The application of drug behavior management methods in the treatment of dental fear and oral diseases in children: A review.

Oral behavior management methods include basic behavior management methods and drug behavior management methods. In many cases, dental treatment that cannot be done simply through basic behavior management is not possible. The uncooperative behavior of children with dental fear in oral treatment has increased the demand for medication based behavior management methods. Drug sedation can provide more effective analgesic and anti-anxiety effects, thereby helping to provide comfortable, efficient, and high-quality dental services. This article will review the drug sedation methods selected in clinical treatment of pediatric dental fear in recent years, as well as the safety and effectiveness of commonly used drugs, in order to provide guidance for dental professionals in clinical practice.

Effectiveness of auditory distraction on the management of dental anxiety in patients undergoing tooth extraction at a tertiary care hospital in Islamabad.

OBJECTIVES: The study aimed to assess the effectiveness of anxiety reduction protocol using auditory distraction in alleviating dental anxiety among patients undergoing tooth extraction. MATERIALS AND METHODS: A randomized controlled trial was conducted at the Oral Surgery Department at Islamabad Dental Hospital from July to December 2022, involving 50 patients scheduled for tooth extraction. Participants were randomly divided into two groups: an interventional group, exposed to auditory distraction, and a noninterventional group, without exposure to auditory distraction before the dental extraction. Dental anxiety was measured using the modified dental anxiety scale (MDAS) questionnaire, which scores anxiety levels on a range from 5 (not anxious) to 25 (extremely anxious). Anxiety levels were assessed in the waiting room and just before extraction, and the results were compared across both groups to evaluate the effectiveness of auditory distraction in reducing dental anxiety. RESULTS: The sample size of 50 was randomly and equally allocated to the interventional and noninterventional groups. The study population consisted of 28 (56%) female and 22 (44%) male participants. No significant difference was observed between the anxiety scores of interventional and noninterventional groups at baseline. A significant reduction in anxiety scores was observed in the intervention group during postintervention assessment, while no significant difference was seen in the noninterventional group's anxiety scores. CONCLUSIONS: The study supports the efficacy of anxiety reduction protocol using auditory distraction as a practical tool for reducing dental anxiety among patients undergoing tooth extraction.

Predicting dental anxiety in young adults: classical statistical modelling approach versus machine learning approach.

OBJECTIVES: To predict and identify the key demographic and clinical exposure factors associated with dental anxiety among young adults, and to compare if the traditional statistical modelling approach provides similar results to the machine learning (ML) approach in predicting factors for dental anxiety. METHODS: A cross-sectional study of Western Illinois University students. Three survey instruments (sociodemographic questionnaire, modified dental anxiety scale (MDAS), and dental concerns assessment tool (DCA)) were distributed via email to the students using survey monkey. The dependent variable was the mean MDAS scores, while the independent variables were the sociodemographic and dental concern assessment variables. Multivariable analysis was done by comparing the classical statistical model and the machine learning model. The classical statistical modelling technique was conducted using the multiple linear regression analysis and the final model was selected based on Akaike information Criteria (AIC) using the backward stepwise technique while the machine learining modelling was performed by comparing two ML models: LASSO regression and extreme gradient boosting machine (XGBOOST) under 5-fold cross-validation using the resampling technique. All statistical analyses were performed using R version 4.1.3. RESULTS: The mean MDAS was 13.73 ± 5.51. After careful consideration of all possible fitted models and their interaction terms the classical statistical approach yielded a parsimonious model with 13 predictor variables with Akaike Information Criteria (AIC) of 2376.4. For the ML approach, the Lasso regression model was the best-performing model with a mean RMSE of 0.617, R2 of 0.615, and MAE of 0.483. Comparing the variable selection of ML versus the classical statistical model, both model types identified 12 similar variables (out of 13) as the most important predictors of dental anxiety in this study population. CONCLUSION: There is a high burden of dental anxiety within this study population. This study contributes to reducing the knowledge gap about the impact of clinical exposure variables on dental anxiety and the role of machine learningin the prediction of dental anxiety. The predictor variables identified can be used to inform public health interventions that are geared towards eliminating the individual clinical exposure triggers of dental anxiety are recommended.

