Clinical correlates of dental anxiety among older adults

Dental Anxiety and Influencing Factors in Adults

Dental anxiety is one of the most common conditions present amongst the masses globally. It is this fear that makes individuals avoid seeking dental treatment which results in a deteriorated oral health-related quality of life (OHRQoL). Discrepancies exist in the prevalence of dental anxiety based on gender, education levels, level of deprivation of a society and its socioeconomic status. In this study, a sample size of 522 respondents was collected. Kuppuswamy's socioeconomic status scale and modified dental anxiety scales were used to collect the necessary data. These data were analyzed by cross tabbing and chi-square test of significance was applied to assess the association between dental anxiety and other factors. Female gender was significantly associated with dental anxiety with p-value = 0.03. Higher education levels and dental anxiety also displayed significant associations with each other, with a p-value of 0.048. Seventy-six percent of the individuals of lower socioeconomic status were prone to be more dentally anxious. Dental anxiety was more significant in individuals with higher levels of education in our study. Respondents who were part of a lower socioeconomic class were also more prone to being anxious while receiving dental treatment. Knowing the factors that cause dental anxiety can help dentists effectively manage and treat their patients.

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.

The Current and Potential Application of Medicinal Cannabis Products in Dentistry

Oral and dental diseases are a major global burden, the most common non-communicable diseases (NCDs), and may even affect an individual's general quality of life and health. The most prevalent dental and oral health conditions are tooth decay (otherwise referred to as dental caries/cavities), oral cancers, gingivitis, periodontitis, periodontal (gum) disease, Noma, oro-dental trauma, oral manifestations of HIV, sensitive teeth, cracked teeth, broken teeth, and congenital anomalies such as cleft lip and palate. Herbs have been utilized for hundreds of years in traditional Chinese, African and Indian medicine and even in some Western countries, for the treatment of oral and dental conditions including but not limited to dental caries, gingivitis and toothaches, dental pulpitis, halitosis (bad breath), mucositis, sore throat, oral wound infections, and periodontal abscesses. Herbs have also been used as plaque removers (chew sticks), antimicrobials, analgesics, anti-inflammatory agents, and antiseptics. Cannabis sativa L. in particular has been utilized in traditional Asian medicine for tooth-pain management, prevention of dental caries and reduction in gum inflammation. The distribution of cannabinoid (CB) receptors in the mouth suggest that the endocannabinoid system may be a target for the treatment of oral and dental diseases. Most recently, interest has been geared toward the use of Cannabidiol (CBD), one of several secondary metabolites produced by C. sativa L. CBD is a known anti-inflammatory, analgesic, anxiolytic, anti-microbial and anti-cancer agent, and as a result, may have therapeutic potential against conditions such burning mouth syndrome, dental anxiety, gingivitis, and possible oral cancer. Other major secondary metabolites of C. sativa L. such as terpenes and flavonoids also share anti-inflammatory, analgesic, anxiolytic and anti-microbial properties and may also have dental and oral applications. This review will investigate the potential of secondary metabolites of C. sativa L. in the treatment of dental and oral diseases.

Sedative and Behavioral Effects of Intranasal Midazolam in Comparison with Other Administrative Routes in Children Undergoing Dental Treatment - A Systematic Review

AIM

The aim of this study was to systematically identify and evaluate the available literature on the effectiveness of intranasal midazolam sedation compared with midazolam administered through other routes in the sedation and behavior management of children during dental treatment.

MATERIALS AND METHODS

The search was done using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, LILACS, ScienceDirect, and SIGLE. All studies comparing the sedative effect and behavior management effectiveness of intranasal midazolam with midazolam administered through other routes in children were included.

RESULTS

Electronic database search identified 163 articles, out of which 143 were excluded after reading titles and removing duplication. The remaining 20 studies were evaluated in detail. A final of 13 studies were included based on the inclusion criteria. Among the 13 studies included in the present review, a high risk of bias was noted in all the 13 articles. There was no adequate blinding of personnel and participants in the study, allocation concealment was improper and presence of inadequate blinding of the outcome assessment. . Statistically, no significant difference was observed between intranasal midazolam and other midazolam routes on behavior and sedation level in the studies included in this review.

