The role of dental therapists in pharmacological and non-pharmacological treatment of anxious and phobic patients.

Dental Therapists are in a prime position to be involved with the management of anxious and phobic patients. They earn less than dentists and are therefore a more cost-effective way of providing specialised care for anxious patients. Dental Therapists can spend more time educating and acclimatising these patients, do most if not all of the patient's treatment, only referring back to the dentist for RCT, crown/bridgework/dentures and permanent extractions. Ultimately this means that the patient receives high quality continuity of care. Treating anxious and phobic patients is time-consuming but ultimately very rewarding. If handled correctly and sensitively the anxious and phobic patient will not always be anxious or phobic, in the same way that children won't always be children. Dental Therapists can now extend their duties to include Relative Analgesia. This should enhance their employability and role within the dental team especially in the management of anxious and phobic patients. Employing a therapist with a toolbox of techniques at their disposal can be seen as part of a long-term practice plan to ensure that anxious and phobic patients become rehabilitated, happy, compliant and loyal to the practice! In fact .... the sort of patients every dentist really wants to see.

Assessment of dental fear and anxiety levels in eating disorder patients undergoing minor oral surgery.

PURPOSE: The aim of the present study was to evaluate the levels of dental fear and anxiety in women with eating disorders (EDs) scheduled for oral surgery. PATIENTS AND METHODS: A total of 61 patients with EDs, an identical number of age-, gender-, and education-matched healthy controls, and 2 consecutive, randomly selected, clinical and nonclinical samples each consisting of 220 female subjects were included in the present study. The participants completed the demographic and clinical forms, as well as the modified dental anxiety scale (MDAS) and dental fear survey (DFS) before the surgical procedure. RESULTS: The mean scores of the MDAS and DFS for the study population correlated negatively with age and positively with a previous unpleasant experience related to dentistry (P < .01 for both). Patients with EDs had significantly greater mean scores on the MDAS than the clinical and nonclinical groups (P < .05 for both). Their mean scores on the DFS were significantly greater than those for the nonclinical participants (P < .05). A significant difference was found in the DFS subscale "fear of specific situations and stimuli" compared with the healthy matched controls and clinical and nonclinical subjects (P < .05 for all). CONCLUSION: The results of our study have shown that patients with EDs can be more sensitive to the auditory, visual, and contact stimuli of the oral surgery procedures under local anesthesia. They also had greater levels of dental fear and anxiety than routine clinical patients and randomly selected subjects from a nonclinical environment.

The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial.

OBJECTIVES: To review the effect of lavender scent on anticipatory anxiety in dental participants. METHODS: In a cluster randomized-controlled trial, patients' (N = 340) anxiety was assessed while waiting for a scheduled dental appointment, either under the odor of lavender or with no odor. Current anxiety, assessed by the brief State Trait Anxiety Indicator (STAI-6), and generalized dental anxiety, assessed by the Modified Dental Anxiety Scale (MDAS) were examined. RESULTS: Analyses of variance (anovas) showed that although both groups showed similar, moderate levels of generalized dental anxiety (MDAS F((1,338)) = 2.17, P > 0.05) the lavender group reported significantly lower current anxiety (STAI: F((1,338)) = 74.69, P < 0.001) than the control group. CONCLUSIONS: Although anxiety about future dental visits seems to be unaffected, lavender scent reduces state anxiety in dental patients.

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.

Children's preferences concerning the physical appearance of dental injectors.

PURPOSE: This pilot study was carried out to assess how the physical appearance of dental injectors influenced children's choice. METHODS: The study group consisted of 34 randomly selected children (17 boys, 17 girls) between the ages of 7 and 11 (mean age=8.6 +/- 1.4), who had been registered for treatment at the School of Dentistry, Marmara University. A combination of tests-the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Venham Picture Test (VPT), and facial image scale (FIS)-were used to assess the multi-dimensional character of children's dental anxiety. Dental injectors (Wand, Citoject, traditional metal injector [MI], and plastic injector [PI]) were displayed on a tray and introduced to the children. The children were asked to consider which injectors they would choose "if their tooth had to be put to sleep," and their preferences were noted starting with their first choice. RESULTS: The children's first choice was: (1) the Wand (56%); (2) PI (29%); (3) Citoject (12%); and (4) MI (3%). The anxious children (n= 13) preferred the Wand with significantly higher ratings (Wand=84%; Citoject=8%; MI=8%; PI=0%). CONCLUSION: The physical appearance of dental injectors is important to children and even more important for children who are anxious.

