ArticleLiterature Review

Psychological treatment of dental anxiety among adults: A systematic review

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Abstract

The aim was to investigate the efficacy of behavioural interventions as treatment of dental anxiety/phobia in adults, by conducting a systematic review of randomized controlled trials (RCTs). The inclusion criteria were defined according to the Patients, Interventions, Controls, Outcome (PICO) methodology. The study samples had documented dental anxiety, measured using validated scales [the Dental Anxiety Scale (DAS) or the Dental Fear Survey (DFS)], or fulfilled the psychiatric criteria for dental phobia. Behavioural interventions included were based on cognitive behavioural therapy (CBT)/behavioural therapy (BT), and control conditions were defined as information, sedation, general anaesthesia, and placebo/no treatment. The outcome variables were level of dental anxiety, acceptance of conventional dental treatment, dental treatability ratings, quality of life and oral health-related quality of life, and complications. This systematic review identified 10 RCT publications. Cognitive behavioural therapy/behavioural therapy resulted in a significant reduction in dental anxiety, as measured using the DAS (mean difference = -2.7), but the results were based on low quality of evidence. There was also some support that CBT/BT improves the patients' acceptance of dental treatment more than general anaesthesia does (low quality of evidence). Thus, there is evidence that behavioural interventions can help adults with dental anxiety/phobia; however, it is clear that more well-designed studies on the subject are needed.

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... An alternative would be a deep breathing technique [32]. Unlike patients who present with mild symptoms, those who present with severe signs of dental anxiety may be referred to a special dentistry clinic [37]. At these clinics, patients may receive adapted dental care, including different types of sedations (general anesthesia, nitrous oxide, intravenous and oral sedation) or behavioral interventions. ...
... At these clinics, patients may receive adapted dental care, including different types of sedations (general anesthesia, nitrous oxide, intravenous and oral sedation) or behavioral interventions. These interventions can be used alone or in combination with each other, but this is decided by the oral care provider on a case-by-case basis [37]. ...
... Cognitive Behavioral Therapy (CBT)/ Behavioral Therapy (BT) are two forms of psychological treatments used in the dental setting [37]. Behavioral therapy includes exposures like relaxation techniques and systematic desensitization. ...
Article
Dental anxiety is a common condition that can lead to dental avoidance behavior. As such, the oral health of patients suffering from dental anxiety typically deteriorates over time resulting in costly treatments and complex procedures that could had been avoided, prevented, and treated while they were simple and easy to care for. Dental anxiety is commonly misdiagnosed, has been linked to different etiological factors, and can manifest at any time in an individual’s life. Identification of this condition is simple and can be routinely done using short, standardized surveys. In addition, there are many efficient and cost-effective options to treat or alleviate this condition. However, dentists and other oral health practitioners such as dental hygienists and dental assistants, are usually unaware of how to identify and address dental anxiety during dental care. Thus, herein we reviewed the literature about definitions of dental anxiety and associated conditions such as dental fear and dental phobia. Furthermore, we discuss possible etiologies and how to effectively diagnose this condition. Finally, we present possible treatment options available for dentists and other dental care providers to safely care for dental patients suffering from dental anxiety
... In light of these psychological triggers, dental practitioners must deal with more than just oral pathologies [11,16,17]; they must also address patients' psychological needs. Empirical evidence shows that specialised treatment such as cognitive behavioural therapy (CBT) may be effective in alleviating dental anxiety, enabling oral health restoration for trauma and phobic patients [18,19]. However, to the best of our knowledge, few countries offer services customised for the psychological needs of the type of patients described above, even though this patient group is substantial: in Europe, 8−25% of the population have been subject to physical abuse, 7−22% to sexual abuse, and 13−45% to emotional abuse [20]. ...
... The therapy tests catastrophic thoughts by stimulating an initial, less intense fear response. This desensitises the patient and is the treatment choice for specific phobias [7,18,19,24,25]. The TADA service, through the inclusion of exposure therapy, has two intended outcomes: first, to alleviate dental anxiety, and subsequently, to restore oral health. ...
... Therapeutic interventions are in the psychological domain and are primarily administered by a psychologist [18,19]. However, using dental practitioners in a natural real-world clinical setting is logistically and therapeutically advantageous [2]. ...
Article
Patients with dental phobia or a history of trauma tend to avoid dental services, which may, over time, lead to poor oral health. In Norway, a specific service targets these patients by providing exposure therapy to treat their fear of attendance and subsequently enable oral restoration. Dental practitioners deliver the exposure therapy, which requires a role change that deviates from their traditional practice. This paper explores how – and under what circumstances – dental practitioners manage this new role of alleviating dental anxiety for patients with a history of trauma or dental phobia. Using a realist evaluation approach, this paper develops theory describing which contexts promote mechanisms that allow practitioners to alleviate dental anxiety for patients with trauma or dental phobia. A multi-method approach, comprising service documents (n = 13) and stakeholder interviews (n = 12), was applied. The data were then analysed through a content analysis and context-mechanism-outcome heuristic tool. Our findings reveal that dental practitioners must adopt roles that enable trust, a safe space, and gradual desensitisation of the patient to their fear triggers. Adopting these roles requires time and resources to develop practitioners' skills – enabling them to adopt an appropriate communication style and exposure pace for each patient.
... Visibly decayed teeth and the reduced ability to cope with dental treatment may lead to feelings of shame, guilt, and embarrassment, all domized controlled clinical trials, behavioural interventions proved effective in the treatment of dental anxiety. Wide Boman et al. [27] concluded the same in their review from 2013 based on 7 randomized controlled clinical trials (RCTs). CBT is the best documented psychological treatment method for anxiety disorders, and studies have also shown its usefulness in relation to dental anxiety. ...
... It has been suggested by Hare et al. [32] that severe cases of dental anxiety should be referred for CBT treatment, while milder cases should be managed in general dental practice. However, most studies on dental anxiety treatment are based on interdisciplinary treatment performed in special clinics [27]. In 2000, Willumsen and Vassend [33] tested a 10-session CBT intervention administered by a dentist alone in a university clinic and saw clinically significant favourable effects that persisted over a five-year period. ...
... Most studies on CBT treatment for dental anxiety have reported favourable findings [27]. For sedation treatment, outcomes are more variable. ...
Article
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The study aimed to test the effectiveness of cognitive behavioural therapy (CBT) administered by a general dental practitioner (GDP) in a general dental practice. In a two-arm parallel randomised controlled trial, the experimental group received a short dentist-administered CBT-intervention (D-CBT). A best-practice control group (FHM) received dental treatment during sedation with midazolam combined with an evidence-based communication model (The Four Habits Model). Ninety-six patients with self-reported dental anxiety were allocated to the treatment arms at a 1:1 ratio. Modified Dental Anxiety Scale (MDAS) scores spanned from 12 to 25, and 82 patients (85%) had a score of 19 or more, indicating severe dental anxiety. In both treatment arms, scores on MDAS and Index of Dental Anxiety and Fear (IDAF-4C) decreased significantly, but no differences were found between treatment arms. Mean reductions were: MDAS scores: -6.6 (SD = 0.5); IDAF-4C scores: -1.0 (SD = 1.1). In conclusion, local GDPs in general dental practices with proper competence have the ability for early detection of dental anxiety and, with the use of a manual-based D-CBT or FHM treatment, GDPs could offer efficient first-line treatment suitable for dental anxiety of varying severities.
... Dental anxiety may be managed by psychotherapeutic interventions, which enable patients to feel more comfortable when receiving the treatment and which help those patients not visiting the dentist due to a high fear to attend the treatment. These interventions include relaxation, distraction, exposure, and other forms of cognitive behavioral therapy (Armfield and Heaton 2013;Gordon et al. 2013;Wide Boman et al. 2013;Craske et al. 2014). Of these, relaxation and distraction are mostly used during dental treatment, whereas exposure therapy, including inhibitory learning, and other forms of cognitive behavioral therapy might be needed before the dental treatment (Armfield and Heaton 2013;Craske et al. 2014). ...
... Of these, relaxation and distraction are mostly used during dental treatment, whereas exposure therapy, including inhibitory learning, and other forms of cognitive behavioral therapy might be needed before the dental treatment (Armfield and Heaton 2013;Craske et al. 2014). While some of these interventions may be conducted by a dentist, others require support from psychologists (Armfield and Heaton 2013;Wide Boman et al. 2013). Several treatment visits are usually needed to manage dental anxiety, especially for those with extreme dental anxiety; however, a single appointment to reduce dental anxiety has also shown some success (Armfield and Heaton 2013;Gordon et al. 2013;Wide Boman et al. 2013). ...
... While some of these interventions may be conducted by a dentist, others require support from psychologists (Armfield and Heaton 2013;Wide Boman et al. 2013). Several treatment visits are usually needed to manage dental anxiety, especially for those with extreme dental anxiety; however, a single appointment to reduce dental anxiety has also shown some success (Armfield and Heaton 2013;Gordon et al. 2013;Wide Boman et al. 2013). Based on this research evidence, a brief patient-centered intervention is needed that may be routinely incorporated into daily practice in primary dental care. ...
