Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale

This study analyzed and assessed dimensions of a questionnaire developed to measure general fears and phobias. A previous factor analysis among 109 dental phobics had revealed a five-factor structure with 22 items and an explained total variance of 54%. The present study analyzed the same material using a multivariate statistical procedure (LISREL) to reveal structural latent variables. The LISREL analysis, based on the correlation matrix, yielded a chi-square of 216.6 with 195 degrees of freedom (P=0.13S) and showed a model with seven latent variables. One was a general fear factor correlated to all 22 items. The other six factors concerned "Illness & Death" (5 items). "Failures & Embarrassment" (5 items), "Social situations" (5 items), "Physical injuries" (4 items). "Animals & Natural phenomena" (4 items), One item (opposite sex) was included in both "Failures & Embarrassment" and "Social situations". The last factor, "Social interaction", combined all the items in "Failures & Embarrassment" and "Social situations" (9 items). In conclusion, this multivariate statistical analysis (LISREL) revealed and confirmed a factor structure similar to our previous study, but added two important dimensions not shown with a traditional factor analysis. This reduced FSS – II version measures general fears and phobias and may be used on a routine clinical basis as well as in dental phobia research.     

Dental fear of Finnish children in the light of different measures of dental fear

OBJECTIVES: The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the "peak value for dental fear" (PV), and "fear of dental treatment in general" (GF). METHODS: The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. RESULTS: The questionnaire was reliable. Two factors were revealed for each age: "treatment of dental decay" (TDD), which included fears related to invasive treatment, and "attending the dentist" (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. CONCLUSION: The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.     

Assessment of patients with direct conditioned and indirect cognitive reported origin of dental fear

This study investigated the reported conditioned or cognitive origin of dental phobia in 100 adult patients at a specialized dental phobia clinic. It was shown that a majority of patients reported a conditioned background to their dental fear. Patients'avoidance time and level of dental anxiety corresponded to previously reported data for fearful groups. Individuals with an aruosal conditioning etiology of dental fear reported significantly longer avoidance time as compared to individuals with a cognitively learned reaction. With the exception of an elevated level of general fears, most psychometrically assessed emotional reactions were well within normal ranges. However, patients with a non-conditioned, cognitive etiology reported significantly higher levels of trait anxiety and fear of embarrassment. In addition, a separate analysis among women revealed a greater fear of physical injuries among patients with cognitive etiology.     

An evaluation of self-reported oral health and health-related quality of life

The purpose of this study was to investigate the general and oral health status of patients at a dental hospital in Tokyo and examine the correlations between general health and oral health items. One hundred and seventy-four (174) new patients at the Dental Hospital of Tokyo Medical and Dental University participated in this study. The Visual Analog Scale (VAS) was employed to investigate dental demands and symptoms, as well as satisfaction with oral and general health conditions, while SF-36 served an indicator for health-related quality of life (HRQOL). The results were statistically analyzed at a significance level of p = 0.05. The results of VAS were further examined using factor analysis. Several VAS items showed significant correlations with SF-36 subscales (p<0.05). The factor analysis of VAS items suggested a structure involving three factors: self-cognition of oral status, related function and pain, and dental fear and discomfort. The dental fear and discomfort factor showed no significant correlations with SF-36 subscales (p>0.05). Emotional elements and esthetic demands on dental status, as well as physical symptoms, influence HRQOL. Dental discomfort proved to be independent of general health status and was considered a dental-specific item that needs to be measured separately from general health status.     

Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs

Persons with special health care needs due to physical and cognitive impairment can be at increased risk for dental disease which can be attributed to, as well as exacerbate, existing medical conditions. This study assessed the nature of perceived barriers to obtaining oral health care among a special-needs population and the influence of these factors (in particular, fear and anxiety) on utilization of dental services. A total of 27.9% of the sample reported fear/anxiety about dental visits, with approximately half of those reporting to be very nervous or "terrified". There was an inverse relationship between the frequency of dental visits and the proportion of respondents reporting themselves as very nervous or terrified, and between the perception of oral health status and the level of dental fear/anxiety (P < 0.001). A large difference was reported between patient preference for pharmacologic modalities for anxiety control and those received at dental visits, with 40% of the youngest age group indicating that they would go to the dentist more frequently if sedation or general anesthesia were offered. The levels of self-reported fear/anxiety and the high proportion of respondents indicating an unmet need for adjunctive anesthesia services suggest that fear/anxiety acts as a barrier to dental care among this special-needs group which could be ameliorated with greater use of these services.     

