Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study

OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.     

Changes in Prevalence Over Time and Determinants of Dental Care Visits Amongst Tennessee Seniors

IntroductionRates of dental visits of older adults in the United States, particularly in Tennessee, are rapidly increasing, coupled with the growing complexity of older adults’ dental treatment. Notably, increased dental visits help detect and treat dental disease and offer opportunities for preventive care. This longitudinal study aimed to examine the prevalence and determinants of dental care visits amongst Tennessee seniors.MethodsThis observational study combined multiple cross-sectional studies. Five even years of Behavioral Risk Factor Surveillance system data were used, including 2010, 2012, 2014, 2016, and 2018. Our data were limited to Tennessee seniors (60 years or older). Weighting was conducted to account for the complex sampling design. Logistic regression analysis was performed to determine the factors associated with dental clinic visits. A P value < .05 was considered statistically significant.ResultsThe current study comprised 5362 Tennessee seniors. Older individuals visiting dental clinics within 1 year gradually decreased from 76.5% in 2010 to 71.2% in 2018. The majority of participants were female (51.7%), White (81.3%), and located in Middle Tennessee (43.5%). Logistic regression showed that those more likely to visit dentists or dental clinics included females (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1–1.8), never-smokers and former smokers (OR, 2.2; 95% CI, 1.5–3.4), individuals with some college education (OR, 1.6; 95% CI, 1.1–2.4), college graduates (OR, 2.7; 95% CI, 1.8–4.1), and those with high incomes (eg, >$50,000; OR, 5.7; 95% CI, 3.7–8.7). Conversely, Black participants (OR, 0.6; 95% CI, 0.4–0.8), participants with fair/poor health (OR, 0.7; 95% CI, 0.5–0.8), and those who have never married (OR, 0.5; 95% CI, 0.3–0.8) were less likely to report dental visits.ConclusionsRates of Tennessee seniors visiting dental clinics within 1 year have gradually decreased from 76.5% in 2010 to 71.2% in 2018. Several factors were associated with seniors seeking dental treatment. Effective interventions to improve dental visits should take the identified factors into account.     

Are Oral Health Status and Care Associated with Anxiety and Depression? A Study of Portuguese Health Science Students

The relationship between oral health and anxiety/depression were assessed in a cross-sectional study conducted in 388 Portuguese students from the Health Sciences (age: 21 +/- 3 years, 75% women). Oral health included prevalence of reported tooth pain/gum bleeding, dentist attendance, and dentifrice and dental floss use. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Subjects with anxiety or depression had a higher frequency of perceived gum bleeding and reported a higher dentist attendance than normal subjects. On multivariate analysis, anxiety was significantly and independently related to perceived toothache (OR = 2.90, 95% CI: 1.25-6.72) and dentist attendance (OR = 2.15, 95% CI: 1.18 - 3.91) whereas depression was associated with perceived gum bleeding (OR = 4.96, 95% CI: 1.68 - 14.59), and no differences were found regarding teeth brushing or dental flossing. The author concludes that anxiety and depression are related to perceived toothache and gum bleeding, but this association cannot be explained by decreased dental care.     

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.     

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.     

Predicting anxiety during dental treatment using patients'self-reports: less is more

BACKGROUND: Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment. METHODS: One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales. RESULTS: Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment. CONCLUSIONS: Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.     

Relationship between children's first dental visit and their dental anxiety in the Veneto Region of Italy

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 tht first dental visit (no/yes), parental dental anxiety (none-some/fairly much-very much), number of previous visits (0-3/4 < or =) site visited (public/private) and age of the child (< 10 years/10 < or = 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.     

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.     

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.     