Article
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Introduction Dental anxiety is common and causes symptomatic use of oral health services. Objectives The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. Methods A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. Results Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (β = −0.75, P < .001, for MDAS total score; β = −0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (β = −1.08, P < .001) and treatment-related dental anxiety (β = −0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (β = −0.217, P < .026) and women (β = −0.498, P < .001). Conclusion Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). Knowledge Transfer Statement Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.
... The evidence-based treatment of specific phobias is CBT based on exposure (see below). Effective treatments for adults with dental phobia/severe dental anxiety using CBT in the dental setting are presented in the literature [28][29][30][31]. The second approach, adapted dental treatment, is recommended for patients with severe comorbidity (substance abuse, eating disorders, depression, general anxiety, or PTSD) or patients not motivated for CBT. ...
... In 2017, Region Västra Götaland in Sweden decided on new regional clinical guidelines for adult individuals with severe dental anxiety/phobia, including the provision of specialised CBT administered by psychologists working in interdisciplinary collaboration with dental personnel at the same dental clinic to patients in the region. Systematic literature reviews, including meta-analyses, have clearly indicated CBT as the most effective treatment for adult individuals with severe dental anxiety [28][29][30][31]. These regional clinical guidelines improve the treatment for dental anxiety patients and make it available to all citizens in the region, thereby providing more equal evidence-based dental care. ...
Article
Full-text available
Dental anxiety and dental phobia are still prevalent among adult individuals and should be considered a dental public health issue. Dental anxiety/phobia is often described as a vicious cycle where avoidance of dental care, poor oral health, and psychosocial effects are common features, often escalating over time. Treatment should include therapy for dental anxiety/phobia and oral diseases. This paper discusses aetiology, prevalence, and diagnosis of dental anxiety/phobia and, in detail, presents a conceptual treatment model at the Dental Fears Research and Treatment Center in Gothenburg, Sweden. In addition, based on systematic reviews, evidence-based treatment for dental anxiety is revealed including the interdisciplinary approach between psychology and dentistry.
... Patients who have received cognitive behavioural therapy (CBT) for dental fear have reported a significant, in most cases permanent decrease in their fear to such a level that it does not disrupt later dental care [6,13]. Indeed, successful reduction of dental fear may lead to regular dental attendance and the acceptance of normative dental care [11,[14][15][16], which in turn diminishes the need for emergency visits. However, reduction of dental fear does not always have a significant impact on dental attendance [17,18]. ...
... Those with a successful baseline condition had more dental examinations than the ones with no success, which can be considered a sign of regular dental attendance among those with preliminary success. This result is in accord with the findings of the review by Wide-Boman et al. [15]. ...
Article
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Background Dental fear may lead to avoidance of regular dental treatment. The scope of this long-term practe-based study was to monitor the dental attendance of patients who received chair-side dental and fear treatment. Methods In 2000–2006, patients in the City of Oulu, Finland, received treatment for dental fear in the Clinic for Fearful Dental Patients (CFDP) from primary health care dentists trained on this subject. Of the originally treated patients (n = 163), 152 (93%) with sufficient information in dental records made up the study population. Information on their age and sex was available. The number of dental examinations, emergency visits and missed appointments was collected covering the follow-up period of 10 years 2006–2016. For analyses, data were dichotomized according to age at baseline and preliminary outcome baseline condition of dental fear treatment evaluated in 2006. To investigate association further, Poisson regression as well as binary logistic regression models were conducted. As register keeper, the City of Oulu gave permission for this retrospective data-based study. Results Patients receiving dental fear treatment at younger age (2–10 y) had significantly more dental examinations than those treated at > 10 years. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. Sex was not a significant factor in later dental attendance. There was an association between few dental examinations and dental emergency care need with unsuccessful baseline outcome of dental fear treatment. Conclusions Successful dental fear treatment especially at an early age is beneficial for future dental attendance measured by the number of examinations and consequently, less need for emergency care than in the opposite case. Successful fear treatment has positive impact on later dental care and regular dental attendance.
... Dazu zählen die Hypnose (Seligman et al., 2017), Aromatherapie (z.B. Lavendelölduft), die Anwendung von Akupunktur oder Homöopathie (Appukuttan, 2016;Gordon, Heimberg, Tellez, & Ismail, 2013a;Karnad, 2015;Wide Boman, Carlsson, Westin & Hakeberg, 2013). ...
... Die psychotherapeutischen Interventionen haben sich für die Behandlung der Zahnarztangst grundsätzlich als effektiv erwiesen. Systematische Reviews und Metaanalysen ziehen dennoch eher vorsichtige Schlüsse, was an der Vielfalt der Methoden liegt, die in Studien auch gemischt eingesetzt wurden, ebenso an der Heterogenität der Messverfahren, wodurch die Vergleichbarkeit eingeschränkt ist (Appukuttan, 2016;Goettems et al., 2017;Wide Boman et al., 2013). Einen Sonderfall stellen die Kinder dar, weil ängstliches und abwehrendes Verhalten in einer potenziell Angst machenden Situation verbunden mit einem drohenden Kontrollverlust bis zum Alter von 11, 12 Jahren normal ist (Klinberg, 2008). ...
... Extant research supports cognitive behavioral therapy (CBT) as the gold standard psychological therapy for the treatment of dental anxiety in both children 24,25 and adults. 26 However, owing to limited training opportunities available for general dentists for learning to administer therapeutic (cognitive behavioral) interventions, patients with dental anxiety may be referred to specialists or dental fear clinics, but these services are not widely available. In addition, there are indications that most individuals with specific phobias, including dental phobia, do not seek professional help. ...
... 50 Hence, the observed findings with the application of video modeling, C-CBT, and VRET support the extant knowledge on the efficacy of behavioral interventions in the treatment of dental anxiety. 26 In the two distraction studies included in this review, 34,38 the audiovisual distraction administered during dental treatment significantly reduced dental anxiety in children compared with audio distraction and treatment as usual controls (no intervention). 38 Conversely, music relaxation administered before dental treatment yielded no dental anxiety-reducing effect compared with the control (resting in silence). ...
... Extant research supports cognitive behavioral therapy (CBT) as the gold standard psychological therapy for the treatment of dental anxiety in both children 24,25 and adults. 26 However, owing to limited training opportunities available for general dentists for learning to administer therapeutic (cognitive behavioral) interventions, patients with dental anxiety may be referred to specialists or dental fear clinics, but these services are not widely available. In addition, there are indications that most individuals with specific phobias, including dental phobia, do not seek professional help. ...
... 50 Hence, the observed findings with the application of video modeling, C-CBT, and VRET support the extant knowledge on the efficacy of behavioral interventions in the treatment of dental anxiety. 26 In the two distraction studies included in this review, 34,38 the audiovisual distraction administered during dental treatment significantly reduced dental anxiety in children compared with audio distraction and treatment as usual controls (no intervention). 38 Conversely, music relaxation administered before dental treatment yielded no dental anxiety-reducing effect compared with the control (resting in silence). ...
Article
Objectives: The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. Data sources: A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. Inclusion criteria: Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. Results: A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. Conclusions: A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. Clinical significance: The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. Prospero registration number: CRD42017064810.
... Some methods generally used in dental offices were also frequently mentioned, such as signaling and tell-show-do. Body contact (n = 6) Comfort object (n = 5) Wearing dark glasses (n = 2) Others b 7 4.8 a Non-pharmacological interventions listed here were covered by previous systematic reviews [12,[26][27][28]. b Other non-pharmacological interventions included: (each n = 1) acupuncture, cognitive behavioral therapy, cranial electrostimulation device, relaxation system (NuCalm), modeling, deep pressure stimulation (weighted blanket), and emotional freedom technique (EFT) tapping. ...
Article
Full-text available
The aim of this study was to review the health information of dental fear-, dental anxiety-, and dental phobia-related videos on YouTube. The 100 most widely viewed videos for the keywords “dental fear”, “dental anxiety”, and “dental phobia” were chosen for evaluation. Out of the 300 videos, 145 videos met the inclusion criteria and were analyzed. It was found that most of them were produced by the professions, with a dentist delivering the key messages or with patients giving testimonials. Many etiological factors and symptoms were described. Many pharmacological and non-pharmacological interventions were recommended to the audience, such as sedation and distraction, respectively. However, there was a lack of information on the definition or diagnostic criteria of dental fear, dental anxiety, and dental phobia. Videos with high views had a higher ratio of misleading information. Videos with a dentist being the informant had a similar ratio of misleading information compared to other videos. Without adequate information on how to diagnose, it would be very difficult for the audience to determine if the video content was relevant or useful. The dental profession can work together with psychologists or psychiatrists to produce authoritative videos with accurate content.
... Det ble funnet sviktende forskningsmessig kvalitet og store kunnskapshull i feltet. Saerlig rammer kunnskapsmangelen langtidseffekter av behandlingen og overgangen til ordinaer tannbehandling (5). Klinisk erfaring fra TOO-team tilsier at overgangen fra angstbehandling hos spesialopplaert tannlege til ordinaer tannbehandling er krevende for mange, og risikoen for tilbakefall er relativt stor. ...
