Outcome of Chair-Side Dental Fear Treatment: Long-Term Follow-Up in Public Health Setting.

AIM: Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000-2005. METHODS: A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. RESULTS: The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. CONCLUSIONS: A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.

Self-reported causes for referral to dental treatment under general anaesthesia (DGA): a cross-sectional survey.

AIM: To determine causes leading to dental care under general anaesthesia (DGA) in public health care reported by the patients or the parents/caregivers. STUDY DESIGN: All the patients referred to DGA at the Municipal Health Centre, Oulu, Finland, during 10 months were invited to participate in the present cross-sectional survey. They were sent a questionnaire on indications for referral to DGA, dental fear, possible reasons for it as well as prior treatment of dental fear. For measuring overall dental fear, the modified Corah dental anxiety scale (MCDAS) and visual analogue scale (VAS) forms were also included in the questionnaire. RESULTS: The most common self-reported indication for referral to DGA was dental fear (63.9%). For children and adolescents (<18 years), need for extensive care was the second most common reported cause. The great majority of the respondents reported having dental fear (90.8%). Dental fear was more common among females than males, but the difference between the genders was not statistically significant. The most common cause for dental fear was earlier negative experiences in dental care (51.9%). The mean MCDAS score was 19.0 (SD 5.7; 5-25) indicating severe dental anxiety. An increasing trend towards older age groups could be seen in VAS scores reporting fear of pain, needles, scaling, scolding by the dentist, extractions, as well as endodontic treatment. Dental fear had been taken into consideration in dental treatment preceding DGA. CONCLUSION: Dental fear is the most common self-reported indication for referral to DGA and should be taken into consideration.

Timing of first fillings in the primary dentition and permanent first molars of asthmatic children.

The aim of this study was to analyze the timing of first fillings posteruptively in a cohort comprising 51 asthmatic children receiving inhaled corticosteroids and living in three communities in Ostrobothnia, Finland. They had all been born in the 1980s and had had asthma check-ups in the local asthma policlinic. A group of 102 healthy age- and sex-matched children served as controls. A longitudinal survival analysis of the timing of the first filling in the primary teeth and first permanent molars was conducted retrospectively using data from the annual dental health records. The timing of the first fillings in permanent first molars showed no statistically significant differences between asthmatic and healthy children, but the filling increments in the primary molars were consistently higher in the asthmatic group; the difference for the upper first primary molars was, for instance, statistically significant (risk ratio = 2.565; 95% confidence interval = 1.333-4.935). More extractions because of caries were also performed on primary molars in the asthmatic children. The findings support the hypothesis that factors related to the asthmatic condition might increase the risk of caries. A longer surveillance time would be needed to evaluate the effect of asthma on the permanent dentition.