What is the gold standard of the dental anxiety scale?

A Cross-Sectional Study on the Impact of Dental Fear and Anxiety on the Quality of Life of Romanian Dental Students

Background and Objectives: Dental anxiety influences quality of life, causing emotional and physical discomfort. The aim of this study was to identify the prevalence of dental anxiety among young adults and how it influences the dimensions of quality of life, especially in terms of physical and psychological health. Material and Methods: This study was conducted between March and July 2024, within the Community Dentistry Discipline at the "Grigore T. Popa" University of Medicine and Pharmacy in Iași, on a group of 180 students to assess dental anxiety and its impact on their quality of life. Participants completed questionnaires using scales such as the IDAF, DAS-R CORAH, and WHOQOL-BREF. Results: Most participants presented a moderate level of dental anxiety, with 59.4% without anxiety and 6.1% with severe anxiety. Significant correlations were established between dental anxiety and physical and psychological dimensions of quality of life. In contrast, there were no significant correlations between dental anxiety and social relationships or the environment. Anxiety and fear were negatively correlated with perceived physical well-being, but positive correlations were also identified between sensitivity to dental stimuli and more favorable perceptions of physical and psychological health. Discussion: Dental anxiety has a significant impact on patients' physical and psychological health, especially on their perception of their well-being. This study confirms previous research showing that dental anxiety is related to certain dental procedures. Conclusions: Dental anxiety has a significant impact on psychological and physical perception but does not significantly affect social interactions.

Safety and Satisfaction Analysis of Intravenous and Inhalational Conscious Sedation in a Geriatric Population Undergoing Oral Surgery

Aim: The objective of this research was to compare two methods of conscious sedation (midazolam vs. sevoflurane) used for performing oral surgical procedures in the older adult population by analyzing dental treatment-related anxiety levels, the quality of sedation, and potential hemodynamic changes during the interventions, as well as post-recovery symptoms and patient satisfaction levels. Methods: A total of 104 patients underwent oral surgery with intravenous (age: 84.00 ± 8.410; 17 men and 36 women) and inhalation conscious sedation (age: 82.73 ± 8.809; 18 men and 33 women). Anxiety levels were recorded using the Modified Corah Dental Anxiety Scale (MDAS) and the Hamilton Anxiety Rating Scale (HARS). During the intervention, the heart rate, systolic/diastolic blood pressure, oxygen saturation, episodes of hypoxia (<90%SpO2), sedation duration, and Sedation-Agitation Scale (SAS) values were monitored. Upon completion of their treatment, all patients completed three questionnaires which evaluated their recall of the intervention, postoperative symptoms, and recommendation of the sedation method used. Results: Anxiety levels were slightly higher in the midazolam group (MDAS score: 9.60 ± 5.849; HARS score: 27.19 ± 6.802) compared to the sevoflurane group (MDAS score: 8.37 ± 5.063; HARS score: 24.92 ± 5.199), with no statistical significance (MDAS, p = 0.453/HARS, p = 0.065). No significant differences in the analyzed hemodynamic parameters were observed between the two groups. However, SAS values were significantly higher in the sevoflurane group (p = 0.006), while the sedation duration was longer in the midazolam group (p = 0.000). Postoperative symptoms, particularly gastrointestinal disturbances and dry mouth, were significantly more prevalent in the midazolam group, while there were no differences in neurological symptoms between the two groups. The majority of patients expressed a preference for either of these sedation methods. Conclusions: Sedation with agents such as midazolam and sevoflurane appears to be quite safe, given the absence of relevant hemodynamic changes. Midazolam has been shown to be effective for a longer duration, as well as to have a lower risk of developing greater digestive problems during the postoperative period. On the contrary, sevoflurane produced a greater sensation of dry mouth. Both sedative agents are perceived by the older adult population as satisfactory, recommending their use.

Exploring the Variations in the Use of Modified Dental Anxiety Scale (MDAS) in Literature: A Survey of Studies Published from 2014 to 2023

OBJECTIVES

Modified Dental Anxiety Scale (MDAS) is a frequently used psychometric tool to evaluate the dental anxiety level of dental patients or the general population. However, it was largely unclear if MDAS was consistently administered in the original format in the academic literature. This work aimed to survey the literature published in the last 10 years to reveal the current usage of MDAS.

