Ansiedade de responsáveis por pacientes com deficiência frente ao atendimento odontológico dos seus filhos / Anxiety in care givers of children with disabilities about their dental care

A ansiedade do responsável pode ser um fator determinante na ansiedade infantil durante a prática odontológica, levando a criança a apresentar comportamentos não colaborativos. Objetivou-se identificar a ansiedade dos responsáveis de pacientes com deficiência ­ Grupo 1 (G1) - atendidos na FOUFRJ, diante do tratamento odontológico de seus filhos, sua relação com Traço e Estado de ansiedade e com o comportamento na consulta, comparando com responsáveis de pacientes sem deficiência ­ Grupo 2 (G2). 128 responsáveis (64 do G1 e 64 do G2) responderam a 3 questionários: 2 validados (Escala de Ansiedade Odontológica (DAS) e Inventário de Ansiedade Traço/Estado) e o terceiro criado pela autora para coleta de dados pessoais e relacionados a percepção de ansiedade frente ao atendimento odontológico do filho (Kappa = 0,96). A maioria do G1 (93,79%) e do G2 (90,63%) era do sexo feminino, com média de idade similar. O comportamento negativo foi mais frequente no G1 com 31,2% contra 9,49% no G2 (p=0,002, Qui²). Ansiedade na 1ª consulta foi relatada em 54,7% no G1 e 48,4% no G2, tendo essa persistindo nas consultas posteriores em 20% do G1, no qual teve médias de DAS (p=0,002) e Estado (p=0,001) maiores nos mais ansiosos; e em 19,6% do G2, com maiores média de Estado (p=0,02) nos mais ansiosos. O comportamento ruim não foi relacionado a maiores valores DAS, Traço ou Estado, mas, nos que permanecem ansiosos, 63,6% das crianças tiveram comportamento ruim no G1 contra 15,4% no G2 (p=0,033). Responsáveis por pacientes com e sem deficiência apresentam ansiedade odontológica semelhante, no entanto a presença de um comportamento ruim está relacionada a ansiedade de responsáveis apenas no grupo dos pacientes com deficiência. (AU)

The caregiver's anxiety can be a determining factor in childhood anxiety during dental practice, leading the child to exhibit non-collaborative behaviors. The objective of this study was to identify the anxiety of those caregivers of patients with disabilities - Group 1 (G1) - treated at the School of Dentistry of the Federal University of Rio de Janeiro, about their children's dental treatment, the relationship with Trait and State anxiety, and with the behavior at the appointment, comparing it with caregivers of non-disabled patients - Group 2 (G2). 128 guardians (64 from G1 and 64 from G2) answered three questionnaires: two validated (Dental Anxiety Scale (DAS) and State-Trait Anxiety Inventory) and the third created by the author to collect personal and related data about the perception of anxiety regarding the child's dental care (Kappa = 0.96). The majority of G1 (93.79%) and G2 (90.63%) were female, with a similar mean age. The negative behavior was more frequent in G1 with 31.2% against 9.49% in G2 (p = 0.002, Qui²). Anxiety in the first visit was reported in 54.7% in G1 and 48.4% in G2, persisting in subsequent visits in 20% of G1, in which the mean DAS (p = 0.002) and State (p = 0.001) was higher in the more anxious; and in 19.6% of G2, with the highest mean State (p = 0.02) in the most anxious. The bad behavior was not related to higher DAS, Trait or State values, but in those who remain anxious, 63.6% of the children had a bad behavior in G1 versus 15.4% in G2 (p = 0.033). Caregivers for patients with and without disabilities have similar dental anxiety; however, the presence of a bad behavior is related to the anxiety of the parents of patients with disabilities. (AU)

Psychological Factors in Dental Patient Care: Odontophobia.

Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.

Barriers to special care patients with mental illness receiving oral healthcare. A cross sectional study in the Holy City of Makkah, Saudi Arabia.

