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Albagli A, Rath E, Druckmann I, Efrima B, Kazum E, Parnes N, Sandler AB, Tyler J, Amar E. Pre-injection local anesthesia does not affect experienced pain in intra-articular hip injections. World J Orthop 2025; 16:101197. [PMID: 40027959 PMCID: PMC11866109 DOI: 10.5312/wjo.v16.i2.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 01/02/2025] [Accepted: 01/17/2025] [Indexed: 02/12/2025] Open
Abstract
BACKGROUND Intra-articular hip injections (IAHIs) are commonly used for diagnostic and therapeutic purposes but are often associated with patient anxiety and fear. The disparity between anticipated and experienced pain during IAHIs and the role of pre-injection local anesthesia in pain modulation remains unclear. AIM To investigate the difference between anticipated and experienced pain during IAHIs and the impact of pre-injection local anesthesia. METHODS This prospective study enrolled 60 patients undergoing IAHI, 30 receiving pre-injection superficial local anesthesia and 30 serving as a control group without pre-injection local anesthesia. Pain levels were assessed using numeric rating scales. RESULTS Patients significantly overestimated anticipated pain compared to experienced pain (6.43 ± 2.48 vs 3.68 ± 2.37, P < 0.001). Pre-injection local anesthesia did not significantly reduce experienced pain (3.19 ± 2.38 vs 4.20 ± 2.29, P = 0.130). CONCLUSION Patients overestimate anticipated pain during IAHIs. Pre-injection local anesthesia does not reduce experienced pain.
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Affiliation(s)
- Assaf Albagli
- Department of Orthopedic, Tel Aviv Medical Center, Tel Aviv-Yafo 6801298, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopedic, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Ido Druckmann
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv-Yafo 6801298, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo 6801298, Tel Aviv, Israel
| | - Ben Efrima
- Department of Orthopedic, Tel Aviv Medical Center, Tel Aviv-Yafo 6801298, Tel Aviv, Israel
| | - Efi Kazum
- Department of Orthopedic, Tel Aviv Medical Center, Tel Aviv-Yafo 6801298, Tel Aviv, Israel
| | - Nata Parnes
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
| | - Alexis B Sandler
- Department of Orthopedic Surgery, Texas Tech University Health Sciences-El Paso, El Paso, TX 79905, United States
| | - John Tyler
- Department of Orthopedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
- Department of Orthopedic Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, United States
| | - Eyal Amar
- Department of Orthopedic, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
- Department of Orthopedic, Tel Aviv University, Tel Aviv 62308, Israel
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Saxena B, Goswami M, Saxena A, Padha S, Sharma A, Garg Y, Singhal P. Auxillary aids for pain and anxiety reduction during dental local anesthesia in pediatric patients: a systematic review. Evid Based Dent 2025:10.1038/s41432-024-01094-4. [PMID: 39775158 DOI: 10.1038/s41432-024-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/18/2024] [Indexed: 01/11/2025]
Abstract
AIMS/OBJECTIVES This systematic review aimed to evaluate the effectiveness of auxiliary aids-Transcutaneous Electrical Nerve Stimulation (TENS), vibrotactile devices, and Low-Level Laser Therapy (LLLT) in reducing pain and anxiety during dental local anesthesia in pediatric patients. METHODS The review followed PRISMA guidelines, employing a comprehensive search strategy across multiple databases (PubMed, Cochrane, EBSCO, LILACS, Google Scholar, and Embase) from 2014 to July 2024. Eligibility criteria were based on the PICOS framework, focusing on randomized clinical trials and clinical studies involving pediatric patients undergoing dental procedures with local anesthesia. The interventions included TENS, vibrotactile devices, or LLLT. Pain and anxiety were assessed using validated scales such as the Wong-Baker Faces Pain Rating Scale and physiological measures like heart rate. RESULTS Nineteen studies with a total of 1094 pediatric patients aged 4-12 were included. TENS and vibrotactile devices consistently showed significant reductions in pain and anxiety compared to standard methods. LLLT results were more variable, with some studies reporting significant pain reduction while others showed no significant difference. Meta-analysis was not possible due to heterogeneity among the studies. Overall, TENS and vibrotactile devices were more effective in alleviating injection-related pain, especially when combined with cold applications or topical anesthetics. DISCUSSION The findings highlight the potential of these auxillary aids as non-invasive and effective adjuncts for reducing pain and anxiety in pediatric dental procedures. LLLT showed mixed outcomes, likely due to variability in application protocols, suggesting a need for standardized methods. While all interventions demonstrated promise, inconsistencies in study designs and subjective measures limit the generalizability of the results. CONCLUSIONS TENS and vibrotactile devices are effective auxiliary aids for reducing pain and anxiety during dental local anesthesia in children. Further research is required to optimize LLLT protocols and standardize intervention applications to achieve consistent results across studies.
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Affiliation(s)
- Bhawna Saxena
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India.
| | - Mousumi Goswami
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Aditya Saxena
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Sanjesh Padha
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Ananya Sharma
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Yashika Garg
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Prachi Singhal
- Department of Paediatric and Preventive Dentistry I.T.S Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
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Ye G, Ying Y, Shen B, Liu J, Lu J. Effect of intraoral photobiomodulation therapy on pain perception associated with local anaesthesia infiltration: a systematic review and meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2025; 54:82-92. [PMID: 39438196 DOI: 10.1016/j.ijom.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 10/04/2024] [Accepted: 10/08/2024] [Indexed: 10/25/2024]
Abstract
Local anaesthetic injections, commonly used in dentistry and oral surgery, often cause discomfort. This review aimed to examine the impact of intraoral photobiomodulation therapy (PBMT) on pain associated with local anaesthesia. Up to March 2024, two independent reviewers searched four databases, ultimately screening 17 randomized controlled trials for meta-analysis using Stata 17.0. The results indicate that intraoral PBMT application significantly reduces the perception of pain associated with local anaesthetic injections (standardized mean difference (SMD) -0.89, 95% confidence interval (CI) -1.27 to -0.52; P < 0.001). This analgesic effect remained consistent irrespective of concurrent topical anaesthetics, and PBMT was efficacious in paediatric (SMD -0.53, 95% CI -0.89 to -0.17; P = 0.004) and adult (SMD -1.46, 95% CI -2.32 to -0.61; P = 0.001) populations. Subgroup analysis provided very low to low-quality evidence that using a wavelength between 900 nm and 980 nm (SMD -0.87, 95% CI -1.36 to -0.39; P < 0.001) and an irradiation time of 13-40 s (SMD -0.94, 95% CI -1.35 to -0.53; P < 0.001) are associated with significant pain reduction. The use of PBMT could aid in reducing pain perception for patients during dental injections, encouraging earlier presentation for dental consultations.
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Affiliation(s)
- G Ye
- Department of Pain Medicine, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - Y Ying
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China.
| | - B Shen
- Nursing Department, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - J Liu
- Department of Radiotherapy, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - J Lu
- Department of Anaesthesiology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
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Kalladka M, Markman S, Raman KR, Mansdorf A. Psychological Factors Determining Prognosis of Dental Treatments. Dent Clin North Am 2024; 68:739-750. [PMID: 39244254 DOI: 10.1016/j.cden.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Many psychological factors may have a significant bearing on an individual's oral health and success of dental treatments. Overall, these factors may result in the avoidance of dental visits, emergency-based dental appointments, noncompliant dental behavior, the utilization of multiple oral health care providers, and poor oral health. These factors may affect the quality of life of individuals and may lead to patient dissatisfaction, poor prognosis, and failure of dental treatment. Multiple psychological factors may affect the dentist and the patient. Those factors may alter the prognosis for successful dental treatment. Physician empathy is fundamental in developing long-term physician-patient trust.
