When the fear of dentist is relevant for more than one's oral health. A structural equation model of dental fear, self-esteem, oral-health-related well-being, and general well-being

Impact of Paper Information Leaflets on Dental Anxiety and Well-Being in Czech Patients: A Randomized Clinical Trial

Aim

Dental anxiety and well-being significantly influence patients' oral health and quality of life. This study investigated whether providing paper information leaflets (PILs) before performing dental procedures improved psychological well-being and reduced anxiety in Czech patients.

Materials and Methods

This parallel-group, single-blind randomized, prospective clinical trial was conducted at a private dental clinic in the Czech Republic in 2020. A total of 167 adult patients were randomly assigned to either the experimental group (n = 82), receiving both verbal information and a PIL, or the control group (n = 85), receiving only verbal information before their dental procedure (fillings, endodontic treatment, prosthetic restorations, or extractions). Pre- and post-procedure psychological well-being and anxiety were assessed using study-specific questionnaires. Data analysis was conducted in R using RStudio, with a significance level set at P < 0.05. Between-group differences were assessed while controlling for gender and education. Linear regression was used to analyze pre-procedure anxiety, and logistic regression was used to analyze post-procedure well-being outcomes (reporting "everything was fine," "unpleasant mouth sensations," and "quick adjustment"). The Benjamini-Hochberg correction was applied to control for multiple comparisons. Sensitivity analysis used the "best-worst and worst-best case" method to evaluate nonrandom missing data. Power analysis determined a minimum of 64 participants per group for a two-tailed t test.

Results

Baseline anxiety levels, measured on a 1-6 scale, were similar between the PIL group (mean 4.26, SD 1.11) and the control group (mean 4.36, SD 1.17; β = -0.11, P = 0.54). Post-procedure, while fewer patients in the PIL group reported that "everything was fine" (28/82 vs. 39/85), this difference was not statistically significant after correction for multiple comparisons (uncorrected P = 0.038, α FDR = 0.01). No significant differences were found between groups regarding "unpleasant mouth sensations" (P = 0.84) or "quick adjustment" (P = 0.52).

Conclusion

Providing PILs in addition to verbal information did not significantly impact pre-procedure anxiety or post-procedure well-being in this sample of Czech dental patients. These findings indicate that verbal communication alone may be sufficient for managing patient anxiety and promoting well-being in this context. Further research using validated instruments and exploring different communication strategies is warranted.

Structure equation modeling in oral health research: A review of applications and considerations

This review provides an overview of structure equation modeling (SEM) and its applications in dental research. SEM is a statistical technique that allows researchers to examine the relationships between variables and is useful for analyzing data from a wide range of research designs, including cross-sectional, longitudinal, and experimental studies. The process involves specifying a theoretical model, testing the model with data, and evaluating the model fit. It has been used in dental research to investigate a wide range of topics, including dental diseases, oral health-related quality of life, and dental anxiety. SEM is particularly useful in modeling the relationships between various risk factors and dental diseases and also has the potential to provide a deeper understanding of the multifactorial nature of dental diseases such as periodontitis, dental caries, and oral cancer. Moreover, the insights provided can aid in the development of effective strategies for the prevention and treatment of dental diseases. It is a powerful statistical tool that can be used by dental researchers to gain a better understanding of the intricate interplay of factors that underlie dental diseases and other oral health-related outcomes.

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.

Dental anxiety, Quality of Life and body image: gender differences in Italian and Spanish population

BACKGROUND

Dental anxiety is an excessive and irrational negative emotional state experienced by population; the dental anxiety is common throughout the lifespan and is an obstacle to improving oral health behaviors and outcomes. The aim of this study was to assess gender differences in dental anxiety and to investigate if oral health impacts patients' Quality of Life and the perception of their body image.

METHODS

The sample consisted of 366 subjects selected in Italy and Spain (January 2021-September 2021). For this study, data were gathered using Google Forms (Google LLC, Mountain View, CA, USA). Data were collected including the Dental Anxiety Scale (DAS), Oral Health Impact Profile (OHIP-14) questionnaires and Body Uneasiness Test.

