Associations between dental anxiety,dental treatment due to toothache,and missed dental appointments among six to eight-year-old Danish children: a cross-sectional study

The aims of this study were to estimate the prevalence of missed dental appointments among Danish children at 6 to 8 years of age and to examine the association between dental anxiety, dental treatment due to toothache, and missed dental appointments in a population-based cross-sectional study. The study was conducted in four municipalities in the County of North Jutland, Denmark, and included a total of 1235 children (response rate 74.1%). Data on missed dental appointments and toothache were obtained from dental records, and data on dental anxiety from the Children's Fear Survey Schedule–Dental Subscale. Overall, 37.7% of children missed one or more dental appointments, while 17.7% missed two or more appointments. These proportions did not differ by age or gender. Among children with dental anxiety, the adjusted OR for an association with two or more missed dental appointments was 1.32 (95% CI: 0.72–2.40), and among children who had dental treatment due to toothache, the adjusted OR of two or more missed dental appointments was 2.61 (95% CI: 1.63–4.18).     

Associations between dental anxiety, dental treatment due to toothache, and missed dental appointments among six to eight-year-old Danish children: a cross-sectional study

The aims of this study were to estimate the prevalence of missed dental appointments among Danish children at 6 to 8 years of age and to examine the association between dental anxiety, dental treatment due to toothache, and missed dental appointments in a population-based cross-sectional study. The study was conducted in four municipalities in the County of North Jutland, Denmark, and included a total of 1,235 children (response rate 74.1%). Data on missed dental appointments and toothache were obtained from dental records, and data on dental anxiety from the Children's Fear Survey Schedule-Dental Subscale. Overall, 37.7% of children missed one or more dental appointments, while 17.7% missed two or more appointments. These proportions did not differ by age or gender. Among children with dental anxiety, the adjusted OR for an association with two or more missed dental appointments was 1.32 (95% CI: 0.72-2.40), and among children who had dental treatment due to toothache, the adjusted OR of two or more missed dental appointments was 2.61 (95% CI: 1.63-4.18).     

Dental problem behaviors in children of parents with severe dental fear.

Dental problem behaviors and dental health were investigated retrospectively in 99 children, whose parents had been treated at the Dental Fear Clinic in Gothenburg, Sweden, due to severe dental fear and avoidance of dental treatment. A high frequency of missed or cancelled appointments and high DMFT and defs scores were found. Problem behaviors occurred in 45% of the children and a relationship between dental fear in parents and children was revealed.     

Appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in eastern Iowa

PURPOSE: The purpose of this prospective study was to assess the appointment-keeping behavior of Medicaid-enrolled pediatric dental patients in three Eastern Iowa practices. METHODS: During the month of October 1998, a tally was kept of all patient appointments at a private pediatric dental office, a public health dental clinic, and a university-based pediatric dentistry clinic. Patients were categorized as either Medicaid or non-Medicaid. Appointment behavior categories were defined as: On time; Failure; Late-notice Cancellation (less than 24 hours notice); and Tardy (greater than 10 minutes). The data was entered in SPSS and analyzed using the chi square statistic. Statistical significance was P < 0.05. RESULTS: A total of 1,406 appointments were recorded for all three sites. Overall, patients on Iowa Medicaid had higher appointment failure, late-notice cancellation, and tardiness rates than non-Medicaid patients at all three clinics. However, these differences were only statistically significant for the private office and the university-based clinic. Failed appointment rates for Medicaid patients were much higher at the private office (38%) than at the other two sites. CONCLUSION: Consistent with anecdotal reports from dentists, Medicaid patients had higher rates of broken appointments than did non-Medicaid patients, particularly in a private practice setting.     

Cerebral activations resulting from virtual dental treatment

Pain, and anxiety of pain, for some people are serious problems in dental treatment. It is a common practical experience that even entering a dental surgery office, or the sound of a dental drill, may evoke vegetative correlates of toothache without any underlying disease. This everyday phenomenon suggests the hypothesis of a corresponding activation of pain‐related brain areas by virtual dental treatment. Twenty healthy subjects viewed two different video clips presenting a dental treatment from the first‐person perspective (simulation movie) and a moving hand holding an electrical toothbrush (control movie). Using functional magnetic resonance imaging, the cerebral hemodynamic responses that occurred during simulation and control movies were compared. Virtual dental treatment was associated with increased activity in pain‐related brain areas such as the cingulate cortex, the insula, and primary and secondary somatosensory cortexes (SI, SII). The brain activation pattern indicates not only affective‐motivational but also sensory‐discriminative pain components during virtual dental treatment in all volunteers. Volunteers with a higher level of dental anxiety showed stronger activation of SI and SII. This may be a result of their higher anticipation of pain.     

