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.

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. .

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.

Evaluation of psychometric properties of the Dental Anxiety Inventory (DAI-36) questionnaire using iterative hybrid ordinal logistic: Differential item functioning (DIF).

OBJECTIVES: Dental Anxiety Inventory (DAI-36) questionnaire is an instrument for assessing dental anxiety. The different perceptions of the questionnaire items in the individual at the same level of underlying dental anxiety may lead to different reported dental anxieties. This study aims to determine the differential item functioning (DIF) of the DAI-36 measure items. METHODS: The DAI-36 was completed by 950 participants. An iterative hybrid ordinal logistic regression model was used to detect DIF across gender, education, and age groups. DIF analysis was done by lordif package in R3.1.3 software. RESULTS: The chi-square statistics declared 7, 7, and 4 nonuniform DIF items, and 2, 5, and 4 uniform DIF items across gender, education, and age groups, respectively. ΔR2 was always lower than 0.07 in all uniform and nonuniform DIF items. However, Δß1 revealed significant uniform DIF in items 1 and 8 across gender (Δß1(item 1) = 0.0137, Δß1(item 8) = 0.0124) and items 22 and 27 across age categories (Δß1(item 22) = 0.0110, Δß1(item 27) = 0.0136). CONCLUSIONS: DIF items had no large magnitude or cancel out each other, so statements phrased in the DAI-36 questionnaire have equivalent meaning across participants, regardless of their gender, education, and age groups.

The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children.

BACKGROUND: Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care. METHODS: This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model. DISCUSSION: Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group. TRIAL REGISTRATION: This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

Dental clinicians recognizing signs of dental anxiety: a grounded theory study.

INTRODUCTION AND OBJECTIVE: There is a knowledge gap in how dental clinicians recognise dental anxiety. The aim of this study was to identify, describe and generate concepts regarding this process. MATERIALS AND METHODS: Eleven semi-structured interviews were conducted with dental clinicians from the public dental service of Östergötland, Sweden. Purposive and theoretical sampling was used. Theoretical saturation was reached after eight interviews. The interviews were audio-recorded and transcribed verbatim. Classical grounded theory was used to inductively analyse data by constant comparative analysis. RESULTS: The core category was identified as; 'the clinical eye', clinicians noticing behaviours possibly due to dental anxiety based on their knowledge, experiences, or intuition. The core category comprises the five categories: Sympathetic activation, Patient-reported anxiety, Controlling behaviours, Avoidance and Accomplishment. Initially there is usually uncertainty about whether a behaviour is due to dental anxiety or part of a patient's normal behaviour. To gain additional certainty, clinicians need to recognise a stressor as something in the dental setting by observing a change in behaviour, for better or for worse, in the anticipation, presence or removal of the stressor. CONCLUSIONS: Clinicians identify patients as dentally anxious if their behaviour changes with exposure to a stressor.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT.

OBJECTIVE: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. METHODS: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. RESULTS: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. CONCLUSION: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.

Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE.

There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

[Diagnosis and treatment of dental anxiety]. / Diagnostiek en behandeling van angst voor de tandheelkundige behandeling.

Fear of dental treatment is a common phenomenon. Every oral health care provider will have to treat a patient with this fear one day. Adequate diagnostics are essential for a correct assessment of the level of fear and how an anxious patient can best be helped. In cases of mild fear, lowering the state anxiety by teaching the patient coping skills, will suffice. In cases of extreme fear, reducing disposition anxiety (the core of the anxiety disorder) comes first, since this will not only reduce fear during the treatment, but will also halt avoidance behavior, which in the end will have a positive effect on the oral health care of the patient.

Reliability and Validity of the Dental Anxiety Question Used With Children.