RESULTS

Women showed higher scores than men for the dental anxiety. The regression analysis showed that gender, age, and Oral Health Impact are predictors of "dental anxiety." A borderline significance emerges for the independent variable body uneasiness.

CONCLUSIONS

The dental anxiety is widespread in the population, with a higher prevalence among women and increases with increasing age. It can negatively affect patients' Quality of Life, well-being, and self-esteem. These results underline the importance of addressing both individual and group strategies for preventing or treating dental anxiety.

The Moderating Role of Self-Rated Oral Health on the Association Between Oral Health Status and Subjective Well-Being: Findings From Chinese Older Adults in Hawai'i and Taiwan

This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawai'i and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts.

Factors Associated With Regular Dental Care in People With Spinal Cord Injury: A Secondary Analysis of Data From the FRASCI Study

Background

Oral health and regular dental care are critical to overall health. Research has found associations between oral health and infections, respiratory disease, and poor quality of life in the general population. While risks for all are increased in people with spinal cord injury (SCI), there is limited information on dental care after SCI.

Objectives

The purpose of this analysis was to examine factors associated with regular dental care in people with SCI.

Methods

We analyzed data from 348 individuals with traumatic and nontraumatic SCI who were enrolled in the Fracture Risk after SCI (FRASCI) study. The dataset included two variables on dental care, as well as demographics, injury-related characteristics, and secondary conditions. Bivariate relationships were determined using two-sided t tests and chi-square tests.

Results

Over 60% of the sample received regular dental care twice per year, and 71% reported seeing a dentist within the past year. Those participants receiving regular dental care twice a year were more likely to be female, be working, have more than a high school diploma, have private insurance, and need a caregiver compared to those who do not receive regular dental care. In addition, these participants were more likely to have had pneumonia since their SCI and have had a urinary tract infection in the past year and since injury.

Conclusion

More data on oral health are needed to make conclusions about the impact of oral health on secondary conditions and quality of life in people with SCI.

Prevalence, Predictors, and Reasons for Permanent Tooth Extraction Among High School Students in Saudi Arabia: A National Cross-Sectional Study

Background

Tooth loss is a major dental health concern that has adverse consequences on the remaining dentition and on the patient’s general well-being. This present study aimed to assess predictors and causes of permanent tooth extraction among students.

Methods

This national cross-sectional study in Saudi Arabia included a random sample of school students of both genders from grades 10 to 12 (15-18 years of age) and spanned the period of September 2012 to January 2016. Demographic, social, and medical history were recorded. Moreover, a list of possible reasons for tooth extraction was discussed with participants and their parents. The questionnaire was divided into two parts. They first asked for the patient's gender, age, marital status, education level, history of smoking, and the time of the last dental visit. Periodontal and dental examinations were performed. Multivariable logistic regression was used to determine predictors of tooth loss among the sample.

Results

A total of 2,435 school students were included in the study. Notably, 24% of the students had extractions of at least one permanent tooth. Nearly 27% of female students had a permanent tooth extraction compared with only 21.7% of male students, which was statistically significant. Students who visited dentists regularly had significantly more tooth extractions (39%) than students who did not (20.6%). Multivariate logistic regression analysis showed that the significant predictors for permanent tooth extraction were age, regular dental visits, and mean probing depth (PD). Caries (15%) followed by orthodontic treatment (6%) were the main reason for permanent tooth extraction among the sample.

Conclusion

Caries was responsible for most of the tooth loss among the study population. Significant predictors for permanent tooth extraction were age, regular dental visits, and mean probing depth. It follows that there is a need for intensified oral health education and awareness programs in the population with an emphasis on the prevention of dental caries.

Long-term impact of implant-supported oral rehabilitation on quality of life: A 5 years prospective study

BACKGROUND

This study analyzed the impact of oral rehabilitation with implant-supported fixed complete dentures (IFCDs) on the oral health-related quality of life (OHRQoL) and its relationship with self-esteem and gratitude.