OBJECTIVES: To assess barriers to patients with mental illness receiving oral healthcare in Makkah city, Saudi Arabia. Methods: This was a 3-month cross-sectional study from the Department of Psychiatry at Al-Noor, Specialist Hospital in Makkah city, Saudi Arabia, between January 2017 and April 2017. A structured questionnaire with closed-ended questions was considered. A total of 161 psychiatric patients were recruited, made up of 81 male (50.3%) and 80 female (49.7%) participants. Simple descriptive statistics were used to define the characteristics of the study variables, through a form of counts and percentages. The chi-square test was also used to evaluate the distribution of the nominal variables. Results: Of the 161 psychiatric patients, 51 were aged 26-35 years old (31.7%). Most participants (n=73) had psychological development disorders (45.3%). Ninety-one (56.5%) were unemployed, and among them, 25 (15.5%) reported problems with access to oral health and dental care. Participants also suffered from dry mouth (64%) and dental anxiety (23%). Conclusions: This study suggested that dental anxiety is considered the major barrier to dental care, followed by the cost of dental treatments and accessibility. Most belonged to the group of psychological development disorder and reported having the most barriers to oral healthcare.

Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students.

AIM: Evaluate factors associated with pain and analgesic consumption following non-surgical periodontal therapy. MATERIALS AND METHODS: The sample consisted of 218 patients with chronic periodontitis, submitted to non-surgical scaling and root planing under local anaesthesia at a public dental service in southern Brazil. The data collection instruments included a demographic questionnaire, as well as State-Trait Anxiety Inventory, Corah's Dental Anxiety Scale, Visual Analogue Scale, Numerical Rating Scale and Verbal Rating Scale. The presence and intensity of pain were evaluated at 2, 6, 12, 24 and 48 hr after scaling and root planing. RESULTS: A total of 52.3% of the patients reported mild intensity pain at some point during the 48 hr after scaling and root planing with local anaesthesia. Smoking (PR = 1.47; 95% CI = 1.16-1.65), severe periodontal inflammation (PR = 1.31; 95% CI = 1.09-1.58) and dental anxiety (PR = 1.24; 95% CI = 1.03-1.49) were associated with postoperative pain after adjusting for age, gender and state and trait anxiety scores. Moreover, 46.8% of the subjects used analgesics at some time during the 48-hr follow-up period and dental anxiety was the only factor associated with postoperative analgesic use. CONCLUSIONS: Smoking, severe periodontal inflammation and dental anxiety were identified as factors associated with pain after non-surgical scaling and root planing with local anaesthesia. Dental anxiety was also a factor associated with postoperative analgesic use.

The multiple diagnoses of comorbid anxiety disorders and higher interpersonal sensitivity predict treatment-resistant depression.

BACKGROUND: The present study was conducted to examine the hypothesis based on our previous studies, that the multiple diagnoses of comorbid anxiety disorders (ADs) and higher interpersonal sensitivity predict treatment-resistant depression (TRD). METHODS: The participants were 199 consecutive outpatients with major depressive disorder (MDD), who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview (MINI). TRD was defined as the failure to achieve remission with two or more adequate antidepressant trials. Using multiple logistic regression, the clinical features including the number of comorbid ADs and the Interpersonal Sensitivity Measure (IPSM) score of the TRD group (N=31) were compared with those of the remission group (N=123). RESULTS: Comorbid ADs (odds ratio (OR), 4.5), higher IPSM score (OR, 4.1), suicidal risk (OR, 3.9), and non-melancholic features (OR, 3.3) were identified as the most discriminative variables associated with TRD. All the participants with two or more comorbid ADs (N=12) belonged to the TRD group. CONCLUSION: The results showed that the multiple diagnoses of comorbid ADs and higher interpersonal sensitivity were associated with TRD, suggesting that considering the concept of MDD with "anxious distress," which appears in DSM-5, may be useful for managing TRD.

Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder.

