daily Performances in older Southern Chinese people

Objective: The objective of this study was to assess the relationship between different clinical indicators of dental status and an Oral Health‐Related Quality of Life (OHRQoL) measure, the Oral Impacts on Daily Performances (OIDP) index, using different scoring formats, among older Southern Chinese people. Methods: A total of 1,196 dentate people aged 55 years and older, attending routine annual health checkups at Guangxi Medical University Hospital Health Centre in Guangxi, China, participated in the study. They had a face‐to‐face structured interview and a clinical dental examination. The OIDP index was used to assess the impacts of oral conditions on quality of life. Spearman and Pearson as well as partial correlation coefficients were used to assess, respectively, the unadjusted and adjusted associations of 14 clinical indicators with the overall OIDP score, OIDP intensity, and OIDP extent. Results: All clinical indicators, except number of filled teeth, were significantly correlated with the OIDP index, after controlling for covariates. However, correlations were weak, ranging between 0.07 and 0.26. The strongest correlation was for the relationship between the number of natural plus replaced teeth and the OIDP index, irrespective of whether the overall OIDP score, OIDP intensity, or OIDP extent was used to measure OHRQoL. Conclusions: Clinical dental status indicators were related to OIDP, regardless of the scoring format used to calculate the OIDP index. Clinical indicators that included natural plus replaced teeth were more strongly associated with the OIDP index than their corresponding indicators that included only natural teeth.     

Psychological characteristics of long-term female temporomandibular joint pain patients.

Analysis from the Taylor Manifest Anxiety Scale (TMAS) scores of 44 long-term temporomandibular joint (TMJ) pain patients and 10 facial pain patients of a non-TMJ variety shows no significant differences. Both groups were significantly higher than a normative group. After treatment TMJ patients are not significantly different on the TMAS than the normative group. Etiological implications are discussed.     

Evaluation of psychological factors in orthodontic patients with TMD as applied to the "TMJ Scale"

Physical and psychological evaluation have been required for TMD patients whose problems are multi dimensional. The questionnaire named the "TMJ Scale" was created to differentiate subjective TMD symptoms of patients. The purpose of this study was to clarify the reliability of the TMJ Scale for Japanese orthodontic patients with TMD and to differentiate the symptoms. Fifty orthodontic patients (average age 21y4m) with a chief complaint of TMD symptoms were compared with thirty patients (average age 21y1m) without TMD symptoms. The results were as follows: female patients in the symptom group in particular showed a higher degree of stress due to the chronic pain and abnormalities than those in the non-symptom group. Significant differences were observed in Pain Report, Joint Dysfunction and Global Scale at the 0.1% significant level, in Non-TM Disorder, Psychological Factor and Chronicity at the 1% level, and in Palpation Pain and Perceived Malocclusion at the 5% level in females. Few psychological problems were observed in male patients in the symptom group. Significant differences were observed in Range of Motion limitation at the 5% level in males. The differences in the psychological factors between male and female patients were clarified by using the TMJ Scale. These findings suggested that it was useful to differentiate the multiple symptoms, especially the psychological factors, by using the TMJ Scale for orthodontic patients with TMD.     

The complexity of dental anxiety and its association with oral health-related quality of life: An exploratory study

This study aimed to explore the factors associated with oral health-related quality of life (OHRQoL) in a sample with high dental anxiety. Data were obtained from 107 patients attending a therapeutic treatment program for people who have experienced abuse and for those with dental phobia in Norway. Patients completed questionnaires, including the Index of Dental Anxiety and Fear, the Anxiety subscale of the Hospital Anxiety and Depression Scale, and the Oral Impacts on Daily Performance scale, measuring OHRQoL prior to treatment. The various measurement instruments were evaluated psychometrically, and the variables associated with OHRQoL were explored using hierarchical multiple regression. Symptoms of dental anxiety and general anxiety were high, while OHRQoL was poor. Dental anxiety, higher age, higher number of years since the last dental treatment, and higher general anxiety were discernibly associated with lower OHRQoL. The strongest association was found between general anxiety and OHRQoL. In conclusion, several factors were associated with OHRQoL in a sample with high dental anxiety, suggesting a complex picture of dental anxiety. When treating patients with high dental anxiety, dental practitioners should be aware that there may be factors complicating the therapeutic setting, such as general anxiety.     

