Dental and medical injections: prevalence of self-reported problems among 18-yr-old subjects in Norway

Needle phobia among adult Jordanians: General awareness, prevalence; and exploring microneedles as a promising solution

Needle phobia remains a major drawback of conventional injectable medications, leading to avoidance and low adherence among a reasonable portion of patients. Despite this, there is a limited number of studies investigating needle phobia prevalence and symptoms. In this survey, we studied the knowledge and prevalence of needle phobia and its manifestations among 1182 adult Jordanians. Moreover, we assessed the feasibility of microneedles delivery systems as an alternative approach to conventional injectable methods. The results revealed that 28.5% of the participants identified themselves with needle phobia, with a notably higher prevalence among females compared to males (p-value < 0.001). The overall prevalence of needle phobia based on its measured manifestations was found to be 27.4%. The survey also found that 68% of the population were unfamiliar with the concept of microneedles despite the reasonable proportion of the population who were aware of the disadvantages of conventional injectable medications. Furthermore, the survey identified four significant predictors of needle phobia through hierarchical linear regression analysis. Gender, occupation, and negative past experiences with needle injections accounted for 3%, 1%, and 1% of the variance in needle phobia, respectively. In addition, the participants' preference for microneedles over conventional injectables medications appeared as another significant predictor, contributing 5% of the variance. Overall, the model explained 10% of the variance in needle phobia. Collectively, this study provides an insight into needle phobia prevalence and manifestations in Jordan, while also exploring microneedles as an alternative drug delivery system for patients with needle phobia.

Time to complain about pain: Children's self-reported procedural pain in a randomised control trial of Hall and conventional stainless steel crown techniques

BACKGROUND

Children's pain in dentistry has undesirable short- and long-term consequences; therefore, less invasive treatments merit consideration.

AIM

To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care.

DESIGN

This study was a split-mouth randomised control trial, with secondary outcome analysis. Children (4-8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong-Baker self-report pain scale measured pretreatment dental pain, procedural pain at each treatment and post-operative pain.

RESULTS

Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p = .047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate-high procedural pain with at least one treatment.

CONCLUSIONS

The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting.

Use of virtual reality in the reduction of pain after the administration of vaccines in children in primary care centers: a randomized clinical trial (Preprint)

Background

Pain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions.

Objective

We aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years.

Methods

We will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system—a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age.

Results

The study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination.

Conclusions

VR can be a useful tool in pediatric procedures that generate pain and anxiety.

International Registered Report Identifier (IRRID)

PRR1-10.2196/35910

Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children

Background

Pain is a multidimensional construct that involves sensory, emotional, and cognitive processes. It is an essential component of child behavior guidance. The injection of a local anesthetic agent during pediatric dental treatment is one of the most painful and distressing procedures performed, stimulation of acupoint LI4 provides an analgesic effect in the orofacial region, thus decreasing the pain during injection.

Aims and objectives

To compare and evaluate the effect of low-level laser on LI4 acupoint and surface-acting 20% benzocaine gel during local anesthesia.

Materials and methods

Children of age-group between 5 years and 9 years receiving bilateral local anesthesia were scheduled for dental treatment. Split-mouth cross-over study was planned and was divided into two groups, receiving low-level laser acupuncture on LI4 acupoint with placebo as a moist cotton swab in the first visit and 20% benzocaine gel with placebo as low-level laser acupuncture off mode in second visit and vice versa. Pain intensity was evaluated using the sound eye motor scale as subjective scale, Wong–Bakers pain rating scale. Pulse rate was measured before, during, and after the procedure using a pulse oximeter.

Results

The average heart rate, Wong–Bakers pain rating scale, and Sound Eye Motor scale were significantly lower in the group having low-level laser when compared with the group having placebo low-level laser therapy.

Conclusion

The low-level laser can be used to control pain during local anesthesia in children.

How to cite this article

Sandhyarani B, Pawar RR, Patil AT, et al. Effect of Low-level Laser on LI4 Acupoint in Pain Reduction during Local Anesthesia in Children. Int J Clin Pediatr Dent 2021;14(4):462–466.