Use of dental services by students of Helsinki University during six years.

This follow-up study was carried out to survey the utilization of dental services among university students, together with treatment modalities received during their six years of university studies. Initially 20-year-old students were followed during six years, starting from their first year at the University of Helsinki. Results of the questionnaire showed that during the previous 12 months 59% of the students had had a dental appointment, mostly on their own initiative. According to the patient register, 83% of the students, during their studies, had received dental care financially subsidized at the Finnish Student Health Service (FSHS) in Helsinki. During the six years of follow-up, the mean number of appointments was 9.3 per patient (SD 6.8). Female students made dental appointments relatively more often than did male students (p < 0.01). The main treatment modality was restorative care. Patients did not show up for 3.5% of all appointments reserved. One sixth of all visits were made by a group representing 5% of the study group. In conclusion, as the utilization of FSHS dental services was very common, and as restorative dentistry continues to be the main treatment modality among Finnish university students, prophylaxis of caries in systematic dental health care programmes at FSHS is of prime importance and thus has a good possibility to reach each student.     

The effect of confirmation calls on appointment-keeping behavior of patients in a children's hospital dental clinic.

PURPOSE: The objective of this prospective, randomized, controlled study was to evaluate whether confirmation calls made one or two working days before scheduled appointments reduce the percentage of broken appointments in a children's hospital dental clinic. METHODS: Patients were randomly assigned to three groups: 1) confirmation call made one working day before appointment, 2) confirmation call made two working days before appointment; and 3) control group (no confirmation call). Clinic staff made confirmation calls during normal office hours. Patient arrival was classified as 1) < or =15 minutes late; 2) > 15 minutes late; or 3) broken appointment. RESULTS: Three hundred and thirteen subjects were enrolled in the study: 77 subjects in group 1; 71 subjects in group 2; and 84 subjects in the control group. Eighty-one subjects (26%) could not be contacted by telephone. Overall, there was a 62% reduction in broken appointments among patients who received a confirmation call as compared to the control group. There was no significant difference between confirmation calls placed one or two working days prior to the appointment (P=0.51). Confirmation calls had no effect on punctuality. In comparing indigent care and private insurance, there was no significant difference in broken appointments. However, within the private insurance group, a confirmation call resulted in 93% of patients keeping their appointment as compared to 63% in the control group (P<0.001). No significant difference was noted in the indigent care group, with 79% of patients in the confirmation call group keeping their appointments as compared to 66% in the control group (P=. 093). CONCLUSIONS: Confirmation calls reduced the percentage of broken appointments in a pediatric dental clinic. There was no difference between calls placed one or two working days prior to the appointment. The greatest reduction in broken appointments was shown in the private insurance group.     

An agoraphobic patient with dental anxiety: report of case

A 46-year-old woman made an appointment for dental therapy. The patient's agoraphobia and dental anxiety presented a difficult treatment situation. An open dialogue between patient and dentist along with a flexible treatment plan and unhurried appointments contributed to the success of the dental rehabilitation.     

PERCEIVED DENTAL ANXIETY AMONG SCHOOLCHILDREN TREATED THROUGH THREE CARIES REMOVAL APPROACHES

Objectives:

The aim of the investigation was to test the differences in the perceived level of dental anxiety among children treated restoratively using the Atraumatic Restorative Treatment (ART) approach, the traditional restorative (TRA) approach and ART aided with a chemomechanical caries removal gel (ART plus).

Methods:

The study subjects were 6-7-year-old children. TRA was compared to ART in a clinical setting after children had seen a dentist twice (Group A), ART was compared to ''ART plus'' in a clinical setting after children had seen a dentist once (Group B) and ART was applied outside the clinic on school premises (Group C). The treatments were carried out in Class II cavitated dentine lesion in primary molars. Dental anxiety was measured using the Venham Picture Test (VPT). Three-way analysis of variances and interaction was applied to test for treatment approach, gender and operator effects on the mean VPT scores.