Impact of high-speed handpiece noise-induced dental anxiety on heart rate: analyzing experienced and non-experienced patients - a comparative study.

BACKGROUND: Dental anxiety is very much common among the patients and could be due to different factors like the behavior of the dentist, past experiences, Needle phobia, or word of mouth from other patients. According to recent studies, a strong association between sound and anxiety has been found, so this observational study has been conducted to find out the link between the activation of anxiety with the sound of a handpiece between experienced patients, who have already gone through the dental treatments and non-experienced patients. METHODS: Total of 297 participants were part of this study. These participants were divided into 2 groups according to the experienced and non-experienced dental patients. The researcher first filled out the CORAH Dental Anxiety Scale (DAS) form to mark the anxiety level of the patients, and then noted the readings of the heart rate in 3 intervals which were before during, and after the treatment with the pulse oximeter. Later the data was analysed using the SPSS independent t-test. RESULTS: Results show that patients in group 1 who have gone through the dental treatment before were less anxious and had a lesser effect on their heart rate than the patient who were having the treatment for the first time who were in group 2. Another interesting factor was noticed that in both the groups female were found to be more anxious than male participants. Participants with younger age were found to be more anxious than older age patient in both groups CONCLUSIONS: The sound of the handpiece can provoke anxiety in the patient, affecting the heart and increasing the heart rate. Participants who were experienced were found to be less anxious than the participants who were inexperienced.

Differences in anxiety, depression, and oral health-related quality of life among dental anxiety patients with and without reported abuse experience.

This study aimed to explore the differences in anxiety, depression, and oral health-related quality of life between people with dental anxiety who reported abuse experience (n = 60) and people with dental anxiety who did not report abuse experience (n = 97). Both groups attended a dental service focused on the treatment of dental anxiety intended for people with a history of physiological or psychological trauma, or odontophobia. The participants responded to a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), Oral Impacts on Daily Performance (OIDP), and the Index of Dental Anxiety and Fear (IDAF-4C+ ). The differences between groups were tested for statistical significance using Welch's T-tests, and linear regression was used to adjust for gender. The participants with reported abuse experience expressed greater psychological symptoms of anxiety and poorer oral health-related quality of life. The participants with reported abuse experience also expressed a higher fear of losing control, as well as feeling shame and disgust. This study shows that individuals with dental anxiety and a history of abuse may face more complex challenges than those with dental anxiety and no history of abuse.

Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety.

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

Development and validation of the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM).

OBJECTIVE: The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9-16. METHODS: The CEDAM was translated into Persian following the guidelines of the IQOLA project. A sample of children completed the measure in a clinical setting, with a subgroup completing it again to assess test-retest reliability. Concurrent criterion validity was evaluated by having all participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the CEDAM. Construct validity was examined using exploratory and confirmatory factor analyses. RESULTS: The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test-retest  reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p < .01). Exploratory factor analysis identified two factors, and confirmatory factor analysis confirmed that the instrument aligned well with the factor structure obtained from the exploratory analysis. CONCLUSION: This study provides evidence supporting the validity and reliability of the Iranian version of CEDAM as a valuable tool for evaluating dental anxiety in Persian-speaking children between the ages of 9 and 16. .

A test of pre-exposure spacing and multiple context pre-exposure on the mechanisms of latent inhibition of dental fear: A study protocol.