OBJECTIVE: The aim of this study was to evaluate acceptance of treatment after oral sedation with midazolam in dental patients with major neurocognitive disorder. BACKGROUND: Midazolam is commonly used as premedication in paediatric dentistry, oral surgery and people suffering from dental fear. Little is known about its use in other patient groups. METHODS: Dental and sedation records of 61 patients (64% women) sedated with midazolam were examined retrospectively. All records came from patients with major neurocognitive disorder who had been referred to a special dental care unit in Sweden due to uncooperative behaviour and sedated with orally administered midazolam between 2006 and 2011. Data concerning dose, degree of acceptance of dental treatment (four-point scale) and number of possible interacting drugs were collected from dental records. RESULTS: On average, the participants were 80 years old (range: 62-93) and used 3.4 possible interacting drugs. The average midazolam dose was 0.11 mg/kg body weight, which is in line with the regional medical guidelines for sedation. Twenty-seven participants (44%) had no cooperation problems when sedated, twenty-six (43%) were treated with minor adaptations, five had poor cooperation, and three were not possible to treat. No statistically significant differences were found for degree of acceptance of treatment and dose or number of possible interacting drugs. Antiepileptics were used by 13% (n=7) with good or quite good acceptance compared to 37% (n=3) among those with poor or no acceptance. Unfavourable side effects were rare; one participant became hyperactive and one drowsier than expected. CONCLUSION: Sedation with orally administered midazolam seems to be effective and safe in dental treatment of uncooperative persons with major neurocognitive disorder.

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia.

Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia.

Technical outcome of root canal treatment on permanent teeth in children: a retrospective study.

AIM: The aim was to assess the technical quality of root canal treatment conducted in paediatric patients. No specific data is available assessing endodontic treatment quality in children. General adult populations report satisfactory technical quality between 12.8 and 55.7 %, with higher rates by endodontists (77.4-91.0 %). METHODS: Radiographs of 100 chronological cases, conducted by staff (categorised as; junior staff, middle grades or consultants) in a UK teaching hospital, were evaluated retrospectively. Technical outcomes were compared to the European Society of Endodontology quality guideline consensus. A satisfactory root filling was defined as having: root filling material <2 mm from the radiographical apex; no canal space seen beyond the end of the obturation and an obturation of homogeneous density with no voids. In addition where MTA was used a plug of ≥3 mm was required. Any variation was considered unsatisfactory treatment. RESULTS: 61 % [95 % CI 51-70 %] of cases were deemed satisfactory. Of the remaining obturations 20.5 % were short of the apex, 28.2 % had extruded material and 56.4 % contained voids. Patients with co-operation issues, particularly anxiety, had lower technical outcomes (p = 0.001) and the use of thermoplastic obturation greatly reduced the chance of void inclusion (p = 0.004; OR 0.20 [95 % CI 0.06-0.65]). Although 'staff grade' did not show a statistically significant difference, a trend between experience and quality was suspected. CONCLUSION: Overall technical quality of treatment was comparable to the higher rates found in the general adult population. Additionally thermal obturation may be superior to cold lateral condensation in improving obturation quality, and anxiety negatively impacts on treatment provision.

Sleep quality in patients with dental anxiety.

BACKGROUND: Psychological distress is associated with sleep disturbances; however there is little research on sleep quality in dental anxiety (DA) patients. OBJECTIVES: To measure the sleep quality in patients with DA compared to patients with an exacerbated gag reflex (GAG) and controls and to analyze its association with various demographic and behavioral parameters. METHODS: 67 DA patients, 54 GAG patients and 100 controls with no history of DA or GAG participated in the study. Data regarding: demographic details, smoking habits, the Pittsburgh Sleep Quality Index (PSQI), Numeric Rating Scale (NRS) for pain assessment, Corah's dental anxiety scale (DAS) and Oral Health Impact Profile-14 (OHIP-14), plaque index (PI) and Decay, Missing and Filled Teeth (DMFT) scores were collected. RESULTS: 49.3% of the DA group and 38.9% of the GAG group were poor sleepers (mean PSQI score > 5), compared to 29.0% of the controls (PSQI mean scores: 5.8 ± 3.4, DA group; 5.2 ± 3.6 GAG group vs. 4.5 ± 2.7, control group; p = 0.029). Compared to controls, DA and GAG patients exhibited poorer scores in the sleep disturbances PSQI component (p = 0.001). DA patients exhibited poorer scores in the sleep duration PSQI component compared to the control (p = 0.002) and GAG groups (p = 0.033). Female gender (p = 0.039), higher current (p = 0.046) and maximal NRS (p = 0.019), higher DAS (p < 0.001) and OHIP-14 (p < 0.001) scores and more missing teeth (p = 0.003) were positively associated with higher PSQI scores. CONCLUSIONS: DA patients suffered more from impaired sleep than controls and GAGs. Impaired sleep in DA patients is multidimensional phenomenon influenced by the specific diagnosis, gender, pain, dental anxiety levels, dental experience and oral health related quality of life.

