Evaluation of anxiety level changes during the first three months of orthodontic treatment

Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+)

BACKGROUND AND OBJECTIVES

The goal of this study was to assess the validity of the Romanian version of the Index of Dental Anxiety and Fear (IDAF-4C+) questionnaire.

MATERIALS AND METHODS

This study was conducted on a convenience sample of past patients and their acquaintances through an online questionnaire administered on the Google Forms platform between May 2021 and September 2022. The sections of the survey were demographic characteristics, the dental anxiety scale questionnaire, the IDAF-4C+ questionnaire, a single question about dental fear, and previous dental treatments.

RESULTS

In total, 239 participants were included in the study, and the mean age was 37. The IDAF-4C questionnaire had good internal validity (Cronbach alpha was 0.945). The IDAF-4C had good convergent validity, and it was positively correlated with the dental anxiety scale (r = 0.825, p < 0.001) and the question about the fear of going to the dentist (r = 0.738, p < 0.001). The questionnaire had good reliability, and the intraclass correlation was 0.985. Lower levels of dental anxiety were associated with scaling, orthodontic treatment, and dental implants. A confirmatory factor analysis was conducted after the removal of the first question from the phobia module, and residual covariance was added between items four and nine of the stimulus module, showing a good fit for the retained questions of the IDAF-4C+, grouped by module.

CONCLUSIONS

The Romanian version of the IDAF-4C+ showed acceptable psychometric properties.

A Bibliometric Analysis on the Early Works of Dental Anxiety

Dental anxiety has been a common phenomenon under investigation for decades. This report aimed to identify the historical roots of dental anxiety in the research literature. The literature database Web of Science Core Collection was searched to identify relevant papers on this theme. Cited reference analysis on the collected literature set was performed with CRExplorer, a dedicated bibliometric software. This analysis successfully identified the references dealing with dental anxiety in the late 1800s and early 1900s. They included essays that provided expert opinion on dental anxiety, reported semi-structured interviews to elucidate its underlying reasons, introduced psychometric scales to assess dental anxiety, and proposed theories and arguments from psychoanalytic aspects. Several references dealing with anxiety in general were also identified. To conclude, cited reference analysis was useful in revealing the historical origins of dental anxiety research. These cited references provided a concrete foundation to support subsequent dental anxiety research.

Barriers and facilitators in the orthodontic treatment of teenagers with neurodevelopmental disabilities

INTRODUCTION

Patients with neurodevelopmental disabilities often experience barriers to dental care. Despite greater access to orthodontic treatment, information about the perceptions of patients with neurodevelopmental disabilities regarding orthodontic care remains scarce. The objective of this research was to investigate perceptions of patients, caretakers, and orthodontic residents regarding the barriers to and facilitators of orthodontic care for patients with neurodevelopmental disabilities.

METHODS

A qualitative study was conducted through semistructured interviews of 26 subjects: 10 patients with neurodevelopmental disabilities (4 with cognitive disabilities, 4 with autism spectrum disorder, and 2 with communication disorder), 8 caretakers, and 8 orthodontic residents. The responses were analyzed qualitatively by content analysis.

RESULTS

Four dimensions of analysis were identified: previous experience, barriers to care, facilitators of care, and perception of care. There are different orthodontic care barriers and facilitators perceived by patients, caretakers, and residents treating patients with neurodevelopmental disabilities. Factors such as the reason for consultation, previous experience or exposure to orthodontic care or attention, and personal motivation of those involved were used to model the care of these patients.

CONCLUSIONS

There are barriers and facilitators in orthodontic care for patients with neurodevelopmental disabilities, caretakers, and orthodontic residents. Educational programs in orthodontics must work to improve access and care for patients and educational training programs for students and clinical faculty.

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study

PURPOSE

The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement.

METHODS

Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1‑month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α‑amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah's Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann-Whitney U test and Spearman's rank correlation coefficient analysis were used for statistical evaluations (p < 0.05).

RESULTS

The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C‑DAS, and PCS scores.

CONCLUSIONS

The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment

BACKGROUND AND OBJECTIVES

Clear aligner is an advanced orthodontic method with benefits of comfort, aesthetics, and convenience. This study aimed to compare pain perception, anxiety, and impacts on oral health-related quality of life (OHRQoL) between adult patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatments.

MATERIAL AND METHODS

The two groups were well matched by ages, gender, and levels of malocclusion severity. Pain perception, anxiety, and OHRQoL were assessed through visual analogue scale, state-trait anxiety inventory, and oral health impact profile-14 (OHIP-14), respectively. And the comparison of above scores was performed by two-way analysis of variance.

