成人牙科焦虑症及其相关因素分析

牙科焦虑症已成为世界上大众人群中妨碍口腔保健服务的主要问题之一。严重的牙科焦虑症不仅损害了患者的口腔健康和身心健康,并且常导致医患关系恶化。因此如何准确评估牙科焦虑症并进行有效的预防和治疗已成为牙科医生关注的问题。本文就成人牙科焦虑症的评估方法、流行趋势、相关因素、危害以及治疗措施等的研究进展作一综述。     

Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood

Most studies examining the origins of dental fear and anxiety have relied on cross-sectional data. These are subject to several problems, such as recall and uncertainty concerning temporal relationships. This paper uses longitudinal data from the Dunedin Multidisciplinary Health and Development Study to assess risk factors for the development of dental anxiety in persons between the ages of 18 and 26 years. It was hypothesized that psychological factors would be as important as conditioning experiences in the genesis of dental anxiety over this period. The eight-year incidence of dental anxiety was 16.5%. Five variables entered models predicting onset: multiple fears, symptoms of substance dependence, previous experience of invasive dental treatment, dental visiting pattern, and the extraction of one or more teeth. Separate analyses for those avoiding and those using dental services resulted in different explanatory models. These results indicated that both psychological and conditioning variables contributed to the development of dental anxiety in this population of young adults.     

Psychologic correlates of dental anxiety

In an attempt to establish the relationships between dental anxiety and personality traits, such as neuroticism and locus of control, a survey has been carried out among 30-40-yr-olds in a Dutch town. In the first instance, the questionnaires comprising the psychologic items were treated by Non-Metric Principal Components analysis to detect the underlying structure. The principal components found were then used in a second-stage analysis. The results appear to be at variance with the literature, i.e. subgroups discernible in the sample by sets of psychologic features were not associated with dental anxiety categories.     

Clinical measurement of dental anxiety

Abstract The mean scores on five dental anxiety measurements of 60 patients suffering from extreme dental anxiety are compared with those of an equal-sized, matched group of regular dental attenders free from dental anxiety. Four of the measurements, especially Corah's DAS, appear to be suitable for distinguishing persons suffering from extreme dental anxiety. Also, persons with extreme dental anxiety appear to express their fear openly.     

牙科焦虑与特质焦虑的相关研究

目的 探讨口腔患者牙科焦虑与特质焦虑的相关关系.方法 采用自评焦虑量表(Self-rating Anxiety Scale , SAS)和口腔焦虑测量量表(Dental Anxiety Scale, DAS)问卷对3000位年龄在25～35岁的口腔门诊患者进行牙科焦虑和特质焦虑的调查,对数据进行统计分析.结果 特质焦虑与牙科焦虑相关(P＜0.05 ).结论 特质焦虑患者比非特质焦虑患者更容易表现出牙科焦虑,且特质焦虑患者的牙科焦虑症状比非特质焦虑患者的牙科焦虑症状更不易减轻.为此, 口腔医生应对特质焦虑患者的牙科焦虑给予高度的重视.     

Sociodemographic correlates of dental anxiety

In a survey comprising 620 30-40-yr-old inhabitants of a Dutch town, dental anxiety was measured along with some sociodemographic variables. The data were analyzed in an attempt to reveal associations between sociodemographically determined groups of respondents and their scores on the different measurements of dental anxiety. Women reported higher dental anxiety levels than men, with the exception of body damage anticipation anxiety. The rank order of birth seemed to have no influence. Divorced men and women reported a higher anxiety level on two of the anxiety measurements, but the association appeared to be weak. A lower level of education, irregular dental attendance, and edentulousness appeared to be associated with a higher level of dental anxiety.     

Dimensionality of dental anxiety measurements

A survey among 620, 30-40-yr-olds, was carried out in order to measure dental anxiety with Corah's DAS, Weiner's AALC, and some other questions on anxiety, among which was the duration of psychophysiologic responses prior to a dental appointment. The data were analyzed with a Non Metric Components analysis. The DAS turned out to be unidimensional. The AALC on the other hand appeared to contain four components. A second stage analysis comprising the DAS component, the four AALC components, and the remaining variables revealed a two-dimensional structure, of which only the first component is dentistry related. This component showed better differentiation of the respondents than with DAS or AALC alone. Part of AALC's questions and a question about anxiety in daily life proved to be superfluous for measuring dental anxiety. It is concluded that dental anxiety and anxiety in general have to be measured with questions covering different aspects.     