Survey on choice of intravenous sedative agent at department of dental anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011.

Use of intravenous sedation is increasing in the management of dental patients in consideration of accompanying diseases and patient demand for comfort and safety. We surveyed choice of sedative agent and dosage on the basis of accompanying diseases or conditions in patients receiving treatment at the Department of Dental Anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011. A total of 5,256 patients were reviewed and divided into the following categories: 1) medically compromised patients (MC); 2) minor oral surgery (OS); 3) cerebral palsy (CP); 4) mental retardation (MR); 5) mental disorder (MD); and 6) dental phobia with/without gag reflex. The investigated variables were sex, age, weight, duration of sedation, and dosage of agent. Dosage of midazolam (M), M plus propofol (MP), and P alone was investigated. A total of 2,336 patients were managed by intravenous sedation during the study period. The combination of MP was used in approximately 63-79% of patients in all categories, except MC. Midazolam was used in approximately 47% in the MC group. Propofol was used in approximately 32% of patients in the MR group. Other agents (minor tranquilizers, analgesics, and so on) were used in approximately 12% in the OS group. The dose of M was approximately 0.05-0.06 mg/kg. When MP was administered, the dose of M showed no difference among groups. The dose of P, however, tended to be lower in the MC and CP groups than in the other groups. These results suggest that MP is chosen for intravenous sedation in most types of dental treatment.

An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study.

INTRODUCTION: Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. METHODS: A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. RESULTS: The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. CONCLUSIONS: There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping.

[Treatment of a patient with psychogenic non-epileptic seizures]. / Behandeling van een patiënt met psychogene pseudo-epileptische aanvallen.

A 36-year old man is referred to a centre for special dental care due to problems with treatability in the general dental practice and a deteriorated oral state. His behaviour is unpredictable due to the possible development of sudden changes in the patient's consciousness which are accompanied by severe aggression. The patient suffers from a conversion disorder, a serious mental disorder which expresses itself in his case with the occurrence of psychogenic non-epileptic seizures. The patient fears that dental treatment will provoke a seizure and that he will react aggressively to his surroundings. He therefore requests that he undergoes dental treatment using general anaesthesia and patient fixation measures. This case study provides an example for the discussion of the problems and the rights of patients with severe mental disorders and the use of measures of physical restraint in dentistry.

Management of 2 teeth diagnosed with dens invaginatus with regenerative endodontics and apexification in the same patient: a case report and review.

INTRODUCTION: This review and case report present the treatment of a 10-year-old boy with both permanent maxillary lateral incisors demonstrating Oehlers type II dens invaginatus and pulpal involvement. Treatment was complicated by dental anxiety, supraventricular tachycardia, immature tooth development, and facial cellulitis. METHODS: An infected necrotic pulp of the permanent maxillary left lateral incisor was treated by apexification and endodontic treatment with mineral trioxide aggregate. The necrotic pulp of the permanent maxillary right lateral incisor was treated with canal debridement and dressing under general anesthesia. RESULTS: Periapical healing of both teeth occurred, with the right lateral incisor showing continued root growth, thickening of the dentinal root walls, and completed apex formation. This tooth responded normally to pulp testing. Twenty-eight months after initial treatment, the right lateral incisor displayed progressive sclerosis of the canal. CONCLUSIONS: This case demonstrates possible pulpal regeneration of an infected maxillary right lateral incisor with dens invaginatus and an immature apex after minimal canal debridement.

