Correlates of success and failure in behavior therapy for dental fear.

Extreme dental fear and avoidance are universal problems, with severe adverse effects on the patient's oral health. Although behavior modification techniques were shown to be effective in the treatment of this problem, their success is by no means absolute. In the present article, the SCL-90 questionnaire was used for development of possible predictive measures for success and failure of behavior modification as a treatment for dental fear. Patients who failed in treatment through behavior modification were found to score significantly higher on the global score of Positive Symptom Distress Index (p < 0.01) and on individual subscales of somatization (p < 0.02) and psychoticism (p < 0.05) than patients who were treated successfully. The predictive value of chosen SCL-90 scales was 71%. The results suggest that use of SCL-90 may be valuable for the prediction of success and failure of behavior modification as a treatment for dental fear and avoidance.

Antecedents of burning mouth syndrome (glossodynia)--recent life events vs. psychopathologic aspects.

Burning mouth syndrome--BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)--primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

Self-estimation of oral malodor.

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental-measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Antecedents of dental anxiety: learned responses versus personality traits.

The origins of dental fear and anxiety are numerous and complex. The purpose of the present study was to evaluate the relative effects of learned responses and subjective personality traits on the development of dental anxiety. The study was carried out in kibbutzim (closed homogeneous societies) in Israel where all subjects had received dental treatment from the same dentist since childhood with no choice of dentist. Subjects were requested to fill out questionnaires concerning their dental anxiety (DAS) in the past and at present, an evaluation of their dentist in the past and at present, and a psychopathologic symptom survey (SCL-90). The results show that dental anxiety at present correlates significantly with the evaluation of the present dentist; with dental anxiety as remembered from childhood; and with the following SCL-90 scales: interpersonal sensitivity, anxiety, phobic anxiety and Positive Symptom Distress Index. The best predictors of dental anxiety at present were the evaluation of the present dentist and past dental anxiety (as remembered from childhood). The results suggest that the level of the subject's dental anxiety is affected by environmental factors (evaluation of the present dentist, memories of anxiety from childhood), and by personality traits as evaluated by the SCL-90 questionnaire.

Self-perception of breath odor.

BACKGROUND: Bad breath, also known as halitosis, is a common concern for millions of people. Yet there is almost no reliable way for people to properly assess their breath odor. While many develop faulty perceptions about having bad breath that affect their entire lives, others who have halitosis are unaware of their condition. OVERVIEW: The authors discuss the issues affecting self-perception of breath odor in patients who complain of halitosis, as well as in a more general, "noncomplaining" population. The article presents self-perception of breath odor as a multifactorial, psychophysiological issue that is related closely to one's body image and psychopathological profile. CONCLUSIONS: Based on their data, the authors suggest that every patient has a breath odor self-image. This self-image ranges from little or no distortion to severe psychopathology. Because treating patients with a specific complaint of oral malodor primarily is the responsibility of the dental practitioner, several treatment approaches are outlined: collecting odor samples from the mouth to increase objectivity, involving a confidant in diagnosis and follow-up, corroborating odor judges' scores with objective measurements, increasing the patient's sense of control over the problem and obtaining guidance from mental health professionals, when necessary. CLINICAL IMPLICATIONS: Dentists increasingly are being called on to help patients with complaints of bad breath. In diagnosing and treating such cases, dentists should consider psychological and physiological factors.

Modulation of dental anxiety--the role of past experiences, psychopathologic traits and individual attachment patterns.

OBJECTIVE: To evaluate factors affecting modulation of dental anxiety among adults. METHODS: A total of 183 adult members of a closed communal society (Kibbutz), who have been treated since childhood only by the dentists employed in their community, were investigated concerning their past and present dental anxiety, evaluation of their past and present dentists, psychopathologic symptoms and individual pattern of attachment. RESULTS: The best predictor of subjects' evaluation of their present dental anxiety was the scale of anxiety as recorded by the SCL-90R questionnaire. The best predictors of the decrease in subjects' dental anxiety over time were the evaluation of their past and present dentists and the secure and avoidant patterns of attachment. Patterns of attachment (avoidant and ambivalent) were the best predictors of subjects' evaluation of their present dentist. CONCLUSIONS: While psychopathologic traits are involved in subjects' present dental anxiety, pattern of attachment may have a dominant affect as to whether anxiety persists throughout life or can be modulated through a corrective emotional experience.

Self-perception of breath odor: role of body image and psychopathologic traits.

Oral malodor is a common complaint in Western society and is an important reason why adults seek dental counsel. In the present study, an attempt was made to evaluate the contribution of psychopathologic traits and of body-image char acteristics on participants' self-perception of breath odor. 60 participants without any specific complaint concerning breath odor (55% men: M age 35.5 yr., SD= 10) were evaluated. Variables included self-evaluation of participants' own breath odor (gener ally and current), an organoleptic evaluation of an impartial judge of odor, measurement of the volatile sulfide level in the oral cavity, and questionnaires referring to psychopathologic symptoms and body-image characteristics. Stepwise regression analysis showed that in addition to impartial measurements, self-perception of breath odor among noncomplaining subjects can be predicted by their feelings and attitudes toward the body and by their hostility.

