Dentists' technical competence, communication, and personality as predictors of dental patient anxiety

Adverse childhood experiences and dental anxiety among Chinese adults in Hong Kong: a cross-sectional study

Introduction

This study aimed to investigate the relationship between adverse childhood experiences (ACEs) and dental anxiety among Chinese adults in Hong Kong.

Methods

A cross-sectional survey was conducted at a university in Hong Kong. The recruiting period and data collection started in January 2023 and ended in June 2023. Participants completed an online questionnaire that assessed ACEs (using the Adverse Childhood Experiences International Questionnaire - ACE-IQ) and dental anxiety (using the Modified Dental Anxiety Scale - MDAS and Dental Fear Survey - DFS). The study examined the impacts of both cumulative (i.e., total number) and independent ACE components on dental anxiety. To explore the relationships between cumulative ACEs, individual ACE components and dental anxiety (MDAS and DFS score), Pearson correlations, linear regression and logistic regression were conducted.

Results

Significant associations were observed between ACEs and dental anxiety among 171 subjects. Cumulative ACEs were positively correlated with MDAS scores (r = 0.169, p = 0.027) and DFS scores (r = 0.253, p < 0.001). The odds of an individual having high dental anxiety increased by 26-43% for every additional increase in the number of ACEs. Individual types of ACEs, such as emotional and physical neglect, sexual abuse, and household substance abuse, significantly influenced the likelihood of having high dental anxiety.

Discussion

The results showed a positive association between ACEs and dental anxiety, highlighting the impact of ACEs on dental anxiety. Dental practitioners should consider inquiring about a patient's ACE history to develop personalized treatment plans.

Survey investigation of articaine use in the United States

BACKGROUND

Local anesthesia is an essential component of dentistry, but there is limited quantifiable understanding of what techniques and local anesthetic solutions are used by practicing dentists. Use of the local anesthetic articaine has been highly debated in dentistry regarding its efficacy and risks for paresthesia. The aims of this study were to expand the knowledge of local anesthesia practices of dentists in the United States through a large-scale survey and associate potential influencing factors regarding articaine use specifically.

METHODS

The 23-item survey was sent to 10,340 practicing dentists in the United States, gathering demographic data and local anesthesia approaches and concerns. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression analyses.

RESULTS

A total of 1,128 dentists completed the survey. Previous experience with articaine was reported by 97.6% of respondents, with 3.3% no longer using articaine. Sixty percent of respondents indicated using articaine for most local anesthetic injections administered. Multivariable regression analysis found those reporting to use articaine for all local anesthetic injections involving vasoconstrictors were more likely to be male (odds ratio, 1.59; P = .002) or general dentists (odds ratio, 1.63; P < .001).

CONCLUSIONS

Articaine has a perceived benefit to practitioners as most respondents reported using articaine as their primary local anesthetic. A practitioner's sex and type were found to affect the profile of use of articaine.

PRACTICAL IMPLICATIONS

Assembling evidenced-based local anesthesia practices would be beneficial to ensure US practitioners are more standardized in administering local anesthetics, particularly articaine, in the safest and most efficacious way.

What is the gold standard of the dental anxiety scale?

It is important to understand patients' anxiety and fear about dental treatment. A patient's anxiety can be quantified through a self-report questionnaire, and many related scales have been developed. In this review, I tried to find out which scale is most suitable for the patient's dental anxiety and fear evaluation by examining the contents of previously developed scales and comparing the strengths and weaknesses of each scale.

Trusting the Dentist—Expecting a Leap of Faith vs. a Well-Defined Strategy for Anxious Patients

This article aimed to set into perspective the unique aspects of trust within the dentist–patient relationship by exploring the literature as well as historical aspects of dentistry in the association between trust/distrust and patient anxiety. In order to characterise this uniqueness, the assumptions for trusting in dentistry are compared and contrasted with other professions using a conceptual analysis. The professions of medicine, sociology, psychology, nursing and dentistry were check listed according to the tenets of a concept analytical approach reported by Hupcey et al., in 2001. Recommendations for patient/person-centred care, as opposed to dentist-centred care, that would improve trust are specified according to the literature. These include empowering patients, practicing active listening, empathy and relationship building that might benefit dental patients in relation to the perceived risks of anxiety or induced pain. It was concluded that global distrust of dominating dentists must give way to person-centred professional strategies so that dentists and patients can tackle their dental anxiety-trust challenges, both in the public’s image of the dental profession and in clinical relationships. Future directions would be to explore incentives for dentists to change to patient/person-centred care.