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Affiliation(s)
- Mythili Kalladka
- Diplomate American Board of Orofacial Pain, Eastman Institute for Oral Health, 625 Elmwood Avenue, Rochester, NY 14642, USA.
| | - Stanley Markman
- Orofacial Pain, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07103, USA
| | - Kartik R Raman
- CSMSS Dental College Aurangabad, Plot No. G48, Sector N4, CIDCO, Aurangabad, Maharashtra 431003, India
| | - Asher Mansdorf
- Board Certified Orofacial Pain, Board Certified Dental Anesthesia, Touro College of Dental Medicine, 858 Bryant Street, Woodmere, NY 11598, USA
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Narimany R, Faghihian R, Jafarzadeh Samani M. Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children. Int J Dent 2024; 2024:5515522. [PMID: 39268175 PMCID: PMC11392579 DOI: 10.1155/2024/5515522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/22/2024] [Accepted: 08/06/2024] [Indexed: 09/15/2024] Open
Abstract
Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.
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Affiliation(s)
- Reyhane Narimany
- School of Dentistry Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reyhaneh Faghihian
- Dental Research Center Department of Pediatric Dentistry Dental Research Institute Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Jafarzadeh Samani
- Dental Research Center Department of Pediatric Dentistry Dental Research Institute Isfahan University of Medical Sciences, Isfahan, Iran
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Taqi M, Zaidi SJA, Javaid J, Alam Z, Saleem A, Khan SA. Patient perceptions and experiences of dental fear of different dental specialties: a mixed-method study. BMC Oral Health 2023; 23:884. [PMID: 37981667 PMCID: PMC10659037 DOI: 10.1186/s12903-023-03626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE The primary objective of this study was to validate an Urdu translation of Kleinknecht's Dental Fear Survey (DFS) for use in Pakistan and to explore which items contribute the most to the variance in dental fear scores based on patient perceptions and lived experiences during dental care. METHODOLOGY This mixed-method study was conducted at Dow Dental Hospital from February 2022 to June 2022. For quantitative analysis, a total of 273 participants were enrolled through convenience sampling. After obtaining signed consent, participants were asked to self-report their dental fear. In-depth interviews with 25 patients displaying moderate to high dental fear were conducted to clarify the elements of dental fear scores through the lens of individual perceptions and experiences. RESULTS The prevalence of moderate dental fear was significantly higher among female participants than males. The mean dental fear score was higher among females (39.47 ± 14.23) as compared to males (30.83 ± 10.50). Most of the female participants reported an increase in breathing rate and heartbeat during dental treatment. The highest mean fear score was reported by participants who underwent oral surgical treatment (42.98 ± 14.21), followed by participants who received restorative care (36.20 ± 12.60). Approaching the dentist's office was the significant factor that contributed the most to the variance in dental fear scores. Four themes were generated through the content analysis of the interviews: physical reactions to dental procedures, perceptions and fears about surgical and restorative procedures, and gender and environmental factors in dental fear and interaction with dentists. CONCLUSION The Urdu translation of DFS is a reliable and valid instrument for assessing dental fears in Pakistan based on the findings of this study. Patients perceive surgical and restorative procedures as unpleasant and threatening. It was noted that "the heart beats faster" and "the breathing rate increases." were the top two physiological responses.
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Affiliation(s)
- Muhammad Taqi
- Department of Community Dentistry, Dow Dental College, Dow University of health sciences Karachi, Karachi, Pakistan
| | - Syed Jaffar Abbas Zaidi
- Department of Oral Biology, Dow Dental College, Dow University of health sciences Karachi, Karachi, Sindh 74200, Pakistan.
| | - Javaria Javaid
- Department of Community Dentistry, Dow Dental College, Dow University of health sciences Karachi, Karachi, Pakistan
| | - Zainab Alam
- Department of Community Dentistry, Dow Dental College, Dow University of health sciences Karachi, Karachi, Pakistan
| | - Aimen Saleem
- Department of Community Dentistry, Dow Dental College, Dow University of health sciences Karachi, Karachi, Pakistan
| | - Sadia Asghar Khan
- Department of Community Dentistry, Dow Dental College, Dow University of health sciences Karachi, Karachi, Pakistan
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Yan X, Yan Y, Cao M, Xie W, O'Connor S, Lee JJ, Ho MH. Effectiveness of virtual reality distraction interventions to reduce dental anxiety in paediatric patients: A systematic review and meta-analysis. J Dent 2023; 132:104455. [PMID: 36842625 DOI: 10.1016/j.jdent.2023.104455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVES To analyse the effectiveness of virtual reality (VR) distraction intervention for the management of dental anxiety in paediatric patients. DATA Randomised controlled trials (RCTs) of VR distraction interventions for reducing anxiety in paediatric patients, published in English were included. SOURCES Seven databases, including PubMed, Web of Science, Scopus, MEDLINE via ProQuest, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials, covering the period between January 2000 and September 2022 were searched. STUDY SELECTION A total of 12 RCTs involving 818 participants were included. Quality appraisal was undertaken using the Cochrane risk-of-bias tool for randomised trials by two authors independently. Random-effects model was used to summarise the effects of the interventions and pool data. CONCLUSIONS Results showed that VR distraction interventions were effective in reducing the dental anxiety of paediatric patients. In meta-analysis, the VR distraction interventions had a significant effect on reducing paediatric patients' anxiety (SMD = -1.74, 95%CI = -2.46, -1.02, p < 0.001, I² = 95%), pain (SMD = -1.57, 95%CI = -2.22, -0.91, p < 0.001, I² = 91%) and heart rate (MD = -10.54, 95%CI = -20.26, -0.81, p = 0.03, I² = 99%) during dental treatment. However, the evidence of VR in managing dental anxiety would become weak because of the publication bias. CLINICAL SIGNIFICANCE VR distraction interventions could be an effective approach to alleviate the dental anxiety of paediatric patients. Additional well-designed and high-quality RCTs with larger sample sizes are needed to determine the optimal way to deliver VR interventions in paediatric dental clinics.
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Affiliation(s)
- Xinyi Yan
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China
| | - Yongyang Yan
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China
| | - Mengyao Cao
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China
| | - Wenxuan Xie
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China
| | - Siobhán O'Connor
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China.