Treatment of dental anxiety disorders. Outcome related to DSM-IV diagnoses

In this study we evaluated treatment effects in 70 consecutively admitted patients in a specialized university clinic for treatment of dental fear. Thirty-three (47%) of the patients fulfilled the diagnostic criteria for Specific Phobia alone (Dental Phobia, DP), 24 (33%) had severe dental anxiety without fulfilling the criteria for phobia (ND), and 13 (19%) fulfilled the criteria for multiple DSM-IV diagnoses (MD). Dental anxiety was measured prior to, immediately after and at follow-up (mean = 19 months) using Corah's Dental Anxiety Scale and Dental Fear Survey. Dental attitudes were measured by Getz' Dental Beliefs Survey. Dental attendance and everyday functioning were measured by self-report. DP patients received significantly more treatment-sessions as compared to the ND group. Despite significant overall reductions in scores on all psychometric instruments from pretreatment to follow up, patients in the MD group reported significantly more severe anxiety at pre- and post-treatment and at follow-up as compared to patients in the ND group. There was no interaction between diagnostic group and assessment occasion (pre treatment, post treatment and follow up) on the self-reported anxiety. Patients reported significant improvements in self-esteem, social relations and everyday functioning, regardless of diagnostic group. Sixty-three percentage of the respondents had been to the dentist within 1 year after completed treatment. Patients treated by dentists who had received supervised training in exposure treatment had significantly more often seen the dentist at follow-up.     

Dental anxiety among survivors of childhood cancer: a cross-sectional study

Background.   Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures which are known to be risk factors for dental anxiety.
Aim.  The aim of this study was to examine the prevalence of dental anxiety among children who have survived cancer.
Design.  In a cross-sectional study, we examined 51 6- to 14-year-old children who had been treated for cancer at Aalborg Hospital, and 192 children without cancer. All children answered the Dental Subscale of the Children's Fear Survey Schedule. Dental anxiety was defined as a dental anxiety score exceeding the mean dental anxiety score + 1 standard deviation for the children without cancer.
Results.  Children with cancer did not have an increased prevalence of dental anxiety compared with children without cancer: the prevalence ratio was 0.41 [95% confidence interval (CI): 0.10–1.24]. The mean dental anxiety score was 23.1 (95% CI: 21.2–25.0) among children who had been treated for cancer, and 24.7 (95% CI: 23.4–26.0) among children without cancer (mean difference: 1.6; 95% CI: 1.1–4.3).
Conclusion.  Cancer and cancer treatment during childhood were not associated with an increased risk of dental anxiety in this population.     

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.     

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.     

Is there a relationship of negative oral health beliefs with dental fear and anxiety regarding diverse dental patient groups? A systematic review and meta-analysis

Objectives

This systematic review and meta-analysis aimed to critically appraise the evidence on the relationship of oral health beliefs with dental fear and anxiety in distinct patient groups.

Materials and methods

Observational studies were retrieved by Cochrane, Embase Search, Portal BVS, Clinical Trials, Ovid, Open Gray, PubMed, Scopus, and Web of Science, and they were manually checked for the inclusion of additional articles of interest. The assessment of quality of studies was performed by the application of three different versions of the Newcastle-Ottawa Scale, for cohort, case-control, and cross-sectional studies. Only studies with low or unclear/moderate risk of bias contributed to meta-analyses, regarding the analysis of random effects of mean differences of dental beliefs scores between dental fear/anxiety and control groups, and the correlation of dental beliefs with dental fear and anxiety measures.

Results

Of 276 articles initially retrieved, 10 were included in the systematic review, while only 6 studies with unclear/moderate risk of bias were considered in meta-analyses. The mean difference of dental beliefs effects was higher in patients with dental fear and anxiety compared to controls (1.20; 95% CI 0.27–2.14; P = 0.01). Additionally, a moderate positive correlation was observed between dental beliefs and dental fear measures (r = 0.54, 95% CI 0.47–0.60;P< 0.001).

Conclusions

Based on these results, the presence of negative health beliefs is directly related to the increase of dental fear and anxiety; however, these findings are supported in studies with unclear/moderate risk of bias.

Clinical relevance

Dental fear and anxiety is an important obstacle for the access of dental treatment and patient-dentist relationship, leading to inadequate oral health levels.

     

Hierarchizing caries risk factors among first-year university students in Nice (France): a cross-sectional study

Background

The purpose of this study was to rank the risk factors for dental caries among first-year university students in Nice (France).