Relationships between jaw pain and jaw muscle contraction level: underlying factors and treatment effectiveness

EMG representations of jaw muscle contraction levels were measured in dental patients with TMJ problems in addition to history and physical evidence of bruxing and clenching, TMJ problems alone, bruxing and clenching, and no pain. Patients with TMJ problems plus bruxing/clenching had EMG levels similar to those with clenching and bruxing problems alone. These levels were far higher than those in the groups with similarly low TMJ problems alone and with no pain. The pain groups were normal for anxiety level and life stress. Although a third of the patients produced a conversion V pattern on the MMPI, no effect was seen on treatment effectiveness. All but a few of the mixed TMJ problem/bruxism/clenching patients and of the bruxism/clenching patients showed considerable reduction in pain through use of treatment oriented toward muscle tension awareness and relaxation. The group with TMJ problems and normal masseter muscle tension made little progress.     

深圳市成人牙科畏惧症患者的口腔健康相关生活质量研究

目的：研究牙科畏惧症（DF）患者的口腔健康相关生活质量。方法：选择在深圳市第五人民医院口腔科门诊就诊的358名18～75岁初诊患者,应用口腔焦虑量表（CDAS）和口腔健康影响程度量表（OHIP-14中文版）、人口统计学一般项目表进行调查。结果：DF患者的OHIP-14的分值中位数为21.25,明显高于一般就诊患者（中位数11.20）。且在生理性疼痛、心理不适和心理障碍等领域影响最大。CDAS与OHIP-14分值间的相关系数为0.255。结论：在牙科畏惧症患者中,牙科畏惧程度与口腔健康影响程度之间存在相关性,焦虑程度越高的患者口腔健康相关生活质量越差。对牙科畏惧症患者进行有效的心理干预可以提高其相关生活质量。     

Development of a scale to measure the social and psychological effects of severe dental anxiety: social attributes of the Dental Anxiety Scale

Abstract This paper describes the development of a scale designed to measure the extent to which severe dental anxiety or phobia affects patients' social well-being outside of the dental setting. Items initially selected on the basis of clinical experience were administered to two groups: 78 patients seeking help for severe anxiety and 88 patients attending the general clinic of a dental hospital. Items on the scale discriminated between these two groups and also between patients who were reluctant to attend even when experiencing symptoms and those who attend more regularly. Although the scale correlated moderately well with Corah's Dental Anxiety Scale, factor analysis indicated that its items assess the effects of severe anxiety on the two domains of psychological reactions and social inhibition as they occur as indirect effects of dental care. The scale could be included in assessments designed to measure the social and psychological effects of severe dental anxiety.     

Everyday- and dental-pain experiences in healthy Swedish 8–19 year olds: an epidemiological study

Background.  Very little is known about children's everyday pains and dental treatment pains. A child's gender, age, and level of dental anxiety are factors that could interplay with the perception of pain and are thus worth studying.
Aim.  The objectives of this study were to investigate the frequency and reported intensity levels of children's everyday- and dental-pain experiences, and to study the reported pains in relation to gender, age, and dental anxiety.
Design.  Three hundred and sixty-eight consecutive patients (8–19 years, mean age 13.5 years) from three different Public Dental Service were recruited. Pain ratings were obtained using McGrath's Children's Pain Inventory list and some additional items. Dental anxiety was estimated by the Dental Anxiety Scale.
Results.  Most frequently experienced everyday pains were headache and tummy/stomach ache. Among dental treatment events, dental injection was reported to be most often ranked as painful, and more frequently by girls. Both dental and everyday pains were rated higher grouping children with high dental anxiety.
Conclusions.  The frequency of pain experiences are the same in Swedish children as in other populations. There is a relation between dental anxiety and the perception of pain.     