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study-Tromsø 7

OBJECTIVE

The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population.

METHOD

The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015-2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety.

RESULTS

High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms.

CONCLUSIONS

The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression.

Dentist-patient communication on dental anxiety using the social media: A randomized controlled trial

The purpose of the present study was to assess the effects of dentist-patient communication via social media on dental anxiety and to determine the appropriate timing of such communications. In this randomized, double-blinded and controlled trial, we used Instagram's quick replies system to answer patients' questions to alleviate dental anxiety for patients undergoing impacted teeth extraction under local anesthesia. Patients were assigned randomly into four groups according to the timing of such communications: only after (group 1, n = 36), only before (group 2, n = 35), before and after the operation (group 3, n = 36), and a control group who received no communication on social media (group 4, n = 36). Dental anxiety was evaluated one week before (pre-op) and after the operation (post-op) using recognized assessment scales -the Spielberger's State-Trait Anxiety Inventory, Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS). The results showed that the post-op values of group 4 had higher anxiety scores than the groups 2 and 3 according to VAS (p < 0.05). Within the groups, the anxiety levels showed a decreasing trend after surgery according to MDAS and VAS scores (p < 0.05). The results of this study suggest that communication with patients before the operation is sufficient to reduce their dental anxiety.

A communication-focused curriculum for dental students - an experiential training approach

BACKGROUND

Successful interaction and communication with patients is as vital for dentists as it is for physicians. Therefore, the aim of this study was the development and evaluation of an interactive, experiential training curriculum with an emphasis on communication for dual degree seekers of medicine and dentistry.

METHODS

A pre-clinical course with an emphasis in physician/dentist-patient communication and interaction was adapted by a team of subject experts based largely on the propositions of Experiential Learning Theory. After attending the course, dental students (N = 81) rated the course on a Likert- style scale and answered two open questions.

RESULTS

Students found the interactive course curriculum to be very helpful and vital. Many students reported that their initial interest in the course was mainly because it is a dual degree requirement, but later on rated the course as highly important in terms of later physician/dentist-patient interaction. One aspect of the curriculum course participants regarded as very important, yet neglected during dental studies, was (self-) perception.

CONCLUSION

In the view of dental students, the rigorous structure of the pre-clinical dental curriculum does not allow for time spent on topics such as (self-) perception and awareness, but training one's ability to self-reflect and think critically about one's own actions, conduct or position can aid with advanced medical and dental studies and practices later on. Experiential courses with an emphasis on patient-physician/dentist communication should be offered early on during pre-clinical medical and dental studies as a regular part of the curriculum.

Determining Recommendations for Improvement of Communication Skills Training in Dental Education: A Scoping Review

Professional communication skills have a significant impact on dental patient satisfaction and health outcomes. Communication skills training has been shown to improve the communication skills of dental students. Therefore, strengthening communication skills training in dental education shows promise for improving dental patient satisfaction and outcomes. The aim of this study was to facilitate the development of dental communication skills training through a scoping review with compilation of a list of considerations, design of an example curriculum, and consideration of barriers and facilitators to adoption of such training. A search to identify studies of communication skills training interventions and programs was conducted. Search queries were run in three databases using both text strings and controlled terms (MeSH), yielding 1,833 unique articles. Of these, 35 were full-text reviewed, and 17 were included in the final synthesis. Considerations presented in the articles were compiled into 15 considerations. These considerations were grouped into four themes: the value of communication skills training, the role of instructors, the importance of accounting for diversity, and the structure of communication skills training. An example curriculum reflective of these considerations is presented, and consideration of potential barriers and facilitators to implementation are discussed. Application and evaluation of these considerations are recommended in order to support and inform future communication skills training development.

Concordance between patient satisfaction and the dentist's view: findings from The National Dental Practice-Based Research Network

OBJECTIVES

In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction.

METHODS

Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction.

RESULTS

Most dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which dentists were not aware of this dissatisfaction.

CONCLUSION

For improved patient-centered care, dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed.

PRACTICAL IMPLICATIONS

By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.

Strategies for communicating with older dental patients

BACKGROUND

Communication between dentists and patients 65 years or older is a critical aspect of providing optimum care, particularly given the increasing number of older adults and the communication barriers they often encounter.