OBJECTIVE: Dental fear screening is an important part of providing a positive pediatric dental experience. To improve efficiency, the development of a single-item dental fear assessment tool for children has been desired. In this psychometric analysis, the reliability and validity of the Dental Anxiety Question (DAQ) is studied when used in children aged 7 to 18 years. METHODS: Participants completed the DAQ (pre-tx-DAQ), the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and a demographic information questionnaire before treatment. Participants repeated the DAQ after treatment (post-tx-DAQ) and once more at least 2 weeks later (follow-up-DAQ). Stability reliability within the DAQ scores and criterion validity with the CFSS-DS were evaluated. RESULTS: Stability reliability analyses between pre-tx-DAQ/post-tx-DAQ and post-tx-DAQ/follow-up-DAQ demonstrated significant positive correlations: Spearman rank correlation coefficient (rs) = 0.420, rs2 = 0.18, P < .001, and rs = 0.563, rs2 = 0.32, P < .001, respectively. Criterion validity analysis between the pre-tx-DAQ and CFSS-DS also demonstrated a significant correlation: Pearson correlation coefficient (r) = 0.584, r2 = 0.34, P < .001. CONCLUSION: The stability reliability and criterion validity of the DAQ was proved among children.

Enhancing special care dentistry with sensory-adapted dental environment: A comparative study.

Aim: To compare and evaluate the effect of sensory-adapted dental environment (SADE) and regular dental environment in reducing anxiety levels in children with intellectual disabilities. Materials and Methods: This study was carried out in children with mild intellectual disabilities aged 8-13 years. The developmental screening test was utilized in screening and including these children with IQ scores between 52 and 67, and after random allocation, children were subjected to oral prophylaxis in the SADE and regular dental environment. Anxiety levels were assessed at baseline, 5 min, and at the end of the procedure using Venham's anxiety rating scale, pulse rate, and blood pressure values. Results: The data were coded and analyzed using software SPSS (IBM version 22.0) for statistical analysis. Comparison between the groups was done using independent t-test and repeated measured ANOVA for objective assessment of intergroup and intragroup anxiety levels, respectively, and using Mann-Whitney U-test and Friedman's test for subjective assessment of intergroup and intragroup anxiety levels, respectively. Conclusion: These findings suggest that SADE significantly decreased anxiety levels and cooperative behavior in children with mild intellectual disability and can be used as an alternative behavior management technique in effectively handling children with intellectual disability.

Psychometric Properties of the Hebrew Modified Dental Anxiety Scale in Adult Israeli Population.

Dental anxiety results in the neglect of oral hygiene and poor oral health, requiring an accurate screening tool for dental practitioners to evaluate dental anxiety. The Modified Dental Anxiety Scale (MDAS) is frequently used cross-culturally. The present study aimed to assess the reliability and validity of the Hebrew version of the MDSA. A total of 553 (mean age 35.87 years, SD = 13.14) Israeli participants were recruited through means of social media, mailing lists, and forums. The sample was randomly divided into two population sets. Dental anxiety was evaluated using the Hebrew version of the MDAS. The psychometric evaluation consisted of exploratory factor analysis (study 1, n = 274) and confirmatory factor analysis (study 2, n = 279). Cronbach's alpha coefficient was used to assess internal consistency. Results showed high internal consistency (0.93) for the Hebrew version of the MDAS. Confirmatory factor analysis showed a single factor solution. Findings demonstrated 13.4% of Israeli participants with dental anxiety. Younger participants, females, participants with lower education, lower income, and more religious participants reported higher dental anxiety. In conclusion, the Hebrew version of the MDAS demonstrated high reliability and validity. It is recommended to use the Hebrew version of the MDAS to evaluate dental anxiety in Israeli dental settings.

The methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology: a cross-sectional study.

BACKGROUND: Dental phobia is covered by medical insurance; however, the diagnostic methods are not standardized in Japan. Therefore, the aim of this study was to investigate the methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology. METHODS: We conducted an online survey to obtain information from the members of the Japanese Society for Disability and Oral Health (JSDH, n = 5134) and the Japanese Dental Society of Anesthesiology (JDSA, n = 2759). Response items included gender, qualification, affiliation type, methods of diagnosis and management of dental phobia, use of questionnaire, need to establish standardized diagnostic method for dental phobia, and others. The chi-squared test was used to compare answers between the three groups: JSDH only, JDSA only, and both JSDH and JDSA. Multiple logistic regression analysis was conducted to identify factors associated with the use of an assessment questionnaire. RESULTS: Data were obtained from 614 practitioners (JSDH only, n = 329; JDSA only, n = 195; both JSDH and JDSA: n = 90, response rate: 7.8% [614/7,893], men: n = 364 [58.5%]). Only 9.7% of practitioners used questionnaires to quantify the level of dental anxiety. The members of both JSDH and JDSA group used questionnaires more frequently than members of the JSDH only (19% and 7.1%, respectively; Bonferroni corrected p < 0.01). Most practitioners (89.1%) diagnosed dental phobia based on patient complaints of fear of treatment. Furthermore, majority of the participants (73.3%) felt the need to establish standardized diagnostic method for "dental phobia." Multiple logistic regression analysis showed that membership of the JSDH only was negatively related (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.13-0.60), and use of behavioral therapy was positively related (OR 2.34, 95% CI 1.18-4.84) to the use of a questionnaire. CONCLUSIONS: The results of this study showed that the use of questionnaires was very low, patients' subjective opinions were commonly used to diagnose dental phobia, and a standardized diagnostic criterion was thus needed among practitioners. Therefore, it is necessary to establish diagnostic criteria for dental phobia in line with the Japanese clinical system and to educate dentists about them.

