Some characteristics of regular and irregular attenders for dental check-ups

Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis

This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. In November 2020, multiple electronic databases (Cochrane, EMBASE, MEDLINE, PsycInfo, PsycArticles, PubMed, and Web of Science) were searched for articles published in English. Inclusion criteria were randomized-controlled trials reporting the effectiveness of any non-pharmacological interventions in reducing fear or anxiety levels in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After screening, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. The anxiety levels after intervention in each study were pooled and meta-analyzed by the random-effect model. A significant reduction in anxiety level was observed in non-pharmacological intervention groups (SMD = -0.32; 95% CI -0.57 to -0.07; p = 0.01). Subgroup analyses showed that a significant anxiety reduction by non-pharmacological interventions could be demonstrated by pooled data from studies using psychometric assessments, but not from studies using physiological assessments. Non-pharmacological interventions appear to reduce fear and anxiety levels in patients undergoing third molar extraction under local anesthesia.

Dental students' experience of conscious sedation: A qualitative review of student reflections

INTRODUCTION

The UK General Dental Council (GDC) requires dental graduates to competently identify, manage and refer patients with dental pain and anxiety. This study aimed to explore sedation training experience quantitatively and qualitatively through individual reflective logs.

MATERIALS & METHODS

A single-centred mixed-methods evaluation of teaching, within a UK university conscious sedation department. Fourth-year dental students undertook lectures and supervised clinical sessions following the undergraduate curriculum. Patient attendance patterns, individual experience and group experience were analysed descriptively. Reflective log sheets were analysed by Thematic Framework Analysis.

RESULTS

Seventy-two students participated. Of 153 booked patients, 79 (51.6%) attended of which 74 (48.4%) were treated by undergraduates. The mean performed inhalation sedation and intravenous sedation cases per student were 1 and 0.8, respectively. Three students (4%) assisted only. Group experience varied. Three themes arose from reflections: consolidation of theory and learning; confidence through experience; and responding to challenges.

DISCUSSION

Whilst experience quotas were not met, GDC requirements for increasing students' knowledge and confidence within CS were met. Practical experience enhanced learning. "Hands-on" experience was most valuable for self-reported confidence but learning by proxy also aided development. Students recognised challenges, but not the implications for themselves or their career. Strategies to reduce barriers to experience require research.

CONCLUSION

Whilst variable, all students were provided learning opportunities. Physical experience gave the greatest confidence. Opportunities afforded by the undergraduate curriculum allowed students to learn and develop through consolidation of theory, response to challenges and ultimately the gaining of confidence.

Assessment of Contributing Factors for Discontinuation of Orthodontic Treatment: A Questionnaire Survey

Introduction:

The success of orthodontic therapy depends upon the knowledge and clinical skills of the orthodontist as well as awareness and sincerity of the patient. Due to long treatment duration, commitment and good rapport between both sides is essential. This retrospective study was undertaken to understand the factors affecting the reasons for discontinuation after commencement of treatment in a Government run hospital.

Materials and method:

A telephonic questionnaire survey was conducted on 153 patients who had discontinued treatment midway and their responses were analysed. The subjects were divided into 3 groups depending upon their school going years. The major focus areas were -1. Reasons for seeking orthodontic treatment 2. Reasons for pursuing treatment in this hospital and 3. Reasons for discontinuation of orthodontic treatment.

Results and conclusions:

Long waiting period before starting the treatment, failure to give subsequent appointments by the doctor, and having to leave the city were found to be the three most common causes for discontinuation. To reduce the attrition rate a three step strategy was devised to ensure an improved orthodontic outcome for the patients and to see more smiling faces bid adieu each year.

Predictable prosthetic space maintenance during staged complete-mouth rehabilitation

Staged complete-mouth rehabilitation to accommodate a patient's financial constraints during the course of treatment is presented. Clear acrylic resin added to the anterior cameo surface of the maxillary fixed complete denture (FCD) served as a space maintainer. The restoration of the maxillary FCD addressed the patient's chief complaint. By adding the space maintainer, supraeruption of mandibular anterior teeth and encroachment of the prosthetic space, which could have resulted in additional treatment, was avoided. During the second stage of the complete-mouth rehabilitation, zirconia restorations were used to restore the mandibular arch to the maxillary FCD after straightforward removal of the space maintainer. This allowed a smooth transition after a delay in treatment without having to modify the previous treatment.