METHODS

The authors conducted a targeted literature review of the broad health communication literature and published health literacy guidelines to examine the barriers to effective communication that are specific to the older adult population, as well as strategies for overcoming these barriers.

RESULTS

Findings from health communication and health literacy research provide insight into techniques to improve communication with older patients, such as preparing an agenda for the appointment, exhibiting warm nonverbal behavior, listening attentively, asking open-ended questions, using simple language, presenting key points one at a time and providing patients with written instructions.

CONCLUSIONS

Physical, psychological and literacy issues pertaining to both patients and providers present barriers to effective communication. Practitioners can surmount these barriers by enacting communication strategies tailored to older adults. Practical Implications. Dentists can overcome barriers to communication and improve the quality of patient care by considering the communication barriers specific to older adults and enacting strategies to overcome these barriers.

Inferences of Others' Competence Reduces Anticipation of Pain When under Threat

On a daily basis, we place our lives in the hands of strangers. From dentists to pilots, we make inferences about their competence to perform their jobs and consequently to keep us from harm. Here we explore whether the perceived competence of others can alter one's anticipation of pain. In two studies, participants (Receivers) believed their chances of experiencing an aversive stimulus were directly dependent on the performance of another person (Players). We predicted that perceiving the Players as highly competent would reduce Receivers' anxiety when anticipating the possibility of an electric shock. Results confirmed that high competence ratings consistently corresponded with lower reported anxiety, and complementary fMRI data showed that increased competence perception was further expressed as decreased activity in the bilateral posterior insula, a region localized to actual pain stimulation. These studies suggest that inferences of competence act as predictors of protection and reduce the expectation of negative outcomes.

Dentist-patient communication techniques used in the United States: the results of a national survey

BACKGROUND

The authors conducted a national survey to determine the communication techniques that dentists use routinely and variations in their use.

METHODS

American Dental Association Survey Center staff members mailed an 86-item questionnaire to a random sample of 6,300 U.S. dentists in private practice. Participants reported routine use ("most of the time" or "always") during a typical week of 18 communication techniques, of which seven are basic techniques. The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques.

RESULTS

Dentists routinely use an average of 7.1 of the 18 techniques and 3.1 of the seven basic techniques. Two-thirds or more of dentists used four of the techniques (hand out printed materials, speak slowly, use models or radiographs to explain, use simple language). Less than one-fourth of dentists used any of the techniques in the teach-back method or patient-friendly practice domains. A dentist's age, race/ethnicity, education outside the United States and area of dentistry affected use. Health literacy variables (awareness, education in communication, practice-level change, outcome expectancy) and lack of time were associated with the number of techniques used.

CONCLUSIONS

Routine use of all of the communication techniques is low among dentists, including some techniques thought to be most effective with patients with low literacy skills.

PRACTICE IMPLICATIONS

Professional education is needed to improve knowledge about communication techniques and to ensure that they are used effectively. A firm foundation for these efforts requires the development, evaluation and dissemination of communication guidelines for dental care professionals.

Psychometric properties of the Revised Dental Beliefs Survey

OBJECTIVES

The objectives of this pair of studies were to examine the internal reliability, test-retest reliability, and construct validity of the Revised Dental Beliefs Survey.

METHODS

A total of 108 college students completed two questionnaires containing the Revised Dental Beliefs Survey, as well as the Revised Iowa Dental Control Index, and Desirability of Control scales. As part of another experiment, 141 study participants with dental injection phobia completed the Revised Dental Beliefs Survey and the Dental Anxiety Scale.

RESULTS

Both the internal and test-retest reliabilities of the Revised Dental Beliefs Survey were high. The measure demonstrated good convergent and discriminant validities.

CONCLUSION

The Revised Dental Beliefs Survey is well-suited for use with clinical and nonclinical populations, in which a stable and valid measure of perceptions of the dental situation is desired.

Underlying dimensions of verbal communication between dentists and patients in prosthetic dentistry

The study explores whether the task-focused and socio-emotional dimensions of clinical communication is recognizable in the verbal communication context of prosthetic dentistry, as well as if there are other dimensions of communication in that context. Sixty-one audio recordings were made at three specialist clinics of prosthetic dentistry in Sweden. Sixty-one patients and 15 dentists participated. Sixty-one prosthetic rehabilitation periods were followed. Tooth- or implant-supported fixed prostheses were placed during this time. One visit near the end of each rehabilitation period was audiorecorded. The verbal communication was analyzed with the Roter Interaction Analysis System (RIAS)-dental. The categories were subjected to exploratory factor analysis. Patient and dentist verbal behavior could not be defined exclusively as socio-emotional or task-focused but had to be defined in other dimensions; Emotional exchange, information exchange-patient horizon, relation building exchange, information exchange-dentist horizon, and administrative and counseling exchange. Since the 'emotional exchange' factor was found to capture the largest share of the variance in the communicated patterns, the present study suggests that prosthetic care in dentistry is basically a human relationship with strong emotional communicative content.