Results:

There was no statistically significant difference (p=0.80) observed between the mean VPT scores for the traditional approach and those for the ART approach and between ART with and without a chemomechanical caries removal gel (p=0.07). Children in Group A had lower mean VPT scores than children in Group B (p=0.02) and Group C (p<0.00001) when treated using the ART approach by the same two operators.

Conclusions:

The level of dental anxiety was low. There was no difference in level of dental anxiety observed in children treated with ART in comparison to the traditional restorative approach, and between children treated with ART with and without a chemomechanical caries removal gel. The treatment environment and prepatory visits may be factors determining the level of dental anxiety in children treated through the ART approach only.     

Dental avoidance behaviour in parent and child as risk indicators for caries in 5-year-old children

Aim.  The aim of this study was to explore associations between avoidance behaviour and dental anxiety in both parents and children and caries experience in 5-year-old children. It was hypothesised that parents' dental avoidance behaviour and dental anxiety were related to dental caries in 5-year-old children.
Design.  Data were collected from dental records and by clinical and radiographic examination of 523 children. The parents completed a questionnaire regarding education, national background, dental anxiety, dental attendance, and behaviour management problems. Bivariate and multivariate logistic regression was conducted.
Results.  Children having one or more missed dental appointments (OR = 4.7), child behaviour management problems (OR = 3.3), child dental anxiety (OR = 3.1), and parents avoiding dental care (OR = 2.1) were bivariately associated with caries experience at the age of 5 years. In multivariate logistic regression, having one or more missed dental appointments (OR = 4.0) and child behaviour management problems (OR = 2.4) were indicators for dental caries in 5-year-old children, when controlling for parents education and national origin.
Conclusion.  Parents that avoid bringing their child to scheduled dental appointments and previous experiences of behaviour management problems for the child indicated risk for dental caries in 5-year-old children.     

A three-year retrospective study of emergency visits at an oral health clinic in south-east Queensland

Background: There is little information available regarding dental emergencies for children in Australia. The aim of this study was to investigate the reasons for dental emergency cases which were treated at a public oral health clinic in a low socioeconomic district in south‐east Queensland. Methods: From a register kept at a public oral health clinic, we analysed the monthly number of emergency visits for children over a three‐year period (January 2008 to August 2010) with respect to numbers treated, reasons for presentation and types of treatment rendered. Results: During the period 2008–2010, there was a mean of 196 ± 86 cases presenting for emergency care each month. The proportions of the various types of emergencies remained fairly consistent over the three‐year period, with the majority presenting for caries related problems (74–75%), followed by trauma (8–9%), orthodontic treatment related (2–5%) and other reasons (16–11%). Between 8–11% of cases were preschool children who were added to the waitlist for treatment for caries under general anaesthesia at the public hospital. Conclusions: Trends in the past three years at a public oral health clinic in a low socioeconomic district in south‐east Queensland show that dental caries constitute nearly three‐quarters of all paediatric emergency appointments.     

Self-reported efficacy of an online dental anxiety support group: a pilot study

Abstract – Objectives: This study aimed to explore the self‐reported effectiveness of an existing online dental anxiety support group in terms of perceived level of anxiety since accessing the group. Methods: An online questionnaire was completed by 91 individuals who accessed the Dental Fear Central, an online support group bulletin board, during an 8‐week period in 2005. Participants reported background demographic information, their own self‐reported evaluation of the efficacy of the support group, as well as completing the Modified Dental Anxiety Scale (MDAS). Results: In total, 60% of the sample considered that the support group had ‘somewhat’ or ‘greatly lessened’ their anxiety. Overall MDAS scores were significantly lower in the ‘greatly lessened’ group. Conclusions: The results of this nonrandomised pilot study suggest some individuals retrospectively considered that, since accessing the online group, they experienced a reduction in dental anxiety. Future research should employ a randomised controlled design in order to determine the contribution of the online group to self‐reported changes in dental anxiety over time.     

