The effect of virtual reality glasses on dental anxiety during scaling and root planing in patients with periodontitis: A randomized controlled clinical trial.

OBJECTIVES: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. MATERIALS AND METHODS: This randomized controlled split-mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. RESULTS: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = -0.48, p = 0.01). CONCLUSIONS: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses.

Patient-related evaluation after systematic periodontal therapy - a clinical study on periodontal health-related quality of life (PHQoL).

PURPOSE: To evaluate how periodontitis patients perceive the outcome after long-term supportive therapy. MATERIALS AND METHODS: 281 patients (150 women/131 men) with a mean age of 55 years (range: 45-86 years) were randomly selected and consecutively interviewed using a questionnaire designed for laypersons. All patients had shown high compliance with the recommended supportive periodontal therapy (SPT) for up to 16 years (mean observation period: 12.5 years). Statistical evaluation was performed using the 2-sided t-test. RESULTS: A very high degree of confidence in the periodontal treatment (mean: 9.24, range 0-10) was found. Women noticed a higher positive impact on their social environment (P < 0.05). Patients who underwent SPT < 3 years showed a higher positive perception of treatment success than patients with SPT > 3 years (P < 0.01) and reported a greater impact on appearance (P < 0.01). Regenerative treatment demonstrated advantages over resective open flap debridement (OFD) procedures (P < 0.05) and scaling and root planing (SRP) (P < 0.05). However, treatment costs (P < 0.001) and time required (P < 0.01) for regenerative procedures were perceived as a burden. Periodontal treatment by a specialised team led to a significant reduction in the patients' complaints (P < 0.01). The SPT interval did not influence patients' perception of treatment success. CONCLUSIONS: Systematic periodontal therapy with subsequent SPT met the patients' demand to preserve oral health. Regenerative procedures prompt the perception in patients of better remission of periodontitis symptoms. Further trials should investigate clinical results of periodontal therapy regarding patient expectations.

Dental fear and its possible relationship with periodontal status in Chinese adults: a preliminary study.

BACKGROUND: The aim of the present study was to describe the characteristics of dental fear of Chinese adult patients with periodontal disease and provide information for clinical assessment. METHODS: A total of 1203 dental patients completed questionnaires that included Corach's Dental Anxiety Scales (DAS), Dental Fear Survey (DFS) and the short-form Dental Anxiety Inventory (S-DAI). Among all the patients, 366 cases were self-reported periodontal disease. The general characteristics were described, such as socio-demographics, dental attendances and oral health behaviors. The statistical analysis was performed by t-test, Mann-Whitney U test and linear regression respectively to evaluate correlations between dental fear and general characteristics according to the three scales. RESULTS: The prevalence of dental fear was 74% among 1203 patients, 23.4% of total with high dental fear, while 27.3% in the patients with periodontal disease. The average score of DAS and DFS for patients with periodontal disease was significantly higher than those without periodontal disease. The regression analysis indicated that gender, age, periodontal status, dental attendances and oral health behaviors were correlated with dental fear. Among 366 patients with periodontal disease, gender, dental attendances and oral health behaviors had correlation with dental fear. The analysis of DFS scale exhibited that 'drilling with handpiece' and 'injecting the anesthetic' were the most important factors to contribute to dental fear. CONCLUSIONS: There was high prevalence of dental fear in Chinese adult patients, particularly in patients with periodontal disease, and high level of dental fear may lead to poor periodontal status.

Salivary Cortisol Levels and its Implication on Behavior In Children with Autism during Dental Treatment.