CONCLUSION

Limited studies are available pertaining to the sedative and behavioral effects of intranasal midazolam, and thus, this review recommends need for more research evaluating the sedative effect of intranasal midazolam in comparison with midazolam administered through other routes in the behavior management of children during dental treatment.

The Dental Anxiety Scale and Effects of Dental Fear on Salivary Cortisol

Only a few studies have investigated use of the Dental Anxiety Scale in dental fear-induced neuroendocrine changes. The present study examined 19 female patients, each at two timepoints across an educational and a treatment session within a periodontitis therapy. Subjective measures included a visual analogue scale, the STAI State scale, and the Dental Anxiety Scale. Salivary cortisol was measured in parallel across all four timepoints. Although patients were significantly more aroused and anxious prior to the treatment session, salivary cortisol remained unchanged. However, patients with high Dental Anxiety were significantly more aroused and anxious and showed significantly higher salivary cortisol during the educational session than those with low scores on Dental Anxiety. In conclusion, the Dental Anxiety Scale differentiated mean neuroendocrine change between patients scoring low and high for Dental Anxiety and its use as an accurate tool to identify patients with high dental anxiety should be further studied predictively.

Satisfaction with dental care and life-course predictors: A 20-year prospective study of a Swedish 1942 birth cohort?

OBJECTIVES

The aim was to assess the impact of care experience, health factors and socioeconomic factors on satisfaction with dental care across time and to assess the stability or change in levels of self-reported satisfaction with dental care in individuals as they progress from middle age to early old age.

MATERIALS AND METHODS

The present work is based on five separate data collections from a cohort study with 3585 individuals responding in all years of the survey. Data collection was conducted in 1992 when the subjects were 50 years of age and again 5, 10, 15 and 20 years later. Absolute stability in satisfaction with dental care was assessed by calculating the proportion of individuals who maintained their position in the same category from one survey period to another. Changes across time were tested using Cochran's Q test. Satisfaction with dental care across the 20-year survey period was modeled using the generalized estimating equation (GEE).

RESULTS AND CONCLUSION

The result showed that 85% of women and 83% of men remained satisfied with dental care. Binomial GEE revealed no statistical significant change in satisfaction with dental care between 1992-2012. In sum, this study has shown that this age group, born in 1942, was stably satisfied with dental care between age 50 and age 70, despite all changes during this time period. Females are more satisfied than men and the most important factors are the experience of attention during the last visit, satisfaction with dental appearance and good chewing capability.

Reliability and validity of the Korean version of the Dental Fear Survey

BACKGROUND

Many people experience varying levels of discomfort when confronted with the prospect of dental treatment. Dental treatment can be a traumatic experience, especially for children and adolescents with dental anxiety. In this age group, dental fear causes a significant problem in dental management and has been related to severe dental caries and dental pain. The Dental Fear Survey ( DFS ) is the most widely used measure of dental fear. This study was undertaken to develop the Korean version of the DFS ( K-DFS ) and test its reliability and validity.

METHODS

The K-DFS, which uses projective techniques to measure children's and adolescents' dental fear, was developed. The DFS was translated into Korean and participants were selected via convenience sampling. Reliability and validity were tested using data from a sample of 813 middle school students in Gyeonggi Province, selected from the Self questionnaire survey. The K-DFS was administered twice to 102 adolescents aged 12-15 years.

RESULTS

The K-DFS had high internal consistency reliability (99.1%) but low test-retest reliability.

CONCLUSIONS

The results indicate that the Korean versions of the DFS have good internal consistency reliabilities and test-retest validities. However, we need to further examine the test-retest reliability of the K-DFS and replicate the current study in different samples covering various age groups.

Assessment of dental anxiety and its correlation with denture satisfaction in edentulous patients

OBJECTIVE

The objectives of this study were to measure the level of dental anxiety and its correlation with dental history, denture satisfaction and other variables.