Monitoring and assessment of dietary exposure to chemical contaminants.

The results of the Global Environment Monitoring System/Food Contamination Monitoring and Assessment Programme (GEMS/Food) and other monitoring programmes for priority contaminants in the diet, including lead, cadmium, mercury, polychlorinated biphenyls, organochlorine and organophosphorus pesticide residues and aflatoxin, are presented. These results are assessed with respect to established acceptable or tolerable intakes for these contaminants. While the assessments generally confirm the effectiveness of government efforts to prevent or reduce food contamination in industrialized countries, better exposure estimates for infants and children and other vulnerable groups should be calculated. In developing countries, little reliable information is available on the occurrence of food contamination. Without such information, the health of hundreds of millions of people may be threatened. For these countries, and especially those that employ older agricultural and industrial technologies, basic food contamination monitoring and assessment programmes should be established for at least those contaminants of priority concern. These programmes form an essential basis for developing effective intervention strategies and for efficient management of health and environment resources. In all countries, accidental and sporadic contamination is an ever present danger and continual vigilance is necessary to protect public health. All countries should identify institutions with the analytical capability to support epidemiological investigations of outbreaks of disease that may be associated with consumption of chemically contaminated food. All countries should participate in GEMS/Food to promote health-oriented, population-based monitoring at the national level.

Prediction of success and failure of behavior modification as treatment for dental anxiety.

Behavior modification techniques are effective in the treatment of extreme dental anxiety, but their success is by no means absolute. In the present article, the Corah Dental Anxiety Scale (DAS), the self-report symptom inventory SCL-90R and a questionnaire accessing subjects' daydreaming styles (the Short Imaginal Process Inventory) were used to develop possible predictive measures for success and failure of behavior modification as a treatment for dental fear. The patients' level of distractibility and mind wandering, initial dental anxiety and somatization significantly predicted the success of therapy. The odds ratio indicated that the risk of therapy failure increased about 11 times with an increase of one scale of the Poor Attention Control Scale, about three times with an increase of one level of the mean DAS score, and 0.17 times with an increase of one level of somatization. The predictive value of the chosen scales was 80%. Thus, the use of these scales as part of an initial admittance process for patients who suffer from dental anxiety can enhance our ability to better recognize patients who are prone to fail behavior therapy as treatment for their problem, and enable their referral for other possible modes of treatment.

Effect of gender on acute pain prediction and memory in periodontal surgery.

Pain is a complex experience that is affected by factors such as gender, stress, anxiety and cognitions. The purpose of this study was to investigate the inter-relationship between gender and acute pain prediction and memory under periodontal surgery treatment. The study was conducted on 15 male and 22 female dental patients (mean age 34 yr, mean education level 14.7 yr), who were scheduled for periodontal surgery. Patients were evaluated during four consecutive appointments: at initial check-up, immediately pre-operatively, 1 wk post-operatively, and at 4 wk post-operative follow-up. Patients were requested to complete questionnaires concerning their anxiety at each appointment and to indicate their subjective evaluations concerning pain (on a visual analogue scale). Evaluations concerning expectation to experience pain during the planned surgery (pain prediction) were made at the first two appointments and evaluations of the experienced pain as remembered from the surgery (pain memory) were made at the last two appointments. Gender had a significant effect on pain prediction and pain memory. Men expected to experience more pain pre-operatively than women but remembered less pain post-operatively. It was concluded that cognitive pain perception in clinical situations differs between genders.

Detection of psychopathologic trends in glossodynia patients.

Glossodynia affects primarily middle-aged women. Although many possible etiologies have been proposed for the syndrome, most have not been substantiated. In the present study 56 glossodynia patients were evaluated for their psychopathologic profile as reflected by the SCL-90 questionnaire. The data show that glossodynia patients present a relatively high psychopathologic profile, especially on the scales of somatization and depression. Significant correlations were found between the intensity of pain experienced by the patients and some of the SCL-90 scales (somatization, depression, anxiety, GSI and PSDI). No correlations were found between SCL-90 scores and duration of symptoms, prevalence of symptoms per day and patient's condition during the past year. Patients living alone were found to differ significantly from those living with a significant other (overall group effect significant at the 0.01 level). The data suggest that psychopathologic trends may be associated with glossodynia.

The complaint of oral malodor: possible psychopathological aspects.

Oral malodor (halitosis) is a common concern in Western society. As with other human perceptions, emotional as well as cognitive variables play a major role in one's sensation and complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-90 questionnaire. The patient's self-rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-90 profile of subjects was relatively higher than that of an age- and gender-matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-90 questionnaire.