Real-life dental examination elicits physiological responses different to visual and auditory dental-related stimuli

IS THERE A CORRELATION BETWEEN OBJECTIVE AND SUBJECTIVE METHODS TO ASSESS DENTAL ANXIETY? A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

To assess the evidence about the correlation between objective and subjective methods for evaluating dental anxiety.

METHODS

Eligibility criteria were defined as follows: Patients (P): individuals in the dental care context; Index test (I): subjective methods; Reference test (R): objective methods; Outcome (O): correlation between methods to dental anxiety evaluation. Searches were conducted in 7 databases and grey literature up to November 2023, without language or date restrictions. The QUADAS-2 tool was employed to evaluate Risk of bias. A random-effects meta-analysis was performed to calculate pooled correlation coefficients between methods on the basis of the objective method analyzed. The GRADE approach was utilized to assess evidence certainty.

RESULTS

A total of 29 studies, with 1891 participants aged 3 to 82 years, were included, with 22 studies participating in the meta-analysis. The Risk of bias was mostly "unclear" due to inadequate methodology detail. Weak correlations were observed between subjective methods and heart rate (r 0.15 [0.08, 0.21], P < .001, I2 = 56%) and alpha-amylase (r 0.25 [0.11, 0.38], P < .001, I2 = 43%. Subjective methods showed a moderate correlation with cortisol analysis (r 0.40 [0.33, 0.47] P < .001, I2 = 72%). No other objective method displayed a significant correlation with subjective methods. The certainty of evidence was very low.

CONCLUSION

The findings can suggest a correlation between the following subjective and objective methods: ACDAS, DAS, MCDAS, MDAS and Cortisol; CFSS-DS, DAS, MCDAS, MDAS and Alpha-amylase; and DAS, DAS-R, MDAS, S-DAI, Venham Picture Anxiety, Venham Picture Test and Heart rate. Nonetheless, these results lack conclusiveness due to their very low certainty of evidence.

REGISTRATION

PROSPERO database registration number CRD42022298589.

Psychophysiological wellbeing in a class of dental students attending dental school: anxiety, burnout, post work executive performance and a 24 hours physiological investigation during a working day

Aim

To the best of our knowledge, dental school students have never been evaluated for stress, anxiety, burnout, physiological indexes during a 24-h working day, and executive function performance post-work and post-work after returning from vacation; therefore, this research has been conducted.

Methods

Data were acquired at the Dental School of the University of Padua on 16 students in their 4th year, far from the exam session. While performing clinical activity on the dental chair and during a working day, electrodermal activity (EDA), heart rate variability (HRV), and heart rate (HR) were recorded. Participants' stress was measured with the Perceived Stress Scale (PSS-10 scale) and anxiety with the General Anxiety Disorder Questionnaire (GAD-7) and State-Trait Anxiety Inventory (STAI-Y-2), while burnout with the Maslach Burnout Inventory (MBI-HSS). Executive functions were evaluated using the Tower of London test (TOL-R).

Results

Three students (2F/1M) had a GAD-7 score ≥ 10. Five students (4F/1M) showed trait anxiety. Moderate levels of perceived stress were reported in 85% of participants. MBI-HSS showed that 7 participants scored high on emotional exhaustion and 7 on depersonalization. TOL-R performance (M = 15.85, SD = 4.01) was below the normative value p < 0.00001. A second test, after the holidays, showed normal values. EDA was higher during children's treatment (p < 0.05), ANOVA showed high HR during working time (p < 0.001), and HRV was higher in males (p < 0.001).

Conclusion

Based on the sample size evaluated, it is reported that being a dental student has a moderate impact on stress, anxiety, and burnout while a strong impact on executive functions buffered by rest.

Comparison of Aversion to Visual Dental Stimuli Between Patients and Dentists: A Preliminary Study

Purpose

Fearful dental patients often cite various dental instruments or procedures as triggers for their dental fear. Thus, visual dental stimuli provoke anxiety. This preliminary study aimed to assess the level of aversion to visual stimuli in dental patients and compare it with that in dentists.

Patients and Methods

A total of 43 dental patients (25 women, 18 men; average age, 29.9 ± 13.3 years; patient group) and 13 dentists (4 women, 9 men; average age, 28.2 ± 2.0 years; dentist group) were included. All participants had previously undergone dental treatment. The dental fear level was assessed using the self-reported Dental Fear Survey (DFS). Thirty-two images associated with dental treatment were prepared and classified into three categories: dental instruments, dental procedures, and the dental environment. All participants rated their level of disgust toward each image on a visual analog scale with scores ranging from 0 to 100.

Results

In the patient group, the disgust ratings for tooth extraction, dental drilling, and local anesthesia were >60, which were significantly different from those in the dentist group (Mann-Whitney U-test, p<0.001, p=0.001, and p=0.001, respectively). The ranking order of the disgust ratings for the 32 images showed significant correlation between the patient and dentist groups (Spearman correlation coefficient, r=0.80, p<0.001). In the patient group, the disgust ratings for dental impressions and the interdental brush, dental light, and dental chair were significantly correlated with DFS scores (r=0.61, p<0.001; r=0.47, p=0.001; r=0.41, p=0.006; and r=0.40, p=0.008, respectively).

Conclusion

This study revealed that patients have more negative feelings toward invasive procedures than dentists. However, a significant correlation was identified between the ranking of aversion-provoking dental stimuli by patients and dentists. Furthermore, the level of aversion to several dental-related items that do not cause pain was correlated with the dental fear level.

Immediate Effects of Dry Needling on Central Pain Processing and Skin Conductance in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

Although current evidence supports the use of dry needling for improving some clinical outcomes in people with neck pain, no previous research explored the effects of dry needling on the central processing of pain and autonomic nervous system in this population. Therefore, this clinical trial aimed to compare the effects of real and sham dry needling on autonomic nervous system function, pain processing as well as clinical and psychological variables in patients with chronic nonspecific neck pain. A double-blinded randomized clinical trial including 60 patients with neck pain was conducted. Patients were randomized to the real needling (n = 30) or sham needling (n = 30) group. Skin conductance (SC), pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) as well as pain intensity, related-disability, catastrophism, and kinesiophobia levels were assessed by an assessor blinded to the allocation intervention. The results did not find significant group * time interactions for most outcomes, except for the global percentage of change of SC values (mean: F = 35.90, p < 0.001, ηp2 = 0.459; minimum: F = 33.99, p = 0.839, ηp2 = 0.371; maximum: F = 24.71, p < 0.001, ηp2 = 0.037) and PPTs at C5-C6 joint in the same side of needling (F = 9.982; p = 0.003; = 0.147), in favor of the dry needling group. Although the proportion of subjects experiencing moderate to large self-perceived improvement after the intervention was significantly higher (X2 = 8.297; p = 0.004) within the dry needling group (n = 18, 60%) than in the sham needling group (n = 7, 23.3%), both groups experienced similar improvements in clinical and psychological variables. Our results suggested that dry needling applied to patients with chronic nonspecific neck pain produced an immediate decrease in mechanical hyperalgesia at local sites and produced an increase in skin conductance as compared with sham needling. No changes in central pain processing were observed. A single session of sham or real dry needling was similarly effective for decreasing related disability, pain intensity, catastrophism, and kinesiophobia levels. Further studies are needed to better understand the clinical implications of autonomic nervous system activation on central sensitization and pain processing in the long-term after the application of dry needling.