RESULTS

A total of 110 patients (55 pairs) were enrolled in this study. Orthodontic pain levels peaked on the first day and decreased gradually afterwards in both groups, which were significantly higher in the fixed group on the first, second, fourth, and fifth days. Likewise, anxiety levels peaked on the first day and decreased thereafter, with significant difference on the 1st, 3d, 5th, 7th, and 14th days. Moreover, the OHIP-14 scores increased and peaked on the first day and then gradually decreased for both groups, which were also significantly higher in the fixed group on the 1st, 7th, and 14th days.

LIMITATIONS

More malocclusion types should be used for group matching. The effect of exclusion of small groups should be taken into consideration in sample size calculation. Income was significantly unbalanced between two groups due to higher cost of clear aligners, and random assignment of treatment modalities was unfeasible.

CONCLUSIONS

Patients treated with clear aligners experienced lower pain levels, less anxiety, and higher OHRQoL as compared to those receiving fixed appliances.

Does audiovisual information affect anxiety and perceived pain levels in miniscrew application? - a within-person randomized controlled trial

BACKGROUND

Anxiety can cause difficulties during surgical procedures. The main objective of this study was to evaluate changes in patients' anxiety and perceived pain levels after receiving audiovisual and verbal information about miniscrew application.

MATERIALS AND METHODS

Eighty-eight patients (30 males and 58 females) with a mean age of 18.18 ± 5.39 years who had fixed orthodontic treatment and required miniscrew anchorage took part in this questionnaire-based randomized controlled trial. The participants were randomly allocated to two groups and either watched a video depicting miniscrew application (study group, 44 patients) or were informed verbally about the procedure (control group, 44 patients) before miniscrew placement. The audiovisual information was given via a video containing footage of local anesthesia injection, topical antiseptic application, and miniscrew insertion. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure anxiety immediately before miniscrew application. Self-drilling miniscrews (8 mm length, 1.5 mm diameter; Aarhus System Miniscrews, American Orthodontics, Washington, USA) were placed in posterior buccal interdental region. Each patient received only one miniscrew. Postoperative pain (PP) was determined using a 100-mm horizontal visual analog scale (VAS).

RESULTS

State and total anxiety scores were significantly higher in the study group than in the control group (p = 0.009 and p = 0.011 respectively). The mean PP scores (SD) for control and study groups were 12.86 (14.22) and 12.8 (16.22), respectively. The results of Mann-Whitney U test showed no significant difference (p > 0.05). Participants' PP scores did not have a significant effect on state, trait, or total anxiety scores. There was a weak but significant positive correlation between trait anxiety and state anxiety scores in both groups.

CONCLUSION

Using an audiovisual method to inform patients about miniscrew placement increased anxiety levels but did not affect pain perception.

A comparison of patient experience, chair-side time, accuracy of dental arch measurements and costs of acquisition of dental models

OBJECTIVE

To compare patient experience, chairside time, dental arch distances, and costs of dental models derived from intraoral scans and alginate impressions in pre-orthodontic children and young adolescents.

MATERIALS AND METHODS

Fifty-nine children and young adolescents (9-15 years, mean: 12.70 years) had an intraoral scan and an alginate impression prior to orthodontic treatment. During the procedures, chairside time was registered in minutes and patient experience was assessed by a Visual Analogue Scale questionnaire. Four maxillary dental arch distances were measured on digital models, on plaster casts, and directly in the mouth (intraoral). The cost of each procedure was presented graphically. Differences between the two procedures were tested by paired t-test and general linear model.

RESULTS

Patient experience was statistically better during intraoral scan compared with alginate impression regarding comfort, gag reflex, breathing, smell/sound, taste/vibration, and all statements concerning anxiety (P < .05). No significant difference in chairside time between the two procedures was found. No statistically significant differences in dental arch distances between digital models and plaster casts were found, but dental arch distances measured intraorally differed significantly from both digital models and plaster casts (P < .05). Cost calculation showed that the digital procedure was 10.7 times more expensive than the conventional procedure initially and, that after 3.6 years, the two procedures were equal in cost.

CONCLUSIONS

Children preferred intraoral scan rather than alginate impression. Chairside time was equal for the two procedures as were the measurements of maxillary dental arch distances. The two procedures were equal in cost at 3.6 years.

Does orthodontic debonding lead to tooth sensitivity? Comparison of teeth with and without visible enamel microcracks

INTRODUCTION

Our aim was to assess the possible changes in sensitivity of teeth with and without visible enamel microcracks (EMCs) up to 1 week after the removal of metal brackets.

