Psychological distress and anxiety compared amongst dental patients- results of a cross-sectional study in 1549 adults

Validity and Reliability of the Dental Neglect Scale in German

Background/Objectives: The Dental Neglect Scale (DNS) is known and used to evaluate and assess adult behaviors and attitudes related to oral self-care and oral-health. In English-speaking countries, the DNS has been used in many studies. At the moment, there is no validated version of the DNS that is available in the German language. The aim of this study is to validate a German version of the DNS to evaluate and assess the oral health and behavior among the German population. Methods: The study population consisted of N = 311 German adults (180 female, 130 male, 1 diverse) aged from 18 to 90 years from a dental clinic in Germany. The participants answered a questionnaire. In addition to questions on their socio-demographic background and the DNS, the survey included more standardized instruments relating to preventive behavior, dental anxiety, and oral health. Results: The DNS was translated into German. An explanatory factor analysis was conducted, which supported the unifactorial structure of the scale. The following results were obtained for the reliability of the resulting DNS: Cronbach's Alpha = 0.710, McDonald's Omega = 0.711, and Mean = 25.63 (SD = 4.02, Range 12-30). Convergent and divergent validity were demonstrated through associations between the DNS and various oral health scales, and by differences between genders and age groups. Conclusions: This study confirms the quality of the criteria of the DNS for German adults. The DNS is a convincing instrument that is used for epidemiological studies in the field of dentistry and psychology. Further validation with other samples should be conducted.

The relationship between Body Mass Index and dental anxiety among pediatric patients in Jeddah, Saudi Arabia: a cross-sectional study

BACKGROUND

Studies suggested a relationship between anxiety and Body Mass Index (BMI). However, dental anxiety and BMI was not previously investigated. This cross-sectional study aimed to assess the impact of BMI levels on dental anxiety and behavior among pediatric patients.

METHODS

Children 6-11 years attending four-referral centers in Jeddah, Saudi Arabia and their parents were interrogated. The BMI level scores, child's behavior (Frankel's classification) and dental-anxiety (Abeer Dental Anxiety Scale (ACDAS)) were evaluated.

RESULTS

Out of 952 children participated in this study, 496 (52.1%) had normal BMI, 264 (27.7%) had high BMI (overweight), and 192 (20.2%) had low BMI (underweight). Regression analysis found that overweight was significantly associated with an increased adjusted odds ratio (AOR) of dental anxiety (AOR = 3.018) and uncooperative dental behavior (AOR = 8.714) with p < 0.001. Also, statistically significant increase in the odds ratio (OR) of the child feeling shy in the clinic (P = 0.002; OR:2.113) and parents/operators reporting child behaving scared (P = 0.004; OR:1.985 and p < 0.001; OR:3.03, respectively) when overweight compared to normal-weight.

CONCLUSIONS

This study highlights the impact of overweight on the emotional and behavioral dimensions of the child's dental experience as they significantly increased the probability of dental anxiety and uncooperative behavior by three and eight times, respectively.

Developing and validating a scale to measure perceived barriers to prosthodontics treatments among partially edentulous patients

Background

People experiencing tooth loss need dental prostheses to preserve the integrity of their oral structures and replace the missing teeth. Patient-related outcome measures (PROMs) for perceived barriers to prosthodontics treatment are scarce in the literature.

Aims

The aim of this study was to develop a comprehensive scale to identify and measure barriers to prosthodontic treatment as perceived by partially edentulous patients.

Methods

This cross-sectional study was conducted among N = 334 partially edentulous adults who seeking prosthodontic treatment. Data collection was carried out in February to September 2024. Exploratory factor analysis was utilized to elucidate the latent factor structure. A six-factor model was validated through confirmatory factor analysis. Reliability was evaluated using Cronbach's alpha. The convergent and discriminant validity of the final scale were assessed.

Results

EFA produced a 21-item scale grouped into six factors that explain 75.78% of the total variance with eigenvalues >1. All items showed acceptable reliability, ranging from 0.807 to 0.935. The first factor pertained to financial constraints; the second factor was concerning lack of knowledge and awareness; the third factor was related to anxiety and fear; the fourth factor related to negative past dental experiences; the fifth factor included issues related to limited accessibility to dental services; and the last factor was concerning insufficient dental guidance. The CFA results indicate an acceptable model fit, with standardized factor loadings spanning from 0.54 to 0.99. The model factors' convergent and discriminant validity were confirmed.