Controlled clinical and psychometric studies on the relation between periodontitis and depressive mood

BACKGROUND: Depressive mood is considered a risk factor for the development of periodontitis. OBJECTIVES: Investigation of the relationship between periodontitis and psychopathology utilizing psychometry (both observer- and self-rating scales). METHODS: Forty periodontitis patients were compared with 41 age- and sex-matched controls. The percentage of smokers was similar in both groups (30% versus 24.4%). Dental variables included probing depth, clinical attachment loss (CAL), radiographic loss of attachment, papillary bleeding index (PBI) and approximal plaque index (API). Psychometry comprised the Hamilton Depression Scale, the Zung Self-Rating Depression and Anxiety Scales, the von Zerssen Well-being and Complaint Scales, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Quality-of-Life Index, crystallized intelligence and the Freiburg Personality Inventory (FPI). RESULTS: Multifactorial analysis of variance demonstrated increased depression and anxiety scores, reduced well-being, increased somatic complaints, deteriorated quality of life and introversion in periodontitis. Partial correlation analyses between psychometric measures and dental variables revealed positive correlations of periodontal disease severity/CAL with the depression/anxiety, subjective well-being and complaints scores, and a negative correlation with quality of life. The API was negatively correlated with social orientation, and the CAL was positively correlated with somatic complaints and introversion in the FPI. CONCLUSION: Our clinical-psychometric studies confirm depressive mood as a relevant pathogenetic factor for periodontitis.     

Dental anxiety before removal of a third molar and association with general trait anxiety.

PURPOSE: The aim of the present study was to evaluate dental anxiety in patients consulting for third molar removal, and to assess possible relationships with general trait anxiety. MATERIALS AND METHODS: Dental anxiety was measured using Corah's Anxiety Scale (DAS), the Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. RESULTS: Trait anxiety showed significant positive correlations with both DAS score and DFS score. The 3 measures of dental anxiety all showed significant positive correlations with each other. The difference between men and women was only statistically significant in the case of trait anxiety. CONCLUSION: These results suggest that trait anxiety may be a useful predictor of a patient's predisposition to dental anxiety.     

Approximal plaque and gingival sulcus bleeding in routine dental care patients: relations to life stress, somatization and depression

OBJECTIVES: Previous research on relations between life stress and periodontal conditions was often based on indicators of periodontal destruction history and stimulus-specific measures of life stress. The present study was undertaken to compare patients showing different degrees of gingival sulcus bleeding with patients without signs of bleeding, using an instrument measuring cognitive impacts of events and assessing reported symptoms of depression and somatization. Additionally the patient groups were compared with regard to dental status and dental visiting behaviour. Analog comparisons were conducted in patients with different degrees of approximal plaque. MATERIALS AND METHODS: 140 routine dental care patients attending a private dental practice were examined. Measurement devices were the sulcus bleeding index (SBI), the approximal plaque index (API), the Dental Avoidance Scale, the Life Experience Survey (LES), the Impact of Event Scale with the subtests cognitive intrusion and cognitive avoidance, and the SCL-90-R subscales somatization and depression. RESULTS: Patients with high API scores differed from their zero-score counterparts in dental avoidance and time since last visit only. By contrast, subjects scoring high in the SBI not only had more missing teeth and reported more dental avoidance than their zero-score counterparts but also had elevated scores in intrusive and avoidant thoughts related to a stressful event as well as in symptoms of somatization and depression. No difference was found for the measure of stimulus specific recent life events (LES). CONCLUSIONS: The results suggest that cognitive preoccupation with adverse events and the presence of somatization and depression symptoms might play a role in gingival inflammation.     

Short‐term longitudinal changes in adult dental fear

This study aimed to evaluate (i) longitudinal fluctuations and considerable changes in adult fear at five data‐collection points during a 2.5‐yr period and (ii) the stability of symptoms of depression in dental fear‐change groups. Pilot data from the FinnBrain Birth Cohort study, of 254 families expecting a baby, were used. Data‐collection points (DCPs) were: 18–20 and 32–34 gestational weeks; and 3, 12, and 24 months after delivery. At baseline, 119 women and 85 men completed the Modified Dental Anxiety Scale (MDAS) questionnaire. At all DCPs, 57 (48%) women and 35 (41%) men completed MDAS. Depression was measured using the Edinburgh Postnatal Depression Scale. Changes in MDAS were analyzed using general linear modelling for repeated measures. Stability of dental fear was assessed using dichotomized MDAS scores. Dental fear among women decreased statistically significantly in late pregnancy and increased thereafter. Among men, dental fear tended to increase in late pregnancy and decreased afterwards. Depression scores varied in high and fluctuating fear groups but the differences diminished towards the last DCP. Dental fear among adults experiencing a major life event does not seem to be stable. Clinicians should take this into account. The mechanisms behind these changes need further research.     