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, 3 Sassoon Road, Hong Kong, China
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Mobin T, Khan TZ, Mobin A, Tahir MR, Imran Q, Gardezi SAM, Waqar R, Hanif M, Mohamed Jiffry MZ, Ahmed-Khan MA. Evaluating Dental Fear and Anxiety in Pediatric Patients Visiting a Private and a Public Dental Hospital in Lahore, Pakistan. Cureus 2023; 15:e35243. [PMID: 36968883 PMCID: PMC10034220 DOI: 10.7759/cureus.35243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Background One of the biggest hurdles in treating pediatric patients is managing dental fear and anxiety. Some factors that contribute to an increase in dental anxiety are fear of pain, the presence of unknown individuals, a change in the setting of an environment, and separation from parents. Aim The aim of this study was to evaluate dental fear and anxiety in pediatric patients, between the ages of 6 and 12 years, visiting private and public dental hospitals using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Methods A total of 280 children, 140 in a private dental hospital setting and 140 in a public dental hospital setting, were enrolled in this study. The purpose of the study was explained to the accompanying guardian of the patient and written consent was taken. The CFSS-DS was explained verbally in Urdu and the questionnaire was given to guardians alongside the patients which they were asked to fill out following their dental treatment. Result The data obtained from the questionnaires were analyzed using the unpaired t-test. The highest dental fear mean scores and standard deviation in a private dental hospital were for "choking" (3.25 ± 1.21), "the noise of the dentist drilling" (3.24 ± 1.04), and "having somebody put instruments in your mouth" (3.19 ± 1.06), whereas, for a public dental hospital, the highest fear score was recorded in "choking" (3.17 ± 1.69), "injections" (3.07 ± 1.72), and "people in white uniforms" (1.90 ± 1.21). Conclusion The study showed a higher prevalence of dental fear and anxiety in a private dental setting when compared to a public dental setting. Factors responsible for an increase in dental fear need to be assessed for each patient and then treatment given accordingly.
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Computer-controlled Intraligamentary local anaesthesia in extraction of mandibular primary molars: randomised controlled clinical trial. BMC Oral Health 2022; 22:194. [PMID: 35596166 PMCID: PMC9121608 DOI: 10.1186/s12903-022-02194-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Local anesthesia (LA) poses a threat in children more than the treatment process itself, so pediatric dentists are always demanding less painful techniques. Computer-controlled Intraligamentary anaesthesia (CC-ILA) is designed to reduce injection pain and side effects of conventional techniques. The present study aims to assess the pain experience using Computer-controlled Intraligamentary anaesthesia (CC-ILA) during injection and its effectiveness in controlling pain during extraction of mandibular primary molars in pediatric patients. METHODS This randomized controlled clinical trial includes 50 healthy cooperative children, aged 5-7 years with mandibular primary molars indicated for extraction. They were randomly allocated to two groups according to LA technique: test group received CC-ILA and control group received Inferior alveolar nerve block (IANB). Pain was measured during injection and extraction: physiologically using Heart rate (HR), subjectively using Face-Pain-Scale (FPS), and objectively using Sound-Eye-Motor scale (SEM). Patients were recalled after 24-h to record lip-biting events. Data was collected and statistically analysed. RESULTS A total of 50 children (29 females and 21 males) with mean age 6.10 ± 0.76 participated in the study. There were significantly lower scores in the heart rate in the CC-ILA group during injection (p = 0.04), but no significant difference was recorded between the two groups during extraction (p = 0.17). The SEM and FPS showed significant lower scores in the CC-ILA group during injection (p < 0.0001, p < 0.0001) and extraction (p < 0.0001, p = 0.01) respectively. No children in CC-ILA group reported lip-biting after 24-h compared to 32% in IANB (p < 0.0001). CONCLUSION CC-ILA provides significantly less painful injections than conventional techniques and has proved to be as effective as IANB during extraction of mandibular primary molars. An important advantage of this technique was the complete absence of any lip/cheek biting events. Trial registration The study was prospectively registered in ClinicalTrials.gov with the identifier: NCT04739735 on 26th of January 2021, https://clinicaltrials.gov/ct2/show/NCT04739735 .
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Dourado CR, Martins RF, Azevedo JA, Souza SF, Thomaz EB. Anxiety/fear of dental treatment during pregnancy: use of the Modified Dental Anxiety Scale (MDAS). Minerva Dent Oral Sci 2021; 71:79-88. [PMID: 34609113 DOI: 10.23736/s2724-6329.21.04554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite advances in the control of anxiety and fear, dental treatment (DT) continues to be a stressful event, especially during pregnancy. There are several instruments to measure anxiety and fear about DT (AFDT). However, few are validated for use in Brazil. Our objective was to validate the Modified Dental Anxiety Scale (MDAS) for use in Brazil and to evaluate the association between AFDT and the use of oral health services (OHS) during pregnancy. METHODS This is a cross-sectional study nested in a prospective cohort. We conducted a face, content, and construct validation. The Visual Analogue Scale (VAS) was the comparison instrument with MDAS. Sociodemographic and behavioral characteristics were also assessed. Associations were estimated by odds ratios (OR) and 95% confidence intervals (95%CI) in multiple logistic regression analysis (alpha=5%). RESULTS There were no difficulties in the translation/back-translation process. The reproducibility of the instrument was 0.54 (P=0.01). The correlation of MDAS with VAS was 0.71 (P=0.003). The reliability of the instrument was high (Cronbach's alpha: 0.79 to 0.87). After validation, the instrument was administered to 486 women. Mild or moderate AFDT was reported by 81.3% of pregnant women and at higher levels, by 8.2%. There was no association between the use of OHS and AFDT at moderate levels (OR=2.03; 95%CI: 0.45-9.09) or high (OR=1.35; 95%CI: 0.20-9.13). CONCLUSIONS MDAS is a valid instrument for measuring AFDT. The prevalence of AFDT among pregnant women is high, but this event does not seem to be associated with the use of OHS.
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Affiliation(s)
- Carolina R Dourado
- Graduação em Odontologia, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - Rafiza F Martins
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - Juliana A Azevedo
- Programa de Pós-Graduação em Odontologia, Universidade Federal do Maranhão, Universidade Federal do Maranhão, Campus Universitário, Bacanga, São Luís, MA, Brasil
| | - Soraia F Souza
- Universidade Federal do Maranhão, Campus Universitário do Bacanga, São Luís, MA, Brasil
| | - Erika B Thomaz
- Universidade Federal do Maranhão, São Luís, MA, Brasil -
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Townsend JA, Randall CL. Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance. Dent Clin North Am 2021; 65:731-751. [PMID: 34503664 DOI: 10.1016/j.cden.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.
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Affiliation(s)
- Janice A Townsend
- Department of Dentistry, Nationwide Children's Hospital, 700 Children's Drive, LA Suite 5A, Columbus, OH 43205, USA; Division of Pediatric Dentistry, The Ohio State University, Columbus, OH, USA.
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA
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Baakdah RA, Turkistani JM, Al-Qarni AM, Al-Abdali AN, Alharbi HA, Bafaqih JA, Alshehri ZS. Pediatric dental treatments with pharmacological and non-pharmacological interventions: a cross-sectional study. BMC Oral Health 2021; 21:186. [PMID: 33845835 PMCID: PMC8040197 DOI: 10.1186/s12903-021-01555-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Behaviour management strategies involving pharmacological or non-pharmacological interventions during dental procedures should be considered to attain safe and successful treatment outcomes. This study compared the frequencies of use and the completeness of treatment with these interventions. Methods A total of 1725 dental records of patients up to 18 years old, who were treated in the King Abdulaziz Medical City in Jeddah City from October 2018 to June 2019, were used in this retrospective, cross-sectional study. Inferential analysis, Chi-square test, Kruskal–Wallis test, and regression model were used in the data analysis. Results About two-thirds of the patients were treated with attendant non-pharmacological interventions, while one-third, with pharmacological interventions. The application of General Anesthesia (GA) was the most frequently used intervention. Restorative procedures and extractions were done in higher frequencies with pharmacological interventions. Treatments with space maintainers and orthodontic appliances were carried out in higher frequencies with non-pharmacological strategies. The choice of intervention was significantly influenced by the systemic conditions of the patients. Patients treated with non-pharmacological intervention comprised the dominant type of patients, because they required treatments with less pain. Those treated with GA needed restorative treatments and extractions, or treatments that involve pain, but these treatments had higher frequencies of being completed. Conclusions The treatments with pharmacological intervention through GA have higher frequencies of being completed, compared to those with non-pharmacological interventions. Factors, such as age, potential to complete the treatment, and the type of dental treatment applied, influence the choice of treatment intervention.