Serine protease activity is essential for thrombin-induced protein synthesis in cultured human dental pulp cells: modulation roles of prostaglandin E2

Chang MC, Lan WH, Chan CP, Lin CP, Hsieh CC, Jeng JH: Serine protease activity is essential for thrombin-induced protein synthesis in cultured human dental pulp cells: modulation roles of prostaglandin E₂. J Oral Pathol Med 1998; 27: 23–9. © Munksgaard, 1998.
Irritations and injuries to the dental pulp usually lead to different degrees of pulpal inflammation. To investigate the roles of thrombin and prostaglandins in the healing and inflammatory processes of dental pulp as well as their effects on pulpal protein synthesis, human dental pulp cell cultures were established and their protein production was measured with or without the presence of exogenous thrombin and prostaglandins. At concentrations of 1–25 U/ml, a-thrombin increased the protein synthesis to 1.4–2.3 fold over the vehicle control. On the contrary, 0.1 (μg/ml of prostaglandin E] (PGE₁ suppressed protein synthesis by 60%. Prostaglandin E₂ (PGE₂) also inhibited protein synthesis with an IC50 of 0.4 ug/ml. The stimulatory effects of thrombin (10 U/ml) can be inhibited by antithrombin III (2 U/ml) (a natural thrombin inhibitor) with heparin (2 U/ml), PPACK (D-Phe-Pro-ArgCH₂Cl) (20–50 ug/ml) (a serine protease inhibitor), and PGE₂ (0.5–1.0 μg/ml). Moreover, TRAP (20–40 μg/ml), a thrombin receptor agonist peptide, also exerted a stimulatory effect (1.21–1.37 fold). In conclusion, thrombin-induced protein synthesis by pulp cells is dependent on proteolytic activity, but not on binding to receptors. Both PGE₁ and PGE₂ exert suppressive effects on protein synthesis, indicating that interactions between thrombin and prostaglandins are important in regulating the inflammation, repair and regeneration of pulp tissue following injury.     

Dental fear among population aged 30 years and older in Finland

OBJECTIVE: The aim of the study was to examine how the percentage of subjects reporting dental fear varied in accordance with age, gender, level of educational attainment, and marital status in a nationally representative sample of the adult population in Finland. MATERIAL AND METHODS: The two-stage stratified cluster sample (n=8028) represented the population aged 30 years or older living in Finland. Of this nationwide sample, 88% participated. Dental fear was measured with the question: "How afraid are you of visiting a dentist?" The reply alternatives were: "Not at all", "Somewhat", and "Very much". Age-specific multiple logistic regression analyses were used to explore the associations between dental fear and age, gender, marital status, and level of educational attainment. RESULTS: Overall prevalence of being somewhat or very afraid of visiting a dentist among adults in Finland was high (37%), particularly among 30 to 34-year-olds (47%). Among men and women of different ages, 5% to 19% were very afraid and 16% to 59% at least somewhat afraid of visiting a dentist. Female gender was the best determinant of dental fear. Those with higher educational attainment were about half as likely to be very much afraid of dentistry compared to those with secondary educational attainment. Among the youngest age group, non-singles were more likely to report being very much afraid of dentistry than single subjects. CONCLUSIONS: The fairly high prevalence of reported dental fear among adults, especially in the youngest age group, presents a challenge to dental personnel in Finland.     

Expectations of treatment and satisfaction with dentofacial appearance in orthodontic patients.