UNLABELLED: The aim of the study was to estimate the diurnal variations of salivary cortisol in children with autism and healthy children and it's implication on behavior during non-invasive dental procedures. STUDY DESIGN: 50 children with autism and 50 healthy children in the age group between 6 to 12 years of both genders with the need for dental treatment were included in the study. Whole unstimulated saliva was collected from them during early hours of the day and during evenings for 2 consecutive days . The collected saliva was then subjected to electrochemiluminescence assay . Minimum invasive dental procedures like hand scaling, pit and fissure sealants and glass ionomer cement restorations were performed for the participants each time after the saliva sample collection and their behavior during the procedures was rated using Frankl's Behavior Rating Scale. RESULTS: Significant correlation was seen between cortisol levels and behavior in children with autism. As cortisol levels increased in children with autism, behavior worsened and as the cortisol levels decreased they showed positive behaviour. CONCLUSION: Cortisol acts as a stress marker and studying the diurnal variations of salivary cortisol can help us in attaining better knowledge about the behavior pattern and thereby assist us in modifying the behavior modification procedures and treatment planning in this group of special children.

The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment.

OBJECTIVE: The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlinscy motivation scale adjusted to the needs of periodontology. BASIC RESEARCH DESIGN: Cross sectional study. CLINICAL SETTING: Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. PARTICIPANTS: 199 adult periodontal patients, aged 20-78. INTERVENTIONS: 14-item questionnaire. The items were adopted from the original Zychlinscy motivation assessment scale. MAIN OUTCOME MEASURES: Validity and reliability of the proposed motivation assessment instrument. RESULTS: The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment. CONCLUSION: The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India.

PURPOSE: To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district. MATERIALS AND METHODS: A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels. RESULTS: The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84). CONCLUSION: The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.

Knowledge of periodontitis and self-perceived oral health: a survey of periodontal specialist patients.

The aim of this study was to investigate changes in knowledge of periodontal disease among patients referred to periodontal specialist clinics. A further aim was to investigate the patients' self- perceived oral health before the treatment. Patients referred to five specialist clinics in periodontology for comprehensive periodontal treatment were consecutive sampled. The study was based on a questionnaire in a before and after design. The first questionnaire was sent to the patients before visiting the specialist clinic and the second was sent after six months. Four questions were analysed, two to measure knowledge about periodontitis and two to measure the patients self- perceived oral health. The first questionnaire was sent by post to 273 patients with a response rate of 31%. The second questionnaire was sent to 85 patients with a response rate of 73%. The results of the study showed a statistically significant improvement of correct answers on the knowledge questions after six months was found for scaling (p = 0.006), X-ray examination (p = 0.001) and increased space between the teeth (p = 0.001). The most frequent self-perceived trouble from the mouth was bleeding gum (70%) and sensitive teeth (51%). In conclusion knowledge of periodontitis improved after visiting the specialist clinic of periodontology. Many of the patients experienced some problems of the mouth.

Effect of sensory adaptation on anxiety of children with developmental disabilities: a new approach.

PURPOSE: The aim of this study was to evaluate the effect of a sensory-adapted dental environment (SADE) on anxiety, relaxation, and cooperation of children with developmental disabilities (CDDs). Pharmacological treatment has been widely used to reduce anxiety, but nonpharmacological methods may be similarly effective. The standardized clinical situation chosen was a dental hygiene cleaning. METHODS: A SADE was structured. Sixteen CDDs participated in an open cross-over intervention trial measuring behavioral and psychophysiological variables. RESULTS: There was a substantial increase in relaxation and cooperation in the SADE as opposed to the regular dental environment (RDE). This was reflected by: mean duration of anxious behaviors (SADE = 9.04 minutes vs. RDE = 23.44 minutes; P < .01); mean magnitude of anxious behaviors (SADE = 8.49 vs. RDE = 15.50; P < .01); cooperation levels (SADE = 331 vs. RDE = 1.94; P < .01); mean electrodermal activity (EDA; SADE = 1230 vs. RDE = 446; P < .001); and difference in degree of relaxation by EDA (SADE=2014 vs. RDE=763; P < .004). CONCLUSIONS: The findings indicate the potential importance of considering the sensory-adapted environment as a preferable dental environment for this population.

Full-mouth versus quadrant-wise scaling--clinical outcome, efficiency and treatment discomfort.