MATERIALS AND METHODS

A cross-sectional study was conducted on 150 completely edentulous patients reporting to the Department of Prosthodontics, KLES's Institute of Dental Sciences, Belgaum, over a period of 17 months (August 2005 to March 2007). The anxiety level of the patients was assessed with the help of a questionnaire, after obtaining an informed consent. Reliability of the dental anxiety scale was assessed by means of coefficient alpha.

RESULTS

The results of this study concluded that dental anxiety scale for edentulous patients was a reliable scale for measuring dental anxiety. The anxiety score was higher for female than male patients. A significant correlation was found between denture satisfaction score and anxiety.

DISCUSSION

Anxiety plays a major role in denture satisfaction. The variables included: Previous denture experience, occupation, medical history, age, gender, dental anxiety scale, period of edentulousness, age of previous dentures, number of complete dentures, denture satisfaction score, and the score on the Hamilton anxiety scale.

CONCLUSION

The study indicated that gender correlates significantly with dental anxiety. Patients with medical history were found to be more anxious than normal patients. Patients with higher anxiety values were less satisfied with the treatment. Lastly, subjects with higher general anxiety showed greater values on the dental anxiety scale.

CLINICAL SIGNIFICANCE

The assessment of dental anxiety will help the prosthodontist in the management of anxious patients and secondly to provide evidence-based research into this psychological construct which has been shown to predict dental avoidance.

Additional psychometric data for the Spanish Modified Dental Anxiety Scale, and psychometric data for a Spanish version of the Revised Dental Beliefs Survey

Background

Hispanics comprise the largest ethnic minority group in the United States. Previous work with the Spanish Modified Dental Anxiety Scale (MDAS) yielded good validity, but lower test-retest reliability. We report the performance of the Spanish MDAS in a new sample, as well as the performance of the Spanish Revised Dental Beliefs Survey (R-DBS).

Methods

One hundred sixty two Spanish-speaking adults attending Spanish-language church services or an Hispanic cultural festival completed questionnaires containing the Spanish MDAS, Spanish R-DBS, and dental attendance questions, and underwent a brief oral examination. Church attendees completed the questionnaire a second time, for test-retest purposes.

Results

The Spanish MDAS and R-DBS were completed by 156 and 136 adults, respectively. The test-retest reliability of the Spanish MDAS was 0.83 (95% CI = 0.60-0.92). The internal reliability of the Spanish R-DBS was 0.96 (95% CI = 0.94-0.97), and the test-retest reliability was 0.86 (95% CI = 0.64-0.94). The two measures were significantly correlated (Spearman's rho = 0.38, p < 0.001). Participants who do not currently go to a dentist had significantly higher MDAS scores (t = 3.40, df = 106, p = 0.003) as well as significantly higher R-DBS scores (t = 2.21, df = 131, p = 0.029). Participants whose most recent dental visit was for pain or a problem, rather than for a check-up, scored significantly higher on both the MDAS (t = 3.00, df = 106, p = 0.003) and the R-DBS (t = 2.85, df = 92, p = 0.005). Those with high dental fear (MDAS score 19 or greater) were significantly more likely to have severe caries (Chi square = 6.644, df = 2, p = 0.036). Higher scores on the R-DBS were significantly related to having more missing teeth (Spearman's rho = 0.23, p = 0.009).

Conclusion

In this sample, the test-retest reliability of the Spanish MDAS was higher. The significant relationships between dental attendance and questionnaire scores, as well as the difference in caries severity seen in those with high fear, add to the evidence of this scale's construct validity in Hispanic samples. Our results also provide evidence for the internal and test-retest reliabilities, as well as the construct validity, of the Spanish R-DBS.