METHODS

66 patients were interviewed to collect data on OHRQoL (OHIP-14), gratitude, and self-esteem, after denture delivery. OHIP-14 scores were analyzed over time and contrasted between groups with IFCD complication or not.

RESULTS

OHIP-14 changed from 22.1 ± 13.8 at baseline to 1.8 ± 2.3 after rehabilitation. Gratitude and self-esteem mean scores were 38.6 ± 3.0 and 36.9 ± 3.8, respectively. OHIP-14 was statistically different from baseline (22.1 ± 13.8) and 1, 3 and 5 years after rehabilitation (2.3 ± 3.7; 1.9 ± 3.1, and 1.8 ± 2.3). No difference was found between the follow-up times and among OHIP-14 domains. Thirteen out of 66 patients (19.7%) had repairable prosthetic complications, but OHIP-14 did not differ between patients with or without complications. Gratitude and self-esteem showed a moderate association (rs = 0.36; p = 0.003), but no association with OHIP-14.

CONCLUSIONS

IFCD treatment has a long-term positive impact on patient's OHRQoL, even among patients who had prosthetic complications. The long-term stability in improved OHRQoL is not associated with self-esteem and gratitude. © 2022 Australian Dental Association.

Reviewing challenges in access to oral health services among the LGBTQ+ community in Indiana and Michigan: A cross-sectional, exploratory study

Objective

In healthcare settings, lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations often experience discrimination, leading to decreased healthcare services utilization. In this study we have tried to identify oral healthcare providers (OHP)’s perceptions toward LGBTQ+ patients, perceived barriers for LGBTQ+ patients in accessing oral health services, and whether they were open to inclusive oral healthcare practices. In addition, the experiences of LGBTQ+ patients in oral healthcare settings including their oral healthcare seeking behaviors and beliefs were also explored.

Methods

Descriptive, quantitative surveys were administered to OHPs and LGBTQ+ patients within Indiana and Michigan. Surveys contained questions about participant demographics, including gender and sexual minority status, and the presence of inclusive healthcare practices within the oral healthcare settings. Descriptive analyses and regression modeling were used to explore the distribution of participant responses and to identify predictors associated with patient comfort and OHP’s attitudes toward LGBTQ+ patients.

Results

Overall, 71% of LGBTQ+ patients reported regularly attending dental appointments; however, 43% reported feeling uncomfortable going to appointments and 34% reported being treated unfairly during appointments because of sexual orientation. Among OHPs, 84% reported that the healthcare settings where they practiced were welcoming for LGBTQ+ populations and 84% reported willingness to improve LGBTQ+ care. The presence of inclusive healthcare practices predicted comfort for LGBTQ+ patients (P < 0.10). Additionally, OHPs who either identified as an ally or as having a family member or close friend in the LGBTQ+ community had higher odds of feeling responsible to treat LGBTQ+ patients.

Conclusion

Many LGBTQ+ patients often experience discomfort in oral healthcare settings. While OHPs were largely unaware of this, evidence suggests the need for cultural competency training for OHPs.

The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study

BACKGROUND

Dental anxiety is of public health importance because it leads to postponed dental treatment, which comes with health complications. The present study investigated whether there is a correlation between the degree of dental anxiety and other kinds of anxiety and whether there are prognostic factors for the different kinds of anxiety.

METHOD

In the sample (N = 156) from a dental practice in a large German city, 62% of patients received a check-examination and 38% received dental surgery. The target variables were recorded with validated questionnaires: dental anxiety (IDAF-4c+), subclinical anxiety (SubA), anxiety of negative evaluation (SANB-5), current general anxiety (STAI state), loneliness (LS-S) and self-efficacy (GSW-6). The applied statistics were: t-tests for 31 variables, correlation matrix and multivariate and bivariate regression analyses.

