Editorial: Immunological tolerance: the good,the bad,and the ugly

The aim of this study was to explore the association between negative experiences during children's first dental visit and any subsequent dental anxiety and related factors in three dental clinics in the Veneto Region of Italy. For this purpose, parents of 378 children filled out a questionnaire. Factors related to child dental anxiety (none-some/fairly much-very much) were explored by means of logistic regression analysis. The independent variables were: problems with the first dental visit (no/yes), parental dental anxiety (none-some/fairly much-very much), number of previous visits (0-3/4 &;#104 ), site visited (public/private) and age of the child (<10 years/10 &;#104 years). Parental anxiety was associated with child's anxiety (OR = 2.3, 95% CI = 1.1-4.9). A problematic first visit was a strong predictor of dental anxiety. However, this effect was modified by the number of subsequent visits. Children with 4 or more visits after the first visit were less likely to be anxious after a problematic first visit (OR = 4.6, 95% CI = 1.5-14.1) than children with 3 visits or less after the first visit (OR = 19.8, 95% CI = 7.2-54.5). Thus, the negative effect of a problematic first visit may fade during subsequent dental visits.     

An evaluation of the PALS after treatment modelling intervention to reduce dental anxiety in child dental patients

Aim.  The aim of this study was to assess the effectiveness of the passivity to activity through live symbolic (PALS) after treatment modelling intervention to reduce child dental anxiety.
Methods.  A convenience sample of consecutive 5- to 10-year-old dental patients were randomly assigned to intervention or control groups. Self-reported child dental anxiety was assessed at the start of each visit. At the end of each visit, children in the intervention group were introduced to a glove puppet, which acted as the PALS model. The intervention group children re-enacted the treatment they had just received on the puppet's teeth. At the end of each visit, the control children received motivational rewards only. The change in dental anxiety scores was examined by t -tests and analysis of covariance.
Results.  The final analysis included 27 intervention children and 26 control children. For the intervention group, there were no statistically significant changes in dental anxiety over a course of treatment, between first and second preventive visits, between first and second invasive treatment visits, or between first attendance and subsequent recall attendance. For the control group, a statistically significant decrease in dental anxiety was observed between the first and second invasive dental treatment visits.
Conclusion.  The PALS after treatment modelling intervention was ineffective in reducing child dental anxiety.     

The effect of virtual reality during dental treatment on child anxiety and behavior

Virtual reality, a three-dimensional computer generated world, has been shown to relax adults during dental treatment. The purpose of this study was to investigate the effect of virtual reality on the behavior and anxiety of children during dental treatment. The behavior, anxiety and heart rate of twenty-six children, ages five to seven years were evaluated for the first five minutes of two restorative treatment visits. Thirteen children viewed virtual reality at their first restorative visit and not the second, and thirteen children viewed virtual reality at the second restorative visit and not the first. Before and immediately following the restorative visits, each child was instructed to draw a human figure. The restorative appointments were video recorded and heart rate monitored. The drawings and videotapes were rated independently by two examiners. The Koppitz method of evaluating drawings was used to measure anxiety. The Frankl behavior rating scale was used to evaluate behavior. Differences (ANOVA) in behavior (p < or = 0.50) and anxiety (p < or = 0.65) were not significant. The overall pulse rate was significantly lower (ANOVA p < or = 0.001) when the child was wearing glasses and viewing virtual reality. In conclusion, virtual reality during dental treatment had no significant effect on the behavior or anxiety but significantly reduced the pulse.     

Children's use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children's quality of life

OBJECTIVES?: The purpose of the study was to investigate the influence of a child's clinical condition; maternal characteristics such as dental anxiety and dental visit pattern; socioeconomic conditions; and maternal perception of the child's oral health-related quality of life (OHRQoL) on a child's use of dental care services. METHODS?: A cross-sectional study of 608 mother-child dyads was conducted during the Children's Immunization Campaign in Pelotas, Brazil. Mothers answered a questionnaire regarding their use of dental services, dental anxiety (Dental Anxiety Scale), socioeconomic status, and perception of their children's OHRQoL (the Early Childhood Oral Health Impact Scale). Clinical examination of the children was performed to assess dental caries (dmf-t). Associations between the above-mentioned factors and child use of dental services were assessed using Poisson regression models (prevalence ratio [PR]; 95% CI; P?≤?0.05). RESULTS?: The majority of children (79.3%) had never had a dental appointment and of the children who had visited a dentist, 55 (43.65%) presented with untreated dental caries at the time of examination. More than half the mothers (60.2%) did not visit a dentist regularly. In the final model, low schooling level of mothers (PR, 0.64) and irregular visits to a dentist by the mother (PR, 0.48) were factors because of which a child did not have a dental appointment. Children who had experienced pain (PR, 1.56), those who had poor OHRQoL (PR, 1.49), and older children (PR, 2.14) visited a dentist with higher frequency. CONCLUSIONS?: Use of dental care services by preschool children was low, and treatment was neglected even among children who had visited a dentist. Children of mothers with low schooling level who do not visit a dentist regularly were at greater risk of not receiving dental care. Maternal perception of their child's oral health motivated visits to the dentist.     

