Prediction of success and failure of behavior modification as treatment for dental anxiety

Mind wandering in anxiety disorders: A status report

Many investigations have targeted the subject of worry in anxiety disorders. Worry can be regarded as a subtype of mind wandering (MW), which is undeliberate, perseverative, negatively-valenced, and mainly future-oriented. Nevertheless, until now only a few studies have explored the role of overall MW in the origin and course of anxiety disorders. To foster progress in this field, we briefly describe and discuss relevant studies addressing MW in subjects with anxiety disorders or symptoms or disorders associated with anxiety symptoms. Provisional synthesis suggests that: a) the overall amount of MW is positively correlated with anxiety symptoms; b) MW characteristics reflecting worry and rumination appear to be relevant in anxiety; c) comorbid depressive and ADHD symptoms may contribute to excessive MW in anxiety; d) MW-related therapeutic interventions may be useful as complementary treatments in anxiety disorders. However, more studies related to MW in anxiety disorders or symptoms are necessary to corroborate and extend these initial findings. Such investigations should ideally combine experience sampling with self-rating assessments of both MW and worry/rumination.

An exploratory study investigating children's perceptions of dental behavioural management techniques

BACKGROUND

Behaviour management techniques (BMTs) are utilised by dentists to aid children's dental anxiety (DA). Children's perceptions of these have been underexplored, and their feedback could help inform paediatric dentistry.

AIM

To explore children's acceptability and perceptions of dental communication and BMTs and to compare these by age, gender, and DA.

DESIGN

A total of sixty-two 9- to 11-year-old school children participated in the study. Children's acceptability of BMTs was quantified using a newly developed Likert scale, alongside exploration of children's experiences and perceptions through interviews. anova and t-tests explored BMT acceptability ratings by age, gender, and DA. Thematic analysis was used to analyse interviews.

FINDINGS

Statistical analyses showed no effect of age, gender, or DA upon BMT acceptability. Children generally perceived the BMTs as acceptable or neutral; stop signals were the most acceptable, and voice control the least acceptable BMT. Beneficial experiences of distraction and positive reinforcement were common. Children described the positive nature of their dentist's communication and BMT utilisation.

CONCLUSION

Dental anxiety did not affect children's perceptions of BMTs. Children were generally positive about dentist's communication and established BMTs. Children's coping styles may impact perceptions and effectiveness of BMTs and should be explored in future investigations.

A comprehensive review of predictive and prognostic composite factors implicated in the heterogeneity of treatment response and outcome across disease areas

AIM

To assess and present the current body of evidence regarding composite measures associated with differential treatment response or outcome as a result of patient heterogeneity and to evaluate their consistency across disease areas.

METHODS

A comprehensive review of the literature from the last 10 years was performed using three databases (PubMed, Embase and Cochrane). All articles that met the inclusion/exclusion criteria were selected, abstracted and assessed using the NICE level-of-evidence criteria.

RESULTS

Forty-nine studies were identified in the data abstraction. Approximately one-third focused on existing composite measures, and the rest investigated emerging composite factors. The majority of studies targeted patients with cancer, cardiovascular disease or psychological disorders. As a whole, the composite measures were found to be disease-specific, but some composite elements, including age, gender, comorbidities and health status, showed consistency across disease areas. To complement these findings, common individual factors found in five previous independent disease-specific literature assessments were also summarised, including age, gender, treatment adherence and satisfaction, healthcare resource utilisation and health status.

CONCLUSIONS

Composite measures can play an important role in characterising heterogeneity of treatment response and outcome in patients suffering from various medical conditions. These measures can help clinicians to better distinguish between patients with high likelihood to respond well to treatment and patients with minimal chances of positive therapeutic outcomes. Herein, the individual factors identified can be used to develop novel predictive or prognostic composite measures that can be applicable across disease areas. Reflecting these cross-disease measures in clinical and public health decisions has the distinctive appeal to enable targeted treatment for patients suffering from multiple medical conditions, which may ultimately yield significant gains in individual outcomes, population health and cost-effective resource allocation.

Behavioural interventions could reduce dental anxiety and improve dental attendance in adults

DATA SOURCES

PubMed and Psychlit were searched from 1966 to 2001. Reference lists from retrieved articles were also examined for more studies. Study authors were contacted for additional information where necessary.

STUDY SELECTION

For inclusion, an article had to satisfy the following criteria: the study sample should be adult subjects with documented high dental fear or avoidance; outcome measures should include at least self-reported changes in dental fear; outcomes should preferably include changes in dental behaviour or attendance post-treatment.

DATA EXTRACTION AND SYNTHESIS

Studies were categorised into 3 behavioural interventions: behaviourally oriented approaches, cognitively oriented approaches and educational interventions. Attendance measures were grouped into <6 months, 6 months to 4 years after the intervention and longer term. The effect size (ES) for self-reported dental anxiety and for dental attendance post-treatment was calculated. Homogeneity tests were conducted.

RESULTS

The search identified 80 articles, of which 38 met the inclusion criteria. The calculated ES for self-reported anxiety after intervention indicated positive changes in 36 out of the 38 studies and no change in two. The overall ES was 1.78 [95% confidence interval (CI), 1.67-1.89]. The proportion of subjects with post-treatment dental visits in the first 6 months varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, was 1.4 (95% CI, 1.27-1.58). The homogeneity analysis indicated that the studies could not be adequately described in one ES. The reported proportion of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, was 1.17 (95% CI, 0.99-1.35).

CONCLUSIONS

Despite extensive heterogeneity, changes in self-reported anxiety represented a medium to large ES. Patients signing up for a behavioural intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance (>4 years after treatment) was 77%.

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder

OBJECTIVES

The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder.

METHODS

Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed.

RESULTS

At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month.

CONCLUSIONS

Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.