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。     

Music interventions for dental anxiety

Anxiety is a significant issue in the dental care of adults and children. Dental anxiety often leads to avoidance of dental care which may result in significant deterioration of oral and dental health. Non‐pharmacological anxiety management interventions such as music listening are increasingly used in dental care. Although efficacy for music's anxiolytic effects has been established for pre‐operative anxiety, findings regarding the use of music listening for dental anxiety are inconclusive, especially for children. The use of music for passive distraction may not be adequate for children and highly anxious adults. Instead, interventions offered by a trained music therapist may be needed to optimize music's anxiolytic impact. Music therapy interventions are individualized to the patient's presenting needs and geared at enhancing patients’ active engagement in the management of their anxiety. Interventions may include (i) active refocusing of attention, (ii) music‐guided deep breathing, (iii) music‐assisted relaxation, and (iv) music‐guided imagery. In addition, music therapists can teach patients music‐based anxiety management skills prior to dental treatments, offer them the opportunity to express emotions related to the upcoming procedure, and help them gain a sense of control and safety. Clinical guidelines for the use of music listening by dental practitioners are offered.     

Strategies for combating dental anxiety

Dental anxiety and subsequent avoidance of dental care and deterioration of oral health pose a significant problem for the dental profession. In an attempt to elucidate preferences of anxious dental patients, we gathered survey data from 121 persons at a small, private liberal arts college in the mid-Atlantic region of the United States. Half of the respondents experienced dental anxiety, and most of these (66 percent) attributed anxiety to fear of anticipated pain. The majority of anxious patients preferred a dentist to be friendly (93 percent), talkative (82 percent), and to have an office with adorned walls (89 percent) and a slightly cool temperature (63 percent). Patients who identified themselves as anxious also indicated that music in the background (89 percent) and magazines and books in the dental office (75 percent) were helpful. Anxious patients were more likely than non-anxious patients to prefer a male dentist (77 percent versus 52 percent). This finding was especially marked among anxious male respondents, 93 percent of whom preferred a male dentist compared to 73 percent of anxious female respondents. These survey data may assist dental professionals in understanding and combating patients' dental anxiety, in order to increase the frequency of dental visits and to prompt a corresponding restoration or maintenance of oral health.     

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。     

Effect of a special dental program upon extreme dental anxiety

Abstract Dental anxiety of 60 extremely anxious dental patients enrolled in a special program, was measured multioperationally before and immediately after treatment, and 6 months later. The mean anxiety level was substantially lowered during the course of treatment, indicating a favourable effect of the program. After Amsterdam, The Netherlands 6 months dental anxiety was still at the lower level.     

Structural relationships of dental anxiety, mood, and general anxiety

The aim of this study was to explore the structural relationships between dental anxiety, mood, and general anxiety among 220 dentally anxious patients who participated in a clinical study. A structural equation modeling analysis (SEM) was applied by using the LISREL program on the hypothesized latent variables dental anxiety, mood, and general anxiety, which were measured by means of several psychometric tests. The final model showed that mood and general anxiety had positive factor loadings on dental anxiety. However, the impact of the general anxiety latent variable was not significant as compared with the mood factor. Another finding was that the residual variance for the latent variable dental anxiety was 0.68, indicating that a major portion of the variance is still unexplained by the tested variables. In conclusion, this study showed a relationship between dental anxiety, general anxiety, and mood among dentally anxious patients.     

Evaluation of the ability of dental clinicians to rate dental anxiety

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients’ levels of dental anxiety on a Visual Analogue Scale. The correlation (r_s) between the clinicians’ and patients’ ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians’ and patients’ ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians’ confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self‐assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.     

Structural relationships of dental anxiety,mood, and general anxiety

The aim of this study was to explore the structural relationships between dental anxiety, mood, and general anxiety among 220 dentally anxious patients who participated in a clinical study. A structural equation modeling analysis (SEM) was applied by using the LISREL program on the hypothesized latent variables dental anxiety, mood, and general anxiety, which were measured by means of several psychometric tests. The final model showed that mood and general anxiety had positive factor loadings on dental anxiety. However, the impact of the general anxiety latent variable was not significant as compared with the mood factor. Another finding was that the residual variance for the latent variable dental anxiety was 0.68, indicating that a major portion of the variance is still unexplained by the tested variables. In conclusion, this study showed a relationship between dental anxiety, general anxiety, and mood among dentally anxious patients.