Conclusion

This study enhances the understanding of barriers to prosthodontic treatment in a Saudi Arabian teaching dental hospital. It introduces a novel scale for further data collection, aiding policymakers and stakeholders in addressing these barriers and improving public oral health. Future studies should validate this scale and explore its applicability in various contexts and populations.

The efficacy of iatrosedation and music listening techniques in attenuating dental anxiety in patients undergoing dental crown preparation: A randomized clinical trial

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety-reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One-way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety.

Variables associated with oral health-related self-efficacy - results of a cross-sectional study

BACKGROUND

Oral health-related self-efficacy (OH-SE) is pivotal for oral health and is associated with other oral-health related variables, such as dental fear and anxiety (DF/A) and dental hygiene behaviors (DHB). This study attempts to analyze associations between OH-SE and oral healthrelated variables in a German population to extend previous research by analyzing whether OH-SE can be predicted by these variables, as this might contribute to the development of treatment interventions.

METHODS

OH-SE, DF/A, oral health-related quality of life (OHRQoL), self-perceived dental condition, satisfaction with general health, DHB, and socioeconomic status were assessed as a part of the Saxon Longitudinal Study in an adult sample (n = 309, 56.3% female, all Saxon secondary school 8th graders in 1987). The associations of OH-SE with these variables were examined by means of correlation, multiple linear regression analyses, and group comparisons. Significance (p), standardized regression coefficients (β), and effect size (Cohen's d) were calculated.

RESULTS

The correlation analyses revealed increased OH-SE to be accompanied by low levels of DF/A, high levels of OHRQoL, high levels of self-perceived dental condition, increased satisfaction with general health and socioeconomic status (all r ≥ 0.142; all p ≤ 0.013). In the regression analysis, OH-SE was mainly predicted by self-perceived dental condition and satisfaction with general health (R2 = 0.157) as well as by daily frequency of toothbrushing, OHRQoL, and socioeconomic status on a trend-level basis. In the group comparisons OH-SE was lower in participants with moderate for manifest DF/A and higher in individuals with higher OHRQoL, better self-perceived dental condition, increased satisfaction with general health, increased daily frequency of toothbrushing, more dental appointments, and above-average socioeconomic status (trend level; all t ≥ 1.57; p ≤ 0.059).

CONCLUSIONS

In this cross-sectional study, high levels of OH-SE were mainly predicted by general health as well as self-perceived dental condition. It was also associated with decreased DF/A, increased DHB, higher OHRQoL, and higher socioeconomic status. Future research should analyze these associations in longitudinal designs to address whether interventions focusing on adherence to good DHB improve (dental) health and thus OH-SE. This might be a promising approach, particularly in relation to the treatment of DF/A.

Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey

This study assessed the association between emotional distress, sleep changes, decreased frequency of tooth brushing, and self-reported oral ulcers, and the association between COVID-19 status and decreased frequency of tooth brushing. Using a cross-sectional online survey, data were collected from adults in 152 countries between July and December 2020. Binary logistic regression analyses were conducted to determine the associations between dependent (decreased frequency of tooth brushing, oral ulcers, change in sleep pattern) and independent (tested positive for COVID-19, depression, anxiety, frustration/boredom, loneliness, anger, and grief/feeling of loss) variables after adjusting for confounders (age, sex, level of education, employment status). Of the 14,970 participants data analyzed, 1856 (12.4%) tested positive for COVID-19. Respondents who reported feeling depressed (AoR: 1.375), lonely (AoR: 1.185), angry (AoR: 1.299), and experienced sleep changes (AoR:1.466) had significantly higher odds of decreased tooth brushing frequency. Respondents who felt anxious (AoR: 1.255), angry (AoR: 1.510), grief/sense of loss (AoR: 1.236), and sleep changes (AoR: 1.262) had significantly higher odds of oral ulcers. Respondents who tested positive for COVID-19 had significantly higher odds of decreased tooth brushing frequency (AoR: 1.237) and oral ulcers (AoR: 2.780). These findings highlight that the relationship between emotional distress and oral health may intensify during a pandemic.

Dental fear and anxiety in Asian youths: response components and inducing stimuli

OBJECTIVES

This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA.

MATERIALS AND METHODS

A convenience sample of youths, aged 17 to 24 years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05).

RESULTS

A total of 215 participants were enrolled (mean age of 18.9 ± 2.0 years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups.

CONCLUSIONS

Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most.