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Affiliation(s)
- Rania A Baakdah
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Jihan M Turkistani
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia.
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Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated prevalence of dental fear in adults: A systematic review and meta-analysis. J Dent 2021; 108:103632. [PMID: 33711405 DOI: 10.1016/j.jdent.2021.103632] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To systematically review the literature about: 'What is the global estimated prevalence of dental fear in adults?'. DATA/SOURCES Inclusion criteria were observational population-based studies reporting the prevalence or raw data of dental fear in adults (>18 years). Five electronic databases (Embase, PubMed, Scopus, Virtual Health Library and Web of Science) were searched without language restrictions up to March 2020. Two researchers independently performed the study selection, data extraction and quality assessment of the included studies. Risk of bias was performed using the Joanna Briggs Critical Appraisal Checklist for Prevalence and Incidence studies. The prevalence pooled estimates of dental fear were calculated using fixed- and random-effect models. Subgroup analyses were performed. STUDY SELECTION The search strategy identified 4,486 studies. After removal of duplicates (1,722), title and abstract screening (2,764) and full-text reading (108), 31 publications were deemed eligible for this systematic review. Three studies presented low risk of bias and 28 studies presented high risk of bias. A total of 72,577 individuals 18 years of age or older composed the sample of this systematic review. The global estimated prevalence of dental fear and anxiety (DFA), high DFA and severe DFA in adults were 15.3 % (95 %CI 10.2-21.2), 12.4 % (95 %CI 9.5-15.6) and 3.3 % (95 %CI 0.9-7.1), respectively. Subgroup analyses showed a higher prevalence of DFA, high DFA and severe DFA among women and younger adults. The instruments used to measure dental fear also affected its prevalence. CONCLUSIONS Dental fear and high dental fear are prevalent in adults worldwide, being more prevalent among women. CLINICAL SIGNIFICANCE Evidence suggests fear negatively impacts dental care pattern, clinical and subjective oral health conditions. A better knowledge of the global prevalence and the factors associated with this problem will allow that prevention or even behavior modulation strategies of the fearful individual's in dental setting being carried out.
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Affiliation(s)
- Ethieli Rodrigues Silveira
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, 457, Gonçalves Chaves Street, 96015-560, Brazil.
| | - Mariana Gonzalez Cademartori
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, 457, Gonçalves Chaves Street, 96015-560, Brazil.
| | - Helena Silveira Schuch
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, 457, Gonçalves Chaves Street, 96015-560, Brazil.
| | - Jason A Armfield
- Australian Centre for Precision Health, University of South Australia, Adelaide, 101 Currie St, Adelaide, SA, 5001, Australia.
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, 457, Gonçalves Chaves Street, 96015-560, Brazil; Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, 1160, Marechal Deodoro Street, 96020-220, Brazil.
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Craveiro MA, Caldeira CL. Influence of an Audiovisual Resource on the Preoperative Anxiety of Adult Endodontic Patients: A Randomized Controlled Clinical Trial. J Endod 2020; 46:909-914. [DOI: 10.1016/j.joen.2020.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 12/25/2022]
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Monteiro J, Tanday A, Ashley PF, Parekh S, Alamri H, Cochrane Oral Health Group. Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment. Cochrane Database Syst Rev 2020; 2:CD011024. [PMID: 32104910 PMCID: PMC7045283 DOI: 10.1002/14651858.cd011024.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delivery of pain-free dentistry is crucial for reducing fear and anxiety, completion of treatment, and increasing acceptance of future dental treatment in children. Local anaesthetic (LA) facilitates this pain-free approach but it remains challenging. A number of interventions to help children cope with delivery of LA have been described, with no consensus on the best method to increase its acceptance. OBJECTIVES To evaluate the effects of methods for acceptance of LA in children and adolescents during dental treatment. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 24 May 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019 Issue 4) in the Cochrane Library (searched 24 May 2019); MEDLINE Ovid (1946 to 24 of May 2019); Embase Ovid (1980 to 24 May 2019); and Web of Science (1900 to 24 May 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were also searched to 24 May 2019. There were no restrictions on language or date of publications. SELECTION CRITERIA Parallel randomised controlled trials (RCTs) of interventions used to increase acceptance of dental LA in children and adolescents under the age of 18 years. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors for missing information. We assessed the certainty of the body of evidence using GRADE. MAIN RESULTS We included 26 trials with 2435 randomised participants aged between 2 and 16 years. Studies were carried out between 2002 and 2019 in dental clinics in the UK, USA, the Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea. Studies included equipment interventions (using several LA delivery devices for injection or audiovisual aids used immediately prior to or during LA delivery or both) and dentist interventions (psychological behaviour interventions delivered in advance of LA (video modelling), or immediately prior to or during delivery of LA or both (hypnosis, counter-stimulation). We judged one study to be at low risk and the rest at high risk of bias. Clinical heterogeneity of the included studies rendered it impossible to pool data into meta-analyses. None of the studies reported on our primary outcome of acceptance of LA. No studies reported on the following secondary outcomes: completion of dental treatment, successful LA/painless treatment, patient satisfaction, parent satisfaction, and adverse events. Audiovisual distraction compared to conventional treatment: the evidence was uncertain for the outcome pain-related behaviour during delivery of LA with a reduction in negative behaviour when 3D video glasses where used in the audiovisual distraction group (risk ratio (RR) 0.13, 95% confidence interval (CI) 0.03 to 0.50; 1 trial, 60 participants; very low-certainty evidence). The wand versus conventional treatment: the evidence was uncertain regarding the effect of the wand on pain-related behaviour during delivery of LA. Four studies reported a benefit in using the wand while the remaining studies results suggested no difference between the two methods of delivering LA (six trials, 704 participants; very low-certainty evidence). Counter-stimulation/distraction versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with children experiencing less pain when counter-stimulation was used (RR 0.12, 95% CI 0.04 to 0.34; 1 trial, 134 participants; very low-certainty evidence). Hypnosis versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with participants in the hypnosis group experiencing less pain (mean difference (MD) -1.79, 95% CI -3.01 to -0.57; 1 trial, 29 participants; very low-certainty evidence). Other comparisons considered included pre-cooling of the injection site, the wand versus Sleeper One, the use of a camouflage syringe, use of an electrical counter-stimulation device, and video modelling acclimatisation, and had a single study each. The findings from these other comparisons were insufficient to draw any affirmative conclusions about their effectiveness, and were considered to be very low-certainty evidence. AUTHORS' CONCLUSIONS We did not find sufficient evidence to draw firm conclusions as to the best interventions to increase acceptance of LA in children due to variation in methodology and nature/timing of outcome measures. We recommend further parallel RCTs, reported in line with the CONSORT Statement. Care should be taken when choosing outcome measures.
