Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation.

BACKGROUND: Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate. AIM: To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors. DESIGN: Data included videos from 238 children (52% female, aged 3-5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parent's dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the child's home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression was applied to predict child refusal of the varnish application. RESULTS: The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (ß = 5.14, P = 0.001), no previous varnish application (ß = -3.89, P = 0.04), and no nurse praise (ß = -1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant. CONCLUSION: Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.

Measuring children's dental anxiety.

DATA SOURCES: Medline and the Social Science Index Citation databases were searched. STUDY SELECTION: Studies had to have used measures of dental anxiety completed by children themselves (≤16 years), been published in English and reported primary data. Non-validated measures, those using proxy measures and non-dentally specific measures were excluded. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently using a standardised form. Validity and reliability of the questionnaires were assessed, and measures were evaluated against a theoretical framework of dental anxiety. A qualitative summary of the measures is presented. RESULTS: Sixty studies met the inclusion criteria. These covered seven 'trait' and two 'state' measures of dental anxiety used to assess children's dental anxiety over the past decade. CONCLUSIONS: The findings from this systematic review can be used to help guide dental academics, clinicians, psychologists and epidemiologists to choose the most appropriate measure of dental anxiety for their intended use. Future work should involve evaluating the content and developmental validity of existing measures with further consideration given to the use of theoretical frameworks to develop this field.

Examining the effectiveness of different dental recall strategies on maintenance of optimum oral health: the INTERVAL dental recalls randomised controlled trial.

Objective To compare the clinical effectiveness of different frequencies of dental recall over a four-year period.Design A multi-centre, parallel-group, randomised controlled trial with blinded clinical outcome assessment. Participants were randomised to receive a dental check-up at six-monthly, 24-monthly or risk-based recall intervals. A two-strata trial design was used, with participants randomised within the 24-month stratum if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or six-month recall interval.Setting UK primary dental care.Participants Practices providing NHS care and adults who had received regular dental check-ups.Main outcome measures The percentage of sites with gingival bleeding on probing, oral health-related quality of life (OHRQoL), cost-effectiveness.Results In total, 2,372 participants were recruited from 51 dental practices. Of those, 648 were eligible for the 24-month recall stratum and 1,724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding on probing between intervention arms in any comparison. For those eligible for 24-month recall stratum: the 24-month versus six-month group had an adjusted mean difference of -0.91%, 95% CI (-5.02%, 3.20%); the 24-month group versus risk-based group had an adjusted mean difference of 0.07%, 95% CI (-3.99%, 4.12%). For the overall sample, the risk-based versus six-month adjusted mean difference was 0.78%, 95% CI (-1.17%, 2.72%). There was no evidence of a difference in OHRQoL (0-56 scale, higher score for poorer OHRQoL) between intervention arms in any comparison. For the overall sample, the risk-based versus six-month effect size was -0.35, 95% CI (-1.02, 0.32). There was no evidence of a clinically meaningful difference between the groups in any comparison in either eligibility stratum for any of the secondary clinical or patient-reported outcomes.Conclusion Over a four-year period, we found no evidence of a difference in oral health for participants allocated to a six-month or a risk-based recall interval, nor between a 24-month, six-month or risk-based recall interval for participants eligible for a 24-month recall. However, patients greatly value and are willing to pay for frequent dental check-ups.

A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age.

BACKGROUND: The development of dental anxiety in children is poorly understood. AIMS: The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors. DESIGN: A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years. RESULTS: The majority (54.3%N = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7%N = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7%N = 85) than the proportion of children who were reported as being anxious at baseline (8.8%N = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old. CONCLUSIONS: Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.

The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age.