Addressing dental fear in children with autism spectrum disorders: a randomized controlled pilot study using electronic screen media.

BACKGROUND: Dental care is a significant unmet health care need for children with autism spectrum disorders (ASD). Many children with ASD do not receive dental care because of fear associated with dental procedures; oftentimes they require general anesthesia for regular dental procedures, placing them at risk of associated complications. Many children with ASD have a strong preference for visual stimuli, particularly electronic screen media. The use of visual teaching materials is a fundamental principle in designing educational programs for children with ASD. PURPOSE: To determine if an innovative strategy using 2 types of electronic screen media was feasible and beneficial in reducing fear and uncooperative behaviors in children with ASD undergoing dental visits. METHODS: We conducted a randomized controlled trial at Boston Children's Hospital dental clinic. Eighty (80) children aged 7 to 17 years with a known diagnosis of ASD and history of dental fear were enrolled in the study. Each child completed 2 preventive dental visits that were scheduled 6 months apart (visit 1 and visit 2). After visit 1, subjects were randomly assigned to 1 of 4 groups: (1) group A, control (usual care); (2) group B, treatment (video peer modeling that involved watching a DVD recording of a typically developing child undergoing a dental visit); (3) group C, treatment (video goggles that involved watching a favorite movie during the dental visit using sunglass-style video eyewear); and (4) group D, treatment (video peer modeling plus video goggles). Subjects who refused or were unable to wear the goggles watched the movie using a handheld portable DVD player. During both visits, the subject's level of anxiety and behavior were measured using the Venham Anxiety and Behavior Scales. Analyses of variance and Fisher's exact tests compared baseline characteristics across groups. Using intention to treat approach, repeated measures analyses were employed to test whether the outcomes differed significantly: (1) between visits 1 and 2 within each group and (2) between each intervention group and the control group over time (an interaction). RESULTS: Between visits 1 and 2, mean anxiety and behavior scores decreased significantly by 0.8 points (P = .03) for subjects within groups C and D. Significant changes were not observed within groups A and B. Mean anxiety and behavior scores did not differ significantly between groups over time, although group A versus C pairwise comparisons showed a trend toward significance (P = .06). CONCLUSION: These findings suggest that certain electronic screen media technologies may be useful tools for reducing fear and uncooperative behaviors among children with ASD undergoing dental visits. Further studies are needed to assess the efficacy of these strategies using larger sample sizes. Findings from future studies could be relevant for nondental providers who care for children with ASD in other medical settings.

[Reverse takotsubo cardiomyopathy-a life-threatening disease. Successful resuscitation of a 31-year-old woman with cardiologic shock after a visit to the dentist]. / Reverse Takotsubo-Kardiomyopathie - eine lebensbedrohliche Erkrankung : Erfolgreiche Reanimation einer 31 Jahre alten Frau mit kardiogenem Schock nach Zahnarztbesuch.

We report on a 31-year-old woman requiring resuscitation because of ventricular fibrillation during a standard dental procedure with local anaesthesia. In cardiac ventriculography, reverse takotsubo cardiomyopathy was diagnosed. Because of protracted cardiogenic shock early treatment with calcium sensitizers, as well as the use of an intra-aortic ballon pump (IABP) were necessary to achieve stable hemodynamics. Despite a maximum neuron-specific enolase value of 37.8 ng/ml, the patient was released from the hospital 19 days after admission without a neurological deficit and with completely restored cardiac function.

Children's dental fear in relation to dental health and parental dental fear.