... With the high prevalence of dental fear worldwide [20], reducing levels of fear and anxiety in dental care procedures is desirable for both patients and dental practitioners. The use of non-pharmacological interventions as an adjunct to pharmacological treatments has been increasingly supported by recent systematic reviews [21][22][23]. However, most of the published reviews either address reducing anxiety in a general dental care procedure or focus exclusively on psychological interventions. ...
Article
Full-text available
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.
... Mens sedasjon helst brukes for å oppnå reduksjon av angstsymptomer i selve behandlingssituasjonen, så brukes psykologiske intervensjoner for å oppnå varig reduksjon av tannbehandlingsangsten (23,24). Kognitiv atferdsterapi (CBT) er den best dokumenterte psykologiske behandlingsmetoden for angstlidelser generelt og flere studier har vist at metoden også er nyttig som intervensjon ved tannbehandlingsangst (25,26 ...
Article
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Hovedbudskap Tannlegeadministrert kognitiv atferdsterapi (D-CBT) er en metode som effektivt kan redusere både alvorlig og mindre alvorlig tannbehandlingsangst i løpet av få behandlingstimer (5 timer) hos allmennpraktiserende tannlege. Tannbehandling under sedasjon med midazolam kombinert med bruk av kommunikasjonsmetoden «Fire gode vaner» kan effektivt redusere tannbehandlingsangst. Studien støtter en modell der pasienter kan få behandling av tannbehandlingsangst i primær tannhelsetjeneste utført av allmenntannlege. Det tverrfaglige offentlige tilbudet (TOO) kan i en slik modell spisses mot sammensatte og/eller mer behandlingsresistente tilfeller av tannbehandlingsangst.
... A working group consisting of dental practitioners, psychologists and researchers was established to design and implement a dental service catering to these patients [9,10], and cognitive behavioural therapy (CBT) was chosen as the main form of treatment for the TADA service. Both national and international research suggests that elements of CBT, specifically in vivo exposure therapy, could effectively treat the anxiety aspect, which is assumed to be the precursor to avoiding dental services [11][12][13]. The underlying assumption was that their oral health could be restored by relieving patients' dental anxiety through CBT. ...
Article
Full-text available
Background Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service’s structure alleviates dental anxiety and restores these patients’ oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts. Methods This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12). Results The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service. Conclusions Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.
... Previous research involving dental practitioners who have used CBT on patients with dental phobia has shown a significant lower dental anxiety score, better dental service attendance and decreased decayed teeth counts after a 1-year follow-up [24][25][26]. A review by Wide Boman et al. [27] concluded that CBT is a promising therapy and often a therapy of choice for the treatment of patients with dental anxiety or phobias. A cognitive behavioural therapist assumes that the patient's cognition and thinking are disrupted, thus affecting dysfunctional emotion and behaviour [21]. ...
Article
Full-text available
Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients’ dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients’ experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients’ dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context‐mechanism‐outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person‐centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self‐esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person‐centred care approach helps alleviate patients’ dental anxiety. This provides insights into how dental services could be executed for these patients.
... In addition, many review articles note the lack of quality and certainty of the evidence of these intervention studies [28,[255][256][257]. For individuals with extreme levels of DFA, psychological interventions (e.g., cognitive behavioral therapy, systematic desensitization, exposure therapy) have shown success in reducing DFA and increasing dental attendance [204,238,[258][259][260][261][262][263][264][265][266][267]; however, dentists may encounter challenges utilizing and implementing these types of training-and time-intensive intervention techniques [238,268]. ...
Article
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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.
... With the high prevalence of dental fear worldwide 20 , reducing level of fear and anxiety in dental care procedures is desirable for both patients and dental practitioners. The use of non-pharmacological interventions as an adjunct of pharmacological treatments have been increasingly supported by recent systematic reviews [21][22][23] . However, most of the review addressed on reducing anxiety in a general dental care procedure, while some of these reviews focus exclusively on psychological interventions. ...
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Objective To investigate the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. Materials and Methods Multiple electronic databases were searched for articles published in English. Inclusion criteria were randomized controlled trials reporting the effectiveness of any non-pharmacological interventions on reducing fear or anxiety level in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After removal of duplication, screening of title and abstract, and assessment of full text, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. A total of 1843 study participants composed the sample of the systematic review. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. Quality assessment was performed by using the Revised Cochrane risk-of-bias tool for randomized trials. Results The anxiety level after intervention in each study were pooled and meta-analyzed by random-effect model. Significant reduction of anxiety level was observed in non-pharmacological interventions 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. Conclusions Non-pharmacological interventions appear to reduce fear and anxiety level in patient undergoing third molar extraction under local anesthesia. Clinical Relevance Evidence suggests fear in third molar extraction bring negative impacts on both oral health and psychosocial well-being. The use of non-pharmacological intervention as an adjunct of local anesthesia should be considered in dental care setting.
... One of the most common co-occurring conditions is anxiety, 20 with the lifetime adult prevalence for autistic individuals thought to be 42%, higher than the reported 27% within the general population. 21,22,23 Though many people find visiting the dentist an anxiety-inducing process, 24 it may be disproportionately stressful and demanding for autistic individuals and their families. 16 Indeed, in Sweden and the UK, autistic adults report higher levels of dental anxiety than non-autistic adults. ...
Article
Aims Previous research has demonstrated that autistic individuals often experience difficulties accessing dental care, both as a result of autism specific difficulties and practitioners’ attitudes towards autism. However, very little research exists that explores dental professionals’ experiences of providing care to their autistic patients. The aim of this study was to investigate the strategies UK-based dental professionals’ use when working with autistic patients Methods and Results In this study, dental professionals (n = 16) from a variety of specialty roles (special care, paediatrics, orthodontics) were interviewed. We asked participants to talk through, in depth, specific cases they had encountered in their practice, what sorts of accommodations they had provided, and what concerns had arisen during appointments. Thematic analysis was used to analyses the data and revealed four main themes: the unique dental needs associated with being autistic, effective adaptations to practice, the crucial role of the caregiver, and the importance of specialist knowledge Conclusion Recommendations for how dentists can improve the dental experiences of autistic patients can be drawn from the specialist dentists’ responses in this study. These include involving autistic patients in decisions about their treatment and being flexible and willing to work with autistic patients and their caregivers.
... Strategies that have been developed to combat/manage dental anxiety include nonpharmacological approaches such as (1) establishment of good communication and rapport between dentist and patient, (2) systemic desensitization (3) hypnosis (4) cognitive behaviour therapy, a type of psychological therapy aimed at removing the negative thoughts associated with dental anxiety and phobia, and (5) pharmacological interventions such as intravenous sedation, inhalation sedation, local and general anaesthesia [179][180][181][182][183][184][185]. ...
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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.
... Behavioral therapy and cognitive behavioral therapy is the most accepted form of psychological treatment for anxiety and can be applied in the dental setting (Kvale, Berggren & Milgrom, 2004;Wide Boman, Carlsson, Westin & Hakeberg, 2013). In a systematic review, Wide Boman et al., (2013) described that both interventions (such as memory reconstructing) decrease dental anxiety/phobia. ...
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The purpose of the present study was to assess the effects of dentist–patient communication via social media on dental anxiety and to determine the appropriate timing of such communications. In this randomized, double‐blinded and controlled trial, we used Instagram’s quick replies system to answer patients' questions to alleviate dental anxiety for patients undergoing impacted teeth extraction under local anesthesia. Patients were assigned randomly into four groups according to the timing of such communications: only after (group 1, n = 36), only before (group 2, n = 35), before and after the operation (group 3, n = 36), and a control group who received no communication on social media (group 4, n = 36). Dental anxiety was evaluated one week before (pre‐op) and after the operation (post‐op) using recognized assessment scales –the Spielberger’s State‐Trait Anxiety Inventory, Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS). The results showed that the post‐op values of group 4 had higher anxiety scores than the groups 2 and 3 according to VAS (p < 0.05). Within the groups, the anxiety levels showed a decreasing trend after surgery according to MDAS and VAS scores (p < 0.05). The results of this study suggest that communication with patients before the operation is sufficient to reduce their dental anxiety.
... Various psychotherapeutic and pharmacological D strategies like acupuncture, hypnosis, and sedation have been tried out to minimize dental anxiety with limited success. [5][6][7][8] Music intervention as an alternative therapy has been proven effective in the management of several medical conditions including depression 9,10 schizophrenia, 11,12 and Parkinson's disease (PD). 13 Music therapy is said to bring down anxiety and pain through deep relaxation and distraction that in turn reduces the activity of the neuroendocrine and sympathetic nervous systems (SNS). 1 It is a well-known fact that listening to music can lower the anxiety in patients undergoing medical procedures. ...
Article
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BACKGROUND AND AIM: The purpose of the present study was to evaluate the impact of passive music intervention in patients with moderate to high dental anxiety undergoing ultrasonic scaling procedure.
... Various psychotherapeutic and pharmacological D strategies like acupuncture, hypnosis, and sedation have been tried out to minimize dental anxiety with limited success. [5][6][7][8] Music intervention as an alternative therapy has been proven effective in the management of several medical conditions including depression 9,10 schizophrenia, 11,12 and Parkinson's disease (PD). 13 Music therapy is said to bring down anxiety and pain through deep relaxation and distraction that in turn reduces the activity of the neuroendocrine and sympathetic nervous systems (SNS). 1 It is a well-known fact that listening to music can lower the anxiety in patients undergoing medical procedures. ...