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Affiliation(s)
- Joana Monteiro
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Ajit Tanday
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Paul F Ashley
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Susan Parekh
- UCL Eastman Dental InstituteUnit of Paediatric Dentistry, Department of Craniofacial Growth and Development256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Hamdan Alamri
- The University of ManchesterPhD student at School of Medical Sciences, Division of DentistryManchesterUK
- College of Dentistry, Majmaah UniversityDepartment of Preventive DentistryAl Majma'ahSaudi Arabia
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McLenon J, Rogers MAM. The fear of needles: A systematic review and meta-analysis. J Adv Nurs 2018; 75:30-42. [PMID: 30109720 DOI: 10.1111/jan.13818] [Citation(s) in RCA: 308] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to evaluate the prevalence of needle fear and summarize the characteristics of individuals who exhibit this fear. BACKGROUND Injections are among the most common medical procedures, yet fear of needles can result in avoidance of preventive measures and treatment. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (1966-2017), Embase (1947-2017), PsycINFO (1967-2017), and CINAHL (1961-2017) were searched, with no restrictions by age, gender, race, language, or country. REVIEW METHODS The prevalence of needle fear was calculated and restricted maximum likelihood random effects models were used for meta-analysis and meta-regression. RESULTS The search yielded 119 original research articles which are included in this review, of which 35 contained sufficient information for meta-analysis. The majority of children exhibited needle fear, while prevalence estimates for needle fear ranged from 20-50% in adolescents and 20-30% in young adults. In general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males. Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospitals. Needle fear was common when undergoing venipuncture, blood donation, and in those with chronic conditions requiring injection. CONCLUSIONS Fear of needles is common in patients requiring preventive care and in those undergoing treatment. Greater attention should be directed to interventions which alleviate fear in high-risk groups.
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Affiliation(s)
- Jennifer McLenon
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mary A M Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Barriers and Drawbacks of the Assessment of Dental Fear, Dental Anxiety and Dental Phobia in Children: A Critical Literature Review. J Clin Pediatr Dent 2018; 41:399-423. [PMID: 28937891 DOI: 10.17796/1053-4628-41.6.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Dental anxiety, fear and phobia have different etiology, response patterns, time courses, and intensities that justify a clear distinction between these constructs. Differentiation of dental anxiety, fear or phobia in practice is a critical prerequisite for developing and implementing effective treatment for children. The aim of this study was to investigate whether current researches in the pediatric dentistry appropriately discriminate the central construct of dental anxiety, fear and phobia. We also highlighted the specific methodological issues in the assessment of these issues in pediatric dentistry. STUDY DESIGN A systematic search was conducted in Pubmed/medline and Scopus for articles which assessed dental anxiety, fear or phobia in children. RESULTS 104 research papers were included in the review that had made a distinction between dental anxiety, fear and phobia and had not used them interchangeably. Only five studies used different clinical measures or cut-offs to discriminate between dental anxiety, fear and phobia. CONCLUSION The dental literature appears unable to capture and also measure the multi-sided construct of dental anxiety, fear and phobia and, therefore, there was a tendency to use them interchangeably.
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Berge KG, Agdal ML, Vika M, Skeie MS. Treatment of intra-oral injection phobia: a randomized delayed intervention controlled trial among Norwegian 10- to 16-year-olds. Acta Odontol Scand 2017; 75:294-301. [PMID: 28270029 DOI: 10.1080/00016357.2017.1297849] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effect of five sessions of cognitive behavioural therapy (CBT) for 10- to 16-year-olds with intra-oral injection phobia. MATERIAL AND METHODS This was a randomized delayed intervention controlled trial in 67 patients, fulfilling the DSM-5 criteria for specific phobia. All patients received the same CBT performed by dentists specially trained in CBT. The patients were randomly assigned to either an immediate treatment group (ITG) (34 patients) or a waitlist-control group (WCG) (33 patients). The WCG was put on a waitlist for 5 weeks. After treatment, all patients were combined for post-treatment analyses. Assessments including the psychometric self-report scales Intra-oral injection fear scale (IOIF-s), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Injection Phobia Scale for children (IS-c) and Mutilation Questionnaire for children (MQ-c) and a behavioural avoidance test (BAT) followed by a questionnaire on cognitions during the BAT, occurred pre-, post-treatment/waitlist and at a 1-year follow-up. RESULTS CBT had a significant effect compared to no treatment (WCG). After treatment, the scores on the psychometric self-report scales were significantly reduced and higher levels in the BAT were achieved. The results were maintained at 1-year follow-up. Of the 67 patients, 70.1% received intra-oral injections during CBT treatment, whereas 69.4% of those completing the CBT, in need for further dental treatment, managed to receive the necessary intra-oral injections at their regular dentist. CONCLUSIONS The 10- to 16-year-olds diagnosed with intra-oral injection phobia benefitted positively on CBT performed by specially trained dentists.
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Affiliation(s)
- Karin G. Berge
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maren Lillehaug Agdal
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Margrethe Vika
- Oral Health Centre of Expertise in Western Norway, Hordaland, Bergen, Norway
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Marit Slåttelid Skeie
- Department of Clinical Dentistry Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Oliveira MA, Vale MP, Bendo CB, Paiva SM, Serra-Negra JM. Influence of negative dental experiences in childhood on the development of dental fear in adulthood: a case-control study. J Oral Rehabil 2017; 44:434-441. [PMID: 28386938 DOI: 10.1111/joor.12513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the factors associated with high dental fear among Brazilian university students, especially the effect of a negative dental experience in childhood. This paired case-control study was conducted at the Universidade Federal de Minas Gerais in Brazil. Dental, psychology and mathematics students were divided into cases (high fear) and controls (low fear), defined by cluster analysis, according to the items of the Dental Fear Survey (DFS). Cases (n = 65) and controls (n = 260) participants were paired (1:4) by gender, undergraduate course and social vulnerability. The students self-reported the DFS and a questionnaire about oral health. Descriptive analysis, bivariate and multivariate conditional logistic regression were used as statistical tests with a significance level of 5%. The multivariate model showed that students who reported negative dental experiences in childhood (OR = 2·97; 95% CI: 1·44-6·14), toothache in the last 12 months (OR = 11·31; 95% CI: 4·79-26·68), discomfort during dental treatment (OR = 5·36; 95% CI: 2·53-11·36) and poor self-evaluation of oral health (OR = 3·82; 95% CI: 1·61-8·11) were more likely to have high dental fear. Negative dental experiences in childhood influence dental fear in adulthood. Oral health education should be addressed among university students to reduce dental fear.