Syncope in Dental Practices: A Systematic Review on Aetiology and Management

INTRODUCTION

This systematic review aimed to give an overview of the current evidence surrounding the aetiology and management in terms of treatment and prevention of syncope in dental practices. Alongside the occurrence, the practitioner's competence, and the association between syncope and local anaesthetics were discussed.

METHODS

An electronic search in EMBASE, Web of Science, PubMed, Cochrane databases and a hand search were performed by 2 independent reviewers to identify studies up to November 2019. Eligibility criteria were applied and relevant data was extracted. Inclusion criteria covered all types of dental treatment under local anaesthesia or conscious sedation performed by a wide range of oral health care workers in their practices. Risk of bias of the included studies was assessed using the methodological tools recommend by Zeng et al.¹ No restrictions were made to exclude papers from qualitive analysis based on risk of bias assessment.

RESULTS

The search yielded a total of 18 studies for qualitative analysis. With the exception of one prospective cohort study, all articles were considered having a high risk of bias. Meta-analysis showed that dentists encountered on average 1.2 cases of syncope per year. The male gender (RR = 2.69 [1.03, 7.02]), dental fear (RR = 3.55 [2.22, 5.70]), refusal of local anaesthesia in non-acute situations (OR = 12.9) and the use of premedication (RR = 4.70, [1.30, 16.90]) increased the risk for syncope. Treatment and prevention were underreported as both were solely discussed in one study. The supine recovery position with raised legs and oxygen administration (15l/min) was presented as an effective treatment. The Medical Risk-Related History (MRRH) system was proposed as prevention protocol, yet this protocol was ineffective in reducing incidence rates (p = 0.27). The majority of dentists (79.2%) were able to diagnose syncope, yet most (86%) lacked the skills for appropriate treatment. Only 57,6% of dental practices were equipped with an oxygen cylinder.

CONCLUSIONS

Syncope is the most common emergency in dental practices. Nonetheless, the vast majority of dentists do not seem competent nor prepared to manage this emergency. Psychogenic factors seem to play an important role in provoking syncope. Placing the patient in a supine reclined position with raised legs in combination with the administration of oxygen seems effective for regaining consciousness. Although valuable in many aspects, risk assessment by medical history taking is not proven to result in fewer episodes. The strength of these conclusions is low based on GRADE guidelines.².

Barriers and facilitators for adolescent girls to take on adult responsibility for dental care - a qualitative study

Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county. Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis. Results: The study findings could be summed into the theme "Triggers for adolescent girls to take on or not take on adult responsibility for dental care". The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories. Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.

Dental avoidance among adolescents - a retrospective case -control study based on dental records in the public dental service in a Swedish county

Objective: This study aimed to investigate the occurrence of missed dental appointments among 16-19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009-2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents' individual situation and be observant of early signs of avoidance.

The fear of needles: A systematic review and meta-analysis

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.

Video-based Education to Reduce Distress and Improve Understanding among Pediatric MRI Patients: A Randomized Controlled Study

PURPOSE

Evaluate the effectiveness of an educational video vs. standard of care in improving relaxation and procedural understanding among pediatric patients undergoing a magnetic resonance imaging (MRI) procedure.

DESIGN AND METHODS

This pilot randomized controlled trial was conducted in a large, urban academic children's hospital. Pediatric patients were randomized to receive either a 7-minute educational video or standard of care. Standardized surveys, which consisted of a 1-10 visual analog scale and open-ended questions were administered to patients to measure their level of relaxation, understanding of the procedure, and perceptions of the MRI education received. Bivariate statistics were used to compare changes in relaxation score and baseline understanding scores between study groups. Open-ended questions were analyzed using content analysis.

RESULTS

A total of 50 pediatric patients completed the study. Improvements in relaxation scores and baseline procedural understanding scores were significantly higher among children 13-17 years of age who received the intervention compared to those that did not (P < 0.05). No statistically significant differences were noted in relaxation scores and procedural understanding scores among children < 13 years of age between study groups. A total of 26 patients, half from the control group and half from the intervention group responded to open-ended survey questions. Content analysis revealed that nearly all respondents perceived the educational video to increase their understanding of the MRI procedure.

CONCLUSIONS

Video-based education effectively improved the relaxation and procedural understanding of children 13-17 years of age undergoing a MRI.