Article
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Background and Aim The purpose of the present study was to evaluate the impact of passive music intervention in moderate to high dental anxiety patients undergoing ultrasonic scaling procedure. Methods Eighty healthy subjects with an anxiety score of 13-25 by Modified Dental Anxiety Scale (MDAS) in a randomised controlled trial were recruited into study and control group. Study group of forty subjects, underwent ultrasonic scaling procedure with pre-recorded instrumental music intervention. Forty subjects in control group received same dental treatment without music intervention. Physiologic parameters such as Pulse rate (PR) and systolic and diastolic Blood pressure (BP) were recorded twice (Before, and at the end of procedure) for both the groups. Dental anxiety experience was recorded using visual analogue scale (VAS) for all the subjects at the end of study program. Repeated measure ANOVA is used to test the significant mean difference between pre and post measurements of all clinical parameters among study and control groups. Independent sample t-test was applied to analyses VAS intergroup significance. Results Result of the study showed the mean values of PR (pre and post), systolic and diastolic BP (pre and post)were statistically significant for study group as compared to control group Mean values of PR (pre and post) and systolic and diastolic BP (pre and post ), showed statistically significant reduction in study group compared to control group. Post therapy VAS score was significantly lower in the study group as compared to the control group. p value was maintained at < 0.05. Conclusion Music intervention, during ultrasonic procedure helps to reduce dental anxiety in subjects with moderate to high dental anxiety levels.
... Cognitive behavioural therapy (CBT) alleviated severe dental fear in adults according to systematic reviews [20,21]. Usually, the interventions in studies were composed of the diagnostic interview and exposure to dental treatment. ...
Article
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Objectives: The aim was to examine how patients describe and perceive their dental fear (DF) in diagnostic interviews. Material and methods: The sample consisted of dentally anxious patients according to the Modified Dental Anxiety Scale (MDAS), who had problems coping with conventional dental treatment. The voluntary participants (n = 7, aged 31-62 years) attended a diagnostic interview aiming to map their DF before dental treatment. The data were analysed by theory-driven qualitative content analysis. The themes consisted of the four components of DF: emotional, behavioural, cognitional, and physiological, derived from the Index of Dental Anxiety and Fear. Results: Within these four themes, treated as the main categories, 27 additional categories related to the patients' interpretations of DF were identified in three contexts: before, during and after dental treatment. 10 categories depicted difficult, uncontrollable, or ambivalent emotions; nine depicted behavioural patterns, strategies, or means; five depicted disturbing, strong, or long-lasting physiological reactions, including panic and anxiety symptoms. The remaining three categories related to cognitive components. Conclusions: The results indicate that dental care professionals may gain comprehensive information about their patients' DF by means of four component-based diagnostic interviews. This helps them to better identify and encounter patients in need of fear-sensitive dental care. Trial registration number: NCT02919241.
... Nach einem Review von Klingberg und Broberg (2007) leiden 9 % der Kinder und Erwachsenen beträchtlich unter diesem Zustand (Chhabra, Chhabra & Walia, 2012;Lee, Chang & Huang, 2007). Die dadurch bedingte Vermeidung zahnärztlicher Untersuchungen begünstigt Karies und Parodontalerkrankungen, ist aber auch mit psychosozialen Problemen assoziiert wie einem reduzierten Selbstwertgefühl und einer geringeren Lebensqualität (Wide Boman, Carlsson, Westin & Hakeberg, 2013). Für die Entstehung von Zahnbehandlungsängsten im Kindesalter werden neben kindlichen Temperamentsfaktoren auch elterliche Ängste, sozialer Status sowie eine ungünstige medizinische oder zahnärztliche Vorgeschichte diskutiert (Arnrup, Broberg, Berggren & Bodin, 2007;Campbell, Busuttil-Naudi & Chadwick, 2015;Krikken & Veerkamp, 2008;Wright, Alpern & Leake, 1973). ...
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Dental anxiety in preschool children: How helpful are behavioral control management strategies? Abstract.Objective: Dental anxiety is a frequent problem in the dental treatment of young children. Control management methods are widely used in pediatric dental care as coping strategies. This study compares two control management strategies regarding their reduction of dental anxiety and treatment success. Method: A group of 60 preschool children with known dental fear in their medical history underwent professional dental cleaning in which the Tell-Show-Do Method (TSDM) was applied. Patients were randomized into two groups according to the controlling method employed: (1) limited controlling method (L-K) and (2) standardized controlling method (S-K). The efficacy of the two control methods was tested using pulse rate as an objective measure of anxiety and self-rating as a subjective indicator. Results: Both the S-K and the L-K condition showed a significant reduction in pulse rate, and there was no difference in physiological arousal and treatment success. However, independent of the group disposition, there was a noticeable increase in pulse rate in children after TSDM. Conclusion: The results of this study indicate that even limited options for controlling dental treatment do not lead to greater burdens on the children in question with dental anxiety. However, further studies are necessary to investigate the use of control methods independent of TSDM.
... Critical and systematic reviews have pointed out that cognitive-behavioural therapy and relaxation training are effective in reducing patients' dental anxiety. 69,70 Perhaps in the future, the differential activation patterns in the brain triggered by dental fear may serve as neuroimaging biomarkers for more precise psychological diagnoses, interventions and follow-up evaluations, so that the "how" question can be better answered. F I G U R E 2 Co-activation of loci found in neuroimaging studies of mastication and dental fear/anxiety, based on a previously published systematic review and meta-analysis that combined (A) 13 studies of chewing tasks, 28 (B) 7 studies of clenching tasks 28 and (C) 7 studies of dental fear/anxiety tasks. ...
Article
Background: The number of neuroimaging studies on the brain and oral sensorimotor functions has increased recently. Behind the dazzling 'brain maps', what does the neuroimaging evidence truly tell us? What can dentists learn from it to improve clinical practice?. Objectives: We summarize the pros and cons of applying magnetic resonance imaging (MRI)-based neuroimaging to study oral behaviors of the dental patients. Methods: This is a narrative review of previous neuroimaging research of oral functions, focusing on MRI-related studies of human subjects. Results: MRI has gained popularity in dental research due to its noninvasive nature, its approachability and its versatility in quantifying a variety of brain signatures. We argue that MRI-based neuroimaging is suitable for investigating the association between the between-individual variations in brain structure (e.g., gray matter volume) / brain functions (e.g., brain activation) and oral behaviors of the patients. Two specific topics of the daily dental practice, mastication and dental fear and anxiety, are discussed to exemplify the potential of neuroimaging methods. The methodological and interpretive limitations of MRI techniques are highlighted, and most importantly, we emphasize that the neuroimaging findings should be carefully interpreted given these limitations. Conclusions: MRI-based neuroimaging techniques can provide a better evaluation of the association between the brain and stomatognathic functions, which could be pivotal to the evidence-based clinical management of dental patients.
... The main features are behavior analysis or conceptualization, psychoeducation, exposure, cognitive restructuring, assertiveness techniques, and home exercises. A systematic review of psychological treatment for dental anxiety among adults found evidence that CBT and associated behavioral therapy resulted in significant reduction in dental anxiety (Wide Boman et al. 2013). Moreover there is some support that CBT and associated behavioral therapy improve patients' acceptance of dental treatment more than general anesthesia does, but the results were based on a low-quality level of evidence reported. ...
Article
The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond “disease” to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of “treatment” to oral health “care,” notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and “behavior change.” Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.
... The results also supported that dental anxiety is a common problem for CSA survivors (2,4,21). Thus, treatment of dental anxiety needs to be addressed in CSA survivors, with this study showing that while frameworks for anxiety management (22) and standard treatments for dental anxiety (23,24) and sedation may be used, even this anxiety treatment ought to be based on individual needs. Furthermore, several experts (25,26) have emphasized the need for education of dentists on the topic of sexual abuse (being competent). ...
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This qualitative study aimed to obtain a deeper understanding of what makes adult dentistry possible for child sexual abuse survivors. Sixteen adult informants were recruited from four Centres against Sexual Abuse and interviewed. Qualitative analysis of the transcribed interviews was conducted consecutively until thematic saturation was reached at 16 informants. A conceptual framework was generated, and informants’ experiences of what makes dental treatment achievable were summed as the dentist working in a trauma‐sensitive way, captured by the core category: Being considerate every step of the way. The underlying categories are: (i) offering a good start; (ii) being competent; (iii) being aware of the influence of staff behaviour; (iv) building a safe relationship; (v) arranging a secure treatment situation; and (vi) exploring individual triggers. The findings revealed that dental staff should have adequate competence to build secure relationships and explore individual triggers in dental treatment situations when treating child sexual abuse survivors. Dentists should have a trauma‐sensitive approach to all patients. When treating child sexual abuse survivors, dentists should demonstrate utmost consideration every step of the way, building long‐term solid relationships, and discussing and testing coping strategies individually adapted to the specific needs of the child sexual abuse survivors, in a safe environment.