METHODS

After debonding, 15 patients possessing teeth with visible EMCs and 15 subjects whose teeth were free of EMCs were enrolled in the study. For each experimental group, a control group was formed. The assessments of tooth sensitivity elicited by compressed air and cold testing were performed 5 times: just before debonding, immediately after debonding, and at 1, 3, and 7 days after debonding. Tooth sensitivity was recorded on a 100-mm visual analog scale.

RESULTS

For the patients without visible EMCs, discomfort peaked immediately after debonding and started to decrease on day 1; at 1 week after debonding, the visual analog scale scores were lower than just before debonding and immediately after debonding. For the subjects possessing teeth with visible EMCs, the pattern of sensitivity dynamic was inherently the same. However, the patients with visible EMCs showed higher visual analog scale values at each time interval.

CONCLUSIONS

Debonding leads to a short-term increase in tooth sensitivity. EMCs, a form of enamel damage, do not predispose to greater sensitivity perception in relation to bracket removal.

Individualized intervention to reduce anxiety in adult orthodontic patients based on Q methodology

INTRODUCTION

In this study, we used Q methodology to assess the concerns of adults seeking orthodontic treatment and to determine individualized interventions to reduce their anxiety.

METHODS

Statements of concern were derived by in-depth interviews with 70 adult patients. Q sorting methodology was then used to identify the main factors associated with anxiety in a cohort of 40 adults who had not been involved in the first part of the study. The final stage involved a randomized study in which 160 new adult patients were recruited and randomized into intervention and control groups. Participants in the intervention group sorted the statements, after which individualized interventions were implemented. Participants in the control group received routine treatment. The State-Trait Anxiety Inventory was used to measure changes in participants' anxiety levels before and during treatment.

RESULTS

In total, 41 statements were identified, and participants were classified according to 5 factors. Factor 1 participants were concerned about the lack of treatment information; factor 2 represented concerns about cost and other people's opinions; factor 3 represented concerns about impact on work related to wearing braces; factor 4 encompassed concerns about treatment effects, pain, and dental fears; and factor 5 reflected concerns about side effects and finding a partner. The mean state anxiety inventory scores for both the intervention and control groups were highest 24 hours after bonding (intervention group, 44.63 ± 4.49; control group, 49.43 ± 5.42). The intragroup state anxiety inventory scores differed significantly across the 6 time points (P <0.01), with the state anxiety inventory scores of the intervention group significantly lower than those of the control group (P <0.01) at all time points except baseline. No significant intergroup or intragroup differences were found in relation to trait anxiety.

CONCLUSIONS

Adult orthodontic patients expressed diverse concerns. Individualized interventions based on Q methodology may reduce anxiety in this patient population.

Cross-Cultural Adaptation of Kannada Version of Modified Dental Anxiety Scale Among an Adult Indian Population

BACKGROUND

Dental anxiety is one of the most common barriers in seeking dental care. In order to overcome this barrier dentist need to screen patients to successfully help in treatment. A scale is thus needed to measure dental anxiety which is socially & culturally acceptable.

AIM

This study aimed to assess the Cross cultural adaptation and validity of the Kannada translation of the Modified Dental Anxiety Scale (MDAS-K).

MATERIALS AND METHODS

A test-retest was conducted on 30 patients visiting a dental institution to assess the reliability of MDAS- K. A cross-sectional survey of 301 patients was conducted in different departments at a dental institution to test the psychometric properties of MDAS-K. The assessment tool consisted of a proforma containing socio-demographic, non socio- demographic variables, MDAS-K and Visual analogue scale (VAS).

STATISTICAL ANALYSIS

Reliability was assessed using Cronbach's alpha, inter-item Spearman's correlation. Independent t-test, ANOVA and post hoc Bonferroni were used to analyse dental anxiety in the psychometric constructs.

RESULTS

The internal consistency of MDAS-K was good with Cronbach's alpha of 0.83. The test-retest reliability for MDAS K had a good correlation of 0.901. The psychometric variables established the construct validity of MDAS-K.MDAS-K also showed good convergent validity with VAS score. The anxiety levels differed in patients visiting different dental departments.

CONCLUSION

The high reliability and validity of the MDAS-K supports its cross cultural adaptation and indicates that it can be a valuable tool for dental practioners in quantifying anxiety among patients and provide quality dental care.

Comparison of personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment

OBJECTIVE

To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.

MATERIALS AND METHODS

One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences.

RESULTS

Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11).

CONCLUSIONS

Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.