U Klages’s research while affiliated with Johannes Gutenberg University Mainz and other places

Der Erfolg kieferorthopädischer Behandlungen hängt wesentlich auch von der Mitarbeit der Patienten ab. Die klinische Erfahrung, dass die Kooperation durch gezielte Einwirkungen grundsätzlich verbessert werden kann, konnte in einschlägigen Untersuchungen bestätigt werden. Darauf aufbauend wurden systematische Überlegungen angestellt, welche Möglichkeiten Erfolg versprechend erscheinen, die Compliance der Patienten zu verbessern.

Background Dental malocclusion is a highly prevalent health condition in adolescence. Patients seek treatment primarily for aesthetic reasons. Therapy benefits are regarded, in the first place, to be psychosocial in nature. Therefore, it is mandatory to consider the perspective of the patient in treatment planning and control using a dental-aesthetics-related quality of life measure. The objective of this study was to investigate whether the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) developed in adult samples including the subscales Dental Self-Confidence, Social Impact, Psychological Impact and Aesthetic Concern is also applicable in adolescents aged 11 years and above. The psychometric properties were examined across three age-groups (11–12, 13–14, 15–17 year olds) with respect to factorial invariance, internal consistency, temporal stability, discriminant validity and gender- or age-associated scale mean differences and item response bias. Method Participants were 1,112 adolescents recruited from 4 institutions: orthodontic and dental practices, schools, and youth clubs. They answered the 23 partially reformulated items of the PIDAQ. Subjective and dentist evaluations of dental occlusion were assessed using the Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need. Both indices were aggregated to one Malocclusion Index (MI-S and MI-D). Results The fit indices using confirmatory factor analyses suggested that the factor structure and factor loadings underlying the PIDAQ items were invariant across ages (comparative fit index = 0.91, root-mean-square error of approximation = 0.04). Internal consistency and temporal stability were adequate within the age-groupings (Alpha = 0.71–0.88; intra-class correlations = 0.82–0.96). Adolescents with severe compared to slight malocclusion according to both self-evaluation and dentist evaluation were found to differ in all PIDAQ subscales at a level of p

The aim of this study was to develop a measure of childhood information learning experiences related to dental anxiety according to Rachmnan's theory of fear acquisition entitled "Dental Information Learning History Questionnaire (DILHQ)" and to determine its test quality with regard to factorial validity, reliability, divergent, discriminant, and predictive validity. Sample 1 included 228 dental patients, answering a 17-item-pool of the DILHQ, the Dental Anxiety Scale (DAS: Corah, 1969), and the Self-Consciousness Scale by Fenigstein et al. (1975). A second sample of 197 patients filled in the final 12-item test version, the DAS and the state version of the State-Trait Anxiety Inventory (Spielberger et al., 1970). Ninety-five participants constituting the third sample answered the DILHQ twice with a 14-days interval. An exploratory study using the first sample resulted in two dimensions underlying the DILHQ-answers after removal of the unique loading items. The two-factorial structure was confirmed in the second sample. The factor-analytically derived Danger Information and Acceptance Information subscales showed sufficient internal consistency (Alpha = 0.87 and 0.72) and temporal stability (r(tt) = 0.77 and 0.76). Dentally fearful patients remembered being exposed to more danger information and less acceptance information about dentistry during childhood than low-fearful patients did (p < 0.001 each). Danger information and acceptance information predicted anxious response to the following dental procedure in opposite directions (r = 0.29 and r = -0.29). The results suggest that the DILHQ fulfils criteria of good construct validity. Exposure to threatening information about dentistry during childhood may increase the risk for dental fear acquisition and for exaggerated anxious response to treatment, while acceptance information might have a protective effect.

The aim of this study was to develop an instrument measuring core concerns about dental treatment guided by Reiss' expectancy theory of fear. This would include the content domains of injury, somatic reaction and interpersonal concerns, to study the underlying factorial structure, and to determine the test quality of the resulting subscales. A total of 555 regular dental patients answered the item pool. Subsamples filled in the Dental Anxiety Scale (DAS) (n = 346) and the Anxiety-Present Scale of the state-form of the State-Trait Anxiety Inventory (STAI-S) (n = 187). A second sample (n = 89) was used to determine test-retest reliability and bias for social desirability [Self Disclosure Scale of the Freiburg Personality Inventory (FPI)]. Exploratory and confirmatory factor analyses identified a stable three-dimensional structure underlying the items convergent to the content domains of interpersonal, injury and somatic reaction concerns. Internal consistencies of the resulting subscales were between alpha = 0.84 and alpha = 0.87, test-retest reliabilities were from r(tt) = 0.72-0.78. No evidence for a social desirability response bias was found. All subscales discriminated between patients with low and high dental trait anxiety at a level of P < 0.00001. Dental treatment concerns predicted 36% of variations in actual anxiety during treatment. The results suggest that the proposed instrument, namely the Dental Treatment Concerns Inventory, shows good test qualities according to construct, discriminant and predictive validity, and may be a promising tool for research and clinical applications.