RESULTS

The dental surgery patients displayed more dental anxiety and more dental interventions than the check-examination group. The main result was a positive correlation of all kinds of anxiety with each other, a positive correlation of loneliness and neuroticism with all forms of anxiety and a negative correlation between all forms of anxiety and self-efficacy. Especially dental anxiety is positively associated with other kinds of anxiety. In multivariate regression models only neuroticism is associated with dental anxiety, but feelings of loneliness are positively associated with with the other kinds of anxiety assessed in this study. The higher the self-efficacy, the lower the level of general anxiety.

CONCLUSIONS

In dentistry, anxiety from negative experiences with buccal interventions should be distinguished from anxiety caused by personality traits. Self-efficacy tends to protect against anxiety, while loneliness and neuroticism are direct or indirect risk factors for anxiety in this urban dentistry sample. Dental anxiety seems to be independent from biographical strains but not from neuroticism. In practice, more attention must be paid to anxiety control, self-management and efforts to improve the confidence of patients with emotional lability, less self-confidence and propensity to shame.

Aspirations and Worries: The Role of Parental Intrinsic Motivation in Establishing Oral Health Practices for Indigenous Children

Aboriginal and Torres Strait Islander (respectfully, subsequently referred to as Indigenous) children in Australia experience oral disease at a higher rate than non-Indigenous children. A history of colonisation, government-enforced assimilation, racism, and cultural annihilation has had profound impacts on Indigenous health, reflected in oral health inequities sustained by Indigenous communities. Motivational interviewing was one of four components utilised in this project, which aimed to identify factors related to the increased occurrence of early childhood caries in Indigenous children. This qualitative analysis represents motivational interviews with 226 participants and explores parents' motivations for establishing oral health and nutrition practices for their children. Findings suggest that parental aspirations and worries underscored motivations to establish oral health and nutrition behaviours for children in this project. Within aspirations, parents desired for children to 'keep their teeth' and avoid false teeth, have a positive appearance, and preserve self-esteem. Parental worries related to child pain, negative appearance, sugar consumption, poor community oral health and rotten teeth. A discussion of findings results in the following recommendations: (1) consideration of the whole self, including mental health, in future oral health programming and research; (2) implementation of community-wide oral health programming, beyond parent-child dyads; and (3) prioritisation of community knowledge and traditions in oral health programming.

Dental Fear and Associated Factors among Children and Adolescents: A School-Based Study in Lithuania

Dental fear is a challenging problem in dentistry and many contributing factors have been identified. Although this problem among children and adolescents has been studied in the literature for a long time, few such studies have been conducted in Lithuania. This study aimed to evaluate the prevalence of dental fear and examine its association with gender, age and several psychological and social factors among children and adolescents in Lithuania. The cross-sectional survey included a randomly selected sample (n = 1590) of children aged 11-14 and adolescents aged 15-18. The data were supplemented by interviewing the parents of these subjects (n = 1399). Dental fear was measured with a single five-score question. The data collection also included questions on oral health, socioeconomic status, oral health-related quality of life and self-esteem. Poisson regression analysis was used to assess the association between perception of dental fear and potential predictor variables. It was found that 32.2% (95% CI: 29.9-34.4%) of children and adolescents reported no fear of dental treatment, 12.5% (10.8-14.2%) of their peers were highly afraid of dental treatment, and other subjects assessed their dental fear gradually. Girls reported greater dental fear scores than boys, but the level of dental fear did not depend on the age. We identified the groups of subjects by gender and age, and a higher level of dental fear was significantly associated with untreated caries experience, a delay in the age of the subject's first visit to the dentist, low self-esteem, low oral health-related quality of life, low overall life satisfaction and low family affluence. The results also suggested that dental fear could originate from previous toothache, dentists' actions, high sensitivity in the child and poor psychological readiness for treatment. It was concluded that dental fear among Lithuanian children and adolescents is a common problem that is associated with gender and several dental, psychological and social factors. The findings indicate that school-based health policies, paediatric dentists and parents should be encouraged to focus on the psychosocial factors associated with dental fear because most of them can be prevented.