BACKGROUND: Latent inhibition occurs when exposure to a stimulus prior its direct associative conditioning impairs learning. Results from naturalistic studies suggest that latent inhibition disrupts the learning of dental fear from aversive associative conditioning and thereby reduces the development of dental phobia. Although theory suggests latent inhibition occurs because pre-exposure changes the expected relevance and attention directed to the pre-exposed stimulus, evidence supporting these mechanisms in humans is limited. The aim of this study is to determine if two variables, pre-exposure session spacing and multiple context pre-exposure, potentiate the hypothesized mechanisms of expected relevance and attention and, in turn, increase latent inhibition of dental fear. METHODS: In a virtual reality simulation, child and adult community members (ages 6 to 35) will take part in pre-exposure and conditioning trials, followed by short- and long-term tests of learning. A 100ms puff of 60 psi air to a maxillary anterior tooth will serve as the unconditioned stimulus. Pre-exposure session spacing (no spacing vs. sessions spaced) and multiple context pre-exposure (single context vs. multiple contexts) will be between-subject factors. Stimulus type (pre-exposed to-be conditioned stimulus, a non-pre-exposed conditioned stimulus, and an unpaired control stimulus) and trial will serve as within-subject factors. Baseline pain sensitivity will also be measured as a potential moderator. DISCUSSION: It is hypothesized that spaced pre-exposure and pre-exposure in multiple contexts will increase the engagement of the mechanisms of expected relevance and attention and increase the latent inhibition of dental fear. It is expected that the findings will add to theory on fear learning and provide information to aid the design of future interventions that leverage latent inhibition to reduce dental phobia.

Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis.

OBJECTIVE: The objective of this review is to determine the global prevalence of dental fear and anxiety (DFA) in early childhood and identify its related factors. METHODS: The systematic review utilized three common English-language databases (PubMed, EMBASE, and Web of Science). Two independent researchers performed a systematic search to include observational studies on young children published from 2000 to 2023. They extracted information on prevalence of DFA, assessment tools used, study sites, respondents, and children's dental visit experiences. RESULTS: A total of 2,895 studies were identified, and 25 studies met the inclusion criteria for analysis. The pooled prevalence of DFA among 2- to 6- year-old children was estimated to be 30 % (95 % CI=25, 36). Children without dental visit experience (OR=1.37, 95 % CI=1.18, 1.59) and children with caries experiences (OR=1.18, 95 % CI=1.09, 1.27) had higher odds of experiencing DFA compared to those with dental visit experience or caries-free status. The most commonly used assessment tools in the included studies were the Frankl Behaviour Rating Scale (32 %, 8/25), Children's Fear Survey Schedule-Dental Subscale (20 %, 5/25), and Dental Anxiety Question (20 %, 5/25). CONCLUSIONS: This systematic review reveals that approximately one-third of young children globally experience DFA. Children who lack dental visit experience or have caries experiences are at increased risk of DFA. Clinicians can use this information to make informed decisions regarding dental care provision for young children. CLINICAL SIGNIFICANCE: This study provides comprehensive information on the global prevalence of dental fear and anxiety and its associated factors in early childhood. The findings can assist clinicians in understanding and addressing DFA in their dental care approach for young children. REGISTRATION: PROSPERO (CRD42023446464).

Assessment of patients' dental anxiety levels in the context of infectious diseases: development and validation of Musa Kazim's Dental Anxiety Scale (MK-DAS).