OBJECTIVE: The aim was to (1) assess the proportion of children with dental fear, to (2) compare results obtained by a single fear question to those obtained by using a set of 11 fear questions, to (3) study associations between children's dental fear and their dental health, and to (4) compare children's dental fears to those of their parents. MATERIALS AND METHODS: A cross-sectional sample of 344 8-10-year-old schoolchildren from South Estonian primary schools participated. Children's fears were measured with the modified Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). The scale includes 11 fear items amongst which five represent less invasive (noninvasive items), another five invasive aspects of dental treatment (invasive items), and one question represents general dental fear of the child. In addition, two questions were included to assess parental dental fear. The dental health of children was examined using the International Caries Detection and Assessment System (ICDAS) criteria. RESULTS: The proportion of children with general dental fear was 6.1%. The mean score of noninvasive fears was higher among the youngest than among the oldest age group (p<0.02). Children whose dmft/DMFT-scores were >0 had higher fear scores than those whose dmft/DMFT-scores were =0 (p<0.01). A total of 16.8% and 15.7% of mothers and fathers afraid of dentistry in general. There were strong correlations between children's dental fears and maternal (p<0.01), and paternal (p<0.01) dental fear. CONCLUSIONS: Children's fears were strongly associated with untreated caries and experience of dental treatment, and with parental fears.

Attention deficit hyperactivity disorder and dental anxiety in adults: relationship with oral health.

The aim of the present study was to investigate the presence of attention deficit hyperactivity disorder (ADHD) in adult patients with severe dental anxiety. Specifically, we analysed the relationship among ADHD, oral health, and dental anxiety. The World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was administered to a consecutive sample of patients referred to a dental fear research and treatment clinic. Patients completed questionnaires measuring dental anxiety (Dental Fear Survey) and self-rated oral health, and underwent a full radiographic examination. Of the total sample (n = 110), 16% scored above the established ASRS cut-off point, which is indicative of having ADHD. The ADHD group showed a higher level of dental anxiety and poorer self-rated oral health. There were also indications of poorer clinical oral health in the ADHD group, but these results did not reach statistical significance. In conclusion, the results of this study indicate an increased prevalence of ADHD in highly dentally anxious adults and the need to pay special attention to these patients because of greater treatment needs and increased dental anxiety.

Dental coping strategies, general anxiety, and depression among adult patients with dental anxiety but with different dental-attendance patterns.

The aim of the present study was to investigate dental coping strategies, general anxiety, and depression in relation to regularity of dental treatment among persons with either regular dental care or phobic avoidance, whilst controlling for sociodemographic factors. Psychometric questionnaires on dental anxiety, dental coping strategies, general anxiety, and depression were delivered to 263 adult patients with dental phobic avoidance behavior who were seeking help from a specialized dental fear clinic and to 141 adult patients with dental anxiety who were receiving regular dental care from various public dental clinics. The results showed that the levels of dental and general anxiety and of depression were significantly higher among irregular attendees compared with regular attendees. Irregular attendees admitted fewer adaptive coping strategies. Predictive of irregular dental care were gender, dental anxiety, general anxiety, and the nonuse of the coping strategy 'optimism'. This study further confirms earlier preliminary results that the use of optimistic thinking is predictive for regular dental attendance habits and that male gender is a risk factor for irregular attendance. Moreover, this study adds that a high level of general anxiety indicates a higher risk for irregular dental care.

Changes over time in adult dental fear and correlation to depression and anxiety: a cohort study of pregnant mothers and fathers.

We aimed to evaluate (i) changes in dental fear over time during pregnancy and after delivery among mothers and fathers and (ii) whether these changes inter-relate to changes in depression and anxiety. Longitudinal pilot data for the FinnBrain Cohort study were used. Of 254 pregnant families, 80% agreed to participate and 60% returned questionnaires at the first data-collection point. After three data-collection points [weeks 18-20 and 32-34 of pregnancy (H18-20 and H32-34, respectively), and 3 months after childbirth], 99 mothers and 74 fathers had filled out at least two out of three Modified Dental Anxiety Scale questionnaires and were included in this study. Other questionnaires used were the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Inventory, and the Pregnancy Related Anxiety Questionnaire. All scales were analyzed as sum scores. Among mothers, dental fear decreased during late pregnancy and increased slightly after childbirth, but no statistically significant correlations between dental fear and depression or anxiety, except for fear of giving birth, were found. Among fathers dental fear increased and was correlated with depression and anxiety. Dental fear seems to fluctuate among women during pregnancy and could be affected by hormonal changes.