The use of a respiratory rate biofeedback device to reduce dental anxiety: an exploratory investigation

Anxiety experienced by individuals visiting the dental office to receive treatment is common. Evidence has shown biofeedback to be a useful modality of treatment for numerous maladies associated with anxiety. The purpose of the current pilot study was to investigate the use of a novel biofeedback device (RESPeRATE™) to reduce patients' pre-operative general anxiety levels and consequently reduce the pain associated with dental injections. Eighty-one subjects participated in this study, forty in the experimental group and forty-one in the control group. Subjects in the experimental group used the biofeedback technique, while those in the control group were not exposed to any biofeedback. All subjects filled out a pre-injection anxiety survey, then received an inferior alveolar injection of local anesthetic. Post-injection, both groups were given an anxiety survey and asked to respond to four questions regarding the injection experience using a Visual Analog Scale (VAS). With the use of the respiratory rate biofeedback device, there was a significant reduction of negative feelings regarding the overall injection experience, as measured by a VAS. Our findings demonstrate that this novel biofeedback technique may be helpful in the amelioration of dental anxiety, and may help produce a more pleasant overall experience for the patient.

The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London

OBJECTIVE

To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health.

METHODS

Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables.

RESULTS

A direct significant association of referral with dental anxiety and attendance patterns was detected, but not with oral health status. However, oral health and anxiety were highly correlated. Also signaled were correlations between age and education and between gender and bad past experience.

CONCLUSION

Referral for treatment under sedation appears to be motivated by both fear and irregular patterns of attendance. Coupled with behavioral treatments to address dental fear and attendance, sedation can be an important part of comprehensive care where curative treatments are long or unpleasant for patients.

Qualitative assessment of the dental health services provided at a dental school in Kerman, Iran

Increasing the quality of the services provided in a Dental School can raise the satisfaction level of patients and consequently increase the level of their oral health. This study was conducted to evaluate the quality of dental care and services provided to patients referred to a Dental School in Kerman, Iran. In this qualitative study, face-to-face, in-depth interviews were conducted with 41 participants [25 patients (P), 5 nurses (N), 6 dental academic staff (AS), and 5 dental students (S)]. Then, the interviews were transcribed and analyzed, using content analysis of data. Data analysis in qualitative research involves breaking down the data and searching for codes and categories that are then reassembled to form themes. Both positive and negative themes emerged. Positive themes included: good infection control, service accessibility, patient appointments and visits were not assigned on merit, precise examinations, and comprehensive treatment plans. Negative themes included: long wait time, lack of options to pass waiting time, such as newspapers and television, an insufficient number of nurses, and not enough professors for supervision. In addition, the results of this study show that the patients and dental staff have high expectations in relation to dental services, and that implementation of these expectations would increase the overall satisfaction with and the quality of the level of services. Finally, some recommendations for improving services in the Kerman Dental School were given to the managing team of the Dental School.

Oral health and oral treatment needs in patients fulfilling the DSM-IV criteria for dental phobia: Possible influence on the outcome of cognitive behavioral therapy

OBJECTIVE

To describe oral health and oral treatment needs in a group of dental phobic patients (DSM-IV) and to explore possible relationships between these factors and changes in self-reported dental anxiety before and after phobia treatment.

MATERIAL AND METHODS

Forty patients (25 women) fulfilling the DSM-IV criteria for specific phobia were included in the study. Mean age of the group was 34.9 years (range 19-60) and mean dental avoidance was 11.2 years (range 3-30 years). They were treated with cognitive behavioral therapy (CBT) during either one session (3 h) or five sessions (1 h each). Oral health was evaluated by orthopantomogram and clinical examination. The outcome of the CBT was measured by the change in dental anxiety scores (DAS, DFS) and in positive and negative thoughts during a standardized dental behavior test from pretreatment to 1-year follow-up.