The relationship between dental anxiety and dental decay experience in antenatal mothers

The aim of this study was to investigate the relationship between dental anxiety and dental decay experience among antenatal mothers attending Maternal and Child Health clinics in Malaysia. A cross-sectional study was conducted on a consecutive sample of 407 antenatal mothers in Seremban, Malaysia. The questionnaire consisted of participants' demographic profile and the Dental Fear Survey. The D(3cv)MFS was employed as the outcome measure and was assessed by a single examiner (intraclass correlation = 0.98). A structural equation model was designed to inspect the relationship between dental anxiety and dental decay experience. The mean Dental Fear Survey score for all participants was 35.1 [95% confidence interval (34.0, 36.3)]. The mean D(3cv)MFS score was 10.8 [95% confidence interval (9.5, 12.1)]. Participants from low socio-economic status groups had significantly higher D(3cv)MFS counts than those from high socio-economic status groups. The path model with dental anxiety and socio-economic status as predictors of D(3cv)MFS showed satisfactory fit. The correlation between dental anxiety and dental decay experience was 0.30 (standardized estimate), indicating a positive association. Socio-economic status was also statistically significantly associated with the D(3cv)MFS count (beta = 0.19). This study presented robust evidence for the significant relationship between dental anxiety and dental decay experience in antenatal mothers.

Age-specific associations between dental fear and dental condition among adults in Finland

OBJECTIVE

Our objective was to study whether dental condition, measured by numbers of sound, decayed, missing, and restored teeth, was associated with dental fear, and whether age, dental attendance, and/or gender modified this association.

MATERIAL AND METHODS

The sample (n=8,028) comprised Finnish adults aged 30 years and older and the study included people (n=6,335) who participated in a home interview and a clinical dental examination. Dental fear was measured by the question: "How afraid are you of visiting a dentist?" Multiple logistic regression analysis was used to determine the association between dental fear and dental condition variables, i.e. numbers of decayed, missing, sound, and restored teeth considering the effects of age, attendance, and gender.

RESULTS

With the exception of number of restored teeth, all dental condition variables were associated with dental fear. The association between dental fear and number of decayed teeth was positive and was independent of age, gender, and attendance. Age modified the association between dental fear and number of missing and sound teeth. Among the oldest age group, the numbers of missing and sound teeth were positively associated with dental fear while being negatively associated among the youngest age group.

CONCLUSIONS

People with high dental fear have poorer dental condition than those with lower fear. Neither gender nor dental attendance affects the association between dental fear and dental condition. The associations between dental fear and numbers of missing and sound teeth vary according to year of birth.

Needs in screening cardiovascular parameters during dental care in the elderly

AIMS

The aim of this study was to compare physiological reactivity during oral care between elderly and young subjects.

MATERIALS AND METHODS

Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP) and blood oxygen saturation (SPO2) were recorded seven times during two consecutive dental impression sessions in 31 complete denture wearers (aged 60.7+/-11.44 yrs) and 31 young subjects (aged 21.8+/-1.5 yrs). Subjects also reported pain and anxiety on a visual analogue scale.

RESULTS

In the group of young subjects, SBP and DBP increased after the first impression and remained unchanged after the second. In the group of elderly persons, SBP and DBP increased significantly during both first and second dental impressions. Intergroup comparisons showed a longer-term relative increase in SBP and DBP in the group of elderly subjects.

CONCLUSIONS

These results emphasize the need to screen cardiovascular parameters during dental care in elderly subjects.

Current state of sedation/analgesia care in dentistry

PURPOSE OF REVIEW

Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field.

RECENT FINDINGS

The literature in the last 12 months falls into four main categories: dental anxiety and its influence on patient care, dental sedation for children, sedation with benzodiazepines for dentistry, and intravenous propofol sedation for dentistry.

SUMMARY

Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.

Oral health in rural and remote Western Australian Indigenous communities: A two-year retrospective analysis of 999 people

AIM

Remoteness is a significant factor determining the level of basic health, education and infrastructure services to which Aboriginal people have access. This study examines the oral health status and oral health behaviours of Aboriginal people attending rural and remote dental clinics.

METHODS

Data were collected as part of routine delivery of dental services in five rural and remote dental clinics.