The relationship between anxiety and dental treatment experience in 5-year-old children

OBJECTIVES: To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. METHODS: A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance experience, past extraction and restoration history were using chi-square and t-tests. Multiple logistic regression analyses identify predictors for dental anxiety. RESULTS: A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8b) judged their child to be dentally anxious. Anxious children had significantly (p<0.001] more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% Cl 2.22, 5.00), have anxious parents (OR 1.60,95% Cl 1.09, 2.36), and to have undergone dental extraction in the past[OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socio-economic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors. CONCLUSIONS: Dental anxiety is a fairly common condition in 5-year-old children in the North West of England. It is closely associated with asymptomatic, irregular attendance pattern, a history of extraction and having a dentally anxious parent. The cause and effect dynamics of these relationships need to be determined.     

Children's dental anxiety: influence of personality and intelligence factors

Forty children (20 boys and 20 girls) aged 8-16 years with no previous experience of dental visits were included in the study. Three psychological variables were determined: anxiety (State-Trait Anxiety Inventory of Children), personality (Eysenck Personality Questionnaire-Junior) and intelligence (Wechsler Intelligence Scale for Children). The relationship between personality and intelligence factors and the levels of anxiety at the beginning of the first dental visit (before treatment) and at the end of the third visit (after treatment) were determined. There was no significant relationship between levels of dental anxiety and age. Dental anxiety both before and after treatment was higher among the girls than among the boys. Children with high intelligence quotients showed less dental anxiety at their first dental visit. There was no relationship between the children's anxiety and their own personality variables.     

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).     

干预治疗下牙科畏惧症患儿就诊次数与其畏惧程度的相关性

目的探讨在口腔专业医护人员干预治疗下,牙科畏惧症患儿就诊次数与其畏惧程度的相关性。方法选取因牙髓炎诊治,具有明显牙科畏惧症的患儿23例;用摄像机将其每次就诊过程拍摄下来。根据Frankl量表,由同一名对治疗过程和就诊次数不知情的观察员根据录像对患儿每次就诊情况进行畏惧程度评估,间隔1周以上再次评估。比较患儿畏惧程度随就诊次数的变化。结果剔除丢失病例,最后纳入研究的患儿18例,2次评估初诊Frankl量表得分平均秩和分别为13.58、14.00,第1次复诊分别为26.44、26.33,第2次复诊分别为42.47和42.17,比较3次就诊的畏惧程度,无论是第1次评估(χ2=33.828,P=0.000)还是第2次评估(χ2=31.838,P=0.000),差异均具有统计学意义。牙科畏惧症患儿畏惧程度随就诊次数而降低,呈负相关。结论有牙科畏惧症的牙髓炎患儿通过多次就诊,增加患儿对牙科就诊的无痛体验和对常用牙科器械的熟悉,可降低其畏惧程度。     

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).     