RESULTS

Mean (SD) DMFT was 16.5 (5.8), range 3-26; DT was 6.6 (4.2). Mean number of teeth with dental treatment need (restorative, periodontal, extractions, etc.) was 9.6 (6.9), range 1-28. There were statistically significant correlations between number of decayed teeth and decrease in negative thoughts (r=-0.39, p=0.048) and maximum anxiety (r=-0.65, p=0.001). The total number of teeth with treatment need correlated with an increase in positive thoughts (r=0.60, p=0.001) and decrease in maximum anxiety (r=0.50, p=0.015).

CONCLUSIONS

There are large variations in oral health and treatment needs among patients fulfilling the DSM-IV criteria for dental phobia. Patients with the best dental health and lowest treatment needs experience the largest increase in positive cognitions during exposure to dental treatment at 1-year follow-up.

Factors associated with dental anxiety among older people in Britain

OBJECTIVE

This paper reports on a study of dental anxiety among adults aged 60 years living independently in Britain.

DESIGN

A national cross-sectional study carried out with the assistance of the Office for National Statistics' Omnibus Surveys in 1999.

SETTING

Data was collected by face to face interviews with older people in their homes.

MEASUREMENTS

Data on dental anxiety were collected from 973 subjects by means of face to face interviews and was measured by the Dental Anxiety Scale (DAS) (Corah, 1969). In addition, data on dental service use and oral health status (self-reported) was collected.

RESULTS

The mean DAS score was 8.4 (sd 3.5), and 13% (129) of subjects were classified as dentally anxious (DAS > or = 13). DAS scores were associated with numerous socio-demographic factors (P < 0.01), self-reported oral health status (P < 0.01) and dental service (P < 0.01) factors. A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioural and oral health outcomes.

CONCLUSION

One in eight older people in Britain are dentally anxious and this is associated with their use of services and oral health status (self-reported).

Marketing dental care to the reluctant patient

There are many varying factors which impact on the behaviour of reluctant patients and the understanding of theoretical behavioural models can help to understand some of the key issues. This paper considers such models and the effective use of marketing communications in helping to change behaviour. The paper concludes with an acronym--OPTIMEM to help dental practitioners and practice managers plan realistic and efficient marketing communications within the overall management strategy.

Dental health attitudes among dentate black and white adults

OBJECTIVES

Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use.

METHODS

As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried.

RESULTS

Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account.

CONCLUSIONS

Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

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.

Chronic low back pain and inaccurate predictions of pain: is being too tough a risk factor for the development and maintenance of chronic pain?

The present study tests whether chronic low back pain (CLBP) patients show a tendency to overpredict or to underpredict pain. Twenty CLBP patients and 20 healthy controls underwent 6 trials of laboratory induced pressure pain. Ratings of predicted and experienced pain intensity were obtained. In contradiction with the hypothesis that CLBP patients show a generalized tendency to overpredict pain, CLBP patients showed a tendency to underpredict the laboratory pain, whereas controls appeared to be more accurate. This finding replicates a previous finding, that there may be a substantial group of CLBP patients who underestimate pain. The tendency to underpredict pain may constitute a risk factor for the development and maintenance of CLBP.

Dental anxiety and attendance in the north-west of England

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

Children's expectations and recollections of discomfort associated with dental treatment

It has been reported that adults, especially those most anxious about dentistry, expect more discomfort than they actually experience during treatment, and that, months after conservative treatment, they describe that experience as more uncomfortable than they had done immediately after treatment. This study sought to determine whether children's expectations and recollections of their discomfort are distorted in this way. Thirty-four children were asked to estimate, using a standard rating-scale, the degree of discomfort, if any, which they expected to experience in the dental treatment that was to follow. Immediately after treatment, which involved injection of local anaesthetic and preparation of a cavity, the children were asked to rate the degree of discomfort which they had just experienced. Six weeks and three months later, the children were sent an identical rating-scale and asked to record, under the supervision of their parents, the degree of discomfort which they recalled having experienced during that treatment. Like adults, the children experienced less discomfort during treatment than they had expected. Unlike adults, even the most anxious children recalled, 6 weeks and 3 months later, no more discomfort than they had reported immediately after treatment. Nevertheless, the unrealistic expectations of discomfort by children should be a prominent target for behavioural management by dentists.