CLINICAL RELEVANCE

DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

A dataset for dental anxiety and psychological distress in 1550 patients visiting dental clinics

Objectives

Information was collected to identify anxiety in dental patients visiting a dental clinic using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and identifying a correlation between these groups as well as the gender and age.

Data description

This data contains a set of 1550 patients’ answers to questionnaires taken before dental treatment in a dental clinic. It is divided into male and female patients as well as according to their age. The level of Dental Anxiety can be interpreted by answers chosen in the Dental Anxiety Scale (DAS) and the level of psychological distress by answers chosen in the Brief Symptom Inventory-18 (BSI-18). This dataset should help to encourage more research in the field of dental anxiety and we hope to see more comparisons with our data in the future or in different regions of the world.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test-retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Psychological Distress, Dental Health, and Dental Fear among Finnish University Students: A National Survey

The aim of this study was to investigate the association between dental fear, psychological distress, and perceived symptoms of teeth controlled for age, gender, educational sector, and tobacco use. The data from the Finnish University Student Health Survey 2016 targeting students (n = 10,000) of academic universities and universities of applied sciences were used. Psychological distress was measured with the Clinical Outcomes in Routine Evaluation 10 (CORE-10) and the General Health Questionnaire 12 (GHQ-12) and dental fear with the question ‘Do you feel scared about receiving dental care?’. The study included 3110 students. In logistic regression analyses those with psychological distress (measured with CORE-10 and GHQ-12) and those reporting teeth-related symptoms were more likely than their counterparts to have high dental fear. In gender-specific analyses men with psychological distress (measured with CORE-10) and women with teeth-related symptoms were more likely to have high levels of dental fear. Finnish university students with psychological distress and teeth-related symptoms were more likely to experience higher levels of dental fear than their counterparts were. The results of this study support possible common vulnerability factors that dental fear and other psychological disorders may share.

Psychodiagnostics as a Mandatory Element of Patient Protocols in Dentistry

Objectives:

This study aims at performing psychodiagnostics of the patients` condition with removable and fixed dentures both before and after dental treatment.

Materials and Methods:

The first group included 200 patients with fixed-type dentures, and the second group consisted of 200 patients with removable dental devices. The control group included 200 patients with healthy teeth. All patients were subjected to Fere’s skin-galvanic reaction procedure. Patients also filled out the Dental Status Questionnaire and were then tested following the Spielberger-Hanin Scale. For a comparison of differences, a two-sample t-test for independent samples was used. The Pearson correlation between features was calculated considering their distribution as normal.

Results:

In the control group, the hemispheric activity index increased 1.1 times after treatment. In Group 2, following the dental status questionnaire, the index of hemispheric activity increased 1.3 times in males with a positive emotional mood (P ≤ 0.01). A 2.2-fold and 2.1-fold (P ≤ 0.01) increase was observed among female and male patients with a negative emotional mood in Group 2, respectively. After the treatment, the hemispheric activity index in Group 1 increased by 1.1 times for males with a positive mood (P ≤ 0.01) and by 1.2 times for male and female patients with a negative mood (P ≤ 0.05). Direct correlation was recorded between the increase in the number of scores and emotional mood among males and females from Group 1 (0.72 and 0.73, respectively). After the survey, a correlation was established between the values of the hemispheric activity index and the increase in scores among males (0.82) and females (0.81). There was also a connection between the increase in scores and the level of personal anxiety in both male (0.57) and female (0.66) patients, as well as between the increase in scores and the level of reactive anxiety (0.56 and 0.57, respectively).

Conclusions:

Changes in the hemispheric activity index were shown to be related to the patient’s dental condition questionnaire. Besides, there is a relationship with the type of dental service. The practical application of this study implies that more reliable information about the patient’s satisfaction with the quality of dental care provided can be obtained using not only standard psychodiagnostic methods but also questionnaires on the patient’s dental status. Once the survey is completed and the data obtained analyzed, it is possible to define the correct strategy to restore the patient’s physical and mental health after dental treatment.

Impact of sociodemographic factors, duration of edentulism, and medical comorbidities on the mental attitudes of individuals with complete edentulism

STATEMENT OF PROBLEM

Understanding the attitude of elderly patients is important for successful complete denture therapy. However, data regarding the impact of sociodemographic factors, impact of medical comorbidities, and duration of edentulism on the mental attitudes of such patients are lacking.

PURPOSE

The purpose of this clinical study was to explore the association of sociodemographic factors, duration of edentulism, and medical comorbidities on the attitudes of completely edentulous patients.