To investigate whether the oral health of young male adults was related to (1) the degree of self-perceived malocclusion, (2) the degree of experienced negative psychosocial impact of dental esthetics, and (3) the history of orthodontic treatment and its duration. The study subjects were 470 male naval recruits undergoing a routine dental health checkup. They answered the Perception of Occlusion Scale (POS) and Negative Impact of Dental Aesthetics Scale (NIDAS). The Approximal Plaque Index (API), the Sulcus Bleeding Index (SBI), and the number of decayed teeth (DT) and missing teeth (MT) were examined by a staff dentist. Statistical procedures were one-way analyses of variance in the API and SBI and nonparametric Kruskal-Wallis, Mann-Whitney, and chi(2) tests in DT and MT as dependent variables. (1) The subjects ranging within the upper POS quartile scored higher on the SBI (contrast: P = .003) and DT (P = .002) than did those in the lower POS quartiles. (2) In contrast to the subjects reporting minor negative impacts in the NIDAS, those with strong impacts had higher scores on the API and MT (each P < .001). (3) In the subjects with a history of orthodontic treatment lasting 30 months and longer, lower API (P < .05), SBI and DT (each P = .002), and MT (P = .007) scores were found than in the subjects without previous orthodontic treatment. The results suggest that self-perceived dental irregularity and negative impact of dental esthetics might affect oral health, whereas previous extensive orthodontic treatment may have favorable effects by improving dental health compliance.

This article reviews, from the socio-psychological perspective on physical attractiveness, recent research on the psychosocial impacts of dental aesthetics. Research on personal impression forming suggests that visual perceptions of detrimental dental conditions might lead to conclusions about social impairments of the target person. Consumers conform considerably with professional assessment of dental aesthetics. Psychosocial impacts of dental appearance in childhood include teasing by peers. Existing research suggests that dental aesthetics contributes to psychosocial well-being of both children and adults. The concept of public self-consciousness is introduced for explaining differences in subjective psychosocial impacts of malocclusion. A promising research direction is the investigation of the relationship between dental aesthetics and oral health behavior, and further development and application of dental aesthetics-related quality-of-life measures is warranted. In addition a description of the behavioral signs of overconcern with dental aesthetics is given to facilitate its recognition and professional psychological attention.

The personality disposition to anxiety sensitivity refers to beliefs about negative consequences of bodily arousal. The concept has recently been successfully applied in research on chronic pain conditions. The present study investigated whether anxiety sensitivity interacts with dental fear to increase expected and experienced pain during routine dental treatment. Subjects were 97 patients undergoing dental procedures of excavation and filling. Anxiety dispositions were measured by the Anxiety Sensitivity Index and the Dental Anxiety Scale. Expected and experienced pain were assessed by affective and sensory verbal descriptor scales and a numerical rating scale measuring pain intensity. Dentally fearful patients scoring high in anxiety sensitivity both expected and experienced more pain than low scorers did. Significant interactions were found predicting expected affective and intense pain and experienced pain intensity. The results lend support to the assumption that dentally fearful patients with a disposition to high anxiety sensitivity amplify pain anticipations when exposed to the critical situation. When dentally fearful patients are under treatment, their beliefs about negative consequences of bodily arousal may negatively influence their evaluation of treatment related pain.

The aim of this study was to develop a psychometric instrument for assessment of orthodontic-specific aspects of quality of life. The study subjects, 194 young adults aged 18–30 years, were interviewed using a pool of 23 items dealing with the psychosocial impact of dental aesthetics. Self- and interviewer-rating of the dental aesthetic appearance of each subject were carried out using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Additionally, the Perception of Occlusion Scale and a modification of the Dental Aesthetic Index (DAI) were applied. Factorial analyses identified four measures within the item pool, namely Dental Self-Confidence, Social Impact, Psychological Impact, and Aesthetic Concern. The factor structure was confirmed in an independent sample of 83 subjects aged 18–33 years. The reliabilities of the factor analysis-derived scales were between alpha (a) 0.85 and 0.91. They differed between respondents with varying severity of malocclusion, as assessed by subject and interviewer ratings. The results suggest that the proposed instrument, termed the ‘Psychosocial Impact of Dental Aesthetics Questionnaire’ (PIDAQ), meets the criteria of factorial stability across samples and criterion-related validity and reliability, and might be a promising tool for further research and clinical application in orthodontics.

The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health. The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents. Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment. These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Previous research on relations between life stress and periodontal conditions was often based on indicators of periodontal destruction history and stimulus-specific measures of life stress. The present study was undertaken to compare patients showing different degrees of gingival sulcus bleeding with patients without signs of bleeding, using an instrument measuring cognitive impacts of events and assessing reported symptoms of depression and somatization. Additionally the patient groups were compared with regard to dental status and dental visiting behaviour. Analog comparisons were conducted in patients with different degrees of approximal plaque. 140 routine dental care patients attending a private dental practice were examined. Measurement devices were the sulcus bleeding index (SBI), the approximal plaque index (API), the Dental Avoidance Scale, the Life Experience Survey (LES), the Impact of Event Scale with the subtests cognitive intrusion and cognitive avoidance, and the SCL-90-R subscales somatization and depression. Patients with high API scores differed from their zero-score counterparts in dental avoidance and time since last visit only. By contrast, subjects scoring high in the SBI not only had more missing teeth and reported more dental avoidance than their zero-score counterparts but also had elevated scores in intrusive and avoidant thoughts related to a stressful event as well as in symptoms of somatization and depression. No difference was found for the measure of stimulus specific recent life events (LES). The results suggest that cognitive preoccupation with adverse events and the presence of somatization and depression symptoms might play a role in gingival inflammation.