Quality of life improves among post-menopausal women who received bone augmentation during dental implant therapy

Quality of life outcomes among patients receiving implants have been well studied, but little is known about the effects of bone augmentation in this therapy. The purpose of this paper was to assess quality of life changes among postmenopausal women receiving dental implants with bone augmentation during implant therapy. This was a prospective cohort study. 48 patients were recruited at the University of Connecticut Health Center and received one of three surgical augmentation methods: dehiscence repair; expansion alone; or expansion with dehiscence repair. The predictor variable was type of augmentation procedure. Quality of life measured by the Oral Health Impact Profile-14 (OHIP-14) was the outcome measure and was assessed prior to treatment, 1 week, 8 weeks and 9 months after surgery. Changes in OHIP-14 were evaluated by repeated measures analysis of variance. The mean initial OHIP-14 scores on total items checked were 4.6 (SD = 3.0) and declined significantly to 2.0 (SD = 2.0) at 9 months. The mean baseline severity score was 15.4 (SD = 8.9) improving significantly to 7.5 (SD = 7.6) at 9 months. Type of augmentation procedure did not affect quality of life. The participants’ quality of life improved continuously from the pretreatment to the 9-month assessment, including improvements 1 week after implant placement.     

Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients.

PURPOSE: This study investigated the role of psychological factors in temporomandibular disorders (TMD). Orofacial pain patients' pretreatment levels of depression, disability caused by pain, and exposure to stressful life events were measured, and differences on these variables between temporomandibular joint (TMJ) disease patients and patients whose pain was of muscular origin (MPD) were evaluated. The use of these variables and patient diagnostic status in predicting response to treatment in a subsample of these patients was also evaluated. PATIENTS AND METHODS: Before undergoing treatment, 258 patients were administered the Beck Depression Inventory (BDI), the Pain Disability Index (PDI), and the Social Readjustment Rating Scale (SRRS). Follow-up data on pain disability, current level of pain, depression, and satisfaction with treatment were obtained on 48 of these patients who were contacted at varying intervals after completing treatment. RESULTS: BDI scores obtained at the outset of treatment were significantly elevated and were positively correlated with SRRS and PDI scores. MPD patients had higher SRRS, BDI depression, and PDI pain disability scores than TMJ patients, and differences between the 2 groups in pain disability were greatest in areas that are often sources of interpersonal stress. Among follow-up patients, PDI scores declined after treatment, with MPD patients showing greater decreases than TMJ patients. Independent of patients' diagnostic status, their pretreatment PDI scores were predictive of their pain level at follow-up and were inversely related to their degree of satisfaction with treatment at follow-up; their pretreatment BDI scores were predictive of their depression level at follow-up. CONCLUSIONS: The findings are consistent with previous research indicating a link between emotional dysfunction and TMD and are largely supportive of the conclusion that psychological factors play a more pronounced role when pain is of muscular origin. Promising behavioral interventions are available for TMD patients in whom psychological factors appear to be playing a significant role.     

Neurophysiological changes and chronic pain in cleft patients

The aim of this study was to evaluate if patients after orofacial cleft repair experience neurophysiological changes with consecutive chronic pain states after surgery.Patients (n = 48) with a repaired orofacial cleft (CLP) recruited in a support group took part in a survey including five questionnaires. They revealed pain states, described cleft situation and history, and epidemiological data. Patients' quality of life and psychological comorbidity after the surgical procedures were assessed with the Oral Health Impact Profile (OHIP), the Giessen Subjective Complaints List (GSCL) and the Hospital Anxiety and Depression Scale (HADS). Furthermore, psychosocial impairment was documented.39 out of 48 subjects with CLP reported to have experienced pain during the last 6 months. Pain was proven to be already chronic for 36 persons. Locations of pain were the orofacial region, back and limbs. Neurophysiological perception to cold, warmth, pressure and touch were found to be inhomogeneous.Local disturbances of subjective sensitivity in hard and soft tissues in the operated region are suspicious for neuropathic disorders and peripheral and central sensitization. 16 participants also reported that during dental interventions higher doses of local analgesia were necessary to achieve a pain free condition. Overall participants with CLP demonstrated elevated levels for anxiety and depression.As a conclusion for daily routine, CLP patients are considered to be at a higher risk to develop chronic pain states. To avoid these, proper pain and psychological management must be performed from early childhood. Further clinical studies examining patients with neurophysiological diagnostic tools are needed.