OBJECTIVES: The study aimed to develop and validate a new scale called Musa Kazim's Dental Anxiety Scale (MK-DAS) to measure dental anxiety in relation to infectious diseases. METHODS: The study utilized a cross-sectional design and recruited participants from Faculty of Dentistry, Altinbas University. The sample included 289 participants who were seeking dental treatment. The Modified Dental Anxiety Scale (MDAS) was employed for the purpose of assessing levels of dental anxiety. In contrast, the MK-DAS, comprised a series of seven inquiries specifically targeting concerns regarding the treatment procedure and the fear of contagion. The data was analyzed using various statistical methods, including descriptive statistics, exploratory factor analysis, criterion validity, cluster analysis for cut-off points, and test-retest reliability. RESULTS: The factor analysis revealed that MK-DAS had a two-factor structure. The first factor consisted of five items related to various aspects of the treatment process (α:0.837), while the second factor included two items related to the fear of infectious diseases (α:0.747). The scale showed good reliability, as indicated by high Cronbach's alpha coefficients for both factors. Strong positive correlations were found between MDAS and the first factor of MK-DAS (r = 0.857; p < 0.01), moderate positive correlations between MDAS and the second factor (r = 0.323; p < 0.01), and a strong positive correlation between MDAS and the overall of MK-DAS (r = 0.782; p < 0.01). Additionally, the cluster analysis yielded a cut-off score of 17 based on the k-means analysis. Moreover, test-retest reliability analyses indicated that dimension 1 (ICC: 0.904), dimension 2 (ICC: 0.840), and overall MK-DAS (ICC: 0.944) demonstrated high internal consistency. CONCLUSION: The MK-DAS is an innovative and modern dental anxiety scale that has been proven to be reliable and valid, surpassing the comprehensiveness of the MDAS.

A study on related factors affecting dental fear in preschool children.

This study aims to examine the manifestations of dental anxiety (DA) and its influencing factors during dental visits among preschool children. The data of 166 preschool children who visited the Department of Dentistry of our hospital from April 2021 to April 2023 with oral problems were retrieved. Their DA performance was investigated using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). In addition, based on their general data and potential risk factor information, we performed logistic regression analysis to identify the factors influencing DA. Of the 166 questionnaires distributed, a total of 160 valid questionnaires were retrieved. The average CFSS-DS score was 35.57 ± 3.51 points. Sixty-six children had DA, resulting in an incidence rate of 41.25%. The top 5 items with the highest CFSS-DS scores were fear of needles, dentists, tooth extraction, drilling and oral anesthesia. When the 66 children with DA were classified into a DA group and a non-DA group, we observed significant differences in age distribution, dental experience, only child status, general anxiety symptoms, dental condition, family income and specific dental treatment procedures, particularly tooth extraction, between them (p < 0.05). Multivariate logistic regression analysis revealed that preschool children aged ≤4 years, those with prior dental experiences, single-child status, general anxiety symptoms, suboptimal dental health, family incomes below 100,000 yuan/year, and those undergoing specific dental procedures, such as tooth extractions, were independently associated with a higher risk of DA (p < 0.05). The incidence of DA in preschool children is high, and they exhibit substantial fear of needles, dentists, tooth extraction, drilling and oral anesthesia. Preschool children aged ≤4 years, with prior dental experiences, single-child status, the presence of general anxiety symptoms, suboptimal dental health, family incomes below 100,000 yuan/year, and those undergoing dental procedures, particularly tooth extraction, could be more predisposed to DA.

A study protocol testing pre-exposure dose and compound pre-exposure on the mechanisms of latent inhibition of dental fear.

BACKGROUND: Dental stimuli can evoke fear after being paired - or conditioned - with aversive outcomes (e.g., pain). Pre-exposing the stimuli before conditioning can impair dental fear learning via a phenomenon known as latent inhibition. Theory suggests changes in expected relevance and attention are two mechanisms responsible for latent inhibition. In the proposed research, we test whether pre-exposure dose and degree of pre-exposure novelty potentiate changes in expected relevance and attention to a pre-exposed stimulus. We also assess if the manipulations alter latent inhibition and explore the possible moderating role of individual differences in pain sensitivity. METHODS: Participants will be healthy individuals across a wide range of ages (6 to 35 years), from two study sites. Participants will undergo pre-exposure and conditioning followed by both a short-term and long-term test of learning, all in a novel virtual reality environment. The unconditioned stimulus will be a brief pressurized puff of air to a maxillary anterior tooth. Pre-exposure dose (low vs. high) and pre-exposure novelty (element stimulus vs. compound stimuli) will be between-subject factors, with stimulus type (pre-exposed to-be conditioned stimulus, a non-pre-exposed conditioned stimulus, and an unpaired control stimulus) and trial as within-subject factors. Pain sensitivity will be measured through self-report and a cold pressor test. It is hypothesized that a larger dose of pre-exposure and compound pre-exposure will potentiate the engagement of the target mechanisms and thereby result in greater latent inhibition in the form of reduced fear learning. Further, it is hypothesized that larger effects will be observed in participants with greater baseline pain sensitivity. DISCUSSION: The proposed study will test whether pre-exposure dose and compound stimulus presentation change expected relevance and attention to the pre-exposed stimulus, and thereby enhance latent inhibition of dental fear. If found, the results will add to our theoretical understanding of the latent inhibition of dental fear and inform future interventions for dental phobia prevention.