PRACTICE IMPLICATIONS

Nurses may use video-based education to supplement existing MRI education among older children.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and under.The review will address the following question: Is vibratory stimulation effective in reducing needle-related procedural pain in children aged 18 years and under, in comparison with no stimulation for needle-related procedures?

Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors

The purpose of this clinical update is to provide an overview of the fear of needles and needle phobia in children and adolescents including characteristics and diagnosis, prevalence and epidemiology, etiological factors, and treatment options. Needle-related fear and needle phobia present as significant needle-related distress and avoidance behavior. The etiology is biopsychosocial. These challenging conditions are more common in children and adolescents than in adults. The nurse–patient relationship enables the provision of suitable preparation before injection procedures. Nurses can use exposure-based interventions and incorporate coping strategies and teaching of parents and children. Nurses play a pivotal role in noticing the need for further treatment. Procedural needle-related distress is a complex phenomenon representing a continuum ranging from needle fear to more severe needle phobia. For patients with needle fear management and training methods used by nurses can possibly prevent a progression of the condition into needle phobia. In cases of needle phobia, a correct diagnosis made by a psychiatrist is necessary and enables referral to a psychotherapist with experience in treating children and adolescents with needle phobia.

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake

PURPOSE

Fear of needles develops at approximately five years of age, and decreases compliance with healthcare. We sought to examine the relationship of preschool vaccine history, parent and preadolescent needle fear, and subsequent compliance with optional vaccines.

METHODS

As part of a private practice randomized controlled trial, parents and 10-12year olds rated needle anxiety on a 100mm visual analog scale. This follow-up cohort study compared their needle anxiety to previous vaccination records, including number of vaccinations between ages four and six years (total and same-day maximum), and subsequent initiation of the HPV vaccine through age 13.

RESULTS

Of the 120 preadolescents enrolled between 4.28.09 and 1.19.2010, 117 received preschool vaccinations between ages four and six years. The likelihood of being in the upper quartile of fear (VAS≥83) five years later increased with each additional same-day injection (OR=3.108, p=0.0100 95%CI=1.311, 7.367), but was not related to total lifetime or total four-to-six year injections. Only 12.5% (15) of parents reported anxiety about their preadolescents' vaccines (VAS>50). Parent and child anxiety was weakly correlated (r=0.15). Eight children in the upper fear quartile began their HPV series (26.67%) compared to 14 in the lower quartile (48.28% VAS<32) (OR 2.57, p=0.0889, 95%CI 0.864-7.621); there was no difference in HPV uptake between upper and lower quartile of parent anxiety.

CONCLUSIONS

The more same-day preschool injections between 4 and 6years of age, the more likely a child was to fear needles five years later. Preadolescent needle fear was a stronger predictor than parent vaccine anxiety of subsequent HPV vaccine uptake.

Prevalence and correlates of dental anxiety in patients seeking dental care

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.

Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia

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.

Pain and fear in connection to orthodontic extractions of deciduous canines

BACKGROUND

Interceptive extractions of deciduous canines are, from a patient perspective, poorly investigated.

AIMS

To describe pain, discomfort, and dental fear in connection to extractions of the deciduous canines, indicated as an orthodontic treatment procedure.

DESIGN

Thirty-two Swedish children aged 7-9 years had all four deciduous canines extracted over three occasions. The children rated procedural and postoperative pain on visual analogue scales. Acceptance of injections and extractions was assessed by the treating dentists. Analgesic consumption and recovery time for drinking and eating was reported by parents. Dental fear was assessed using the Children's Fear Survey Schedule questionnaire.

RESULTS

Procedural pain showed low median levels, although some individuals reported high values. Boys reported significantly more pain at appointments when two (as opposed to one) canines were extracted. Postoperative pain levels were low and use of analgesics sparse. Dental fear paralleled norm values and did not increase from pre- to post-extraction.

CONCLUSIONS

Pain management routines during extractions of this kind should be revised. Single tooth extractions seem to be preferable to extractions of two canines at the same appointment. Extraction of four deciduous canines should not cause major postoperative inconvenience; these extractions neither triggered nor increased dental fear.

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

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.