Anxiety/fear of dental treatment during pregnancy: use of the Modified Dental Anxiety Scale.

BACKGROUND: Despite advances in the control of anxiety and fear, dental treatment (DT) continues to be a stressful event, especially during pregnancy. There are several instruments to measure anxiety and fear about DT (AFDT). However, few are validated for use in Brazil. Our objective was to validate the Modified Dental Anxiety Scale (MDAS) for use in Brazil and to evaluate the association between AFDT and the use of oral health services (OHS) during pregnancy. METHODS: This is a cross-sectional study nested in a prospective cohort. We conducted a face, content, and construct validation. The Visual Analogue Scale (VAS) was the comparison instrument with MDAS. Sociodemographic and behavioral characteristics were also assessed. Associations were estimated by odds ratios (OR) and 95% confidence intervals (95%CI) in multiple logistic regression analysis (alpha = 5%). RESULTS: There were no difficulties in the translation/back-translation process. The reproducibility of the instrument was 0.54 (P=0.01). The correlation of MDAS with VAS was 0.71 (P=0.003). The reliability of the instrument was high (Cronbach's alpha: 0.79 to 0.87). After validation, the instrument was administered to 486 women. Mild or moderate AFDT was reported by 81.3% of pregnant women and at higher levels, by 8.2%. There was no association between the use of OHS and AFDT at moderate levels (OR=2.03; 95%CI: 0.45-9.09) or high (OR=1.35; 95%CI: 0.20-9.13). CONCLUSIONS: MDAS is a valid instrument for measuring AFDT. The prevalence of AFDT among pregnant women is high, but this event does not seem to be associated with the use of OHS.

Turkish version of the faces version of the Modified Child Dental Anxiety Scale (MCDASf): translation, reliability, and validity.

OBJECTIVES: To cross-culturally adapt of MCDASf into Turkish and to evaluate reliability and validity of the Turkish version of MCDASf using explorative factor analysis (EFA), confirmatory factor analysis (CFA), and receiver operating characteristic (ROC) analysis to form a less time consuming and easy to understand tool for measuring dental anxiety. MATERIALS AND METHODS: A total of 300 children (174 females, 126 males) aged 6-12 years who were recruited at the Department of Paediatric Dentistry in RTEU at the first visit participated in the present study. For the internal consistency reliability, Cronbach's alpha was calculated. Intraclass correlation coefficients (ICCs) were calculated for test-retest reliability (n=67). Construct validity was determined by comparing with the Venham Picture Test (VPT). The factor structure was examined using EFA. CFA was used for dimensionality. The cut-off points of the Turkish version of MCDASf were plotted using a ROC curve. RESULTS: The Turkish version of MCDASf showed high internal consistency (0.703) and an excellent ICC value (0.827). Good correlations were found between the global scores of MCDASf and VPT (r=0.632). Three factors were identified from EFA and verified with CFA. Discriminant validity was supported by high scores of females and younger children (p<0.05). The cut-off point was assigned as >24.50. The area under the ROC curve (AUC) was 0.921 (95% CI: 0.873-0.969). CONCLUSIONS: The Turkish version of the MCDASf is a reliable and valid scale that satisfied psychometric properties. CLINICAL RELEVANCE: The Turkish version of MCDASf is a usable tool for the measurement of dental anxiety among Turkish speaking children.