The aim of this study was to investigate correlations between satisfaction with dental and facial appearance and expectations of orthodontic treatment. The effects of sex and age on these variables were also explored. A sample of 154 patients who applied for orthodontic treatment at the Academic Centre of Dentistry Amsterdam, The Netherlands, completed 2 questionnaires, containing 16 items on satisfaction with facial appearance and 23 items on expectations of orthodontic treatment. First, the structure of the questionnaires was analyzed. Next, correlations between patients' expectations, satisfaction with facial appearance, age, and sex were examined. A multiple regression analysis was used to estimate the effect of the initial facial satisfaction on expectations of orthodontic treatment. Principal components analysis of the questionnaire about expectations showed 4 factors with an Eigenvalue greater than 1, accounting for 72% of the total variance. These were defined as "general well-being," "self-image/appearance," "future dental health," and "oral function." We found that "satisfaction with facial appearance" could be divided into 2 factors, each with an Eigenvalue greater than 1, accounting for 64% of the total variance. These were interpreted as "general facial appearance" and "dental appearance." Significant correlations were found between satisfaction with dental appearance and patients' expectations. These correlations were invariant over gender, but not over age. It was concluded that satisfaction with dental appearance is a significant predictor of orthodontic patients' expectations of treatment.     

Oral-health-related quality of life among children with and without dental fear

Objectives.  This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured.
Material and methods.  The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register ( n  = 51) and schoolchildren ( n  = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule–Dental Subscale and a single question. ORHQoL was measured with CPQ_11–14. Background variables were gender and the dental care experienced.
Results.  The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ_11–14 total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P  < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics.
Conclusion.  Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.     

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ and subjective oral impacts were measured using the 14‐item Oral Health Impact Profile (OHIP‐14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP‐14 items fairly often or very often, and the ‘extent’ and ‘severity’. Those with high dental fear reported higher levels of prevalence, ‘extent’, and ‘severity’ of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP‐14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.     

Dental fear of Finnish children in the light of different measures of dental fear

Objectives. The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the “peak value for dental fear” (PV), and “fear of dental treatment in general” (GF). Methods. The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. Results. The questionnaire was reliable. Two factors were revealed for each age: “treatment of dental decay” (TDD), which included fears related to invasive treatment, and “attending the dentist” (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. Conclusion. The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.     

Effectiveness of dental trauma education for elementary school staff

Abstract –  The purpose of this study was to assess the knowledge of elementary school staff members regarding the management of traumatic dental injuries (TDI) before and after an educational intervention aimed to increase TDI knowledge. Using a newly developed reliable survey instrument, we tested our elementary school staff participants about TDI before (time₀), immediately after (time₁), and three months after (time₂) the intervention. Schools were randomized into three groups: no intervention/control (C), pamphlets (P), and pamphlets + lecture (P + L). Outcomes of interest were TDI knowledge over time relative to the interventions vs controls. Statistical analysis involved a repeated measures linear model. At time₀, TDI knowledge was low among all three groups. At time₁, knowledge increased among all groups and is given by P > P+L > C. For time₂ vs time₁, the P + L group retained the knowledge while in both the C and P groups the knowledge level decreased. Between time₁ and time₂, significant differences were found between both intervention groups when compared with the control (P vs C and P + L vs C: both P  < 0.05). In summary, both P and P + L groups significantly improved TDI knowledge among elementary school staff, and this difference held up over time. These interventions have the potential to improve TDI management by elementary school staff when faced with such injuries.     

Dimensions of dietary and other health-related behaviors in a group of Danish adolescents

The relationship between dietary, dental health behaviors, and other health-related behaviors was studied using factor analysis. The study group comprised 234 8th graders from 11 schools in the municipality of Aarhus. A semi-structured interview included 12 items of health behavior (e.g. sugar intake, meal pattern, sports activities, sleeping habits, and consumption of alcohol, cigarettes, vitamin pills, candy, and milk). The analysis is based on the assumption that the 12 observed variables are determined by a reduced number of underlying but unobservable factors. Four dimensions of health behavior which explained 38.6% of the variance between the variables were produced. The four unrotated factors accounted for a varying proportion of the total variance (17.6%, 11.8%, 4.4%, 4.3%, respectively). Factor 1 was denoted "Sugar behavior", factor 2: "Regularity of dietary behavior", factor 3: "Problem behavior" and factor 4: "Spare-time activity". This could imply that the motives underlying sugar consumption are different from those of other health-related behaviors. The present behavioral pattern is consistent with that of other studies in which health behavior has been shown to be multidimensional.     