A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children

OBJECTIVES: Dental anxiety is common in children. This study sought to determine the impact of viewing positive images of dentistry prior to a dental appointment on the anticipatory dental anxiety levels of children attending for dental treatment. METHODS: Controlled trial. Assessment of anxiety and analysis of data were conducted blind to experimental condition. Assessment of anxiety was carried out in the waiting room postintervention but before the patient entered the dental surgery for treatment. PARTICIPANTS: Thirty-eight children and young adults attending a dental clinic in South West England. INTERVENTION: Participants were randomly assigned to one of two conditions. In both conditions the participant was asked to look at photographs for 2 min in the waiting area prior to their appointment. The intervention consisted of viewing positive images of dentistry and dental treatment, the control condition consisted of dentally neutral images. Positive and neutral images were validated independently by four paediatric dentists. The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership. OUTCOME MEASURE: Anticipatory anxiety assessed by the Venham Picture Test. FINDINGS: A significant difference in anticipatory dental anxiety was found between the two groups (median-positive images = 0, median-neutral images = 3; P < 0.001). Anticipatory anxiety was not correlated to age (rho = 0.04 P > 0.05), there was no difference between male and female participants in their level of anticipatory anxiety (median-males = 0.5, median-females = 1 P > 0.05). CONCLUSIONS: Viewing positive images of dentistry and dentists results in short-term reductions in anticipatory anxiety in children.     

Correlation between mothers' perceptions/expectations and the behavior of children with HIV during dental treatment

The aim of this study was to evaluate the mothers' perceptions and expectations of the behavior of their children who were HIV positive, during dental treatment. The sample was composed of 40 mother and child pairs. The mothers answered seven questions during two different appointments (M1, the child's initial appointment, and M2, the child's treatment appointment) in order to identify their perceptions and expectations about their children's behavior during dental treatment. In addition, child's behavior during the appointments was evaluated. The results of the mothers' interviews were then correlated with their children's behavior using Spearman's correlation test ( p < 0.05). There was no significant correlation between the mothers' perceptions and expectations and the behavior displayed by their children during dental treatment ( p > 0.05).     

Trends in dental caries in 1‐ to 4‐year‐old children in a Brazilian city between 1997 and 2008

International Journal of Paediatric Dentistry 2010; 20: 125–131 Objective. The objective of this study was to assess trends in dental caries prevalence and severity in 1‐ to 4 year‐old children living in Diadema, Brazil, over a 11‐year period, from 1997 to 2008. Methods. In 2008 an epidemiological oral health survey was carried out and the results on caries were compared with five cross‐sectional studies carried out using the same methods and criteria in 1997, 1999, 2002, 2004, and 2006 in the same city. In all surveys, children were randomly selected from those attending a National Day of Children’s Vaccination. Calibrated dentists carried out the clinical examination using WHO criteria. Caries trends were assessed by time‐lag analysis. In total, 5348 children were examined in the six surveys over the 11‐year period. Results. Time‐lag analysis showed a marked and statistically significant decline in the prevalence (χ² for trends: P < 0.001) and severity (Kruskal–Wallis: P < 0.001) of dental caries between 1997 and 2008. Conclusion. In conclusion, the last cohort of preschool children in Diadema had much better dental caries status than those in 1997.     

Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems

Gustafsson A, Broberg AG, Bodin L, Berggren U, Arnrup K. Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems. Eur J Oral Sci 2010; 118: 270–277. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci This study aimed to identify potential predictors of non‐attendance among children and adolescents with dental behaviour management problems (DBMP). A group of 179 patients, 7.5–19 yr of age, was grouped into 56 ‘non‐attenders’ (discontinued treatment, missed appointments, or ≥ 20% cancellations) and 123 ‘attenders’. In addition to data from an introductory interview and dental recordings, baseline data from psychometric measures of fear and other personal and parental characteristics were included in logistic regression analyses and tree‐based modelling. The non‐attenders had higher scores on impulsivity and sociability and lower socio‐economic status (SES) than the attenders, and they lived more often in single‐parent families. Logistic regression analyses and tree‐based modelling point to SES and parental anxiety as important predictors for non‐attendance within this group of children and adolescents. To predict, and possibly to prevent, non‐attendance among children and adolescents referred for specialized dental care because of DBMP, we must consider their lives and family situations as well as their personal characteristics and oral health status. Further research should focus on whether the observed associations between non‐attendance and factors such as personal characteristics, family and psychosocial factors, and previous dental experiences, also hold for those who remain in regular dental care.     