... De plus, les praticiens dentaires peuvent se retrouver face à une autre difficulté dans le suivi des patients : celle de l'évaluation de la douleur [16]. Une revue de la littérature récente a montré que les patients souffrant de schizophrénie présentaient un déficit global de la perception de la douleur clinique [17]. Certains traitements des troubles psychotiques peuvent diminuer la sensation douloureuse, et retarder le recours aux soins dentaires. ...
Article
Objective: Oral health is problematic in psychiatric patients, as less than 25% of the general population are using a dental surgeon. Starting with this premise, we wanted to understand how the patient anxiety and pain can impact the oral management and the good execution of care. Method: This study was conducted with 100 psychiatric inpatients. Using different scales, we measured their anxiety and pain level, as well as their cooperating with care. Results: Anxiety does not impair management, and significantly decreases after care. Behavior during oral care in psychiatric inpatients seems similar to that of the general population. Conclusion: Our study allows us to better grasp dental care in psychiatry and should contribute to give dental care a central place in psychiatry somatic management.
... BT/CBT alone had the highest association with the positive outcome of treatment in CFDP followed by BT/CBT combined with oral conscious or inhalation sedation. ese findings are in line with those of Wide Boman et al. [14] and Gordon et al. [15]. Gomes et al. preferred a cognitive approach over behavioral management techniques [18]. ...
Article
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Aim: Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000-2005. Methods: A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. Results: The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. Conclusions: A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.
... Literature highlight that there is a gender difference in the experience of dental anxiety. Females are more inclined to experience dental anxiety compared to man, 19 and however, one of the study of adults aged 50 years and older found no difference in dental anxiety according to sex. 18 Similarly our study didn't build upon the findings according the literature reports. ...
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Introduction: Dental anxiety is a prevalent condition found among children as well as among adults of all ages. It is a kind of fear associated with dental procedures. Study Design: Randomized control trial. Setting: Outpatient setting of the department of Operative Dentistry at the Liaquat University of Medical & Health Sciences. Period: January 2014 to December 2014. Methods: Two hundred participants were enrolled in the study, 100 participants in intervention arm and 100 participants in the control arm. Purposive sampling technique was used. Pre and post procedure anxiety was assessed using the dentist rating of patient’s scale. Music intervention was provided to the participants randomized in the intervention arm whereas routine treatment was provided to both group. Multiple Linear Regression test was used for the statistical analysis. Results: The study found an association between music and the post procedure anxiety score. The anxiety score of the participants who received the music intervention was 0.17 units lower than those who didn’t receive the intervention. Conclusion: Music intervention can play an effective role in relaxing the anxious patient coming for the dental procedure, besides trying to make the dentist office less fearful and less anxiety provoking.
... The SDT approach (Deci & Ryan, 2000) to reducing the level of dental anxiety may be used in addition to more intensive competence support by giving patients information and education about oral diseases and allowing them supervised dental hygiene practice at the dental clinic. Competence support related to teaching patients to use reappraisal and acceptance strategies in anxiety and emotion regulation, as well as cognitive-behavioral therapy/behavioural therapy, has also been shown to be effective (Gordon, Heimberg, Tellez, & Ismail, 2013;Gross & John, 2003;Hofmann, Heering, Sawyer, Asnaani, 2009;Wide Boman, Carlsson, Westin, & Hakeberg, 2013). ...
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The aim of this study was to test a structural equation model (SEM) with the following hypotheses: (1) patients’ perceptions of oral health care professionals’ (i.e., dentists and dental hygienists) controlling interpersonal styles would positively predict patients’ dental anxiety through their basic psychological need frustration in treatment; (2) in turn, high dental anxiety would positively predict dysregulation of dental anxiety, which through a feedback loop contributes to perception of oral health care professionals’ controlling styles; and, (3) in addition, both dental anxiety and dysregulation of dental anxiety would predict poor Oral Health‐Related Quality of Life (OHRQoL) and subsequently poor general well‐being. A cross‐sectional study was conducted among 322 students at the University of Oslo. Participants responded to a survey with validated questionnaires. All variables in the model tested were acceptably normally distributed. The SEM did fit the data well and all hypotheses were supported. A bootstrapping procedure indicated that all indirect links in the model were supported. Analysis indicated that common method variance (CMV) did not seriously distort the results in this setting. Although the majority of oral health care professionals are perceived as being noncontrolling by their patients (51%), the proportion perceived as moderately (38%) or highly (11%) controlling represent a challenge for oral health care education and practice. It would be useful for oral health care professionals to be trained in avoiding a controlling treatment style.
... Cognitive-behavioural therapy has proved to be an effective way of reducing dental anxiety, especially in adult patients with moderate anxiety levels [21,22]. Furthermore, the CBT therapy is more effective in lowering dental anxiety levels than pharmacological sedation or anaesthesia [23]. Forbes et al. have shown that over a half of the patients suffering from dentophobia are likely to undergo a psychological or behavioural therapy to eliminate fear. ...
... 33 Recently, CBT has begun to be applied for psychosomatic problems in the dental setting, and the effectiveness of this therapy on these problems has been confirmed in various studies. [26][27][28][29][30][31][32] Conclusion ...
Chapter
Dentist-administered cognitive behavioral therapy (D-CBT) is a method for the treatment of dental anxiety used by dentists in general practice. This method operates within the framework of trauma-sensitive care and CBT. This chapter describes how psychological treatment components like alliance building, cognitive restructuring, psychoeducation, window of tolerance, anxiety hierarchy, and anxiety curve can all be combined with systematic exposure to develop a treatment manual designed to treat dental anxiety. The D-CBT principles are explained and thereafter exemplified by the systematic treatment of Kristin, a 36-year-old woman with high dental anxiety that has avoided dental treatment for the last 7 years.KeywordsDental anxietyCBTD-CBTEvidence-based, dentist-administered treatmentTreatment manualCoping planGeneral dental practice
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Aims: To investigate the effectiveness of a cognitive-behavioral intervention that included either a diagnostic interview (DI) or a DI combined with modified one-session treatment (M-OST) for dental anxiety among adults in a primary care setting. Methods and results: Nineteen participants were assigned to either a DI before conventional dental treatment (group T1) or DI and M-OST (group T2). The severity of dental anxiety was measured with three self-reported measures before and after the intervention: the Modified Dental Anxiety Scale (MDAS), the Index of Dental Anxiety and Fear (IDAF-4C), and the Visual Analogue Scale-Anxiety (VAS-A). Dental care attendance was enquired in a 1-year follow-up. The scores for all three scales decreased among both study groups, with the largest decrease recorded in treatment group T1 assessed with the VAS-A. A higher dental anxiety score measured before the intervention associated most significantly with a higher dental anxiety score after the intervention. At the 1-year follow-up, 82% of participants in T1 and 67% in T2 had visited a dentist. Conclusion: A DI alone and combined with M-OST is potentially effective in reducing dental anxiety and in supporting the engagement of adult patients with dental treatment in primary dental care.
Article
Aims: Dentophobia is a well-know kind of phobia and psychological problem in dentistry. Although patients might suffer from severe oral pain and have serious health complications, dentophobia is still posing a threat to oral healthcare and remains an unresolved worldwide phenomenon. According to estimates, up to 80% of the general population are affected by this condition. Dentophobia is an unpleasant problem with serious consequences not only for patients but also for dentists and the public health system in general. This umbrella review provides a comprehensive overview of the various aspects of dentophoia as addressed in the published literature, and the current level of knowledge concerning their treatment. Methods and results: Based on 35 reviews of the published literature, addressing various aspects of dentophobia and published between 2008 and 2021, this umbrella review was written. The search was based on the PubMed and PsycINFO databases. The extraction was structured by open coding and each aspect of the subject analyzed according to Ritchie and Lewis. Conclusion: We conclude that the evidence concerning the efficacy of the various interventions is still rather weak and there is an obvious need for further research, because of the yet and unresolved challenges and the lack of standardised guidelines to deal with patients with dentophobia.
Article
Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.
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Needle injections of local anaesthetics during dental procedures are known to cause anxiety in patients, especially in paediatric patients. Dental fear and anxiety are well-known barriers to accessing oral health care, with the fear of needle injections being one of the many causative factors. In more severe cases, patients may present with dental phobia and needle phobia, possibly resulting in them postponing or avoiding their dental appointments altogether. These pose challenges for the dental practitioner. The pain associated with local anaesthetics is attributed to factors relating to the patient, local anaesthetic, and injection technique. The pain is predictable as they are planned procedures, therefore dental practitioners should strive to prevent or at least minimise iatrogenic pain and thus discomfort. Various traditional and newer techniques can be employed to assist dental practitioners in minimising discomfort and pain from the needle injections of local anaesthetics, such as desensitisation of the injection site. Continued prioritisation and further research would be beneficial for improving understanding and awareness of the techniques available to achieve a tailored approach to treatment.
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An evidence-based guide for laypeople on psychological, medical, complementary and lifestyle interventions for anxiety disorders.