The relationship of age and gender to fear and anxiety in response to dental care

The apparent association in the published literature of gender and age with dental fear and anxiety is far from consistent or universal. A random, age-stratified telephone survey of 398 adults was performed in a US metropolitan area: Denver, Colorado. Information collected included Kleinknecht's Dental Fear Survey (DFS). In addition to total DFS scores, values were also calculated for the sums of the five DFS. physiologic response items (PATRESP) and 12 DFS fear-producing stimulus items (DENTSTIM). Tests for reliability of these three scales were performed (alpha = 0.804 to 0.936). In this sample population, significant age and gender differences were noted. In general, fear and anxiety decreased in importance with increased respondent age, with the largest difference noted between the 40–50 and 60–69 age groups. Increased fear and anxiety were most apparent among younger females (20–30 and 40–50) as compared with older females (60 and older). However, among males, the summary variable for physiologic response to fear and anxiety did not appear to be age-related. Among the oldest respondents (ages 70+), 12.2% did report a "major" response to muscle tension when in the dental chair. Females reported more fear of some stimuli associated with dental care (e.g., "feeling the drill in the mouth") than did males.     

Fracture toughness measurements of some dental core ceramics: a methodologic study

Abstract— Fracture toughness is regarded as an important property of dental ceramics. The most widely used methods for fracture toughness (K_Ic) determination are based on assessment of cracks created by hardness indentations. Different formulas have been developed for K_Ic calculations and all these methods and formulas include empirical factors based on pure ceramics, i.e. non-composite ceramics. These factors may, however, vary for a specified method for materials with different and complex structure. An important question is whether the various proposed methods and formulas lead to approximately the same numerical K_Ic values or at least to the same ranking of materials. The aim of this work was to compare two indentation methods and various formulas for calculation of K_Ic values when used on four commercial composite dental ceramics. The two applied methods and the different formulas showed substantial differences in the obtained values for one and the same material and a different ranking of various materials. It is unknown which method gives the most correct K_Ic values for these ceramic materials.     

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.     

Relation between sucking habits and dental characteristics in preschoolchildren with unilateral cross-bite

The relationship between sucking habits and dental characteristics of unilateral cross-bite in 4-yr-old children (n = 76) was studied. The cross-bites were classified on the variables "number of teeth involved", incisor "overjet" and "overbite", "terminal plane shift", "midline shift", "asymmetric maxillary dental arch" and "max./mand. arch width difference". Type of sucking habit (dummy, finger) and its duration and intensity were analyzed from a questionnaire answered by the parents. The "max./mand. arch width difference" in the canine region was found to be negatively related to the intensity and duration of the sucking habit, and also negatively related to sucking a dummy compared to finger sucking. The study indicates that the "duration" and "intensity" of the sucking habit have a negative influence by reducing the transverse width of the maxillary arch in children with a unilateral cross-bite. Dummy sucking was more detrimental to the transverse dimension in the canine region than finger sucking.     

The impact of childhood sexual abuse on dental fear

OBJECTIVE: Dental fear is a risk factor for poor oral health. Thus, treatment of dental fear is a challenge to dentists. The consequences of childhood sexual abuse (CSA) may include dental fear. A history of CSA complicates dental fear treatment, and it is often a secret. The aim of this study was to explore differences in subjective evaluations of use of dental services, experiences of dental treatment situations, dental appearance and dental problems in women who report both CSA and dental fear, and women who report dental fear only. METHODS: In an anonymous survey, 58 women with dental fear and a history of CSA were compared with 25 women with dental fear without CSA. Twenty-five women without dental fear acted as a control group. RESULTS: No differences between dental fear patients with and without a history of CSA were found in subjective evaluations of use of dental services, dental appearance and dental problems, or in the scores on the Dental Fear Scale (DFS). Women who reported a history of CSA and dental fear had statistically significant higher scores on the Dental Belief Scale (DBS). CONCLUSION: The results suggest that women who report dental fear and a history of CSA assess interpersonal factors concerning communication, trust, fear of negative information and lack of control as more fear evoking than women who report dental fear without a history of CSA.