RESULTS

The average DMFT score of patients in all the clinics was 8.5 (sd 6.6). Advanced periodontal disease (a CPI score of 3 and/or 4) was present in 60.8% of all patients. Almost 88% of patients had experienced toothache in the previous six months. Almost a third (31.4%) of people could not remember the last time they went to the dentist. Less than half of the people reported brushing their teeth daily (40.4%) with 37.9% cleaning occasionally. A total of 52.4% of patients identified themselves as a 'smoker' of tobacco products. Past smokers accounted for 10.5% of the participants. The most common self-reported reason for visiting the clinic was for 'hole in tooth/fillings required' (37.4%), followed by 'pain/urgent problem' (24.8%).

CONCLUSIONS

This study emphasises the urgent need for the development of strategies targeting Aboriginal oral health, both as stand alone, and as part of a multifactorial risk factor approach where oral health is integral to general health activities.

Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health

Pronounced dental anxiety could lead to avoidance strategies to evade dental visits. The aim of the present epidemiological study was to investigate the prevalence and related oral disease patterns of dental anxiety in young adult male soldiers. Therefore, the intensity and frequency of dental anxiety are presented and the correlation with oral clinical findings are evaluated. Three hundred seventy-four soldiers who underwent a compulsory dental check-up were randomly assigned to this study. Psychological parameters were collected based on a protocol integrating the Dental Anxiety Scale (DAS) and the Gatchell Fear Scale (GaFS). Patient-based measures included D3,4MF-scores for dental status and the Community Periodontal Index of Treatment Need (CPITN) for periodontal status. Thirty-two individuals (8.6%) showed DAS-scores of 13 or 14 (anxious), while 4.6% had a DAS-score > or = 15 (highly anxious/phobic). Highest DAS-values were measured among patients' aged 19-29 (n = 262). DMFS-values of anxious and less anxious patients showed only minor differences. However, anxious patients had significantly more carious lesions (P < 0.001). CPITN periodontal values showed no significant differences between both groups. 89.2% of less anxious individuals and 79.6% of anxious patients went for regular dental check-ups. Thus, every tenth patient was considered to have high dental anxiety. Anxiety results in avoidance behaviour, which can only be discovered upon compulsory examinations and which is associated with higher caries morbidity and need for oral rehabilitation. As anxiety has a direct influence on oral health, it should be detected and accounted for in a treatment concept integrating dental and cognitive-behavioural therapeutic approaches.

Dental fear in adults: a meta-analysis of behavioral interventions

OBJECTIVES

The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia.

METHODS

Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis.

RESULTS

The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4).

CONCLUSIONS

Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance ( >4 years after treatment) is 77%.

Path model of psychological antecedents to pain experience: experimental and clinical findings

OBJECTIVES

Two studies are described addressing how anxiety, fear of pain, and catastrophizing impact on pain experience.

METHODS

In study 1, 66 undergraduates (34 men, 32 women) completed measures of state and trait anxiety, fear of pain, and catastrophizing prior to participating in a cold pressor procedure. In study 2, 60 undergraduates (30 men, 30 women) completed the same measures and participated in dental hygiene treatment and rated the pain they experienced during a scaling procedure (removing deposits from the tooth surface).

RESULTS

In both studies, fear of pain and catastrophizing were significantly correlated with pain intensity ratings, and fear of pain and catastrophizing were correlated with each other. Trait anxiety was correlated with catastrophizing but not with fear of pain or pain. Path analyses revealed significant paths from trait anxiety to state anxiety, from trait anxiety to catastrophizing, and from catastrophizing to pain intensity ratings.

DISCUSSION

The findings suggest that although fear of pain and catastrophizing are related constructs, catastrophizing provides unique predictive ability for pain ratings, while fear of pain does not. Clinical and theoretical implications of these findings are discussed.

The association between dental anxiety and oral health-related quality of life in Britain

OBJECTIVE

The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self-reported) factors.

METHODS

The basic research design included a cross-sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health-related quality of life instrument (OHQoL-UK (W)).

