Psychological Interventions for Poor Oral Health: A Systematic Review.

The aim of this systematic review and meta-analysis was to study the effectiveness of psychological interventions in adults and adolescents with poor oral health. The review follows the PRISMA guidelines for systematic reviews. The PICO format (population, intervention, comparison, and outcome) was used to define eligible studies. The populations were adults or adolescents (≥13 y of age and independent of others) with poor oral health (defined as dental caries, periodontal disease, and/or peri-implantitis). The interventions were psychological and/or behavioral models and theories, in comparison with traditional oral health education/information. The primary outcomes were dental caries, periodontitis, gingivitis, and peri-implantitis. Secondary outcomes were dental plaque, oral health-related behavior, health-related quality of life, health beliefs and attitudes, self-perceived oral health, and complications/risks. The systematic literature search identified 846 articles in December 2013 and 378 articles in July 2015. In total, 11 articles on 9 randomized controlled trials were found to meet the inclusion criteria. These reported on adults with periodontal disease, and several used motivational interviewing (MI) as their mode of intervention. The CONSORT guidelines and the GRADE approach were used for study appraisal and rating of evidence. The meta-analysis showed no statistically significant differences in gingivitis or plaque presence. In addition, a meta-analysis on MI compared with education/information found no statistically significant differences in gingivitis presence. Only 1 meta-analysis-on psychological interventions versus education/information regarding the plaque index-showed a small but statistically significant difference. There were also statistically significant differences reported in favor of psychological interventions in oral health behavior and self-efficacy in toothbrushing. However, the clinical relevance of these differences is difficult to estimate. The certainty of evidence was low. Future research needs to address several methodological issues and not only study adults with periodontal disease but also adolescents and patients with dental caries and peri-implantitis.

Patient characteristics in relation to dental care payment model: capitation vs fee for service.

OBJECTIVE: To analyse patient profiles in two payment models, the capitation (DCH) and the fee-for-service (FFS) systems, in relation to socioeconomic status, self-reported health and health behavior, as well as patient attitudes to and satisfaction with the DCH model in the Public Dental Service (PDS) in Sweden. RESEARCH DESIGN AND PARTICIPANTS: The present survey included a random national sample of the adult population in Sweden. A telemarketing company, TNS SIFO, was responsible for the sample selection and telephone interviews conducted in May 2013. The 3,500 adults (aged =19 years) included in the sample gave a participation rate of 49.7%. RESULTS: Individuals choosing DCH were younger. FFS patients rated their health as less good, were less physically active, were more often smokers and had a lower household income. The DCH patients were more satisfied with their payment model than the FFS patients (98% vs 85%). A multivariate analysis showed that three of the variables significantly contributed to the model predicting DCH patients: age, with an odds ratio of 0.95, household income (OR=1.85) and importance of oral health for well-being (OR=2.05). CONCLUSIONS: There was a pattern of dimensions indicating the choice of payment model among adult patients in the Swedish Public Dental Service. The patients in DCH had higher socioeconomic position, were younger, rated their oral health as better and were more satisfied with the payment model (DCH) than the patients in the FFS system.

Dental anxiety and symptoms of general anxiety and depression in 15-year-olds.

OBJECTIVES: The objective of the study was to analyse the relationship between dental anxiety and symptoms of general anxiety and depression among 15-year-old individuals. METHODS: The sample analysed included 221 randomly selected 15-year-old individuals living in the city of Jönköping, Sweden. One questionnaire captured sociodemography and dental history, while dental anxiety was assessed by the Dental Fear Survey (DFS) and symptoms of general anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). RESULTS: About 6% of the adolescents were classified as dentally anxious. Symptoms of general anxiety and depression were significantly correlated with dental anxiety in both the bivariate and multivariate analyses. The latter analyses were adjusted for gender and previous painful experiences of dental care. Individuals with high dental anxiety showed general anxiety scores on a clinical level (mean=9.8, SD=4.3). CONCLUSIONS: Symptoms of general anxiety and depression were shown to be significantly correlated with dental anxiety among 15-year-old individuals.

Oral health, sense of coherence and dental anxiety among middle-aged women.

AIMS: The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES). MATERIALS AND METHODS: Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC. RESULTS: The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account. CONCLUSIONS: Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.