Dental anxiety, concomitant factors and change in prevalence over 50 years.

OBJECTIVE: To analyse the prevalence of Dental Anxiety (DA) in the general adult population of Sweden, to study concomitant factors of DA and also to compare the prevalence of DA in 1962 with that in 2013. METHOD: The national study for 2013 included 3,500 individuals, randomly selected from the Swedish population. The data sampling was performed as a telephone survey including 38 questions and this report is a selection of those questions with the focus on DA. The national study from 1962 was a face-to-face survey of 1,331 individuals randomly selected from the Swedish population. Both surveys were conducted by the same company. RESULTS: In 2013, severe DA was reported in 4.7%, moderate DA in 4.5%, low DA in 9.8% and no DA in 80.9% of the subjects. Most (72.9%) of the subjects who reported severe DA attended dental care regularly. Important predictive factors of DA were age, gender, education, and self-rated poor oral and general health. The analysis showed a decrease in the prevalence of DA between 1962 and 2013, specifically a change towards more individuals reporting no dental anxiety (38.5% vs. 80.9%) but also smaller proportions of individuals having low and high DA (46.4% vs 9.8% and 15.1% vs 9.2%, respectively). CONCLUSIONS: In this national representative sample of Swedish adults the prevalence of severe DA was 4.7%. The main finding revealed a significant decrease of the prevalence of DA over 50 years.

A new capitation payment system in dentistry: the patients' perspective.

OBJECTIVE: To investigate patients' experiences of a new payment system for dental care in Sweden. METHODS: Twenty interviews, with 12 women and 8 men, were analysed by thematic content analysis. The interviewees were all regularly attending patients, strategically selected from five general Public Dental Service clinics in urban Gothenburg, Sweden, who had chosen a new payment system based on capitation rather than the traditional fee-for-service system. Conducted by two clinical psychologists/researchers independent of dental profession, the interviews were guided by a semi-structured schedule, which included questions about the new payment system and about dental care and oral health. All interviews were audio-recorded and transcribed verbatim. RESULTS: Two themes emerged from the analysis: "Choice" and "Commitment". The sub-themes defined patients as having chosen the new capitation scheme on their own initiative or after being influenced by relatives or by their dentist, and that the change of payment system was occasioned by previous bad (dental) experiences or in the hope of future (dental health) gain. The commitment was perceived as affording economic security and, through the contractual relationship with the provider, regular calls to attend the clinic. CONCLUSIONS: Patients were generally in favour of the new payment system for dentistry in Sweden; however, important arguments were raised to improve the system, such as better communication concerning the contract and risk assessment.

Dental anxiety and oral health in 15-year-olds: a repeated cross-sectional study over 30 years.

OBJECTIVES: To report the prevalence of dental anxiety in Swedish 15-year-olds over a 30-year period (1973-2003) and how dental anxiety relates to oral health. BASIC RESEARCH DESIGN: The study used a repeated cross-sectional design. PARTICIPANTS: In 1973, 1983, 1993, and 2003, random samples of 96 to 107 15-year-olds were selected from the city of Jönköping, Sweden, 405 overall. MAIN OUTCOME MEASURES: Dental anxiety (DA) and its association with oral health (caries, gingivitis, plaque, fillings) were analysed (α = 0.05). RESULTS: The proportions of dentally anxious during the period were 38% (n = 37) in 1973, 26% (n = 28) in 1983, 18% (n = 15) in 1993 and 13% (n = 12) in 2003 a clearly decreasing trend with time. The strongest predictor of DA was gender, with girls reporting higher levels of DA. In three of the four examination years, adolescents with DA had more filled permanent surfaces than those without DA. Those with DA had a greater caries experience only in 1973. No associations were found between DA and plaque or gingivitis. Multivariate logistic modelling confirmed that DA decreased over time and that girls had higher levels of DA. CONCLUSIONS: This study showed a clear decrease in DA in 15-year-olds over a 30-year period, with a greater proportion of girls being more dentally anxious. The results also indicate a relationship between DA and oral health; the dentally anxious having more filled surfaces and, only in 1973, more decayed tooth surfaces.

Perceived mental stress in relation to oral health over time in middle-aged Swedish women.

OBJECTIVES: To study perceived mental stress in relation to oral health among Swedish middle-aged women over a 36-year period, including considerations concerning smoking and socioeconomic status (SES). METHODS: This combined medical and dental study includes three cross-sectional (1968/9 N = 746, 1980/1 N = 432, 2004/5 N = 500) surveys of 38- and 50-year-old women included in the Prospective Population Study of Women in Gothenburg, Sweden. Panoramic radiography was used to register the number of teeth, filled teeth and decayed teeth and the level of periodontal bone loss. The information concerning perceived mental stress, smoking and education (chosen to represent SES) was questionnaire-based. RESULTS: Perceived mental stress increased over the 36-year period, but was not related to oral health. The time of examination year had a protective effect on oral health, with a larger number of remaining teeth, fewer decayed teeth and less periodontal bone loss in the later examination year, 2004/5, compared with 1968/9. Risk factors for poor oral health were smoking, greater age (50 vs. 38 years) and low educational level. Smokers had fewer filled teeth than non-smokers except in 2004/5, and there was a shift over time towards fewer filled teeth among highly educated women. CONCLUSIONS: A remarkable increase in perceived mental stress was seen among the women over time, but was not associated with oral health. Smoking, greater age and low educational were risk factors for poor oral health, whereas a later examination year was a protective factor.

Heritability of dental fear.

The objective was to test a hypothesized genetic component (i.e., monozygotic being more similar compared with dizygotic twins) in dental fear/anxiety by comparing the probandwise concordance. We analyzed data based on a dichotomous measure of Dental Fear/Anxiety and a continuous measure of Dental Fear Intensity from over 2000 twins, collected when participants were 13-14 years old and once again three years later. The hypothesis was confirmed, but heritability of Dental Fear/Anxiety was estimated to be higher for girls (0.77 at time 1 and 0.55 at time 2) than for boys (0.14 and 0.0 at times 1 and 2, respectively). Heritability of Dental Fear Intensity, however, was similar for girls (0.30 and 0.40 at times 1 and 2, respectively) and boys (0.47, 0.44). Studies of the etiology of dental fear/anxiety should take genetic vulnerability into account and include molecular biology measures. Possible heritability differences between girls and boys need attention.

Psychological well-being in women with Turner syndrome: somatic and social correlates.

Our aim was to examine possible somatic and social correlates to psychological well-being in adult women with Turner Syndrome (TS), including hormone replacement treatment Sixty-three women with a diagnosis of TS (mean age, 31.5 years) participated in a cross-sectional study, using interview data, ratings on the Psychological General Well-being (PGWB) Index, and data from medical examinations and medical records. Statistical analysis was performed by bivariate and multivariate analyses. Lack of sex hormones during adult life and the presence of hearing impairment were related to lower psychological well-being, as were higher age at diagnosis, higher age at menarche or induced bleeding, higher chronological age and retrospectively reported difficulties with school subjects. Age at diagnosis and difficulties with school subjects explained 25% of the variation in psychological well-being. This study has identified some correlates to psychological well-being in women with TS, which are important when considering the clinical management of adult women with TS.