RESULTS

DAS was correlated with OHQoL-UK (W) scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self-reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS > or = 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL-UK (W) score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65).

CONCLUSION

Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health-related quality of life in Britain.

Number of teeth, body mass index, and dental anxiety in middle-aged Swedish women

Risk factors for poor dental health include obesity, low socio-economic status, poor dietary habits, and dental anxiety. The aim of this study was to explore the complex relation between body mass index (BMI) and number of teeth in middle-aged women taking education, dietary intake patterns, dental care utilization, and dental anxiety into account. Three groups of women (37-60 years): reference women (group I, BMI 23.8 +/- 3.1 kg/m2), obese women (group II, BMI 35.0 +/- 2.6 kg/m2), and severely obese women (group III, BMI 41.0 +/- 3.4 kg/m2) were included. Questionnaires were used to assess education, smoking, number of teeth, dental care utilization, dental anxiety, dietary intake, and meal patterns. Age, education, and smoking habits did not differ significantly between groups. However, there were significant global differences in number of teeth (27.2 +/- 3.4, 23.0 +/- 9.2, 24.7 +/- 5.9) and reported daily energy intake (9756 +/- 3363 kJ, 10344 +/- 3850 kJ, 11970 +/- 3786 kJ in groups I, II, and m, respectively). In a multiple regression model, a lower number of teeth was independently associated with higher age, higher BMI, lower education, irregular dental care, high dental anxiety, higher energy intake, and lower iron intake. These variables explained 25% of the variation in number of teeth. In conclusion, BMI is an independent predictor of number of teeth in middle-aged women when socio-economic, dietary, and psychological factors are taken into account.

Measurement and predictors of young adults' perceived ability to cope with dental life events

The purpose of the present study was to assess coping skills and predictors of the ability to cope with dental life events employing a 10-item rather than a 48-item rating questionnaire. A representative random sample of 1490 subjects aged 25 years from 3 Norwegian counties received a mail questionnaire in March 1997. The response rate was 62% after 1 reminder. Eight selected items from the Social Readjustment Rating Questionnaire (SRRQ) plus 2 dental items were presented as graphic rating scales with the endpoints 'not difficult at all' and 'more difficult than anything'. Mean values were used to rank the life events and for comparison with findings from a previous study. Information was also collected for 16 predictor variables (Table 2). The informants found it moderately difficult to cope with losing one or more teeth and with getting dentures. A 10- and a 48-item rating scale seemed to give comparable results. In multiple logistic regression analysis, controlling for having experienced extraction during the previous 5 years, gender, and dental anxiety were significant predictors of both dental life events; education, many cavities, and belief in keeping teeth for life influenced coping with getting dentures. The identified predictors of dental life events explained <11% of the variance. In addition to extending the list of predictors of perceived need for skills to adjust to dental life events, the study also provided evidence to suggest that it may be acceptable to rely on a shorter rating questionnaire.

The impact of dental anxiety on daily living

AIM

To explore the impact of dental anxiety on daily living.

METHOD

Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audio-tape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis.

RESULTS

The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships.

CONCLUSION

The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.

Variations in dental anxiety among middle-aged and elderly women in Sweden: a longitudinal study between 1968 and 1996

Cross-sectional studies have shown that older individuals are significantly less dentally anxious than younger ones. However, research has not been able to show if this is a cohort effect or an effect of fear declining with age. If it is a cohort effect, dental anxiety among the elderly may pose a greater-than-expected problem for the providers of dental services. With the exception of longitudinal studies in children and a three-year follow-up on adults, no truly longitudinal epidemiological studies concerning dental anxiety have been performed. The aim of this project was to investigate how dental anxiety changes with aging. In a longitudinal population study of women in Göteborg, Sweden, starting in 1968, 1462 women aged 38 to 54 participated. A representative subsample of 778 women took part in a psychiatric examination where an investigation of dental anxiety was included. The same questions were also included when these women were re-examined in 1974, 1992, and 1996. Three hundred seventy-five women were still eligible for investigation in 1996. In 1968-69, 48 (12.8%) of the participating women assessed themselves as "very afraid" or "terrified" when visiting the dentist, and in 1996 the frequency was 21 (5.6%) among the same women. In 1968-69, 180 women (48%) reported no dental anxiety when visiting the dentist, and 28 years later the frequency was 230 (61%). In the three youngest age groups, dental anxiety decreased significantly (p < 0.001) over the 28-year period. Older compared with younger women reported significantly less dental anxiety, and this was an age effect rather than a cohort effect. Thus, this longitudinal study supported the hypothesis that dental fear, like many other general and specific phobias, declines with age.