Parental attitudes to the care of the carious primary dentition

OBJECTIVES: To examine parents' attitudes to the dental care of their children, taking into account the family's socio-economic background, dentally-related behaviour including the child's level of dental anxiety and dental treatment history. METHODS: A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined; dmft and its components were recorded. A postal questionnaire was sent to the children's parents to measure their preferences for dental care with reference to two scenarios, (1) if their child had a carious but asymptomatic primary tooth, or (2) if their child had a carious primary tooth which was causing toothache. Parents were also asked to provide information on the dental attendance pattern of their child and an assessment of their child's dental anxiety. Family socio-economic status was recorded using the Townsend material deprivation index of the electoral ward in which they resided. RESULTS: Questionnaires were distributed to the home addresses of the 1,745 children who were clinically examined, and 1,437 were returned, giving a response rate of 82%. In both scenarios the majority of parents were happy to leave the decision on treatment to the dentist. In the asymptomatic tooth scenario, approximately one third of parents wanted the tooth to remain untreated but periodically monitored, only 6% expressed a desire to have their child's tooth restored. Multivariate analysis showed that parents of children who had a filling (OR 4.32 95%CI 2.21-8.43) or extraction (OR 2.24 95%CI 1.11-4.53) in the past were significantly more likely to want restorative care for their children. In the scenario where the child had toothache, multivariate analysis confirmed that parents had a preference for an intervention (extraction or filling) if they lived in a deprived area (Townsend score OR 1.10, 95% CI 1.04, 1.16) or if their child had had an extraction (OR 4.35, 95% CI 1.59, 11.88) or filling (OR 2.39, 95% CI 1.05, 5.45) in the past, after controlling for gender, attendance and parentally reported anxiety. When preference for an extraction was considered as the dependent variable, there was no significant relationship with past restorative treatment. In both scenarios there was no association between parentally reported anxiety of the child and parental preferences for treatment. CONCLUSIONS: In this part of the UK, there was little explicit support amongst parents for the restoration of asymptomatic carious primary teeth. Parental expectations for the dental care of young children with caries in their primary teeth, were closely related to the treatment experiences of the child. Families living in deprived areas expressed a preference for more interventionist care than their more affluent counterparts. Parentally judged anxiety of the child or their past dental attendance behaviour had no association with parents' preferences for the care of their children.     

综合医院牙科门诊老年患者焦虑症及影响因素研究

目的：了解牙科门诊老年患者焦虑症流行情况及影响因素,为临床防治牙科焦虑症提供科学依据.方法：2012年2月-2013年2月,利用自制牙科焦虑症相关因素调查问卷和改良牙科焦虑量表（MDAS）,对352例牙科门诊老年患者进行问卷调查.对患者焦虑水平进行评分,并对其影响因素进行多因素logistic回归分析.结果：352例患者中,焦虑症的现患率为56.3％.多因素logistic回归分析结果显示,性别（OR--0.23,95％CI=0.18 ～ 1.07; P=0.0115）、既往躯体创伤史（OR=2.87,95％CI=2.85 ～4.00; P=0.0306）和是否初次就诊（OR =6.69,95％CI=5.03～ 7.64; P＜0.0001）与焦虑症的关系有统计学意义.结论：牙科焦虑症报告率较高,有必要通过针对性的干预措施来有效降低牙科焦虑症的发生及焦虑水平,以提高牙科诊治效果.     

Disparities in dental health issues and oral health care visits in US children with tobacco smoke exposure

BackgroundThe objective of the authors was to assess the relationships between tobacco smoke exposure (TSE) and dental health and dental care visits among US children.MethodsThe authors examined 2018-2019 National Survey of Children’s Health data on TSE, dental health, and oral health care visits. Children aged 1 through 11 years (N = 32,214) were categorized into TSE groups: no home TSE (did not live with a smoker), thirdhand smoke (THS) exposure (lived with a smoker who did not smoke inside the home), or secondhand smoke (SHS) and THS exposure (lived with a smoker who smoked inside the home). The authors conducted multivariable logistic regression analyses, adjusting for child age, sex, race or ethnicity, prematurity, caregiver education level, family structure, and federal poverty threshold.ResultsChildren with home SHS and THS exposure were at increased odds of having frequent or chronic difficulty with 1 or more oral health problem (adjusted odds ratio [AOR], 1.59; 95% CI, 1.07 to 2.35; P = .022) and carious teeth or caries (AOR, 1.74; 95% CI 1.14 to 2.65; P = .010) than those with no TSE. Compared with children aged 1 through 11 years with no TSE, children with SHS and THS exposure were 2.22 times (95% CI, 1.01 to 4.87; P = .048) more likely to have not received needed oral health care but at decreased odds of having had any kind of oral health care visit (AOR, 0.55; 95% CI, 0.32 to 0.95; P = .032), including a preventive oral health care visit (AOR, 0.60; 95% CI, 0.36 to 0.99; P = .047).ConclusionsTSE in children is associated with caries and inadequate oral health care visits.Practical ImplicationsThe pediatric dental visit is an opportune time to educate caregivers who smoke about dental health to improve their children’s teeth condition and increase oral health care visits.     