Dental anxiety in a students' paediatric dental clinic: children, parents and students

Summary. Objective. The purpose of the present study was to investigate the dental anxieties of children, parents and student caregivers in a dental school environment. Methods. Eighty‐eight children, parents and the dental students who treated the children were included in the study. They were asked to complete questionnaires which gathered information about demographics and dental anxiety using the Dental Anxiety Scale (DAS). Students were also asked to respond to a visual analogue scale (VAS) to assess their anxiety prior to treating children. Results. Significant differences were observed between the mean DAS of the children compared to the students (8·8 ± 3·9 and 7·3 ± 2·7, respectively), and between the scores of the parents and the students (8·3 ± 2·9 and 7·3 ± 2·7, respectively). No significance was noted between the mean DAS scores of the children and those of the parents. The number of children in family did not influence the mean DAS of the children. Parents’ age, education or place of birth did not influence the mean DAS of the parents or the children. The mean DAS of children who reacted excellently in previous treatments scored significantly lower in DAS compared with children who were fearful. Female dental students demonstrated higher DAS and VAS scores than male students. Students’ seniority, type of last treatment that they received, time since last treatment, parenthood or self‐ranking in class did not seem to significantly influence their DAS or VAS scores. A strong correlation in DAS scores between parents and children was found (r = 0·41, P = 0·0001). No correlation between children's and students’ DAS scores was found. Conclusions. Students’ dental anxiety, or their anxiety prior to treating a child, may not be directly associated with the child's dental anxiety. However, a positive correlation exists between parental and children's dental anxiety.     

Factors associated with dental behaviour management problems in children aged 2-8 years in Beijing, China

International Journal of Paediatric Dentistry 2011; 21: 200–209 Aim. This study determined the prevalence of children’s dental behaviour management problems (BMP) in our clinic, investigated the influence of non‐dental and dental background variables on BMP, and analysed the predictive power of these variables. Design. The study group included 209 children aged 2–8 years who received dental treatment. Interviews were conducted with accompanying guardians. Children’s dental behaviour was rated by a modified Venham’s clinical anxiety scale and a cooperative behaviour rating scale. Regression models were used to analyse behavioural and interview data and to calculate the power of background variables to predict children’s dental behaviour. Results. During the first treatment, 29.7% of children displayed BMP. Four variables were found to predict BMP in 87.9% of cases. The risk factors for BMP were younger age, negative guardian expectations of the child’s behaviour during treatment, anxiety or shyness around strangers, and presence of toothache. Children aged 2.5–3.5 years who attended kindergarten showed better dental behaviour than those who did not. Conclusions. This study is the first to report BMP prevalence in mainland China. Our results indicate that a simple pre‐treatment interview could provide data allowing the dentist to identify children with special dental behavioural needs.     

Oral health status,dental anxiety,and behavior‐management problems in children with oppositional defiant disorder

Mental disorders have been shown to affect children's oral health. This study was carried out to investigate the oral health status, dental anxiety (DA), and behavior‐management problems (BMPs) during dental treatment in 6‐ to 9‐yr‐old children with oppositional defiant disorder (ODD)/attention‐deficit hyperactivity disorder (ADHD). The study and control groups included 40 children with ODD/ADHD and 80 normal children, respectively. All participants received an amalgam restoration. During the procedure, the children's behavior was assessed using the Frankl Rating Scale and the Verbal Skill Scale. Parents rated their children's DA using the parental version of the Children's Fear Survey Schedule‐Dental subscale (CFSS‐DS). Comorbid anxiety disorders were assessed using the Kiddie‐Sads‐Present and Lifetime Version questionnaire. Oral health status was assessed using the gingival index and the decayed, missing, and filled teeth score for permanent (DMFT) and primary (dmft) teeth. The findings showed that DA and BMPs were significantly higher in children with ODD/ADHD than in the controls. Furthermore, the frequency of DA and BMPs was higher in children with both ODD/ADHD and a comorbid anxiety disorder than in those without comorbid anxiety disorder. Children with ODD/ADHD had significantly higher DMFT/dmft scores than those in the control group, whereas the difference in gingival index was not statistically significant. In conclusion, children with ODD/ADHD had higher levels of DA, BMP and poorer oral health status.