Catastrophizing, anxiety and pain during dental hygiene treatment

OBJECTIVES

This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment.

METHODS

Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale - Revised, and were asked to rate the degree of pain they experienced during the scaling procedure.

RESULTS

Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were significant predictors of pain, even when controlling for gender, and oral hygiene status.

CONCLUSIONS

The findings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.

Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13+ were identified as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was significantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a significant predictor of dental caries experience, and may be a risk factor for dental caries incidence.

Factors associated with dental anxiety

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.

Dental fear and anxiety in an adult Icelandic population

This study was carried out on a random sample drawn from participants in a population-based survey in Reykjavík, Iceland. The sample consisted of 1548 people, men and women, born in 1914-63 (age range, 25-74 years) who lived in and around Reykjavík and a rural area in southern Iceland. The results from a single, modified Dental Anxiety Question (DAQ), designed to classify fear or anxiety into five different levels or categories, were compared with respect to age, oral status, extent of edentulousness, and education level. Of the whole sample 10% admitted to having considerable or more than considerable fear, while 5% classified their fear as extensive or more than extensive. Only 0.3%, however, said that it prevented dental visits. Fear was influenced by sex, as significantly more women experienced some level of fear (P < 0.001) and described their fear as considerable or extensive (P < 0.001). Fear was more common in the younger age groups among both sexes. A significant correlation was found between the number of decayed teeth and anxiety among the men, and patients of both sexes who admitted to fear had significantly fewer fillings. Fear was significantly more common in the rural than the urban population (P < 0.001). Edentulousness, or number of remaining teeth, did not seem to be significantly reflected in the extent of dental fear. People with higher education levels reported less dental fear.

A 9-year longitudinal study of reported oral problems and dental and periodontal status in 70- and 79-year-old city cohorts in northern Sweden

Before 1981 no representative studies of oral health in an elderly population in northern Sweden had been presented, and longitudinal studies of oral health in the aging person were in general rare. Thus the aim of this study was to investigate longitudinal changes in oral health in a representative sample of an elderly city population in northern Sweden. Reported oral problems and treatment needs were noted, and dental and periodontal status was registered in clinical examinations. The frequency of reported annual dental visits and of being called by the dentist increased in the younger but not in the older cohort during the 9-year period. In 1990 all the 79- and 88-year-olds with annual visits reported that they were recalled by the dentist. The clinical investigation showed an increasing amount of tooth loss, root caries, and periodontal disease with increasing age. Among dentulous persons 1.7 teeth per subject were lost from 1981 to 1990 in the younger cohort, compared with 2.6 teeth per subject in the older cohort. The number of sound teeth decreased very little in the younger cohort (from 3.44 to 3.34) but more evidently in the older cohort (from 3.47 to 2.65) during the 9-year period. The frequency of surfaces with attachment level > 3 mm increased statistically significantly from 1981 to 1990 in the older cohort. Subjects with annual visits had in general fewer oral problems.

Assessing dental anxiety, dental care use and oral status in older adults

This study examined associations between dental anxiety and dental care use and oral health status in dentate older adults. Analysis of data from the Piedmont 65+ Dental Study revealed that aspects of dental care use and oral health status were independently associated with high dental anxiety. These results suggest that measures to control dental anxiety may help to improve dental care use and oral health status in older adults.