Children's pain predictions and memories

A cross-sectional descriptive design was utilized to explore expected, experienced and recalled pain, and anxiety. Subjects were 138 children (5-17 yr) who were attending an outpatient laboratory for venipuncture. They reported state anxiety and expected visual analogue scale pain prior to having venipuncture. Following venipuncture, they reported sensory and affective pain. Two months afterward, subjects were contacted and asked to recall sensory and affective pain from the venipuncture. Analysis of data determined that children's recall of pain was quite good although better for affective pain than sensory pain. Prediction accuracy for pain was not good. From analysis it was determined that overestimation of pain was related to anxiety but not to greater experienced pain. Four patterns of responses were identified when prediction and recall accuracy were further examined. These patterns were designated as realism, irrelevance, over-reaction and denial. It was suggested that these patterns of response may provide clues about avoidance and coping behavior for children's pain. In general, the results of this study did not support previous research. It was demonstrated that various statistical techniques which have been employed in research on this topic have influenced the interpretation of pain prediction and recall data.

Dental health behavior and attitudes--an application of correspondence analysis

Differences in dental behavior and dental attitudes between people with (almost) all natural teeth, people with a full denture in both jaws and people with a full denture in only the maxilla are visualized by means of correspondence analysis in one overall picture. In this picture the three distinguished subgroups of dental patients and their characteristics are indicated as points in a two-dimensional space. The distances between the points in this picture show to what extent these points are connected. The findings obtained in this study can lead to the conclusion that: a. differences in dental status are related to differences in dental behavior and dental attitudes; b. people with all natural teeth and people with a full denture in both jaws obviously are opposite of each other in many respects, whereas people with a full denture in only one jaw can be characterized as a dental in-between group.

Dental fear and anxiety in an older adult population

A random sample of 580 people aged between 50 and 89 yr completed a questionnaire containing two measures of dental fear and anxiety. One of these was Corah's Dental Anxiety Scale (DAS) and the other a scale derived from the Structured Interview for Assessing Dental Fear (SIADF). The mean score on the DAS was 7.8, and 8.4% of subjects were classified as dentally anxious. There were no differences in mean DAS scores by sex but significant differences by age, with younger individuals having higher scores (P less than 0.0001). The edentulous had significantly higher scores than the dentate (P less than 0.001). Scores on the SIADF scale were higher among younger individuals (P less than 0.0001), the edentulous (P less than 0.01) and women (P less than 0.05). Older adults who were dentally anxious were less likely to report a regular source of dental care and a dental visit in the previous year and more likely to report having avoided or delayed dental treatment. Possible explanations of higher dental anxiety scores among younger persons and the edentulous are reviewed.

Correlates of dental anxiety among older adults

This paper reports on a study of dental anxiety among adults aged 50 years and over living independently in two communities in Ontario, Canada. Subjects were identified by means of a telephone survey based on random-digit dialing. Data on dental anxiety were collected from 580 subjects by means of a self-completed questionnaire and were measured by the Dental Anxiety Scale (DAS) (Corah, 1969). The mean DAS score was 7.8, and 8.4% of subjects were classified as dentally anxious. Age was the only demographic factor associated with dental anxiety. Older individuals had lower DAS scores than younger individuals (p less than 0.0001). There was also a significant association between dental anxiety and general fearfulness measured by the Fear Survey Schedule II (Geer, 1965) (r = 0.31; p less than 0.001). A series of regression analyses revealed that dental anxiety was a significant predictor of a number of behavioral and oral health outcomes. While these results confirm that dental anxiety is less prevalent among older adults than in younger populations, it has a number of important consequences with respect to dental care provision.

