Eating disorders and oral health: a matched case-control study

The aim was to compare the oral health status of patients with eating disorders (EDs), with sex- and age-matched controls, with a view to identify self-reported and clinical parameters that might alert the dental healthcare professional to the possibility of EDs. All patients who entered outpatient treatment in an ED clinic during a 12-month period were invited to participate. Of 65 ED patients who started psychiatric/medical treatment, 54 agreed to participate. Eating disorder patients and controls answered a questionnaire and underwent dental clinical examinations. Multivariate analysis identified significantly higher ORs for ED patients to present dental problems (OR = 4.1), burning tongue (OR = 14.2), dry/cracked lips (OR = 9.6), dental erosion (OR = 8.5), and less gingival bleeding (OR = 1.1) compared with healthy controls. Sensitivity and specificity for the correct classification of ED patients and controls using the five variables was 83% and 79%, respectively. The ED patients with vomiting/binge eating behaviors reported worse perceived oral health (OR = 6.0) and had more dental erosion (OR = 5.5) than those without such behavior. In ED patients with longer duration of the disease, dental erosion was significantly more common. In conclusion, oral health problems frequently affect ED patients, and this needs to be considered in patient assessment and treatment decisions.     

Results of a dental fear survey in Japan: implications for dental public health in Asia

The purpose of this investigation was to initiate the study of dental fear in Japan. 415 college students, aged 18-22 yr were surveyed. A standardized questionnaire which has been used in the United States was translated into Japanese and was administered to the students. More than 80% of those surveyed reported some dental fear. Six to 14% of the students reported extreme fear of the dentist. The majority of the subjects admitted that they delayed making dental appointments due to fear. Muscle tension was the most common physiological symptom reported. The dental drill and needle were the most fear-provoking stimuli.     

Public knowledge of dental registration and management of common dental problems

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.     

Long-term effects of two different treatments for dental fear and avoidance

Follow-up clinical studies of treatment for dental fear and avoidance behavior are infrequent in the literature. The present investigation reports follow-up results over more than two years from 84 out of 99 patients treated for dental fear in a Swedish community-based dental fear clinic. Broad-based behavioral therapy (BT) or general anesthesia (GA), both in combination with adjusted conventional dental treatment, were used. The frequency of patients' attendance for regular dental care after two years was unchanged or even somewhat increased and was significantly higher in those who had received the BT therapy. Most patients stated that they had no problems after leaving the dental fear clinic. Among patients reporting such problems, the change of dentist was most frequently reported. The level of dental anxiety as measured by Corah's DAS was still at a low level, in spite of a slight increase over the two years since initial therapy.     

Utilization of dental services in the adult Danish population 1975

Lack of information on the dental behavior of adults in Denmark has become a major problem in the national planning of dental services. The purpose of this study was to establish the pattern of utilization of dental services among adult Danes (aged 15 and above). A three-stage cluster sampling design covering the total adult population of Denmark was used to draw a representative sample comprising 1,600 persons. Household interviews by trained interviewers were carried out. Of the adults interviewed, 58% reported yearly dental visits the last 5 years, 32% had not seen a dentist or only when in pain, and 10% went irregularly. Differences according to place of living, age, sex, occupation and school dental care were found. 63% of those who had seen a dentist reported bad teeth or were edentulous with or without dentures. 10% reported fear, 9% had good teeth and 5% reported economic difficulties. The most frequent treatments at the latest dental visit were cleaning and filling for the regular patients and extractions and dentures for the nonregular patients. A multiple classification analysis revealed that the number of teeth was the strongest predictor for dental services, with the following predictors in descending order: age, occupation, place of living, economy, sex and school dental care. These variables could explain 58% of the variation in utilization.     