就诊时机与儿童初诊牙科焦虑的相关性分析

目的 分析初次就诊患儿牙科焦虑程度转变与就诊时机的相关性.方法 选取月龄在45~74个月(3.7~6.2岁),乳磨牙龋类疾病的初次就诊儿童,分为急性期组、非急性期组、常规检查组.利用改良儿童牙科焦虑面部表情量表(face version of the modified child dental anxiety scale,MCDASf)评估其就诊前、就诊后焦虑程度的改变.结果 3组患儿与初诊焦虑具有相关性,差异有统计学意义(x2=9.132,P=0.010).3组相关性差异两两比较,急性期组就诊患儿与非急性期组患儿差异有统计学意义(x2=8.478,P<0.0125).治疗前后患儿牙科焦虑程度转变情况与性别没有相关性(P>0.05).结论 在不同就诊时机,儿童牙科焦虑产生与转变的敏感性有所不同,采取相应的治疗及行为管理措施可以有效管控牙科焦虑.     

What is the function of psychosocial factors in predicting length of time since last dental visit? A secondary data analysis

Aim: To conduct a secondary analysis of the Adult Dental Health Survey, UK (ADHS.UK) data to investigate the function of psychosocial factors (costs, dental anxiety, communication) and whether their interaction mediates the relationship between perception of need and length of time since last dental visit. Materials and methods: The data used from the ADHS.UK interview questionnaires included demography, costs, perception of treatment need, communication, dental anxiety and reported dental attendance. The data were subjected to χ²‐analysis and hierarchical logistic regression analysis. Results: Time since last dental visit was significantly associated with all demographic and psychosocial variables. The hierarchical logistic regression analysis tested three models. Model 1 examined the demography and explained 2% of the variance. Model 2 showed that those in intermediate (e.g. clerical staff) and routine (e.g. agriculture workers) occupations and those who were unemployed/never worked had a greater likelihood of increased interval between dental visits, explaining an additional 2% of the variance of the time interval between dental visits. Model 3 provided an additional 10% of the variance, which included costs, perceived need, communication and dental anxiety. The interaction of the perception of need by extreme dental anxiety (OR = 0.52; 95% CI: 0.40, 0.69) improved the fit of the model [χ² (df1) = 22.85, P < 0.001]. Conclusion: This study revealed that dental anxiety, communication and treatment costs acted as barriers to accessing dental care. Dental anxiety acted as a mediator in the relationship between perception of need and increased time interval between dental visits.     

Parental perception of oral health status of children in mainstream and special education classrooms

The aim of this study was to compare parental perceptions of oral health status and access to dental services by children in 34 special education and 16 mainstream public elementary school classes in San Mateo County, California. A self-administered parental survey was utilized and included questions about demographics, oral health, and dental utilization. The overall response rate was 58.8%. After adjusting for age and gender of the child, compared to mainstream, parents of students in special education classes were significantly more likely to report their children to have worse oral health (OR = 2.4, 95% CI 1.54, 3.67), be lacking a past year dental visit (OR = 1.96, 95% CI 1.01, 3.84), and have missed school days due to dental reasons (OR = 2.5, 95% CI 1.55, 4.17). Both groups rated their children's oral health inferior to the overall health rating ( p < .001). The authors concluded that disparities exist between the two groups in parental perceptions of their children's oral health status and dental service utilization.     

Videotape modeling of the child dental patient.

One week before their first dental visit, 36- to 60-month-old children were shown a videotape to model their behavior in the dental situation. The behavior was then rated for three visits. The children who had been modeled did not behave significantly better than either children who had no previous contact with the dental setting or children who had visited the reception room one week before their first dental visit.     

Determinants of dental referral practices among WIC nutritionists in North Carolina

OBJECTIVES: To examine the effects of knowledge and confidence on dental referral practices among WIC nutritionists in North Carolina. METHODS: A questionnaire consisting of 118 Likert scale-type questions was administered to 92% of all WIC nutritionists in North Carolina (n = 324). The relationship of knowledge and confidence with frequent dental referrals was tested using logistic regression. RESULTS: Regression results found that confidence in performing oral health risk assessments (OR = 2.12; 95% CI = 1.13, 3.96), confidence in making dental referrals (OR = 3.02; 95% CI = 1.45-6.29), and confidence in expected outcomes that parents would seek dental care when advised to do so (OR = 3.11; 95% CI = 1.62, 5.97) were associated with more frequent dental referrals. CONCLUSIONS: The more confident WIC nutritionists feel about oral health, the more likely they are to make dental referrals. Screening and referral by WIC workers may benefit children by improving access to dental care, as the WIC clinic is frequently the first point of contact with a health professional.