The aim of this randomized clinical study was to compare full-mouth scaling and root planing (FM-SRP) in two sessions within 24 hours with quadrant-wise scaling and root planing (Q-SRP) in four sessions within 4-6 weeks and evaluate (I) clinical outcome, (II) treatment efficiency, and (III) treatment discomfort of patients and therapists. Twenty individuals, aged 28-65 years, with severe chronic periodontitis were randomly assigned to treatment with FM-SRP or Q-SRP. At baseline and after 6 months, there were no between-group differences in clinical findings, treatment discomfort, or post-treatment body temperature. The therapists, however, felt that FM-SRP was more physically and psychologically demanding than Q-SRP. Mean effective scaling and root planing (SRP) time was 165.5 min during the two FM-SRP sessions and 202.1 min during the four Q-SRP sessions. FM-SRP's initial time savings of 36.6 min compared with Q-SRP diminished to 30.8 min at the 6-month follow-up due to rescaling needs. Total mean treatment time (comprising SRP and patient reinformation and reinstruction in oral hygiene) during the first 6 months post-treatment was 321.2 min for FM-SRP and 353.0 min for Q-SRP. Thus, mean savings in total treatment time with FM-SRP was 31.8 min compared with Q-SRP. In conclusion, this study found that both treatment modalities may be recommended for chronic periodontitis patients. Although time saving is possible with FM-SRP,the modality may compromise the therapist's well-being if practiced frequently due to the risk of musculoskeletal problems.

Effects of two different methods of non-surgical periodontal therapy on patient perception of pain and quality of life: a randomized controlled clinical trial.

BACKGROUND: The purpose of this study was to investigate the effect of two modes of delivery of non-surgical periodontal therapy on patient experience of pain and oral health-related quality of life (OHQoL). METHODS: Fifty-nine patients with mild to moderate periodontitis received non-surgical therapy using a piezo-ceramic device (n = 30) or curets (n = 29). Periodontal examinations were carried out at baseline and 8 weeks following therapy. Subjects completed the short-form McGill pain questionnaire, visual analog scales regarding sensitivity and satisfaction, and the United Kingdom OHQoL questionnaire (OHQoL-UK) at baseline, treatment, and 1, 4, and 8 weeks. RESULTS: Both groups showed improvements in clinical parameters with no significant differences between the groups. Pain scores and OHQoL-UK showed no significant differences between the groups. After treatment, OHQoL-UK scores improved from an initially negative effect on quality of life to a level of no effect. Differences in sensitivity scores between the groups were statistically significant at 1 week (P = 0.011), 4 weeks (P = 0.005), and 8 weeks (P = 0.025), favoring the use of the piezo-ceramic device. CONCLUSIONS: In mild to moderate periodontitis, therapy had a small positive impact on pain and OHQoL-UK scores. These data support the concept that periodontitis may negatively affect a patient's quality of life and that treatment may improve it.

A survey on misunderstanding of dental scaling in Hong Kong.

UNLABELLED: There is no information on the misunderstanding of dental scaling; on whether the misunderstanding affects the general public to go for scaling or not; on complaints about dental scaling and suggestion of who should educate the public in the existing literature. This study gives the information from the general public in Hong Kong. METHODS: A cross-sectional survey by telephone interview on a random sample of 1412 subjects aged 13 years and above in Hong Kong was conducted from 3rd January to 15th February 2006. RESULTS: More females had received scaling (adjusted OR = 1.73, 95%CI 1.31-2.29 P < 0.001), 51-60 years age group had the highest scaling experience (adjusted OR = 2.69, 95% CI 1.55-4.68, P < 0.001). Higher education was related to scaling experience (P < 0.001). Of the subjects with complete data, 22.5% (307/1364) had never received dental scaling, 17.9% (55/307) did not understand the purpose, 12.1% (37/307) replied that it would make the teeth thinner, 11.4% (35/307) replied that the gum space would become wider, and 11.4% (35/307) stated that scaling would damage the gum. In all, 45.9% (298/649) of the subject reported bleeding, 33.7% (139/413) sensitivity, 40.5% (62/153) smaller teeth and 23.9% (84/351) widened gum space because of mistakes made during the procedure; 8.6% (56/649) of those who experienced bleeding, 17.8% (27/152) of those who reported the teeth became smaller and 12% (42/350) of those who stated that the gum space became wider intended to reduce the frequency, delay or not go for scaling. A total of 79.6% (841/1057) experienced one of the perceived problems; 27.8% (234/841) had complained about scaling. CONCLUSION: This study shows a common lack of knowledge of dental scaling in the Hong Kong population. Patients should be better informed about the aim before the procedure.

Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety.

This study aimed to determine the level of dental anxiety before different dental care procedures. A group of 116 adults presenting for the first time at a French dental hospital were included in the study. These patients completed a French-language version of Corah's Dental Anxiety Scale 1 and used a visual analogue scale to score their perception of the level of difficulty generated by 13 different dental treatments. The acts perceived as the most difficult to face were root canal and restorative treatment without local anaesthesia (LA), followed by oral surgery. There was a positive correlation between DAS score and level of difficulty experienced during dental treatment. Healthy subjects declared difficulty in coping with dental care. Dental procedures may be a factor of co morbidity in terms of the psychological status of dental patients. A classification of dental procedures is given according to the level of difficulty generated.

Interviewing self-reported highly anxious patients during periodontal treatment.

BACKGROUND: Little information exists on highly anxious patients referred for periodontal therapy. METHODS: All patients referred for periodontal therapy between November 1, 2002 and April 1, 2004 were included in this study. Patients who perceived themselves as extremely anxious were interviewed further, and their anxiety levels were observed during the various stages of periodontal therapy. RESULTS: Twenty-one (19 females and two males, average age, 49.76 years) of 176 patients (12.1%) reported extreme anticipatory anxiety. The main reasons for their anxiety were fear of pain and previous bad experience(s). CONCLUSIONS: Average anxiety levels decreased with the progress of the periodontal therapy. However, individual responses varied greatly and were unpredictable.

The Use of Immersive Visualization for the Control of Dental Anxiety During Oral Debridement.

PURPOSE: The purpose of this study was to evaluate the effects of Immersive Visualization (IV) eyewear on anxious, adult patients during oral debridement. METHODS: Thirty adult volunteers (n=23 females; n=7 males) were enrolled in the study. Participants were required to be 18 years or older, exhibit at least moderate anxiety (score 9 or higher) on the Corah's Dental Anxiety Scale-Revised (DAS-R), and be generally healthy. Individuals were excluded from participation if they presented with severe dental calculus, periodontal disease, or dental caries, were taking psychotropic drugs, had a history of convulsive disorders, vertigo, or equilibrium disorders, or required antibiotic pre-medication. Subjects received a full mouth oral prophylaxis (supra- and subgingival scaling and selective polishing) by a single experienced dental hygienist. A split mouth design was utilized whereby each subject served as their own control. Subjects were randomly divided into 2 groups: Group A used IV eyewear during the first one-half of the appointment (right side of the mouth) and Group B used IV eyewear during the second one-half of the appointment (left side of the mouth). At screening, medical and dental histories were obtained, full mouth oral examinations were performed, and DAS-R was scored to determine eligibility. At baseline, the DAS-R was re-scored to validate anxiety levels. The Calmness Scale was scored pre- and post-IV treatment on a Likert scale ranging from 1 (very calm) to 7 (less calm). At the end of the study, subjects completed a Post IV Opinion survey. Data were entered into Microsoft Excel for Mac 2011 (Microsoft Corporation Version 14.3.5) and analyzed using SAS® 9.3 statistical software. RESULTS: Thirty subjects with a mean age of 29.9 years completed the study. Data analysis indicated no statistically significant difference between Group A and B with regard to mean DAS-R anxiety levels at baseline (3.15 and 2.40, respectively), with a p-value of 0.07. Data showed a significant difference when comparing the calmness mean scores within Group A pre- and post-IV treatments (4.66 and 2.93, respectively), with a p-value 0.01. Within Group B the data revealed a statistically significant difference between pre- and post-IV treatments (p<0.01, 4.33 and 2.13, respectively). Both treatment groups experienced a decrease in anxiety levels from pre to post IV treatments. Moreover, combined mean calmness scores of the 30 subjects (Group A and B) expressed in mean standard deviation showed there was a decrease from 4.50±1.31 in pre-IV treatment to 2.53±1.17 in post-IV treatment. Further investigation of the data showed that there was a significant correlation between calmness and gender; females reported higher levels of anxiety than men before and after IV treatment. CONCLUSION: Results from this study support the use of IV eyewear as an effective technique to reduce anxiety in adults during oral debridement. The use of the IV eyewear was well received by all subjects. The portable, affordable and easy-to-operate IV system makes this technique an appealing approach of reducing dental anxiety.