One- vs. five-session treatment of intra-oral injection phobia: a randomized clinical study

The present study aimed to evaluate the effect of one and five sessions of treatment for intra-oral injection phobia in 55 subjects fulfilling the DSM-IV criteria for specific phobia. The subjects were randomly assigned to one or five sessions of cognitive behavioural therapy (CBT) performed by dentists. Assessments included behavioural tests and self-report instruments used pretreatment, post-treatment, and at 1 yr of follow-up. The dental anxiety scale (DAS), the injection phobia scale-anxiety, and the mutilation questionnaires were applied. Mean avoidance duration of intra-oral injections before treatment was 7.0 yr. The results showed that 89% of the subjects had received intra-oral injections from a regular dentist during the 1-yr follow-up. The only significant difference between the one- and the five-session groups was that the five-session group reported less anxiety (as measured using the DAS) at 1 yr of follow-up. It was concluded that both treatments performed by dentists specially trained in CBT have a significant treatment effect on the intra-oral injection phobia.

Anxiety and pain during dental injections

OBJECTIVES

The aim of this study was to study the relationship between anxiety and pain felt during a dental injection in a sample of 'normal' patients about to undergo 'invasive' dental treatment.

METHODS

Duration and intensity of pain during a dental injection were measured within a sample of 247 patients. In addition, data on dental anxiety, fear of dental pain, type of treatment, amount of anesthetic fluid, injection location and the use of surface anesthesia were also collected.

RESULTS

Anxious patients felt more pain and of longer duration than less anxious patients. 28% of variance on the duration of pain felt could be accounted for by fear of dental pain, the use of surface anesthesia and gender. For the intensity of pain felt, 22% of variance could be accounted for by anxiety felt for the injection and dental anxiety.

CONCLUSIONS

Pain felt during dental injections is dependent on dental anxiety, fear of dental pain, fear for the injection, gender and amount of injection fluid (rather than the use of surface anesthesia). In other words, some patients are expected to feel elevated levels of pain during dental injection and would benefit from extra attention and care from the dentist.

Hypersensitivity to local anaesthetics--update and proposal of evaluation algorithm

Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered. Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation of patients suspected with immediate- and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions.

Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18-year-olds in Norway

BACKGROUND

More knowledge about the relationship between blood-injury-injection phobia (BIIP) and dental anxiety (DA) may give new clinically relevant information in the assessment and management of children with DA.

OBJECTIVE

The aims of this study were to explore the relationships between BIIP and DA, and to explore to what extent the two subtypes of BIIP in combination with DA are related to self-reported probability of avoiding dental treatment if a dental injection is needed.

METHODS

The subjects were a random sample of 1385 18-year-olds attending high schools in a county of Norway, and the data were collected by use of questionnaires completed in classrooms. The survey instruments applied were Dental Fear Survey, Injection Phobia Scale-Anxiety, and Mutilation Questionnaire.

RESULTS

About 11% of the subjects with DA and subtypes of BIIP, respectively, reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed. In multiple regression analysis, only DA contributed to self-reports of high probability of avoiding dental treatment.

CONCLUSION

The results indicate that among adolescents, BIIP is relatively often connected with DA. Clinical implications are discussed.

Psychological characteristics of Norwegian adolescents reporting no likelihood of visiting a dentist in a situation with toothache

OBJECTIVES

The aim of the present study was to explore and compare psychological characteristics in two groups of 18-year-old adolescents: (i) subjects reporting no likelihood of visiting the dentist in a situation with toothache (avoiders); and (ii) subjects who definitely would see the dentist in the same situation (non-avoiders).

METHODS

The study included a representative sample (n = 1385) of 18-year-old adolescents attending high schools in the county of Hordaland, Norway. Data were collected by use of questionnaires completed in classrooms.

RESULTS

The following factors increased the risk of being included in the avoider group: negative beliefs of the dentist (communication, trust and control) (OR = 4.3), high dental anxiety (OR = 3.5), and being a male (OR = 2.4). No predictive power for being included in the avoider group was found for general self-efficacy, coping style, multiple fears, or anxiety and depression.

CONCLUSIONS

Adolescents with avoidance behaviour have more negative beliefs of the dentist and higher dental anxiety compared to non-avoiders, but were found to have no other specific psychological characteristics. These results indicate a high potential for prevention of future avoidance of care for dentists that are focusing on patient communication and to give young patients perceptions of trust and control during dental treatment.