The Role of Family Factors in the Development of Dental Anxiety in Children.

Background and Objectives: In the literature, the influence of parents who suffer from dental anxiety and a previous unpleasant experience at the dentist are cited as the two most common causes of dental anxiety in children. The aim of this study is to investigate the relationship between socioeconomic factors and the development of dental anxiety in children aged 9 to 12 years. Materials and Methods: A total of 131 children and their accompanying parents/guardians participated in the cross-sectional study. The children were divided into an experimental group, which visited a specialised office for paediatric and preventive dentistry for the examination, and a control group, which visited a primary care dental office. During the visit, the children completed questionnaires on dental anxiety (CFSS-DS). Parents completed a socioeconomic questionnaire and a dental anxiety questionnaire for adults (CDAS). Results: The results showed a statistically significant positive predictor: parental dental anxiety as measured by the CDAS. In addition, the t-test showed that children who visited a specialised dental office did not show a statistically significant increase in dental anxiety compared to children who visited a primary care dental office. Conclusions: With this study, we confirm the influence of parental dental anxiety on the development of dental anxiety in children. The socioeconomic status of the family and the type of dental office do not play a statistically significant role in the development of dental anxiety in children.

The Association of Social Media Videos and Patients' Preoperative Anxiety.

BACKGROUND: Impacted tooth extraction is regarded as one of the dental procedures that induces the highest levels of dental anxiety. PURPOSE: The study purpose was to measure and compare anxiety levels in patients undergoing 3rd molar extraction between those who did or did not view videos related to 3rd molar operations. STUDY DESIGN, SETTING, AND SAMPLE: This prospective cohort study was conducted on patients who presented to the Department of Oral and Maxillofacial Surgery. The study included patients without any systemic comorbidities who had a indication for the extraction of impacted mandibular third molars. Patients who had previously undergone impacted tooth extractions were excluded from the study. PREDICTOR VARIABLES: The predictor variable was exposure to 3rd molar operation videos on social media. The subjects were grouped into categories; group 1, patients who watched videos and group 2, patients who did not watch videos. OUTCOME VARIABLES: The main outcome variables are state anxiety (S-anxiety) scores and trait anxiety (T-anxiety) scores. Anxiety scores were measured 1 week before the surgery and on the day of the surgery. COVARIATES: Age, sex, education level, and whether the video contained animated or real surgical images were used as covariates. ANALYSES: For normally distributed continuous variables, group means were compared using Student's t-test, while nonnormally distributed variables were compared using the Mann-Whitney U test. A P value of <.05 was considered statistically significant. RESULTS: The sample consisted of 60 patients, with 68.3% female and 31.7% male. In group 1, S-anxiety scores on the surgery day (44.8 ± 10.38) were higher than 1 week before (37.76 ± 8.92), and T-anxiety scores on the surgery day (78.23 ± 5.25) were higher than 1 week before (74.8 ± 5.54). In group 2, S-anxiety scores on the surgery day (35.9 ± 11.27) were higher than 1 week before (32.3 ± 9.53), and T-anxiety scores on the surgery day (79.16 ± 6.32) were higher than 1 week before (75.76 ± 5.55). S-anxiety scores of group 1 were statistically higher than group 2 in both conditions (P < .05), but there was no statistically significant difference between the groups in terms of T-anxiety scores (P > .05). CONCLUSION AND RELEVANCE: Watching videos before the operation may be associated with patients' anxiety levels.