Dental anxiety in young adult Danes under alternative dental care programs

The purpose of the present report is to establish to what extent dental anxiety is expressed by young adults with a long history of regular dental care, to analyze whether expressions of dental anxiety vary during young adulthood in response to different dental care delivery programs, and to study which factors might account for existing expressions of dental anxiety. The study comprised 697 persons who participated in a longitudinal study on alternative dental care programs, running from the youngsters' 16th to their 19th yr. At the end, Corah Dental Anxiety Scale (DAS) was applied through self-completed questionnaires. Overall DAS-mean was 7.26; women expressed more anxiety than men (7.73; 6.78). Significant association between anxiety expressed at the end and at the start of the study indicated that dental anxiety was probably present at an early age. No association was found with utilization of dental services. A multiple regression analysis indicated early expressed dental anxiety and negative self assessment of dental health as important predictors for dental anxiety, while sex, negative assessment of gingival health, and dental program were of less importance, altogether explaining 22% of the DAS score variation. The risk group concept currently employed by the Public Child Dental Health Services might be extended to include expressions of dental anxiety.

Predictions of dental pain: the fear of any expected evil, is worse than the evil itself

In a study of 40 subjects, who twice underwent extensive dental treatment, the relationships between expectations and experiences of pain and of anxiety were investigated. Inaccurate expectations were adjusted in the same way as observed in the laboratory. Especially anxious subjects expected more pain and anxiety than they experienced, and they appeared to need more experiences before their predictions became accurate. In the course of time, the expectations (and memories) of anxious subjects returned to their original more inaccurate level of prediction. The results suggest that the old schema is ultimately reinstated if disconfirmations are few and far between. Anxious subjects did not experience more pain, but they did experience more anxiety than fearless subjects. Detailed investigation of processes of change after disconfirmation showed that anxiety experienced during treatment is a factor that plays a part in maintaining the problem of inaccurate expectations and fear of treatment. Theoretical and clinical implications of these findings are discussed.

The effects of underestimated pain and their relationship to habituation

The intensity of a painful stimulus was experimentally manipulated in order to induce underpredictions of pain. The experiment aimed at (1) replicating previous findings on the effects of underpredicted pain and (2) investigating the relationship between underpredicted pain and habituation. Most previous findings were replicated: underpredictions of pain were followed by raised expectations of pain and increased fear of pain. In addition, the underprediction had long-term effects on fear of pain, uncertainty about predictions, and expected aversiveness of the painful stimulus. In contrast to previous findings and to Rachman's match/mismatch model, it was found that underpredicted pain can have dishabituating effects. It is theorized that inaccurately predicted pain can cause dishabituation, depending on the extent of the underprediction and on the subjective certainty of the prediction. Theoretical and clinical implications are discussed.

A longitudinal study of the contribution of dental experience to dental anxiety in children between 9 and 12 years of age

Dental records of a group of children of both sexes were examined systematically over a period of 3 years to determine if the quantity and quality of their dental experience would be associated with increases in dental anxiety. The study was a follow-up of an earlier cross-sectional survey in which older children had demonstrated increases in dental anxiety with age. According to the evidence obtained from their dental records, the children were divided into four groups depending on their patterns of attendance (regular/irregular) and whether or not they had received invasive treatment. The results indicated that children who did not receive invasive treatment during the period under scrutiny were significantly more anxious than those who had. On the other hand, the dental anxiety of children who attended regularly and received invasive treatment did not change significantly. This applied to boys and girls alike.

Attitudes of some young female bank employees to dentistry

Structured interviews were undertaken with one hundred 18-30-year-old females, seeking their views on dental care. Almost all regarded their own past experience as affecting their general level of dental anxiety. Over half were anxious about visiting the dentist and almost all of these were anxious before entering the surgery. The Anxious emphasized the negative features in dental care and the practice environment whereas the Non-anxious concentrated on positive features, particularly their relationship with the dentist. Many spontaneously commented that their attitudes had been improved by changing dentists, although some still remained anxious. 'Worst visits' had frequently occurred early in their lives. Appearance was of prime importance; function was ignored. Interviewees believed that visiting the dentist would be eased by lower costs, more convenient hours, better surroundings in the practice and improved techniques to make dentistry more comfortable.