MATERIAL AND METHODS

The study was conducted among 125 completely edentulous patients visiting the Department of Prosthodontics, Nepal Medical College from August 2020 to October 2020. General information including age, sex, education level, medical history, and duration of edentulism were collected during a routine clinical evaluation. The mental attitudes of the participants were categorized according to M.M. House Classification into philosophical mind, exacting mind, hysterical mind, or indifferent mind. The participants were categorized into 3 age groups: 45 to 54 years, 55 to 64 years, and 65 years and above. Similarly, they were divided into 3 categories depending upon the duration of edentulism: 0 to 2 years, 2 to 5 years, and more than 5 years. Data were entered in a statistical software program for descriptive analysis using frequency distributions, and the chi-square statistical test and the Freeman-Halton extension of the Fisher exact test were used to determine the association between categorical variables.

RESULTS

The highest number of participants was in the philosophical category (34.4%) with the fewest in the hysterical group (12%). Men had more philosophical and indifferent attitudes, whereas women were more exacting (P<.001). Those with a recent history of extraction had an increased exacting attitude (P<.001). The respondents without any comorbid diseases were more philosophical, whereas a higher percentage of respondents with different comorbid conditions were assessed to be in the hysterical category (P<.001). Significant relationships were not found between mental attitude and educational status or age (P>.05).

CONCLUSIONS

Socioeconomic factors, duration of edentulism, and existing comorbidities had a significant impact on the attitudes of edentulous patients. The role of these factors should be assessed during the appraisal of the mental attitudes of edentulous patients.

Anxiety and facial self-contacts: possible impact on COVID-19 transmission in dental practice

BACKGROUND

The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact).

METHODS

A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients' movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire.

RESULTS

Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact.

CONCLUSIONS

Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.

Effect of dexmedetomidine sedation on swallowing reflex: A pilot study

Background/purpose

Swallowing reflex depression during dental treatment or oral surgery may cause water to enter the lower respiratory tract, leading to coughing, thus hindering these procedures. Based on the hypothesis that dexmedetomidine (DEX) sedation may depress swallowing reflex, we aimed to characterize its effects on swallowing reflex and elucidate the affected functions.

Materials and methods

Swallowing reflex was induced in 9 young healthy male volunteers using a 5 mL-distilled water bolus injection over 3 s through a polyethylene catheter 3 times, both under wakefulness and DEX sedation. Swallowing EMG burst duration, pre-swallow EMG activity value, swallowing EMG burst peak value, latency time, and swallowing reflex timing in relation to the respiratory cycle were analyzed.

Results

The EMG burst duration was significantly prolonged with DEX sedation [206.9 ± 90.3% (1.20 ± 0.98 s)] compared to that with wakefulness [100 ± 00% (0.53 ± 0.28 s), P = 0.007]. No significant differences in the pre-swallow EMG activity value (P = 0.343), swallowing EMG burst peak value (P = 0.218), and latency times were apparent between wakefulness and DEX sedation (P = 0.793). Distributions of timing of the swallows in relation to the respiratory cycle did not significantly differ between the two conditions (P = 0.860).

Conclusion

Our data demonstrate that DEX sedation carries a potential risk of aspiration due to swallowing reflex depression during elevation of the larynx; therefore, suctioning of water and saliva should be rigorously performed. However, peripheral muscle contraction of the submental muscle complex, neural organization function, and timing of the swallowing reflex in relation to the respiratory cycle are not affected.

A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

Health psychology is multidisciplinary, with researchers, practitioners, and policy makers finding themselves needing at least some level of competency in a variety of areas from psychology to physiology, public health, and others. Given this multidisciplinary ontology, prior attempts have been made to establish a framework for understanding the role of biological, psychological, and socio-environmental constructs in disease development, maintenance, and treatment. Other models, however, do not explain how factors may interact and develop over time. The aim here was to apply and adapt the 3P model, originally developed and used in the treatment of insomnia, to couch the biopsychosocial model in a way that explains how diseases develop, are maintained, and can be treated. This paper outlines the role of predisposing, precipitating, and perpetuating factors in disease states and conditions (the 3Ps) and provides examples of how this model may be adapted and applied to a number of health-related diseases or disorders including chronic pain, gastrointestinal disorders, oral disease, and heart disease. The 3P framework can aid in facilitating a multidisciplinary, theoretical approach and way of conceptualizing the study and treatment of diseases in the future.