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Background: Torture, abuse and dental phobia are often precursors to developing a pathological relationship with dental care due to elevated anxiety and the risk for re-traumatisation. Consequently, this patient group tends to avoid dental services, leaving them with severe tooth decay that affects both their general and psychosocial health. Norwegian dental services have implemented a specific dental service targeting this patient group, aiming to both alleviate their dental anxiety and restore their oral health. The outcomes of this service have been positive, but for this model to be transferrable to other national contexts, it is necessary not just to understand whether the service works, but also how and why it works. Therefore, this study developed theories on how the structure of the service alleviates dental anxiety and restores patients’ oral health. Although developed specifically in a Norwegian context, these theories may be applicable to other national and international contexts. Methods: This realist evaluation comprised sequential, multiple methods encompassing a review of service and policy documentation (n=12), followed by realist interviews with service developers and deliverers (n=12). Guided by a retroductive approach consisting of coding, cataloguing and configuring through content analyses and context-mechanism-outcome (CMO) heuristics, the analyses generated four programme theories. Results: First, the state-subsidised dental service affects service access and service uptake. Second, this service can be adapted and tailored to regional resources to meet the needs of the heterogenous patient group. Third, regional service teams are cohesive because of a lack of national communication and cooperative practice. Fourth, the complexity of migration processes and poor dissemination practices leads to poor recruitment of torture survivors to the service. Conclusions: The service follows a hybrid bottom-up, top-down approach, allowing teams to practise discretion and tailor their approach to meet individual needs. With its bi-dimensional structure, the service reaches a patient population that would otherwise avoid dental services. Service uptake is beneficial as patients report experiencing improved quality of life. However, the service is struggling to reach torture survivors, which may be attributable to multiple contextual factors. More research is therefore required to understand the lack of service uptake among torture survivors.
Article
Zusammenfassung. Theoretischer Hintergrund. Die Zahnbehandlungsphobie tritt vergleichsweise häufig auf und geht mit körperlichen und psychischen Belastungen einher (z. B. verringerte Mundgesundheit, eingeschränkte mundgesundheitsbezogene Lebensqualität, erhöhtes Schamgefühl). Fragestellung. Ziel der randomisiert kontrollierten Studie ist die Überprüfung der Wirksamkeit einer verhaltenstherapeutischen Kurzintervention (VT-K) zur Behandlung der Zahnbehandlungsphobie. Methode. 36 Personen mit Zahnbehandlungsphobie nahmen entweder an einer drei Termine umfassenden VT-K oder Motivierenden Gesprächsführung (MG) oder einer Wartebedingung teil. Die Wirksamkeit wurde bis zu einem Jahr nach der Intervention hinsichtlich verschiedener abhängiger Maße beurteilt. Ergebnisse und Schlussfolgerungen. Es zeigte sich eine kurz- und langfristige Verbesserung der selbstberichteten Zahnbehandlungsangst (primärer Endpunkt) sowie der mundgesundheitsbezogenen Lebensqualität (sekundärer Endpunkt) sowohl bei der VT-K als auch MG. Die Ergebnisse des Verhaltenstests (primärer Endpunkt) spiegelten die Fragebogenergebnisse überwiegend nicht wider. Schwierigkeiten bei der Rekrutierung von Betroffenen werfen jedoch Fragen bezüglich der Implementierung von Interventionen in der ambulanten Versorgung auf. Diese Studie wurde registriert im Deutschen Register Klinischer Studien (DRKS00007732).
Article
Background Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested that cognitive–behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives This project was undertaken to map the quality and gaps in the cognitive–behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive–behavioural therapy. Data sources The overview was designed with cognitive–behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Review methods Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive–behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive–behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I ² < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. Results A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive–behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive–behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.05 to 0.50, I ² = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval –0.28 to 0.88, I ² = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.28 to 0.74, I ² = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Limitations Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Conclusion Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive–behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future work Future research should focus on how the modest effect sizes seen with cognitive–behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. Study registration This study is registered as PROSPERO CRD42017078690. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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ESTE ARTÍCULO ES ACERCA DEL EFECTO DE UNA TECNICA DE IMAGINACION GUIADA PARA LA REDUCCION DEL DOLOR EN LA CIRUGIA DE LAS MUELAS DEL JUICIO. ESTA EN ESPAÑOL Y ES DE UTILIDAD PARA LOS CIRUJANOS DENTISTAS QUE REALIZAN EXTRACCIONES DE TERCER MOLAR Y SE APOYAN EN OTRAS DISCIPLINAS COMO LA PSICOLOGIA PARA LA REDUCCION DEL ESTRES Y EL DOLOR.
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Dental anxiety affects many people worldwide and interferes with oral health. Beyond emotional distress, avoidance of dental care visits can lead to serious dental and health consequences. Although emerging research implicates anxiety, pain, and disgust sensitivities in the etiology and maintenance of dental anxiety, no studies to date have concurrently investigated the unique contribution of these vulnerabilities in dental anxiety. As a step toward elucidating salient mechanisms of dental anxiety, the present study investigated the aggregate contribution of anxiety, pain, and disgust sensitivities in dental anxiety, after controlling for relevant covariates. In this study, participants (N = 717; 71.3% female) included an unselected sample of undergraduate students who completed a battery of online questionnaires. Consistent with community rates, 12% of this sample reported high levels of dental anxiety. The hierarchical regression model revealed anxiety and disgust sensitivities were positively associated with dental anxiety symptoms when adjusting for other model variables. Results highlight the roles of anxiety and disgust sensitivities in dental anxiety and indicate the potential benefit of targeting these emotional sensitivities through routine screenings and treatments for dentally anxious patients.
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Die deutsche S3 Leitlinie „Zahnbehandlungsangst beim Erwachsenen“ befasst sich mit der Epidemiologie, der Diagnostik und der Therapie der Zahnbehandlungsangst mit Krankheitswert bei Erwachsenen und wurde unter Beratung und Moderation durch die Arbeitsgemeinschaft der wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) von einem Gremium erstellt, das 26 Fachverbände und andere Organisationen aus allen Bereichen der Zahnmedizin sowie der Psychiatrie, Psychosomatik, Psychotherapie, Psychologie, medizinischen Hypnose, Anästhesiologie sowie Patientenvertretern umfasst. Die Empfehlungen dieser Leitlinie basieren auf einer Sichtung der Evidenz der verfügbaren wissenschaftlichen Literatur und einer strukturierten, moderierten Experten-Konsensfindung.
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Introduction Dental phobia has been widely studied but there is limited research on the effect of dental phobia on oral health. This research is an analysis of the 2013 Child Dental Health Survey, to explore the impact of dental anxiety on factors relating to oral health in the adolescents. Aim To examine if dental anxiety predicts poor oral health in 12- and 15-year-olds. Design Regression analysis of data from 4,950 children aged 12 years and 15 years who participated in the Child Dental Health Survey 2013. Setting National epidemiological survey of UK schools. Materials and methods A series of logistic regressions was carried out to examine if dental anxiety, socio demographic factors and oral health-related behaviour could predict oral health status, the impact of the child's oral health on their own quality of life and the impact of their oral health on the family's quality of life. Additional outcomes examined were self-perceived dental health and general health. Results Dental anxiety was not a predictor of poor oral health but did predict a greater impact of the child's oral health on everyday life. Adolescents with dental anxiety had negative thoughts regarding their dental and general health. Conclusions Dental anxiety affects the everyday life and psychological wellbeing of adolescents.
Article
Аim of the present study is to set up a procedure for interdisciplinary interaction in complicated orthopaedic cases with the analysis of causes of complications after dental implantation and prosthetic treatment. Material and Methods. Digital panoramic radiography (J.Morita Veraviewepocs), cone-beam computed tomography (J.Morita Accuitomo 100), results of MELISA (Memory Lymphocyte Immuno-Stimulation Assay)-tests from InVitaLab (Neuss Germany), histological examination of bone tissue in sections, painted hematoxylin-eosin for I. Van Gieson (x 250/400), metallographic examination of the implant from the ВТ-6 (Ti-6AI-4V) alloy on oblique samples in scanning microscope Epiquant (х250). Results and Discussion. According to clinical studies of biocompatibility of dental materials, the most difficult for diagnosis and treatment are adverse reactions of patients in the form of allergies or intoxication against the background of the so-called "somaticized state", related to the use of dental prostheses. Typical "manifestations of psychosomatic disorders in the oral cavity" include chronic pain or occlusal discomfort, burning mouth syndrome, atypical odontangiography, phantom bite syndrome, senestopathy, and halitophobia. Specialists, distant from the problems of psychosomatic medicine, point out suspected diseases and non-specified conditions (Z.03.89), person with feared health complaint in whom no diagnosis is made (Z.71.1) conditions of unclear etiology (K29.7, K59 .9, D50.9, E03.2, F48.0/ G90.8) or unspecified (K29.9, T78.8 / T88.7). According to the European Academy of Allergy and Clinical Immunology data, the resources for diagnosing hypersensitivity reactions to metals (most often IV type) are still limited, and incidence of allergy upon the use of the titanium alloy Ti-4Al-6V, is one of the causes for the failure of dental implantation. In most patients, elimination of "incompatible" dentures yields a long-lasting positive result. However, in some patients, replacement of fillings, repeated endodontic treatment or even tooth extraction only exacerbate psychosocial distress. Patient H. (43 years old) suddenly felt significantly worse 7 years ago after prosthetic treatment for a partial loss of teeth on the upper and lower jaw (K08.432) . Complaints of malaise increased after completion of subsequent dental restorative treatment with use of dental implants. The dental and periodontal tissues status, orthopantomography and computed tomography data, as well as complete contact osteogenesis of the alveolar bone adjacent to the dental implant, without signs of fibrotisation and cellular inflammatory reaction on histological sections, as well as the absence of relief cracks, fractures, or other signs of destruction on oblique slices of the implant from the alloy ВT-6 (Ti-6AI-4V), did not confirm the hypothesis of postosteointegrational failure of dental implantation and prosthetics. In the process of differential diagnosis with the assistance of specialists of various medical specialties, taking into account the positive reaction to salt / compounds of titanium cadmium, weakly positive - nickel and iron, according to the results of the MELISA test, the clinical diagnosis: main condition-somatoform disorder (F45.2) after accomplished dental prosthetics (Z98.8); other condition-allergy, unspecified (Т78.40) - was clarified. Conclusions. Experience of interdisciplinary collaboration in the process of differential diagnostics and treatment of psychosomatic and allergic disorders and other adverse reactions related to dental practice, is the key element of evidence base for the founding of adapted medical guidelines and unified clinical protocols. Complications in the patient H. occurred due to insufficiently careful analysis of her history of life and disease during arrangement of prosthetic treatment, which should be considered a medical error. In the further treatment of patient H., an individual selection of materials for prosthetics, control of the applicability of dentures, and exact adherence of the patient to all medical orders are necessary.