Comparison of the effect of video glasses and nitrous oxide analgesia on the perceived intensity of pain and unpleasantness evoked by dental scaling.

The aim of this study was to evaluate whether distraction induced by video glasses had an effect on the perceived intensity of pain and unpleasantness during dental scaling compared with the effect of nitrous oxide (N(2)O) analgesia. The pain stimulus was dental scaling (removal of dental calculus) with an ultrasonic scaler. As a standardised, non-dental painful stimulus, Von Frey filaments were used. A total of 26 patients with superficial chronic periodontitis were enrolled in this randomised, controlled clinical study. The effect of video glasses was compared with N(2)O in one session and the effect of video glasses versus a control situation in another. The patients rated the intensity of pain and unpleasantness evoked by dental scaling and Von Frey filament stimulation on 100-mm visual analogue scales (VAS). For dental scaling, there was no effect of video glasses on the perceived pain (p=0.85) or unpleasantness (p=0.73) nor of N(2)O (p=0.69 and p=0.51, respectively) compared with the control situation. Similarly, no significant difference was found between VAS scores in the video glasses and N(2)O session (p=0.48, p=0.58). A significant effect of video glasses and N(2)O(p<0.008) was found on the perceived pain intensity produced by Von Frey filament stimulation compared with the control situation, but no significant difference was seen between these methods (p=0.07). Post-treatment interviews of the patients revealed that 81% of the patients in the video and 65% in the N(2)O session stated that the method had some beneficial effect on their overall experience of the treatment situation. In conclusion, administration of video glasses or N(2)O did not affect the perceived intensity of pain and unpleasantness evoked by dental scaling.

Evaluation of non-surgical periodontal treatment using 2 time intervals.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of non-surgical mechanical instrumentation at 2 different time intervals on short-term healing and to assess patient reactions following non-surgical periodontal therapy. METHODS: The study population consisted of 100 patients with moderate periodontal disease. Patients were equally distributed into 2 groups, treated daily or weekly. The daily group received full-mouth daily scaling and root planing for 4 consecutive days. The weekly group was treated once a week for 4 weeks. All patients were asked for objective (lymphadenopathy, aphthous stomatitis, and edema) and subjective (fatigue, pain, pruritus, burning sensation, and dentinalgia) reactions. Clinical measurements of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and gingival recession (GR) were taken at baseline and 3 months after treatment. All of the objective and subjective reactions were recorded after each treatment session. RESULTS: The results of our study revealed a significant decrease in PI, GI, BOP, and PD measurements at the end of the third month, but no significant changes in GR. The incidence of subjective and objective reactions was higher in the daily treated group compared to those in the weekly group. Most of these complaints were observed after the third treatment session. CONCLUSIONS: Within the limits of this study, no differences were observed between the study groups when the clinical parameters were evaluated. However, taking the subjective and objective reactions into consideration, the smallest time interval for non-surgical periodontal procedures might be 1 week.

Patient perceptions of periodontal therapy completed in a periodontal practice.