METHODS

Web of Science and Scopus were queried to identify papers that mentioned the use of MDAS.

RESULTS

Among a total of 260 analyzed papers, 101 papers included comprehensive information regarding both the questions posed and the response format employed. Two papers only used an explicitly renamed MDAS with modified contents. Among the 258 papers that used MDAS that were supposed to be standardized, many discrepancies from the original version were discovered. There were only 39 papers that strictly followed the recommended scoring scheme: if a participant had a score of ≥ 19, he or she might be highly dentally anxious. Notable modifications included the use of a cut-off score different from the original recommendation, the use of multiple cut-off scores, modifications of the response format or descriptors, and modifications to the question items especially adding extra questions.

CONCLUSIONS

These modifications would create confusion when researchers and clinicians tried to compare data across studies. Researchers are recommended to administer MDAS in its original format.

Associations between Dental Anxiety Levels, Self-Reported Oral Health, Previous Unpleasant Dental Experiences, and Behavioural Reactions in Dental Settings: An Adult E-Survey

Background and Objectives: The aim of this study was to investigate the prevalence of dental anxiety, its association with self-reported oral health, and sociodemographic factors in adults that are critical for improving oral health and well-being. Materials and Methods: An online survey was conducted via social media, with 1551 adults (76.5% women, 23.5% men) participating nationwide. Data collected included demographic data, Modified Dental Anxiety Scale (MDAS) scores, and associations between dental anxiety, negative experiences, and self-reported oral health. The analysis included psychophysiological, behavioural, and emotional responses and avoidance of dental visits, using descriptive and generalised linear regression models. Results: This study found that the mean score of the MDAS was 9.70 ± 5.11 out of 25, 19.1% of the participants reported no dental anxiety, and 7.8% suffered from dental phobia. Gender, age, and socioeconomic status had no significant effect on the prevalence of anxiety. Although more than half of the participants reported negative dental experiences, particularly in childhood, anxiety levels were unaffected. However, those who rated their oral health as excellent or very good had lower anxiety scores (p = 0.008, p = 0.024). Among the dental procedures, oral surgery (58.7%) and prosthetic (restorative) dental treatments (15.2%) caused the most anxiety. Avoidance behaviour correlated with increased anxiety (p ≤ 0.001), as did postponing dental visits until severe pain occurred (p = 0.011). Conclusions: These results emphasise the significant prevalence of dental anxiety in adults, particularly for surgical procedures and drilling, posing challenges in patient management. Tailored strategies are essential to reduce anxiety, improve patient well-being, and optimise dental service delivery and treatment efficacy.

A novel brief questionnaire using a face rating scale to assess dental anxiety and fear

PURPOSE

This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF).

MATERIALS AND METHODS

Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day).

RESULTS

The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days.

CONCLUSION

The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care.

Evaluation of lavender and rose aromatherapies on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized clinical trial

Trial design

This is a prospective, block-randomized, blinded, multiple arm and parallel-group superiority clinical trial.

Methods

Seventy-eight patients satisfying the recruitment standards, were randomly allocated into three groups as follows: Group I (n = 26) - Inferior alveolar nerve block (IANB) devoid of aromatherapy (AT); Group II (n = 26) - IANB with lavender AT and Group III - IANB with rose AT (n = 26) with the help of the ultrasonic aroma diffuser (with respective oils)for 20 min/2 h in operatories 1,2 and 3 respectively. For AT, 3-4 drops of lavender and rose-conditioned oils were added from a 100 ml solution containing 100 mg of these medicinal plants. The pre-operative (PRO) and access opening (AO) pain as well as the anxiety of patients were recorded using the Visual Analog Scale (VAS) and Modified Dental Anxiety Scale (MDAS) respectively. Data thus obtained was entered into the Excel sheet and subjected to statistical tests (analysis of variance and paired t-test). The p-value less than 0.05 was considered statistically significant.