Factors influencing referral of children for dental extractions under general and local anaesthesia.

OBJECTIVE: To investigate the relative importance of a range of explanatory variables concerning why child patients in Scotland enter pathways for tooth extractions under either Dental General Anaesthesia (DGA) or local anaesthesia (LA). BASIC RESEARCH DESIGN: A cross-sectional study was carried out involving DGA centres across Scotland. Data collected related to demographic characteristics of child DGA patients, reported anxiety and dental attendance levels of patients and parents, reasons given by referring practitioners for requesting DGA, number and type of teeth extracted and parental beliefs and attitudes to DGA. Similar data were collected relating to children having teeth extracted in primary care under LA. Multivariate analysis was performed to determine which factors were the best predictors of anaesthetic choice. RESULTS: 425 and 121 children having dental extractions under DGA and LA respectively participated. Ninety-six percent of DGA cases and 48% of LA patients had extractions for caries. For DGA cases, the mean age was 6.7 years, an average of 5.3 teeth were extracted and dental anxiety levels were higher than population norms. Multivariate analysis found the number of teeth extracted was the major predictor of anaesthetic type. On removing this variable, age became the most important factor, with 99% of children under 5.5 years receiving a DGA. Among DGA patients, 25% were reported to have had a previous DGA for tooth extraction. CONCLUSIONS: Future reductions in DGA numbers will be dependent on decreasing the number of young children presenting with advanced caries in multiple teeth. Consequently, guidelines are required concerning the prevention and appropriate management of caries in the primary dentition.

Dental fear of Finnish children in the light of different measures of dental fear.

OBJECTIVES: The aims were: (1) to examine the construct and reliability of the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) among children of different ages and (2) to compare the correlations between fear measured with the modified CFSS-DS, the "peak value for dental fear" (PV), and "fear of dental treatment in general" (GF). METHODS: The study sample consisted of 302, 299, 314, and 297 children aged 6, 9, 12, and 15 years, respectively. Each child received a questionnaire to be filled out at home. An explorative factor analysis with varimax rotation was performed for eight items taken from the CFSS-DS and questions on fear of pain and suction used in the mouth. For further age-specific analyses, mean values were calculated for the sum of items that loaded >0.5 on each factor. The correlations between these values and PV and GF were studied. RESULTS: The questionnaire was reliable. Two factors were revealed for each age: "treatment of dental decay" (TDD), which included fears related to invasive treatment, and "attending the dentist" (AD), which included fears related to dental visits in general. TDD explained over 50% of the variance, except among 9-year-olds. TDD mean values were higher among older children than among younger ones and correlated more strongly with PV than with GF. AD mean values were higher among younger children than among older ones and correlated more strongly with GF than with PV. CONCLUSION: The factor structures were fairly similar but the correlations between fear measures differed among children of different ages.

Effects of cognitive therapy, applied relaxation and nitrous oxide sedation. A five-year follow-up study of patients treated for dental fear.

Five years after completing a controlled, randomized treatment trial comparing the effect of nitrous oxide sedation (NO), cognitive therapy (CT), and applied relaxation (AR), all 62 patients who had participated were invited to a follow-up questionnaire study. Forty-three responded. All participants had been to the dentist during the follow-up period. Mean scores (s) on Corah's Dental Anxiety Scale (CDAS) and Symptom Checklist 90 Revised (SCL-90-R, a measure of general psychological distress) were 10.4 (4.1) and 0.35 (0.34), respectively. There were no between-group effects. Significant changes across the assessment phases (at enrollment, after treatment, and 5 years after) were found for both dental fear and general distress (CDAS: F = 137.8, P < 0.01; SCL-90-R: F = 12.5, P < 0.01). However, no significant changes between measures obtained after treatment and at follow-up emerged. Seven participants (3 from the NO group, 2 from the CT group, and 2 from the AR group) had CDAS scores above 14, indicating a recurrent or continual dental fear problem. The majority (81%) assessed the dental fear treatment received 5 years previously to have been useful for them. In conclusion, the favorable effects on dental fear and general psychological distress continued at 5-year follow-up for all treatment groups.