BACKGROUND: The Modified Dental Anxiety Scale (MDAS) is a brief, self-complete questionnaire consisting of five questions and summed together to produce a total score ranging from 5 to 25. It has reasonable psychometric properties, low instrumental effects and can be integrated into everyday dental practice as a clinical aid and screen for dental anxiety. The objectives were to (i) produce confirmatory evidence of reliability and validity for the MDAS, (ii) provide up-to-date UK representative norms for the general public to enable clinicians to compare their patients' scores, (iii) to determine the nature of the relationship between dental anxiety and age. METHODS: Telephone survey of a representative quota sample of 1000 UK adults (>18 years of age) conducted between 7-21 April, 2008. RESULTS: Attrition of potential participants was high in the recruitment process, although bias was minimal. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Dental anxiety was four times greater in the youngest age group (18-39 yrs) compared to older participants (60+ yrs), controlling for sex, social class and self-reported dental visiting behaviour confirming previous developed-world reports. CONCLUSION: The scale's psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Dental anxiety was high in younger compared to older people.

Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A two-wave panel study.

OBJECTIVE: To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire. BASIC RESEARCH DESIGN: Patients were initially screened to include only those who were dentally anxious. A pre- and post-test was planned with the completion of the Modified Dental Anxiety Scale (MDAS) questionnaire as the intervention. CLINICAL SETTING: Two dental access centres in the North West of England. PARTICIPANTS: Initially, 583 patients were screened. Of these, 182 (31%) were found to be dentally anxious and were recruited into the study. MAIN OUTCOME MEASURES: State-Trait Anxiety Inventory Scale Short Form. RESULTS: State anxiety did not change with the completion of the MDAS questionnaire in either designated dental phobics (MDAS >or=19) or those classified as non-phobics (MDAS <19). CONCLUSIONS: The MDAS can be used to assess dental anxiety without raising anxiety in patients with or without self-reported dental phobia.

Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people.

OBJECTIVE: The objective of the study was to determine the effect of dental health status, dental anxiety and oral-health-related quality of life (OHRQoL) upon homeless people's experience of depression. METHODS: A cross-sectional survey was conducted on a sample of homeless people in seven National Health Service Boards in Scotland. All participants completed a questionnaire to assess their depression, dental anxiety and OHRQoL using reliable and valid measures. Participants had an oral examination to assess their experience of tooth decay (decayed and missing teeth). Latent variable path analysis was conducted to determine the effects of dental health status on depression via dental anxiety and OHRQoL using intensive resampling methods. RESULTS: A total of 853 homeless people participated, of which 70% yielded complete data sets. Three latent variables, decayed and missing teeth, dental anxiety (Modified Dental Anxiety Scale: five items) and depression (Center for Epidemiological Studies Depression Scale: two factors), and a single variable for OHRQoL (Oral Health Impact Profile total scale) were used in a hybrid structural equation model. The variable decayed and missing teeth was associated with depression through indirect pathways (total standardised indirect effects=0.44, P<.001), via OHRQoL and dental anxiety (χ²=75.90, df=40, comparative fit index=0.985, Tucker-Lewis index=0.977, root mean square error of approximation=0.051 [90% confidence interval: 0.037-0.065]). CONCLUSION: Depression in Scottish homeless people is related to dental health status and oral-health-related factors. Decayed and missing teeth may influence depression primarily through the psychological constructs of OHRQoL and, to a lesser extent, dental anxiety.

A qualitative evaluation of patient experiences when diagnosed with oral cancer recurrence.

Loco-regional recurrence after radical primary treatment of oral cancer is associated with poor prognosis and major patient and career distress. The patient's psychosocial response to recurrence is underreported in the literature. This is one of the few papers to address in detail this stage in a patient's cancer journey. Qualitative methodology was used. Patients were recruited over a 13-month period. Analysis of recorded transcripts from 9 patients suggested that their illness experience and psychological response to diagnosis were multifaceted. Six key themes were identified, which were subdivided into 23 categories. Themes included emotional reactions, reevaluation, active coping strategies, life changes, support, and improvement in relationships. Emotional reactions ranged from shock and devastation, to fear and uncertainty, to hopelessness, to shame, to denial. Not all reactions were negative, and more positive experiences such as new found openness and improvement in relationships were expressed. There is heightened emotional vulnerability, and this leads to potentially difficult management issues among clinicians and members of the multidisciplinary team. Extreme sensitivity is required by all the individuals involved in providing healthcare at this acute time of patient and career distress.