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Affiliation(s)
- M A Oliveira
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - M P Vale
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - C B Bendo
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - S M Paiva
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - J M Serra-Negra
- Department of Paediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Minas Gerais, Brazil
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Berge KG, Vika M, Agdal ML, Lie SA, Skeie MS. Reliability, validity and cutoff score of the Intra-Oral Injection Fear scale. Int J Paediatr Dent 2017; 27:98-107. [PMID: 27229655 DOI: 10.1111/ipd.12237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A proper assessment tool is needed to gain more knowledge about fear of intraoral injections in children. AIM The aims of this study were to evaluate the reliability and validity of the novel Intra-Oral Injection Fear scale (IOIF-s) and to establish a cutoff score for a high level of such fear. METHODS Data were obtained from two samples of 10- to 16-year-olds in Hordaland, Norway. Sample I, 1460 pupils attending elementary and high schools, provided questionnaire-based data. The survey instruments used were IOIF-s, Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Mutilation Questionnaire for Children (MQ-c) and Injection phobia Scale for Children (IS-c). Sample II was 67 patients, diagnosed with intraoral injection phobia at the Center for Odontophobia, Oral Health Center of Expertise in Western Norway-Hordaland, who provided IOIF-s data. RESULTS Cronbach's alpha was 0.95. The IOIF-s discriminated between subjects with and without intraoral injection phobia and was associated with the other survey instruments of similar construct. Principal component analysis revealed a two-component solution, characterized as 'Contact Fear' and 'Distal Fear'. Receiver-operating characteristic (ROC) curve indicated that a cutoff score of 38 was appropriate. CONCLUSION The IOIF-s showed satisfying psychometric properties in terms of reliability and validity.
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Affiliation(s)
- Karin G Berge
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway - Hordaland, Bergen, Norway
| | - Margrethe Vika
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway - Hordaland, Bergen, Norway
| | - Maren Lillehaug Agdal
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway - Hordaland, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Marit Slåttelid Skeie
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Khan S, Hamedy R, Lei Y, Ogawa RS, White SN. Anxiety Related to Nonsurgical Root Canal Treatment: A Systematic Review. J Endod 2016; 42:1726-1736. [PMID: 27776881 DOI: 10.1016/j.joen.2016.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes. Dental anxiety has been associated with pain, fear, care avoidance, and more invasive treatments including nonsurgical root canal treatment (NSRCT). The very words root canal are deeply embedded in societal consciousness. Better understanding of dental anxiety may prevent treatment avoidance. The purpose of this study was to conduct a systematic review of NSRCT-associated anxiety. METHODS Inclusion/exclusion criteria defined MEDLINE, Cochrane Library, psychINFO, manual, and citation searches. Title lists and abstracts were read to determine utility; data were extracted, summarized, and compiled into an evidence table, and meta-analyses were performed. RESULTS Defined searching produced 835 titles; 36 articles were included, mostly representing modern populations from countries with very high human development indices. Major sources of heterogeneity included differing study aims, outcome measures, clinical settings, locations, operators, sample selection, and sample size. Meta-analysis of 18 articles including 1989 subjects gave a pretreatment anxiety rating of 39 (standard deviation, 9) on a normalized 100-point scale. Meta-analysis of 4 articles including 232 subjects gave a post-treatment anxiety rating of 27 (standard deviation, 5) on a normalized 100-point scale, representing a 30% reduction. A L'Abbe plot of 5 studies also showed that anxiety decreased after NSRCT. Limited data indicated that gender, age, and prior NSRCT experience influenced NSRCT-associated anxiety. NSRCT-associated anxiety was ranked high among dental treatments, often close to oral surgery. CONCLUSIONS NSRCT-associated anxiety was generally moderate. Anxiety decreased after NSRCT. Limited evidence suggested that anxiety is influenced by patient and treatment factors.
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Affiliation(s)
- Sameera Khan
- UCLA School of Dentistry, Los Angeles, California
| | - Reza Hamedy
- UCLA School of Dentistry, Los Angeles, California
| | - Yuejuan Lei
- UCLA School of Dentistry, Los Angeles, California
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Berge KG, Agdal ML, Vika M, Skeie MS. High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10- to 16-yr-old children. Eur J Oral Sci 2016; 124:572-579. [PMID: 27689943 DOI: 10.1111/eos.12305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Karin G. Berge
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
| | - Maren L. Agdal
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
| | - Margrethe Vika
- Oral Health Centre of Expertise in Western Norway; Hordaland Bergen Norway
| | - Marit S. Skeie
- Department of Clinical Dentistry; Faculty of Medicine and Dentistry; University of Bergen; Bergen Norway
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Pala SP, Nuvvula S, Kamatham R. Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study. World J Clin Pediatr 2016; 5:102-111. [PMID: 26862509 PMCID: PMC4737684 DOI: 10.5409/wjcp.v5.i1.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/16/2015] [Accepted: 12/04/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the efficacy of drawings as a projective measure of pain and distress in children undergoing dental extractions.
METHODS: Children in the age range of 4-13 years with existence of untreatable caries or over-retained primary teeth, indicated for extractions were included. Pain was assessed using one behavioral, faces, legs, activity, cry and consolability (FLACC) scale; and a self report measure; faces pain scale-revised (FPS-R), at two points of time, after completion of local anesthetic administration and after extraction. The general behavior of children was assessed with Wright’s modification of Frankl rating scale. At the end of the session, children were instructed to represent, themselves along with the dentist and their experiences of the dental treatment through drawing. The drawings were scored utilizing Child drawing: Hospital scale (CD: H) manual and correlated with FLACC, FPS-R and Frankl using Pearson correlation test.
RESULTS: A positive correlation, though statistically not significant, was observed between CD: H scores and all other considered parameters (Frankl, FPS-R and FLACC) in the present study.
CONCLUSION: Drawings could not act as surrogate measure of child’s pain; however, they acted as a narrative of his/her experiences and reflection of inner emotions. Hence, drawings can be used as an additional dental armamentarium.
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Almoznino G, Zini A, Sharav Y, Shahar A, Zlutzky H, Haviv Y, Lvovsky A, Aframian DJ. Sleep quality in patients with dental anxiety. J Psychiatr Res 2015; 61:214-22. [PMID: 25529787 DOI: 10.1016/j.jpsychires.2014.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/26/2014] [Accepted: 11/28/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.
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Affiliation(s)
- Galit Almoznino
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel.
| | - Avraham Zini
- Department of Community Dentistry, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Yair Sharav
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Adi Shahar
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel; In partial fulfillment of DMD Degree, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Hulio Zlutzky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Alex Lvovsky
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
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van Houtem CMHH, Aartman IHA, Boomsma DI, Ligthart L, Visscher CM, de Jongh A. Is dental phobia a blood-injection-injury phobia? Depress Anxiety 2014; 31:1026-34. [PMID: 23959839 DOI: 10.1002/da.22168] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 06/05/2013] [Accepted: 07/13/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Dental phobia is part of the Blood-Injection-Injury (B-I-I) phobia subtype of specific phobia within DSM-IV-TR. To investigate the conceptual validity of this classification, the purpose of the present study was to determine the co-occurrence of dental phobia, typical dental (and B-I-I related) fears, vasovagal fainting, and avoidance of dental care. METHOD Data were collected by an online survey in Dutch twin families (n = 11,213). RESULTS Individuals with a positive screen of dental phobia (0.4% of the sample) rated typical B-I-I-related stimuli as relatively little anxiety provoking (e.g. of all 28 fears the stimulus "the sight of blood" was ranked lowest). Presence of dental phobia was significantly associated with a history of dizziness or fainting during dental treatment (OR = 3.4; 95% CI: 1.5-8.1), but of the dental phobic individuals only 13.0% reported a history of dizziness or fainting during dental treatment. Presence of dental phobia (OR = 5.0; 95% CI: 2.8-8.8) was found to be associated with avoidance of dental care, but a history of dizziness or fainting during dental treatment was not (OR = 1.0; 95% CI: 0.8-1.2). CONCLUSIONS The present findings converge to the conclusion that dental phobia should be considered a specific phobia subtype independent of the B-I-I cluster within the DSM classification system.