Dental fear and satisfaction with dental services in Switzerland

Objectives: Dental satisfaction is associated with continuity of dental care, compliance with dentist advice, and positive health outcomes. It is expected that people with higher dental fear might have less dental satisfaction because of more negative dental experiences. The objective of this study was to examine satisfaction and reasons for satisfaction with dental practitioners in Switzerland and variations by dental fear. Methods: A national sample of 1,129 Swiss residents aged 15‐74 (mean = 43.2 years) completed a personal interview at their home with questions assessing dental fear, dental service use, general satisfaction with their dentist, and reasons for satisfaction or dissatisfaction. Results: Overall, 47.9 percent of participants responded that they were satisfied with their dentist and 47.6 percent that they were very satisfied. Satisfaction differed significantly by gender, language spoken, region of residence, and educational attainment. Greater dental fear was significantly associated with greater dissatisfaction with the dentist. The percentage of people who were very satisfied with the dentist ranged from 56.0 percent among people with no fear to 30.5 percent for participants with “quite a lot” of fear but was higher (44.4 percent) for people who stated that they were “very much” afraid of the dentist. The most common reasons attributed for satisfaction with dentists were interpersonal characteristics of the dentist and staff. People with “quite a lot” of fear were found to endorse these sentiments least. Conclusions: Although higher dental fear was associated with more dissatisfaction with the dentist, the level of satisfaction among fearful individuals in Switzerland is still high.     

Treatment experience, frequency of dental visits, and children's dental fear: a cognitive approach

Cognitive elements play a key role in dental anxiety. Nevertheless, relatively little is known about how dental treatments and frequency of visits to the dentist are related to dental fear and its cognitive antecedents. This study aimed to explore the relationships between dental visits, past treatment experiences, expectations on the aversiveness/probability of negative dental events, and dental fear in children. The participants were 147 children (60% female; mean age = 12.0 yr) who completed a questionnaire comprising measures of dental treatment-related experience (attendance, fillings, and extractions), perceived aversiveness and probability of dental events, and dental anxiety. Bivariate correlations and multiple linear regression analyses were used to analyze the data. A higher frequency of dental visits was associated with less dental fear and a decreased belief in the probability of negative events occurring during treatment. The type of treatments received was not directly linked to dental fear. However, having received fillings was significantly associated with the perceived probability of negative dental events, whereas extractions were positively associated with these expectations but negatively associated with the perceived aversiveness of possible dental events. Regular dental visits, as well as dental treatments, can influence, in different ways, cognitive elements associated with dental anxiety in children.     

Attendance pattern of anxiety-treated dental patients: a pilot study

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.     

Dental attendance and anxiety among public and private school children in Jordan

AIM: To evaluate the levels of dental attendance and anxiety among children of public (lower to middle socioeconomic groups) and private schools (higher socioeconomic groups), and to explore the perceived source of dental fear among them. METHOD: A group of 1,021 children selected by a simple random method from 10 public schools in the five geographic areas of Irbid Governate, Jordan and all 10 private schools were included in this study. All children (mean age 13.1 +/- 0.87 years) completed a questionnaire modified from the Dental Fear Scale (DFS) which also contained items related to dental attendance. RESULTS: Private school children (31.4%) visited the dentist regularly more significantly than public school children (15.0%) (P < 0.001). However, the majority of children (public = 82.6%, private = 67.4%) attended the dentist only in an emergency. The main reason for irregular attendance was 'treatment not needed' (42.2%). About 43-44% of children had dental fear of 'low to moderate type', while the prevalence of 'high dental anxiety' was slightly higher among children of public (11.6%) than those of private schools (6.9%). Fear of specific stimuli (pain and trauma) was the most common source of dental fear reactions among 60-65% of children. The sight and sensation of an anaesthetic needle and sight, sound and sensation of the drill were the most fear eliciting stimuli. Moreover, public school children were found to be more anxious with a significantly higher 'overall dental fear' than private school children (P < 0.05).     