Dental fear among a young adult Saudian population.

AIMS: To assess the prevalence of dental fear and reasons for irregular dental attendance among young adult university students; to describe the gender distribution of the dentally anxious population according to the perceived origins or sources of fear; to identify the time of fear development and preference for anaesthesia or sedation before dental treatment. METHOD: A questionnaire incorporating the Dental Fear Scale (DFS) with items related to sources of dental fear stimuli, together with the preference of anaesthesia or sedation before dental treatment and other characteristics. Approximately 500 questionnaires were distributed among Saudian undergraduate students. RESULTS: 368 questionnaires were completed and presented for statistical analysis. The sight and sensation of anaesthetic needles and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. Also, females tended to be more anxious than males. Increased heart rate was the most common reported physiological response to fear resulting from dental treatment. The overall level of fear of dental work among the studied population was found to be about 39%.'Lack of time' and 'no need for treatment' were found to be the main reasons for irregular dental visits. Fear of pain and trauma were the major perceived sources of reported fear reactions and were developed mainly during childhood. About 63% of the subjects preferred to have local anaesthesia before dental treatment to prevent or ameliorate dental fear.

Patient and dentist satisfaction with a computerized local anesthetic injection system.

The fear of dental injections is common among dental patients. Many approaches to reducing this fear of injections and improving local dental anesthesia delivery have been tried in the last few decades. One approach is the use of a computerized or electronic local anesthetic system. This study surveyed dentist and patient satisfaction when local dental anesthesia was delivered with a computerized delivery system. The patients and dentists were both satisfied with the effectiveness of the anesthesia. The patients were satisfied with the level of comfort with the injections. This was particularly true when compared to their previous anesthetic injections. Although the dentists were very satisfied with the performance of the anesthetic delivery system and the anesthesia itself, they did not, in general, choose to use the system in everyday practice. Possible reasons for this within the context of this study are discussed.

The management of severe dental phobia in an adolescent boy: a case report.

Dental fear is a widespread problem that represents one of the major barriers to dental care. This report describes a case study of a 12-year-old boy who presented with dental phobia characterized as 'fear of catastrophe', 'generalized dental fear' and 'fear of specific stimuli'. The referral came from his general dental practitioner who had been unable to carry out even the simplest dental procedure on him. The patient required prevention, conservation and root canal therapy. The case illustrates the use of physical strategies, including muscle relaxation and relaxation breathing; practice strategies, including graded exposure and cognitive strategies, combined with individual control methods and inhalation sedation to successfully complete the dental treatment plan.

Dental anxiety among Israeli dental students: a 4-year longitudinal study.

The aims of the present study were (a) to evaluate students' estimation of their parents' dental anxiety; (b) to measure students' dental anxiety and to study their ranking of the most fear provoking stimuli in the dental situation during their pre-clinical and clinical years; (c) to investigate gender differences among students with regard to dental anxiety. 30 3rd-year students (15 male and 15 female) who completed a 4-section questionnaire which requested sociodemographic information, evaluation of parents' dental anxiety, dental anxiety scale (DAS) and dental fear scale (DFS), completed the DAS and DFS in their 5th and 6th years. Both male and female students estimated their mothers' dental anxiety as significantly higher than their fathers'. Female students ranked their parents higher than males. DAS scores were significantly higher among female students than among males in the 3rd year. However, DAS scores were reduced from the 3rd to the 6th year among the total class and significantly among females, while males' levels of anxiety remained within close range throughout the years. The dental anxiety scores of all students who experienced a dental procedure in the past were higher than the scores of the students who did not. The most fearful stimulus was 'feeling the needle'. Our findings may suggest that the change in the reported dental anxiety of the students during the years of dental studies in the present study may be explained by the increased professional education and clinical experience that the students acquire throughout their studies in the dental school. Being exposed to basic trivial dental procedures (such as local anaesthetic injection) may help students either to be habituated or to use rational coping strategies when dealing with personal dental experience.