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Affiliation(s)
- C M H H van Houtem
- Department of Social Dentistry and Behavioural Sciences ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Luoto A, Tolvanen M, Rantavuori K, Pohjola V, Karlsson L, Lahti S. Individual changes in dental fear among children and parents: a longitudinal study. Acta Odontol Scand 2014; 72:942-7. [PMID: 24922091 DOI: 10.3109/00016357.2014.923582] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim was to study longitudinal changes in dental fear among children and one of their parents separately for girls, boys, mothers and fathers over a 3.5-year period. MATERIALS AND METHODS 11-12-year-old children in Pori, Finland (n = 1691) and one of their parents were invited to participate in this longitudinal study. Dental fear was measured in 2001, 2003 and 2005 when the children were 11-12, 13-14 and 15-16-years-old, respectively. The participants were asked if they were afraid of dental care (1 = 'not afraid', 2 = 'slightly afraid', 3 = 'afraid to some degree', 4 = 'quite afraid', 5 = 'very afraid' and 6 = 'I don't know'). The participants' gender was also registered. Mean values of the change scores were studied. Prevalence and incidence of dental fear and changes in dichotomized dental fear (responses 4-5 = high dental fear and responses 1-3 = low dental fear) were studied using cross-tabulations and Cochran's Q test. RESULTS Overall, the prevalence of dental fear slightly increased and female preponderance in dental fear became more evident during the follow-up. Of the mothers and children with high dental fear at the baseline, 24% and 56%, respectively, reported not to be fearful at the end of the follow-up. CONCLUSIONS Dental fear seems to be more stable in adulthood than in childhood. Thus, it might be better to intervene in dental fear during childhood rather than during adulthood.
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Affiliation(s)
- Anni Luoto
- Department of Community Dentistry, Institute of Dentistry, University of Turku , Turku , Finland
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28
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Tellez M, Kinner DG, Heimberg RG, Lim S, Ismail AI. Prevalence and correlates of dental anxiety in patients seeking dental care. Community Dent Oral Epidemiol 2014; 43:135-42. [PMID: 25346261 DOI: 10.1111/cdoe.12132] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/20/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine the prevalence of dental anxiety and its associations with pain and other psychological variables among patients seeking dental treatment and develop a directed acyclical graph of these relationships. METHODS One hundred and twenty patients who sought regular or emergency dental care completed a semi-structured interview assessing DSM-IV specific phobia of dental procedures and questionnaires assessing dental anxiety, pain at last dental visit, blood-injection-injury (BII) phobia, social appearance anxiety, and other psychological constructs. Differences between regular and emergency patients were explored using t-tests. Potential excess risk of dental anxiety due to interactions between pain and psychological processes was explored. Finally, multivariate linear regression was conducted. RESULTS Thirty-five percent of participants came for emergency care. Almost half (49.2%) reported moderate or high anxiety, and 20% met criteria for specific phobia. The relationship between pain at the last dental visit and dental anxiety scores was confounded by social appearance anxiety and BII phobia. CONCLUSION The dental anxiety-pain response may be affected by psychological processes such as social appearance anxiety and BII phobia. Targeting these related psychological constructs may improve the management of anxiety treatment among adult patients seeking dental care.
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Affiliation(s)
- Marisol Tellez
- Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
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Dental fear among medical and dental undergraduates. ScientificWorldJournal 2014; 2014:747508. [PMID: 25386615 PMCID: PMC4216710 DOI: 10.1155/2014/747508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/01/2014] [Accepted: 09/01/2014] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To assess the prevalence and level of dental fear among health related undergraduates and to identify factors causing such fear using Kleinknecht's Dental Fear Survey (DFS) questionnaire. METHODS Kleinknecht's DFS questionnaire was used to assess dental fear and anxiety among the entire enrollment of the medical and dental undergraduates' of the University of Malaya. RESULTS Overall response rate was 82.2%. Dental students reported higher prevalence of dental fear (96.0% versus 90.4%). However, most of the fear encountered among dental students was in the low fear category as compared to their medical counterpart (69.2 versus 51.2%). Significantly more medical students cancelled dental appointment due to fear compared to dental students (P = 0.004). "Heart beats faster" and "muscle being tensed" were the top two physiological responses experienced by the respondents. "Drill" and "anesthetic needle" were the most fear provoking objects among respondents of both faculties. CONCLUSION Dental fear and anxiety are a common problem encountered among medical and dental undergraduates who represent future health care professionals. Also, high level of dental fear and anxiety leads to the avoidance of the dental services.
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Bhola R, Malhotra R. Dental Procedures, Oral Practices, and Associated Anxiety: A Study on Late-teenagers. Osong Public Health Res Perspect 2014; 5:219-32. [PMID: 25379373 PMCID: PMC4215002 DOI: 10.1016/j.phrp.2014.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 01/24/2023] Open
Abstract
Objectives The study aims to determine the degree of anxiety pertaining to dental procedures and various oral hygiene practices among college teenagers. Methods Corah's Modified Dental Anxiety Scale was administered on a randomly chosen sample of 100 Indian college students (50 males and 50 females) of Delhi University, belonging to the age group of 17–20 years. Results Descriptive statistical computations revealed 12.14 years as the mean age of first dental visit, with moderately high levels of anxiety (60.75%) for various dental procedures among the Indian teenagers and 5% lying in the “phobic or extremely anxious” category. With merely 4.16% people going for regular consultations, general check-ups evoked 78.3% anxiety and having an injection or a tooth removed was perceived as the most threatening. The sample subgroup not using mouthwash and mouthspray, smokers, and alcohol drinkers with improper oral hygiene practices experienced much higher anxiety towards routine dental procedures. Conclusion The majority of the Indian youngsters had an evasive attitude of delaying dental treatment. The core problems lay in deficient health care knowledge, lack of patient-sensitive pedagogy to train dental professionals, inaccessibility of services, and a dismissive attitude towards medical help. The feelings of fear and anxiety prevalent among the Indian youth offer significant insights into causes and preventive measures for future research and practice. Methods of education and motivation could be developed to dissipate the anxiety amongst Indian teenagers that prevent routine dental visits and maintenance of adequate oral hygiene.
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Affiliation(s)
- Rahul Bhola
- Department of Metallurgical & Materials Engineering, Colorado School of Mines, Golden, CO, USA
| | - Reema Malhotra
- Department of Psychology, Faculty of Arts, University of Delhi, Delhi, India
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Blood injury and injection phobia: the neglected one. Behav Neurol 2014; 2014:471340. [PMID: 25049451 PMCID: PMC4094700 DOI: 10.1155/2014/471340] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 01/31/2023] Open
Abstract
Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males (n = 1648) and females (n = 1613). Cronbach' alpha (α) of 0.972 of internal consistency was reported. The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it.
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Monteiro J, Tanday A, Ashley PF, Parekh S, Petrie A. Interventions for increasing acceptance of local anaesthetic in children having dental treatment. Hippokratia 2014. [DOI: 10.1002/14651858.cd011024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joana Monteiro
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Ajit Tanday
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Paul F Ashley
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Susan Parekh
- UCL Eastman Dental Institute; Paediatric Dentistry; 256 Gray's Inn Road London UK WC1X 8LD
| | - Aviva Petrie
- UCL Eastman Dental Institute; Biostatistics Unit; 256 Gray's Inn Road London UK WC1X 8LD
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Agdal ML, Raadal M, Öst LG, Skaret E. Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia. Acta Odontol Scand 2012; 70:463-70. [PMID: 22126665 DOI: 10.3109/00016357.2011.635600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. MATERIALS AND METHODS Subjects were 55 patients (mean age 35.5 ± 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. RESULTS Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. CONCLUSIONS Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.