Increasing prevalence of emergency department visits for pediatric dental care, 1997-2001

BACKGROUND: Hospital emergency department (ED) visits for non-urgent care have been increasing since the late 1950s. This study investigated the prevalence and characteristics of pediatric ED visits for dental problems during a five-year period. METHODS: This retrospective study included newborns through 17-year-olds with dental complaints identified from the electronic register of the ED of Texas Children's Hospital, Houston, between January 1997 and December 2001. The authors described patient characteristics, diagnoses, factors associated with ED use for nontraumatic problems and annual changes in ED visits for dental and nondental complaints. RESULTS: Of the 1,102 subjects, 809 (73.4 percent) had nontraumatic and 293 (26.6 percent) had traumatic dental complaints. The study revealed a 121 percent increase in ED visits for dental complaints and a 66-fold increase in admissions between 1997 and 2001. Of the inpatient admissions, 68 percent were the result of caries and its sequelae. CONCLUSIONS: This study revealed a substantial increase in ED visits and hospital admissions for dental problems during the study period. The majority of dental problems were nontraumatic in nature. PRACTICE IMPLICATIONS: Dental care experts should be available in ED settings in which increases in such visits are seen. Studies must be conducted to explore ways of keeping patients from seeking care in EDs inappropriately.     

Association between dental fear and dental attendance among adults in Finland

OBJECTIVE: Our aim was to evaluate the association between dental attendance and dental fear while considering the simultaneous effects of perceived oral health and treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. MATERIAL AND METHODS: The two-stage stratified cluster sample (n=8028) represented Finnish adults aged 30 years and older. The response rate to this nationwide sample was 88%. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analyses were used to determine the association between dental fear and dental attendance, including the following independent variables: perceived oral health, perceived treatment need, satisfaction with oral health services, age, gender, marital status, and attained level of education. RESULTS: Among all ages, except 30 to 34-year-olds, irregular attenders were more likely to be very afraid of visiting a dentist than regular attenders were. The association was stronger the older the age group. Only age modified the association between dental fear and attendance. Irregular dental attendance can be attributed to high dental fear (etiologic fraction among exposed) in 41% of cases. CONCLUSION: Reducing dental fear would increase the number of regular attenders, especially among older age groups. Individuals for whom oral health services have been provided regularly since childhood seem to continue to use these services regularly despite high dental fear.     

Factors that limit access to dental care for adults with spinal cord injury

This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.     

Dental fear in sexually abused women

The aim of the present study was to investigate dental fear in women who have been exposed to different kinds of sexual abuse. In a cross-sectional questionnaire study, 99 sexually abused women were divided into three groups: one group who reported having been exposed to sexual touching (ST); one group who reported intercourse (IC); and one group who reported sexual abuse involving oral penetration (OP). The mean score on dental fear assessments was significantly higher for all groups than for Norwegian women in general. Women in the OP group scored significantly higher than women in other groups on dental fear. The majority of the women reported that they had experienced problems in relation to dental treatment situations. About half of the women in the OP group and one-third in the other groups reported that they had never considered that there was a relationship between the abuse and their problems with dental treatment situations. Significantly more women in the OP group reported that they had not been aware of the relationship, possibly because the abuse had been repressed. The majority of the women with extreme dental fear had never informed a dentist that they had been sexually abused.     

Anxiety and depressive disorders and dental fear among adults in Finland

Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland.
Eur J Oral Sci 2011; 119: 55–60. © 2011 Eur J Oral Sci We studied the association between dental fear and anxiety or depressive disorders, as well as the comorbidity of dental fear with anxiety and depressive disorders, controlling for socio‐demographic characteristics, dental attendance, and dental health. Nationally representative data on Finnish adults, ≥ 30 yr of age (n = 5,953), were gathered through interviews and clinical examination. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ Anxiety and/or depressive disorders were assessed using a standardized structured psychiatric interview according to criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM‐IV).Those with depressive disorders, generalized anxiety disorder or social phobia more commonly reported high dental fear than did those without these disorders. When age, gender, education, dental attendance, and the number of decayed, missing, and restored teeth were considered, those with generalized anxiety disorder were more likely to have high dental fear than were participants with neither anxiety nor depressive disorders. The comorbidity of depressive and anxiety disorders also remained statistically significantly associated with dental fear; those with both depressive and anxiety disorders were more likely to have high dental fear than were those without these disorders. Our findings support the suggestion that some individuals may have a personality that is vulnerable to dental fear.     