Exploring dental students' attitudes toward patient-centered management of dental fear.

PURPOSE/OBJECTIVES: A patient-centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three-fold: (a) to examine the preliminary psychometric properties of an author-designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th-year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. METHODS: In 2022, 4th-year dental students (N = 453) participated in a cross-sectional study. Participants completed a 16-item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. RESULTS: Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self-efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self-efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. CONCLUSION(S): Results indicate educational gaps within the current behavioral-science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted.

Anxiety sensitivity and disgust sensitivity predict blood-injection-injury fears in individuals with dental anxiety.

BACKGROUND: Anxiety sensitivity (AS) and disgust sensitivity (DS) are transdiagnostic vulnerability factors for anxiety. Both correlate with blood-injection-injury (BII) phobia symptoms in several studies; however, there is ambiguity about their relative contributions, and studies investigating this have relied on unselected samples. Furthermore, although DS reliably predicts BII in studies that do not account for AS, this may be limited to domain-specific DS rather than DS more broadly. AIMS: The aims of this study were to examine AS and DS as separate and simultaneous predictors of BII fears in a sample with a wide range of BII symptoms, and with attention to the specificity of DS to BII-relevant domains. METHOD: Fifty-three participants who scored above a clinical threshold on a validated measure of dental anxiety, and who represented a wide range of BII severity, completed measures of AS, DS and BII symptoms. RESULTS: AS and DS were moderately to strongly correlated with BII severity (r = .40 and .47, p = .004 and <.001), and both independently predicted BII severity when entered as simultaneous predictors (ß = .32 and .35, p = .045 and .015). Furthermore, after omitting DS about injections and blood draws, domain-general DS was still moderately correlated with BII severity (r = .33, p = .017). However, domain-general DS did not significantly predict BII severity after accounting for AS (ß = .20, p = .164). CONCLUSIONS: AS and DS both predict BII symptoms, and prospective research is warranted to examine them as potential vulnerability factors.

The use of dental anxiety management techniques during one-session treatment: a study on five video-recorded patient cases.

OBJECTIVE: The aim was to examine what kinds of dental anxiety management techniques dentists use in the context of one-session treatment. MATERIAL AND METHODS: The data consisted of videotaped treatment sessions for five dentally anxious adults. The treatment was conducted by two experienced dentists without formal training in the treatment of dentally anxious patients or behavioral management techniques. Theory-driven qualitative content analysis, based on the anxiety management classification of Milgrom et al. was used to identify and classify the techniques used during the treatments. RESULTS: Altogether, diverse categories of dental anxiety management techniques were identified under the main themes of enhancing trust and control and psychological management. Techniques that fell into enhancing trust and control included the categories of 'building a trustful relationship', 'informational control', and 'behavioral control'. These techniques were used consistently throughout the sessions. Additionally, psychological management techniques were identified and classified as 'behavioral strategies: relaxing the body' and 'cognitive strategies: relaxing the mind', which were regularly used in specific situations. CONCLUSION: The results indicate that a variety of dental anxiety management techniques were used during one-session treatments. The findings provide valuable insights for dentists in managing their patients with dental anxiety and improving their overall treatment experience.

Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial.

BACKGROUND: Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE: The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS: This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. RESULTS: The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). LIMITATIONS: We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. CONCLUSIONS: Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.

Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study.

OBJECTIVES: U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0-3 "no/low fear" zone) and statistically significant changes in global dental fear. METHOD: Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. RESULTS: As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). CONCLUSIONS: This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.

AGGREGATIBACTER ENDOPHTHALMITIS IN A PATIENT WITH DENTOPHOBIA.

PURPOSE: To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia. METHODS: Case report. PATIENTS: A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation. RESULTS: Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis. CONCLUSION: Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.