BACKGROUND: The perceptions that patients have of periodontal therapy have not been extensively studied and are not well understood. The purpose of this study was to assess the degree of discomfort associated with periodontal therapy carried out in a specialist practice. METHODS: A consecutive group of 150 patients (90 females, 60 males; mean age 54.5 years) who had completed periodontal therapy, which included surgery, in a periodontal practice in Norway was studied. The patients indicated the discomfort they had experienced with periodontal therapy on a visual analog scale (VAS). Other factors associated with postoperative discomfort such as the use of analgesics were recorded. RESULTS: The mean VAS scores were low for all procedures investigated. The highest mean score was recorded for anesthesia in the upper anterior region. There were small differences between the levels of discomfort reported by males compared to females. The VAS scores decreased with increasing age for anesthesia in the lower arch (P = 0.004) and surgery in the lower arch (P = 0.003). Virtually all (97%) of the patients perceived periodontal treatment to be associated with no more discomfort than conventional dental treatment. CONCLUSIONS: Very low reported levels of discomfort were associated with both non-surgical and surgical periodontal therapy by Norwegian patients treated in a specialist periodontal practice.

Catastrophizing, anxiety and pain during dental hygiene treatment.

OBJECTIVES: This study examined the relations between catastrophizing, dental anxiety, and pain during dental hygiene treatment. METHODS: Participants were 78 (32 men, 46 women) consecutive referrals to the Dalhousie University Dental Clinic. All patients were scheduled for a scaling procedure performed by senior dental hygiene students. Following treatment, patients completed the Pain Catastrophizing Scale and the Dental Anxiety Scale - Revised, and were asked to rate the degree of pain they experienced during the scaling procedure. RESULTS: Regression analyses revealed that age and the rumination subscale of the Pain Catastrophizing Scale were significant predictors of pain, even when controlling for gender, and oral hygiene status. CONCLUSIONS: The findings suggest that excessive focus on pain sensations may be one of the mechanisms by which catastrophizing leads to increased pain. The clinical challenges will be to develop cost- and time-effective means of identifying individuals who catastrophize and to implement interventions to reduce their level of distress.

Dental anxiety and attendance in the north-west of England.

The aim of this study was to record the level of anxiety and last recorded visit for a dental check-up of a random sample of 300 workers at three sites in the North-west of England. All subjects were asked to complete a short written questionnaire and 255 (85 per cent) usable forms were returned. The mean level of anxiety using the Corah Dental Anxiety Scale (DAS) (N.L. Corah, 1969, J. Dent. Res. 48, 596) was 9.1. Females had a statistically higher mean DAS than males but there was no correlation between DAS and either age or occupational status. Those subjects who claimed not to have had a check-up in the past year had a significantly higher mean DAS than those who claimed to have been in the past year. Multiple regression analysis showed that the reported time interval since the last check-up was the most important predictor of the DAS score. The implications of the results are considered for the future of restorative dentistry.

Effects of audiovisual distraction during dental prophylaxis.

BACKGROUND: Fear and anxiety often inhibit patients from seeking dental care. Audiovisual, or A/V, distraction techniques have been shown to reduce patient anxiety and pain during dental procedures. The authors investigated the effects of a virtual image A/V eyeglass system on patients' anxiety and pain. METHODS: Twenty-seven routine dental prophylaxis patients participated and completed the Dental Fear Survey and the Fear of Pain Questionnaire-III before treatment. In random order, the clinician scaled and polished two quadrants in subjects while they watched and listened to a standard video using the A/V eyeglasses and two quadrants while they did not. A posttreatment questionnaire was administered to both the patient and the clinician. RESULTS: Subjects reported less anxiety and discomfort when using the A/V eyeglass system than when they did not. Most subjects preferred to use the A/V equipment rather than receive traditional treatment. The clinician experienced no significant technical interference during the use of the A/V device. The use of the A/V eyeglasses led to decreased treatment time in the first one-half of the procedure. The system appeared to lead to some decreases in the physiological parameters over the course of treatment, with the highest systolic blood pressure occurring after the condition with no use of A/V eyeglasses. CONCLUSIONS: A virtual image A/V system is beneficial in the reduction of fear, pain and procedure time for most dental prophylaxis patients. CLINICAL IMPLICATIONS: Use of screening questionnaires may be helpful for identifying anxious patients. An A/V device may be beneficial to the clinician and the mildly or moderately anxious patient.