Methods

All first-year students are required to undergo a compulsory preventive medical examination. Among these students, volunteers were offered a dental visit. Information was collected through an interview followed by an oral examination. We assessed the volunteers’ oral hygiene habits (daily toothbrushing frequency, type of toothbrush used, frequency of toothbrush replacement, place of toothpaste purchase, and flossing), daily health-related behaviors (number of main daily meals, daily sugary intakes, smoking, alcohol consumption, consumption of cannabis or other drugs), oral-health-related behaviors (self-reported oral health, dental visits during the past year, reason for the last dental consultation, and failure to seek dental care due to financial reasons), and oral health issues (dental crowding, oral hygiene, presence of caries, presence of pit and fissure sealant remnants). The dependent variable was the presence of at least one untreated carious lesion. The data were subjected to univariate analyses to select explanatory variables, and subsequently, a logistic regression was performed.

Results

Six hundred twenty-nine students aged 18.8±1.6 years were enrolled in this study. The sex ratio was 0.72, with a strong predominance of the female gender. Only 59.3% of the students had never experienced dental caries, while 22.4% had already undergone restorative procedures and did not have any carious lesion at the time of the examination, and 11.6% presented with carious lesions and had never been treated by a dentist. Lastly, 6.7% had carious lesions despite evidence of prior restorative procedures. The multivariate analysis revealed the following pejorative risk factors: failure to seek dental care due to financial reasons (OR:3.06, 95% CI: 1.40–6.70), poor oral hygiene revealed during the oral examination (OR:2.59, 95% CI: 1.60–4.20), and poor self-reported oral health (OR:2.43, 95% CI: 1.24–4.77). Conversely, the analysis revealed the following protective factors: preventive visits to the dentist (OR:0.63, 95% CI: 0.41–0.99), the use of an electric toothbrush (OR:0.36, 95% CI: 0.17–0.77), and sealant remnants (OR:0.22, 95% CI: 0.05–0.97).

Conclusions

The highest-ranking caries risk factor for the study population was the financial barrier.

     

Clinical, social and psychosocial factors associated with self-rated oral health in Brazilian adolescents

OBJECTIVE: The objective of this study is to investigate the main social, psychosocial and clinical factors associated with poor self-rated oral health in adolescents. METHODS: A cross-sectional survey was carried out in two cities of the Distrito Federal, Brazil. Data were collected by clinical examinations and by self-administered questionnaires from 1302 adolescents aged 14- 15 years in 39 schools. Data analysis was carried out using a Poisson regression model taking into account the cluster sample. RESULTS: Adjusting for social, psychosocial and clinical factors, results showed that poor self-rated oral health was significantly associated (P < 0.001) with sex (males) [prevalence ratio (PR) = 0.8, 95% confidence interval (95% CI): 0.7-0.9]; low social class (PR =1.4, 95% CI: 1.2-1.6); poor self-rated general health (PR = 2.6, 95% CI: 2.3-3.1); mouth appearance (PR = 1.9, 95% CI: 1.6-2.2) and with presence of untreated dental decay (PR = 1.4, 95% CI: 1.3-1.6). CONCLUSIONS: The single question on self-rated oral health appears to be a simple and easy way to collect dental health information in adolescents. Assessment and understanding of self-rated oral health should take into account social, psychosocial and oral factors.     

Dental fear among a young adult Saudian population

AIMS: To assess the prevalence of dental fear and reasons for irregular dental attendance among young adult university students; to describe the gender distribution of the dentally anxious population according to the perceived origins or sources of fear; to identify the time of fear development and preference for anaesthesia or sedation before dental treatment. METHOD: A questionnaire incorporating the Dental Fear Scale (DFS) with items related to sources of dental fear stimuli, together with the preference of anaesthesia or sedation before dental treatment and other characteristics. Approximately 500 questionnaires were distributed among Saudian undergraduate students. RESULTS: 368 questionnaires were completed and presented for statistical analysis. The sight and sensation of anaesthetic needles and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. Also, females tended to be more anxious than males. Increased heart rate was the most common reported physiological response to fear resulting from dental treatment. The overall level of fear of dental work among the studied population was found to be about 39%.'Lack of time' and 'no need for treatment' were found to be the main reasons for irregular dental visits. Fear of pain and trauma were the major perceived sources of reported fear reactions and were developed mainly during childhood. About 63% of the subjects preferred to have local anaesthesia before dental treatment to prevent or ameliorate dental fear.     

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.