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Affiliation(s)
- Maren Lillehaug Agdal
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway.
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Porritt J, Marshman Z, Rodd HD. Understanding children's dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012; 22:397-405. [PMID: 22221141 DOI: 10.1111/j.1365-263x.2011.01208.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services. AIM This article will consider the prevalence, development, and implications of children's dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.
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Affiliation(s)
- Jenny Porritt
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Carvalho RWFD, Falcão PGDCB, Campos GJDL, Bastos ADS, Pereira JC, Pereira MADS, Cardoso MDSO, Vasconcelos BCDE. Ansiedade frente ao tratamento odontológico: prevalência e fatores predictores em brasileiros. CIENCIA & SAUDE COLETIVA 2012; 17:1915-22. [DOI: 10.1590/s1413-81232012000700031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/01/2011] [Indexed: 02/01/2023] Open
Abstract
Diante do impacto negativo que a ansiedade exerce sobre o atendimento odontológico, buscou-se conhecer sua prevalência e seus fatores predictores frente esse tratamento em brasileiros. Foi realizado um estudo de corte transversal, utilizando-se a escala de ansiedade de Corah para avaliar 3000 pacientes. Os resultados demonstram que 2 em cada 8 brasileiros avaliados apresentaram moderada ou severa ansiedade frente ao atendimento odontológico, verificando-se que a probabilidade de um paciente da população da qual a amostra foi extraída apresentar ansiedade é mais elevada se: for mulher (p = 0,007), da faixa etária superior a 20 anos (p = 0,006), se não possuir acesso a internet e/ou jornais (p = 0,016), se tiver baixa frequência de higiene oral (p = 0,001), se a visita dental for motivada por busca de tratamento curativo, por dor ou outro problema, ao invés de um check-up (p = 0,047), e experiência de odontalgia (p<0,001). O medo e a ansiedade a fatores odontológicos existem de fato na população brasileira e as conclusões do estudo sugerem que, além da falta de recursos econômicos, o descaso com a saúde bucal, o gênero e a idade podem aumentar o grau de ansiedade.
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Agdal ML, Raadal M, Skaret E, Kvale G. Oral health and its influence on cognitive behavioral therapy in patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for intra-oral injection phobia. Acta Odontol Scand 2010; 68:98-105. [PMID: 20141364 DOI: 10.3109/00016350903512792] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe self-perceived and clinically assessed oral health and oral treatment needs among intra-oral injection-phobic patients (Diagnostic and Statistical Manual of Mental Disorders-IV) and to explore whether these factors have an impact on the outcome of cognitive behavioral therapy (CBT). MATERIAL AND METHODS Fifty-five patients (43 women, mean age 32.5 years, range 18-62 years) were treated with short-duration CBT. Dental anxiety (Dental Anxiety Scale and Dental Fear Survey) and self-perceived oral health were assessed by means of questionnaires. Three dentists assessed oral health by means of clinical examination and radiographs. Treatment outcome was measured by ability to receive an intra-oral injection by a general dentist within a 1-year follow-up (FU) period or ability to complete a behavioral avoidance test (BAT) at FU, and changes in dental anxiety and positive and negative thoughts from pretreatment to FU. RESULTS Forty percent of patients ranged their oral health as "good" or "very good". Mean decayed teeth (DT) was 2.2 (range 0-15). The total number of teeth in need of treatment, periodontal treatment, endodontic treatment and extractions ranged from 0 to 15, 0 to 19, 0 to 4 and 0 to 5, respectively. Self-rated oral health correlated significantly with clinical oral health. The outcome of CBT in terms of being able to receive a dental injection during FU was not influenced by oral health status. However, correlation analyses indicated that patients with the poorest oral health had the greatest increase in positive thoughts and the greatest decrease in negative thoughts from pretreatment to FU. CONCLUSIONS The oral health of intra-oral injection-phobic patients varies substantially, but is comparable to that of the normal population. Coping with a dental injection after CBT is not influenced by oral health and treatment needs.
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Affiliation(s)
- Maren Lillehaug Agdal
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Aarstadveien 17, Bergen, Norway.
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Ray J, Boman UW, Bodin L, Berggren U, Lichtenstein P, Broberg AG. Heritability of dental fear. J Dent Res 2010; 89:297-301. [PMID: 20075372 DOI: 10.1177/0022034509356918] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective was to test a hypothesized genetic component (i.e., monozygotic being more similar compared with dizygotic twins) in dental fear/anxiety by comparing the probandwise concordance. We analyzed data based on a dichotomous measure of Dental Fear/Anxiety and a continuous measure of Dental Fear Intensity from over 2000 twins, collected when participants were 13-14 years old and once again three years later. The hypothesis was confirmed, but heritability of Dental Fear/Anxiety was estimated to be higher for girls (0.77 at time 1 and 0.55 at time 2) than for boys (0.14 and 0.0 at times 1 and 2, respectively). Heritability of Dental Fear Intensity, however, was similar for girls (0.30 and 0.40 at times 1 and 2, respectively) and boys (0.47, 0.44). Studies of the etiology of dental fear/anxiety should take genetic vulnerability into account and include molecular biology measures. Possible heritability differences between girls and boys need attention.
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Affiliation(s)
- J Ray
- Department of Psychology, University of Gothenburg, P.O. Box 500, SE405 30 Gothenburg, Sweden.
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Sixou JL, Marie-Cousin A, Huet A, Hingant B, Robert JC. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper). Int J Paediatr Dent 2009; 19:360-6. [PMID: 19486372 DOI: 10.1111/j.1365-263x.2009.00983.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intraosseous (IO) anaesthesia has been shown to be effective in children. However, the pain associated with anaesthetic injections, and its acceptance by children, have never been studied. AIM The aim of this study was to assess the pain associated with the IO injection of 4% articaine with 1 : 200 000 epinephrine using the computerized QuickSleeper' system in a population of children and adolescents. DESIGN IO anaesthesia was performed on patients aged 10.4 +/- 2.6 years of age. The patients assessed their pain on a faces pain scale (FPS) and on a visual analogue scale (VAS). The operators were also asked to assess signs of patient pain/discomfort. RESULTS No pain or mild discomfort was reported by, respectively, 81.8% (FPS) and 83.9% (VAS) of the patients. Some 58.9% of children with previous experience of dental anaesthesia reported that computerized IO anaesthesia was more comfortable than traditional infiltration methods. Operators noted signs of discomfort during penetration and injection in 18.3% and 25.3% of the patients, respectively. CONCLUSIONS This study showed that the majority of children reported no pain or mild pain when anaesthetic was administered by computerized needle rotation and solution deposition. This technique holds promise for use by trained paediatric dentists.
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Affiliation(s)
- Jean-Louis Sixou
- Department of Paediatric Dentistry, UFR d'Odontologie de l'Université de Rennes 1 and CHU de Rennes, 35043 Rennes Cedex, France.
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