Who is dentally anxious? Concordance between measures of dental anxiety

Studies of the prevalence of dental anxiety in general population samples have produced estimates which range from a low of 2.6% to a high of 20.4%. It is not clear whether these reflect real differences among populations or whether they are the result of the use of different measures and different cut-off points. We undertook a large scale mail survey of dental anxiety in a random sample of the adult population living in Metropolitan Toronto designed to assess the performance of and agreement between three measures. These were Corah's DAS, the single item used by Milgrom and colleagues in Seattle and the ten-point fear scale used by Gatchel. These measures and their published cut-off points produced prevalence estimates of 10.9%, 23.4% and 8.2% respectively. While there was a significant association between scores on pairs of measures the agreement between them was far from perfect. Kappa values ranged from 0.37 to 0.56, indicating only fair to moderate agreement beyond chance. There was evidence to indicate that the dentally anxious subjects identified by each measure differed according to certain behavioural and other characteristics. The results of the study suggest the need to revisit the issue of measurement in studies of dental anxiety.

Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state, utilisation of dental services and concomitant factors

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Göteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS > or = 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hällström and Halling in their analysis of data from the first Göteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.

Application of cost-utility and quality-adjusted life years analyses to monitored anesthesia care for sedation only

STUDY OBJECTIVE

To determine how much society should spend to decrease anxiety lasting for the duration of a surgical case.

DESIGN

Indications for monitored-anesthesia care (MAC) include: (1) management of an unstable patient, (2) possible induction of general anesthesia, (3) need for the patient to be unconscious for part of the case, and (4) provision of sedation and/or analgesia. The first three indications facilitate quality surgical care. However, MAC solely to decrease anxiety has been criticized on economic grounds. Although MAC for these cases may improve the patient's experience during surgery, it does not facilitate safer surgery. I limited my theoretical analysis to (1) MAC for sedation only and (2) procedures that have an equal outcome with or without an anesthesiologist. Cost-utility analyses compare costs and benefits of technologies by using a common measure of health outcomes. The quality adjusted life year (QALY) gives the expected life years gained from a procedure, with each year weighted to reflect quality of life in that year. Quality of life generally ranges from zero (dead) to one (healthy without distress). Technologies costing more than $75,000 per QALY are usually considered too expensive to justify. I used a deliberately absurd, one unit change in quality of life to calculate the maximum hourly cost of MAC, which lets the cost per QALY be less than $75,000.

MEASUREMENTS AND MAIN RESULTS

Hourly cost must be less than $8.56 per hour. Current Medicare reimbursement corresponds to $876,000 per QALY.

CONCLUSION

MAC for sedation only is a very expensive technology compared with other medical interventions.

Dental anxiety in Danish and Chinese adults--a cross-cultural perspective

The aim of this study was to correlate dental anxiety as reported by two different ethnic groups with socio-demographic factors, dental status, and dental behaviour. Two randomly selected populations aged 35-44 years and 65-74 years were interviewed. The populations comprised 214 and 99 Danes and 384 and 497 Hong Kong Chinese respectively. Dental anxiety was assessed by the Corah Dental Anxiety Score (DAS). Mean DAS scores were significantly higher in Chinese than in Danes (8.7-10.3 and 6.7-8.2, respectively) and higher in the younger than in the older groups. Moderate to phobic dental anxiety was reported by 15% of the Danes and 30% of the Chinese, the latter proportion far beyond what is usually reported in Western populations. Only in the Chinese group did women report more anxiety than men. Regression analysis indicated that only a few of the variables selected to explain anxiety determinants had significant explanatory value. Among Chinese, gender was the most predominant in both age groups followed by perceived condition of teeth in the younger age group. Among Danes, perceived condition of teeth had an explanatory value for both age groups and dental visit pattern was the strongest for the younger age group. In spite of statistical significance, all explanatory values were small and indicate that variables not included in this analysis may exert a greater influence on the variation in dental anxiety. DAS, seemingly, was able to highlight variations in dental anxiety in the populations in spite of their differences and made interpretations feasible with regard to contrasting dental care behaviour and dental status.(ABSTRACT TRUNCATED AT 250 WORDS)