Results

Group I showed non-significant disparity between PRO and AO for both VAS as well as MDAS (p = 0.62, p = 0.71). However, group II (p = 0.04, p = 0.02) and group III (p = 0.03, p = 0.01) revealed significant differences between PO - AO VAS and MDAS. MDAS and VAS intergroup comparison revealed a significant difference among groups I and II (p = 0.03, p = 0.04), and groups I and III (p = 0.02, p = 0.03). However non-significant disparity was observed among groups II and III (p = 0.85, 0.34). Moreover, there was a statistically significant reduction in anxiety levels in females compared to males after rose AT (p = 0.02). Nevertheless, groups I and II did not show any gender predilection for anxiety as well as pain.

Conclusion

Alleviation of dental anxiety as well as reduction in pain during AO of teeth with SIP can be achieved using Lavender and rose AT. In female patients, rose AT can be preferred over lavender AT.

Do Subjects from Different Occupational Groups Experience Dental Fear and Anxiety Equally?

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients.

Impact of high-speed handpiece noise-induced dental anxiety on heart rate: analyzing experienced and non-experienced patients - a comparative study

BACKGROUND

Dental anxiety is very much common among the patients and could be due to different factors like the behavior of the dentist, past experiences, Needle phobia, or word of mouth from other patients. According to recent studies, a strong association between sound and anxiety has been found, so this observational study has been conducted to find out the link between the activation of anxiety with the sound of a handpiece between experienced patients, who have already gone through the dental treatments and non-experienced patients.

METHODS

Total of 297 participants were part of this study. These participants were divided into 2 groups according to the experienced and non-experienced dental patients. The researcher first filled out the CORAH Dental Anxiety Scale (DAS) form to mark the anxiety level of the patients, and then noted the readings of the heart rate in 3 intervals which were before during, and after the treatment with the pulse oximeter. Later the data was analysed using the SPSS independent t-test.

RESULTS

Results show that patients in group 1 who have gone through the dental treatment before were less anxious and had a lesser effect on their heart rate than the patient who were having the treatment for the first time who were in group 2. Another interesting factor was noticed that in both the groups female were found to be more anxious than male participants. Participants with younger age were found to be more anxious than older age patient in both groups CONCLUSIONS: The sound of the handpiece can provoke anxiety in the patient, affecting the heart and increasing the heart rate. Participants who were experienced were found to be less anxious than the participants who were inexperienced.

A systematic review and network meta-analysis of virtual reality, audiovisuals and music interventions for reducing dental anxiety related to tooth extraction

BACKGROUND

Tooth extraction is a common procedure performed by oral and maxillofacial surgeons or dentists, often resulting in dental fear and anxiety. The use of relaxing music, audiovisuals, and virtual reality (VR) technologies has been employed to reduce dental anxiety. This network meta-analysis (NMA) aimed to assess the comparative effectiveness of relaxing music, audiovisuals, and VR in reducing dental anxiety associated with tooth extraction.

METHODS

Four electronic databases were searched up to March 8, 2023, to identify randomized controlled trials (RCTs) evaluating different multimedia interventions, including the application of using relaxing music, audiovisuals, and VR technologies for dental anxiety. Studies utilizing various anxiety scales for tooth extraction were considered eligible. The pooled standard mean difference (SMD) and 95% confidence interval (CI) of anxiety scale scores were analyzed using Bayesian NMA.

RESULTS

A total of 11 RCTs were included in this NMA. The Bayesian NMA results demonstrated that relaxing music (SMD = -0.64, 95% CI: -1.04, -0.25) and VR (SMD = -0.54, 95% CI: -1.08, -0.02) were associated with a reduction in dental anxiety, while audiovisuals (SMD = -0.34, 95% CI: -0.97, 0.33) required further consideration. Ranking probabilities indicated that relaxing music might be the most acceptable method for individuals with dental anxiety. The frequentist NMA yielded consistent rankings in a sensitivity analysis.

CONCLUSIONS

Relaxing music shows the greatest potential for reducing dental anxiety related to tooth extraction when compared to other multimedia interventions.