New intravenous sedative combinations in oral surgery: a comparative study of nalbuphine or pentazocine with midazolam

A randomised, double blind study was conducted to compare the efficacy and safety of nalbuphine or pentazocine with midazolam in patients undergoing minor oral surgery under local analgesia. Forty patients, aged between 17 and 48 years and in American Society of Anesthesiologists A.S.A. Class I participated. The results confirmed that the use of either nalbuphine (0.2 mg/kg) or pentazocine (0.5 mg/kg) allowed for a significant reduction in the mean dosage of midazolam required to produce satisfactory sedation when compared with trials where midazolam was used alone. Thus a mean midazolam, 0.087 mg/kg (nalbuphine group) or 0.081 mg/kg (pentazocine group) was required compared with 0.17 mg/kg (Aun et al., 1984) and 0.19 mg/kg (Skelley et al., 1984). Inadvertent overdosage with midazolam is prevented as the onset of sedation and its end-point are more obvious. No adverse cardiovascular or respiratory side effects were noted. The recovery rate for both groups was similar. Ninety-five per cent (39 of 40) of patients were able to walk unaided at 2 h post operation. At this time significantly more patients in the nalbuphine group were pain free (p less than 0.001). Both combinations provided excellent operating conditions with a high degree of safety and high patient acceptability. As the nalbuphine group enjoyed a more comfortable post-operative period this combination is favoured.

The dentist-patient relationship: perceptions by patients of dentist behavior in relation to satisfaction and anxiety

This study relates perceived dentist behaviors to anxiety in patients during treatment and to satisfaction during the dental visit. The sample consisted of 231 adult patients, 107 men and 124 women, at a public hospital dental clinic. Immediately after treatment, patients were asked to respond to a list of 21 dentist behaviors thought to be associated with positive dentist-patient interaction. Criterion measures obtained were ratings of anxiety by patients during treatment and measures from the DVSS. None of the dentist behaviors was related to anxiety in patients in a way that would suggest that dentist behavior either reduced or increased anxiety. DAS scores obtained before treatment were the best predictor of anxiety in patients during treatment. Most of the dentist behaviors were significantly related to satisfaction in patients. Stepwise multiple regression analyses using DVSS scores as criterion variables indicated that those variables contributing most to satisfaction in patients were indicative of dentist communication that was accepting and caring. Anxiety in patients during treatment also was an important negative predictor of satisfaction. The results indicate that the dentist behaviors explored in this study were associated with satisfaction in patients, but were not clearly related to anxiety reduction.

Prevalence vs. incidence of the mandibular pain dysfunction syndrome: implications for epidemiological research

Conclusions about the aetiology and maintenance of the Mandibular Pain Dysfunction Syndrome (MPDS) are largely based on clinic populations, but there are indications that sufferers who seek help about their symptoms are not typical of the general population of sufferers. This raises important problems in extrapolating findings from the patient population to the general one. This paper argues that future epidemiological studies should take the various influences on the decision to seek advice into account so that conclusions about MPDS can be reached. Specific additions to research designs are noted.

Memory of dental pain

The possibility that patients' memory for acute pain is reconstructed over time was tested by comparing the degree of pain remembered 3 months after a dental appointment with both expected and experienced pain, as reported immediately before and after the appointment. As hypothesised, there was a closer association between remembered and expected pain than between remembered and experienced pain, particularly for those patients who scored high on the Dental Anxiety Scale. These results suggest that the accuracy of patients' reports of pain experienced in the past may be suspect, and that dental anxiety may be slow to extinguish because the discrepancy between expected and experienced pain felt at one appointment may not be recalled accurately by anxious patients at their next appointment.

Patients' perception of dentists' positive and negative attributes

Earlier studies have shown that dental patients concern themselves with the personality characteristics of their dentists as well as with their professional competence. The present study is part of a wider survey which compared the characteristics of regular and irregular or non-attenders for dental check-ups. In this article patients' characteristics such as sex, age, level of dental anxiety and certain previous dental experiences were related to their perceptions of dentists' positive and negative attributes. The results confirmed previous findings that dentists were seen generally by their patients in a favourable light. Respondents who admitted to higher levels of dental anxiety were more likely to choose more negative attributes and less positive ones than respondents who admitted to lower levels; women, younger subjects and the dentally anxious consistently chose unsympathetic and indifferent as the two top negative characteristics of their dentists.