A two-wave interview study of frequency of dental visits and dental complaints

A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.     

Dental attendance and dental status

This article examines the relationship between differences in dental attendance patterns and variations in dental status. A sample of 336 dentate men and 110 dentate women were selected at random from employees of two industrial plants in N.W. England in 1980. They were given a dental examination and asked about visits to the dentist. Regression analysis showed that while the more frequent the dental visits, the lower the rate of tooth loss and the fewer the number of teeth with active decay, the higher, however, the average number of fillings. There were significant differences, moreover, between manual and non-manual workers, the former being more likely to lose their teeth and the latter to have their teeth filled, at each given age and frequency of dental visit. Though the more frequent dental attenders had the advantage over the less frequent of having, on average, a higher number of functioning teeth, restored or otherwise sound, they also had the disadvantage of having higher levels of treated disease and thus of disease experience. The results suggest that while frequent dental visits help to postpone tooth loss and to maintain dental function, they do not apparently help to prevent the onset of further disease.     

恐惧心理对口腔门诊病人就诊行为和服务需求的影响

目的:调查影响口腔门诊病人产生恐惧心理的相关因素,分析恐惧心理对就诊行为以及就诊服务需求的影响。方法:采用系统抽样的方式按照纳入标准选取831名口腔门诊病人作为问卷调查对象,问卷内容包括人口统计学资料、就诊心理状态、就诊行为、对服务舒适度需求等。结果:831人中有恐惧心理503人(60.5%),其中男性173人,女性330人,男女之间有显著性差异(P<0.05);有无恐惧心理在不同年龄、不同职业、不同受教育程度人群中也有显著性差异(P<0.05);有、无恐惧心理两组人群在定期口腔检查、按时复诊两个就诊行为中有显著性差异(P<0.05);在就诊前是否了解医生情况方面无显著差异;两组人群对就诊过程中与服务舒适度相关的因素感到不安的程度由高到低依次均为①牙钻声、②出血、③气味、④灯光、⑤体位,各因素不安程度有显著性差异(P<0.05)。结论:恐惧心理在口腔门诊大多数病人中存在,其形成与性别、年龄、职业、受教育程度相关;与无恐惧心理人群相比,有恐惧心理人群更难定期口腔检查,但更容易按时复诊,对就诊服务舒适度的潜在需求明显增高。     

Prevalence of psychologic, dental, and temporomandibular signs and symptoms among chronic eating disorders patients: a comparative control study

AIMS: To compare the prevalence of psychologic, dental, and temporomandibular disorder (TMD) signs and symptoms between young women suffering from chronic eating disorders (ED) and a control group of age-matched, healthy women, and to evaluate the impact of frequent vomiting on these signs and symptoms among the ED group. METHODS: Clinical examination and self-administered questionnaires were used to evaluate psychologic, dental, and TMD signs and symptoms among 79 women hospitalized because of chronic ED and 48 age-matched healthy women (as controls). ED patients were further analyzed according to their habit of daily vomiting (43 vomiting versus 36 nonvomiting patients). Pearson chi-square and analysis of variance were used to analyze categorical differences between study groups. RESULTS: Women with ED showed a significantly higher sensitivity to muscle palpation (P < .001) and higher levels of depression, somatization, and anxiety (P < .001), as well as a higher prevalence of intensive gum chewing (P < .001), dental erosions (P < .001), and attrition (P < .001), than the healthy controls. Vomiting patients showed higher muscle sensitivity to palpation than nonvomiting patients (P < .001) and greater emotional and psychologic distress (P < .001). CONCLUSION: Women with chronic ED suffer from higher muscular sensitivity to palpation, greater emotional distress, and more hard tissue destruction (dental erosions, dental sensitivity) than healthy women.