Tellington touch before venipuncture: an exploratory descriptive study

Tellington touch (ttouch) is an emerging natural healing modality used by nurses and other health care providers to communicate caring and connection to clients. This simple-to-learn and easy-to-implement form of mindful, gentle physical touch is said to help in diverse areas such as chronic pain management, labor discomfort, and postinjury pain and edema. Despite 15 years of anecdotal evidence outlining reported benefits for humans, no investigation of ttouch has yet been undertaken. This qualitative study initiates a body of knowledge about ttouch by exploring and describing the experience of ttouch when administered to healthy people awaiting a routine venipuncture. The study includes qualitative data from both the participants (n = 47) and the provider (n = 1) and provides essential foundational information regarding the experience of ttouch. Implications for practice and future research are provided.

Model of the dentist-patient consultation in a clinic specializing in the treatment of dental phobic patients: a qualitative study

Thirty semi-structured interviews were conducted with 5 dentists (3 male and 2 female) after first and second consultations with 15 newly enrolled dental phobic patients (2 male and 13 female) in a clinic specializing in the treatment of odontophobia. Analysis of the transcribed interviews was influenced by the principles of grounded theory. Five concepts/higher-order categories were grounded in the data: 1 core category: 'Relatedness, based on affective resonance and concordant roles' and 4 additional higher-order categories: 'the dental phobic patient's emotions'; 'the patient's verbal and non-verbal cues'; 'the dentist's role as a clinician: professional interpersonal skills'; and 'the dentist's role as a fellow-being: general interpersonal skills'. The model developed describes the dynamics of the dentist patient interaction and has a theoretical application.

Customer service in dental offices: analyses of service orientations and waiting time in telephone interactions with a potential new customer

Increasing competition among health care organizations has prompted greater concern for the quality of "customer service" in brief encounters with patients. This study examined service practices engaged by dental office staff interacting over the telephone with a potential new customer. The goals of the study were to determine whether the staff displayed customer-oriented and control-oriented service communication behaviors and to examine the relation between these service behaviors and waiting time required of customers. Structured observational data were collected in phone encounters with staff in 84 dental offices. Approximately 40% of the staff engaged in the customer-oriented behavior of inviting the customer to share questions or concerns, and 31% exhibited the control-oriented behavior of reciting promotional pitches on behalf of the dental office. Six other communication behaviors were observed with less frequency. Staff who made customers wait on the line longer were more likely to use promotional pitches. Analyses revealed no significant relation between waiting time and other service communication behaviors.

Factors associated with dental anxiety

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.

Dentist-patient communication: a review of relevant models

A review of the literature on dental treatment was conducted and models presented of the doctor/dentist-patient relationship. These models are listed and divided into two subgroups, empirical and normative models. The models are scrutinized with focus on the dentist-patient communicative relationship exclusively. Different doctor/dentist-patient relationships are described. External factors influencing these relationships are defined. An analysis of dentist-patient communication is made, and a new model of dentist-patient communication is suggested, which states that what is done and what is said during dentist-patient encounters will have an impact on outcome. Three different purposes of dentist-patient communication are presented. The process of attaining these is discussed. It is concluded that a theory of communication is lacking in the dental context, and the need to develop a reliable and valid interaction analysis system for the patient-dentist communication is confirmed.

A model of pain and anxiety associated with acute stressors: distress in dental procedures

Many acute stressful experiences are not inherently very harmful, yet are associated with great pain and anxiety. The characteristics and experiences that the person brings to the situation are more important than any objective characteristics of the experience itself in determining how aversive the experience will be. Dental procedures are excellent examples of this type of stressor. Drawing primarily on the literature related to dental procedures, the present article discusses the nature of pain and anxiety in the face of an acute stressor, and presents the dispositional and situational factors that contribute to the perception of an acute stressor as aversive. A model is presented illustrating how the various factors interact. It is argued that, in addition to being descriptive, the model is also prescriptive of measures that may be taken to ameliorate the distress of persons subjected to acute stressors like dental procedures.