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Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias.
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The aim was to study the relationship between psychosocial factors and dental status in adult subjects with severe dental fear (DF). A consecutive sample of 148 adults (mean age 36.1 yrs, range 21-69 yrs) referred for dental fear treatment was investigated using an intake questionnaire on dental attendance and history, psychometric questionnaires on dental fear, general anxiety and depression and a radiographic examination. The subjects had a mean DFMT (Decayed, Filled, Missed Teeth) score of 18.6 (SD = 5.6). A deterioration in dental status defined as the presence of root remnants was present in 57% of the subjects and was related to the negative consequences of dental fear, general anxiety and depression. Most subjects (84%) reported clinical levels of general anxiety and 46% reported clinical levels of depression. In conclusion, subjects with severe DF often suffer from psychosocial consequences and distress.This is even more marked if their dental status has deteriorated.The findings support a biopsychosocial vicious circle understanding of the maintenance of DF.
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Overwhelming evidence shows the quality of reporting of randomised controlled trials (RCTs) is not optimal. Without transparent reporting, readers cannot judge the reliability and validity of trial findings nor extract information for systematic reviews. Recent methodological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects. Such systematic error is seriously damaging to RCTs, which are considered the gold standard for evaluating interventions because of their ability to minimise or avoid bias.
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Brian Kavanagh critiques the GRADE system of grading guidelines, arguing that even though it has evolved through the Evidence-Based Medicine movement, there is no evidence that GRADE itself is reliable.
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The purpose of the present study was to estimate the point prevalence of dental fear and dental phobia relative to 10 other common fears and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR subtypes of specific phobia. Data were also analysed to examine differences with regard to severity, presence of distressing recollections of fear-related events, gender, and prevalence across age. Data were obtained by means of a survey of 1,959 Dutch adults, 18-93 yr of age. Phobias were assessed based on DSM-IV-TR criteria, whereas severity of present fears was assessed using visual analogue scales. The prevalence of dental fear was 24.3%, which is lower than for fear of snakes (34.8%), heights (30.8%), and physical injuries (27.2%). Among phobias, dental phobia was the most common (3.7%), followed by height phobia (3.1%) and spider phobia (2.7%). Fear of dental treatment was associated with female gender, rated as more severe than any other fear, and was most strongly associated with intrusive re-experiencing (49.4%). The findings suggest that dental fear is a remarkably severe and stable condition with a long duration. The high prevalence of dental phobia in the Netherlands is intriguing and warrants investigation in other countries.
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The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.
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Prevalence, characteristics and consequences of dental anxiety in a randomly selected sample of 645 Danish adults were explored in telephone interviews. Participation rate was 88%. Demographics, fear of specific procedures, negative dentist contacts, general fear tendency, treatment utilization and perceived oral conditions were explored by level of dental anxiety using a modified Dental Anxiety Scale (DAS). A Seattle fear survey item and a summary item from the Dental Fear Survey (DFS) were also included for fear description comparisons. Correlation between these indices (DAS-DFS: rs = 0.72; DAS-Seattle item: rs = 0.68) aided semantic validation of DAS anxiety intensity levels. Extreme dental anxiety (DAS > or = 15) was found in 4.2% of the sample and 6% reported moderate anxiety (DAS scores 14-12). Bivariate (B) and logistic regression (L) odds ratios (OR) showed that high dental anxiety was associated with gender, education and income, but not with age. Extreme dental anxiety for dentate subjects was characterized by fear of drilling (ORL = 38.7), negative dentist contacts (ORL = 9.3), general fear tendency (ORL = 3.4), avoidance of treatment (ORL = 16.8) and increased oral symptoms (ORB = 4.4). Moderate dental anxiety was also related to drilling (ORL = 22.3), but with less avoidance due to anxiety (ORL = 6.8) compared with low fear subjects.
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Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena. Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20-65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings. Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors. Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect.
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Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.
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Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored. The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates. People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear. Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear.
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The arrival of a book for review usually gives rise to pleasant anticipation, and whatever criticisms have to be made, it is that almost always possible to find some pleasant things to say. But finding praise for this tome is a problem — it is a volume too far. It is to be hoped that the authors
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In order to evaluate the relative effectiveness of the educational component of stress inoculation training (SIT) versus the procedure as a whole, 24 dental phobics were randomly assigned to one of four conditions: education alone; coping skills plus application training; coping skills, application training and education; and wait-list control. Pre-and postmeasures of dental anxiety and state-trait anxiety were obtained. In addition to posttreatment measures of pain tolerance (ischemic muscle pain and cold pressor tasks), all subjects were monitored as to whether they scheduled and completed an actual dental appointment. No significant differences were observed between the four experimental conditions in terms of the anxiety and pain tolerance measures. Significantly more subjects from the three treatment conditions scheduled posttreatment dental appointments than subjects from the wait-list control group. However, significantly more subjects from the two treatments which involved training in and application of coping skills went through with the scheduled appointments as compared to subjects from the education-alone condition. These findings would indicate that education may motivate individuals to take initial steps in seeking health care but may be insufficient in terms of getting patients to follow through with this process.
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The effects of cognitive-behavior therapy (CBT) and a semi-automated behavioral intervention (BT) for the treatment of dental anxiety were compared to a waiting-list (WL) control and to a positive dental experience condition (PDE), which use dentists particularly gentle with anxious patients. Multimodal assessment of cognition, behavior, physiological response, and dental anxiety was employed. Both BT and CBT subjects showed significant improvement compared to PDE and WL groups on their level of dental anxiety and negative thoughts during a dental procedure. On measures of self-efficacy, negative anticipatory thoughts, and pain experienced, the WL group improved significantly less than did the other three conditions. At a 1-year follow-up, subjects treated with BT and CBT reported less dental anxiety and had been to the dentist more often than WL controls. All three approaches thus show promise, with semi-automated behavior therapy and contact with a sensitive dentist being especially cost-effective methods of treatment.
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This study aimed to investigate the association between dental fear and both dental caries and periodontal indicators. A three-stage stratified clustered sample of the Australian adult population completed a computer-assisted telephone interview followed by a clinical examination. Oral health measures were the DMFT index and its components, periodontitis and gingivitis. A total of 5364 adults aged 18-91 years were dentally examined. Higher dental fear was significantly associated with more decayed teeth (DT), missing teeth (MT) and DMFT. There was an inverted 'U' association between dental fear and the number of filled teeth (FT). Periodontitis and gingivitis were not associated with dental fear. The association between dental fear and DMFT was significant for adults aged 18-29 and 30-44 years, but not in older ages. Dental fear was significantly associated with more DT, MT, and DMFT but with fewer FT after controlling for age, sex, income, employment status, tertiary education, dental insurance status and oral hygiene. This study helps reconcile some of the conflicting results of previous studies and establishes that dental fear is associated with more decayed and missing teeth but fewer FT. That people with higher dental fear have significantly more caries experience underlines the importance of identifying and then reducing dental fear as important steps in improving adult oral health.
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The risk of dental rehabilitation under general anesthesia has multiple contributing factors. The literature has addressed the general anesthetic risk of dental general anesthesia and sedation in the operating room and the office settings, but more studies are needed to address the special needs population in particular. There is still a great need for more studies to assess the risk versus benefit for special need population as well as to stratify such risk in order to assist care providers in decision making as well as in sharing such risk concerns with patients, caretakers, and guardians. One recommended approach is to conduct a national retrospective study of patients treated under general anesthesia in the past 10 years in all the various settings and assess the associated risks and complications related to their physical status and the underlying physical and mental disabilities. The product of such a study could be a stratification of risk versus benefit as well as some guidelines for decision making as far as which kind of procedures should be conducted under general anesthesia while weighing the level of risk for the particular patient. Although access to care is not a direct risk factor, it can certainly deter timely treatment and intervention for patients with special needs.