Comparison of ideal and actual behavior of patients and dentists during dental treatment

The ideal behavior of dentists and patients has seldom been studied with the aim of determining whether it is similar to the actual behavior of the two groups. Thus, the purpose of this study was to compare whether the ideal behavior of dentists and patients differed from their actual behavior. Thirty-three volunteering dentists and 271 of their patients from the public and private sectors in different parts of Finland participated in the study. The dentists first filled out a questionnaire with 5-scale Likert-type statements about the ideal patient and questions concerning their own background variables. In connection with normal dental practice their dental nurses selected 10 patients, who before treatment filled out a questionnaire containing statements about the desired behavior of an ideal dentist and their own background variables. Immediately after the treatment, both dentists and patients filled out another questionnaire containing similar statements, which this time indicated whether the dentist/patient actually behaved according to the ideal. Differences between each individual and the independent ideal and actual scores were compared by cross-tabulation and percentage agreement. With regard to the ideal behavior that was directly related to the treatment procedure, the expectations of both dentists and patients were usually met. In general, the patients did not disrupt the procedures and the dentists were able to concentrate on the treatment. The discrepancies most often found between the ideal and the actual behavior concerned the level of communication. The patients often would like to have been talked to more and wanted to be encouraged. The dentists were not sure whether their patients were interested in or motivated about the treatment or whether they followed the home care instructions. In general, there evidently is a clear gap in communication between dentists and patients, which may lead to frustration on both sides. It is thus suggested that when dentists are trained, more emphasis be placed on communication skills.

THE EFFECTS OF INFORMATION-GIVING BEHAVIOR AND GENDER ON THE PERCEPTIONS OF PHYSICIANS: AN EXPERIMENTAL ANALYSIS

A pilot study was conducted in which 107 college students were compared with 137 subjects over the age of 30. Subjects were asked to respond to a scenario describing a physician-patient interaction where the doctor both overlooked questions and gave no diagnosis or to the identical scenario with the wording changed to encourage the subject to identify with the doctor rather than the patient. The physician was rated as more likeable and competent when the subject was asked to identify with him or her. A second experiment was conducted in which 444 male and female subjects were presented with scenarios describing a physician-patient interaction in which the subject was asked to identify with the patient. The interaction was systematically varied as follows: the physician either answered or overlooked questions from the patient; the physician either gave a personal post-examination diagnosis or had a nurse dismiss the patient; the physician was described as being male or female. The physician was rated not only as being more likeable but also as more competent when the patient's questions were answered and when a personal diagnosis was provided. Neither sex of physician nor sex of subject affected the evaluations.

Dental visit satisfaction in a group of adults aged 50 years and over

Studies have found that utilization of dental services is generally less common than utilization of medical services, particularly by older persons. Because satisfied dental patients were found to be greater users of the service than nonsatisfied patients, it was decided to investigate the correlates of dental visit satisfaction in older subjects. Predictions that satisfaction would be positively related to regular use of dental services and negatively related to dental anxiety were confirmed. The results also suggested that older dental patients have different expectations of their dentists than younger ones.

Adolescent dental fear and control: prevalence and theoretical implications

This study examined the prevalence and etiology of dental fear in a large, representative sample of Singapore adolescents. Participants completed a questionnaire regarding fear of the dentist, dental beliefs and their most recent dental visit. The population prevalence of high dental fear was 115 fearful children per 1000 population (SE = 0.02). Children who reported painful treatment and perceived lack of control at the dentist were 13.7 times more likely to report high fear and 15.9 times less likely to be willing to return to the dentist or dental nurse. The etiology of severe clinical fear appears strongly related to direct conditioning in the presence of pain and vulnerability.

Dentists evaluate their patients: an empirical investigation of preferences

Dental treatment is a dyadic encounter. Yet research on the dentist-patient dyad has tended to focus on patient perceptions of dentist, to the neglect of dentist perceptions of patient. Previous theoretic and qualitative work on caregiver perceptions of patients suggested three dimensions of evaluation. Dentists (N = 618) rated their patients on items taken from two prior studies. Dentists' responses were subjected to confirmatory factor analysis. The analysis substantiated the existence of three evaluative dimensions: compliance, tractability, and likability. Further analysis showed that the three dimensions formed a Guttman simplex, revealing a second-order factor of selectivity and allowing a classification of dentists on the basis of patient selectivity.