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To investigate the relationship of dental anxiety with oral health status and oral health-related quality of life (OHQoL) among dentate subjects living in Hong Kong. One thousand Hong Kong residents who were aged 25-64 years and predominantly Chinese were asked to complete the Chinese short-forms of the Dental Anxiety Inventory (SDAxI) and Oral Health Impact Profile (OHIP-14S). Dental (DMFT index) and periodontal statuses [full-mouth clinical attachment level (CAL)] were also assessed. Ninety-six (9.6%; mean SDAxI, 9.6), 799 (79.9%; mean SDAxI, 15.0), and 105 (10.5%; mean SDAxI, 27.4) participants had low, average, and high dental anxiety, respectively. The mean DMFT/CAL scores of each SDAxI subgroup were 8.5/1.4, 9.3/1.9, and 9.8/3.6, respectively. The corresponding mean OHIP-14S scores for each SDAxI subgroup were 4.0, 8.1, and 13.2, respectively. Post hoc analysis, adjusted for possible confounding factors, revealed statistically significant differences in DMFT and CAL scores in subjects with low versus high level of SDAxI, and significant differences in OHIP-14S scores between all 3 SDAxI categories. The trait disposition of dental anxiety may be a significant risk indicator of poor dental and periodontal status and is associated with a worse OHQoL.
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To compare perinatal and maternal outcomes between elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Systematic review and meta-analysis. We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE) and PsycINFO (1980 to November, 2007). Inclusion criteria were systematic reviews and randomized controlled trials comparing elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Three or more reviewers independently read and evaluated all selected studies. Data were extracted and analyzed using Review Manager Software. Perinatal mortality. Thirteen trials fulfilled the inclusion criteria for the meta-analysis. Elective induction of labor was not associated with lower risk of perinatal mortality compared to expectant management (relative risks (RR): 0.33; 95% confidence intervals (CI): 0.10-1.09). Elective induction was associated with a significantly lower rate of meconium aspiration syndrome (RR: 0.43; 95% CI: 0.23-0.79). More women randomized to expectant management were delivered by cesarean section (RR: 0.87; 95% CI: 0.80-0.96). The meta-analysis illustrated a problem with rare outcomes such as perinatal mortality. No individual study with adequate sample size has been published, nor would a meta-analysis based on the current literature be sufficient. The optimal management of pregnancies at 41 weeks and beyond is thus unknown.
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A number of different sets of data concerning the Corah Dental Anxiety Scale were evaluated. The data indicate that the scale is a reliable, valid, and useful measure of dental anxiety. It can be successfully used in the dental office or in research projects.
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Swedish dentists' perceptions of patient behavior problems, levels of stress experienced by the dentists in relation to such behavior, and general problem areas in their occupational situation were investigated by means of a self-administered questionnaire mailed to a sample of 485 Swedish dentists. The questionnaire assessed 16 different patient behavior problems and an additional number of other occupationally related problem areas. A total of 342 replies (71.4%) were analyzed. The relationship between the occurrence of behavior problems and the resulting level of stress was inversely proportional. This implies that Swedish dentists feel confident in dealing with behavior problems in their patients. Furthermore, this study shows that most dentists (93%) feel positive about their work and believe that their work is highly appreciated by their patients (96%) and colleagues (84%).
Article
The aims of the study were to describe the level of dental anxiety in a representative sample of an adult population, to evaluate different demographic variables in relation to dental anxiety, and to compare two measurement scales of dental anxiety. A random sample of residents (n = 830) of the city of Gothenburg (population 432,000) was selected for a telephone survey. The survey comprised different questions concerning demographic variables, dental care habits, and the level of dental anxiety. The methods of measurement of dental anxiety were a 10-point dental Fear Scale (FS) and the Corah Dental Anxiety Scale (DAS). A total of 620 interviews were completed giving a response rate of 74.7%. 41.4% of the respondents were males, 58.6% females. Females were significantly more likely to report a high dental anxiety compared with males. The prevalence of high dental anxiety in the sample as measured by the FS and DAS was 6.7% and 5.4% respectively. The correlation between the FS and DAS was 0.81. The distribution of high dental anxiety and age showed a clearly and significantly higher portion of dental anxiety in the age group 20-39 yr compared to both younger and older groups. The effect of dental anxiety on regularity of dental visits revealed a significant difference as measured by the FS. No significant correlation was found between dental anxiety and educational level or income. A majority of the respondents (82-95%) expressed a desire for establishment of a special dental fear treatment clinic without need for referral.
Article
The levels of, and relationships between, dental fear and general fears and phobias were studied in 109 adult patients at a specialized dental fear clinic using two dental fear scales (the Dental Anxiety Scale and the Dental Fear Survey) together with the Fear Survey Schedule II (FSS-II) and some additional fear items. Referred and self-referred fearful dental patients answered mailed questionnaires in conjunction to being put on a 1 yr waiting list for treatment. Among feared objects and situations the separate item 'pain' revealed the highest mean scores for both men and women, followed by fear of suffocating, death of a loved one and sharp objects among women, and death of a loved one, suffocating and hypodermic needles among men. With few exceptions, women scored higher than men. The frequencies of extreme fears (6 and 7 on a 7-point scale) were high and 92.7% of the patients reported at least one extreme fear. Half of the subjects (49.5%) reported five fears or more. It was also shown that a number of FSS-II items correlated to dental fear indicating a relationship between general and dental fear. These results indicated that a large proportion of these dentally fearful individuals were prone to fear-associated reactions and behaviors, which has previously been shown to negatively influence the prognosis of treatment.
Article
In 1986, 1,019 residents of Seattle were surveyed about their dental fears, dental experiences, and perceived oral health status. High dental fear in Seattle was found to affect 204 per 1,000 people. More than 66% acquired their fear in early childhood. Females were 1.8 times more likely than males to report high fear (P less than .001). An individual was 1.6 times as likely to have high levels of dental fear if he or she had at least one oral problem such as bleeding gingiva (P = .004).
Article
Discussed is the impact of a videotaped dental fear-reduction program on moderately and highly fearful people who avoid dental treatment. Subjects were assigned randomly to one of two groups--the videotaped treatment group or the videotaped placebo group. The results indicate that the videotaped treatment program produced a decrease in self-reported fear in both moderately fearful and highly fearful subjects. However, the treatment program increased dental visitation and appointment-making behavior only for moderately fearful subjects.
Article
Follow-up clinical studies of treatment for dental fear and avoidance behavior are infrequent in the literature. The present investigation reports follow-up results over more than two years from 84 out of 99 patients treated for dental fear in a Swedish community-based dental fear clinic. Broad-based behavioral therapy (BT) or general anesthesia (GA), both in combination with adjusted conventional dental treatment, were used. The frequency of patients' attendance for regular dental care after two years was unchanged or even somewhat increased and was significantly higher in those who had received the BT therapy. Most patients stated that they had no problems after leaving the dental fear clinic. Among patients reporting such problems, the change of dentist was most frequently reported. The level of dental anxiety as measured by Corah's DAS was still at a low level, in spite of a slight increase over the two years since initial therapy.
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Dental fears and other fears were assessed in 67 patients with dental fear with the Corah Dental Anxiety Scale (CDAS), the Geer Fear Scale (GFS), and a behavioral dentist's rating scale (DR). Patients were selected because of extreme initial dental fear (n = 20), favorable response to treatment for dental fear (n = 23). CDAS change paralleled behavioral change (DR), supporting the usefulness of CDAS in assessing dental fear. GFS scores did not change in either group but were higher among patients who did not respond to treatment for dental fear; these findings are discussed in terms of treatment outcome prediction and treatment specificity.
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A questionnaire was used to identify fear stimuli and reactions associated with dentistry. The sight of the anesthetic needle and the sight, sound, and sensation of the d rill were rated the most fear-eliciting stimuli. Females rated themselves more fearful than males did and high school students reported being more fearful than college or junior high school students. Expectations of trauma from dentistry, much previous painful dental work, and perceived ill treatment by dentists were the major perceived sources of the reported fear reactions. Implications for prevention and treatment are discussed.
Article
Ninety-nine individuals, all of whom had long avoided dental treatment due to severe dental fear, received therapy according to one of two treatment modalities - behavioral therapy from a psychologist (BT) and treatment under general anesthesia (GA) - both of which were followed by clinical training and dental test treatments. These treatment programs were followed by referring the individuals to community dental clinics for complete oral rehabilitation. Among BT patients, significantly more (92%) completed the treatment program, compared with the GA patients (69%). Complete oral rehabilitation in community dental clinics was achieved by 78 and 53%, respectively. BT patients also had a significantly lower frequency of cancellations. The reduction in dental anxiety according to the Corah Dental Anxiety Scale was substantial in both groups, but the anxiety was significantly more reduced for BT patients, who reached a level equivalent to that of average dental patients. Patients' self-reported tension and the dentists' ratings of patient behavior during treatment were also significantly more positive for the BT groups.