Translation and validation of modified dental anxiety scale based on adult Taiwan population.

BACKGROUND: Dental anxiety is associated with negative experiences of dental treatment and dental-visiting behavior. The Modified Dental Anxiety Scale (MDAS) is widely used for assessing dental anxiety. The study aims to establish the psychometric properties of a Chinese version of the MDAS based on the Taiwan sample (i.e., T-MDAS). METHODS: The T-MDAS and dental-visiting behavior and experience were assessed for 402 adult subjects recruited from community and clinical sites. The following psychometric properties were assessed: (a) internal consistency, (b) temporal stability, (c) criterion-related validity (i.e., the association with the score of Index of Dental Anxiety and Fear, IDAF-4C), (d) discrimination validity (i.e., the difference in scores between the subjects with and without a habit of a regular dental visit, and (e) the construct validity from a confirmatory factor analysis (CFA). RESULTS: The T-MDAS showed good internal consistency (Cronbach's α = 0.88) and temporal stability (ρ = 0.69, p < 0.001). The score was significantly correlated with the score of the IDAF-4C (ρ = 0.76, p < 0.001) and differed between subjects who regularly visited a dentist or not, supporting good criterion-related validity and discrimination validity. Results from CFA supports good construct validity. Furthermore, higher dental anxiety was related to the lack of a regular dental visit, feeling pain during treatment, and feeling insufficient skills and empathy of dentists. A higher proportion of high-dental anxiety subjects in female subjects (8.5%), compared to male subjects (5.0%), was noted. CONCLUSIONS: The T-MDAS is a valid tool for assessing adult dental anxiety. The score is highly associated with dental-visiting behavior and experience of dental patients.

Psychometric evaluation of the Lebanese Arabic version of the Dental Fear Survey: a cross-sectional study.

BACKGROUND: Dental fear is a prevalent problem that can lead to poor dental health. The Kleinknecht's Dental Fear Survey (DFS) is one of the used scales to assess dental fear. The present study aims to evaluate the psychometric properties of the Lebanese Arabic version of the DFS (DFS-A) and to determine the optimal cut-off to identify dental fear as well as the correlates of dental fear in a group of Lebanese adults dental patients. METHODS: A cross-sectional study was conducted among a group of 442 dental patients (18-65 years) recruited at 29 dental clinics from March to June 2019. Patients completed a questionnaire including questions about demographic characteristics, previous bad dental experience, trauma's experience period, the sensation of nausea during dental treatment, the DFS-A scale, the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A), and a general question about dental fear. RESULTS: DFS-A revealed evidence of adequate psychometric properties. DFS-A scale demonstrated high internal consistency (cronbach's alpha = 0.93). Test-retest reliability assessment demonstrated strong reproducibility of the DFS-A scale score (ICC = 0.92 with 95% CI (0.83-0.96), p value < 0.0001 (N = 30). Confirmatory factor analysis revealed a three-factor structure of the DFS-A reflecting fear associated with specific dental stimuli and procedures, patterns of dental avoidance and anticipatory anxiety, and physiologic arousal during dental treatment. A significant correlation was found between DFS-A and the MDAS-A indicating a good convergent validity. The optimal cut-off point to identify patients with and without dental fear is 41. Considering this cut-off score, the prevalence of dental fear in our sample was reported at 33.8%. Multivariable analysis showed that having previous scary and painful dental experiences, a sensation of nausea during treatment, and having dental anxiety were identified as predictors of dental fear. CONCLUSION: The adapted Arabic version of the DFS (DFS-A) is a valid tool to evaluate dental fear among Lebanese adult patients.

Pain perception and dental anxiety during periodontal probing in patients visiting community oral health programme: a cross sectional study.

BACKGROUND: Periodontal probing is one of the basic clinical oral examination procedures. It is carried out to assess the severity of gingival and periodontal disease. The experience of pain during probing may discourage patients. So, this study was conducted to estimate the pain perception and dental anxiety experienced during periodontal probing in patients visiting the community oral health programmes of B. P. Koirala Institute of Health Sciences (BPKIHS). METHODS: A cross-sectional study was conducted among 100 participants of community oral health programmes of BPKIHS. Demographic profile, WHO modified Community Periodontal Index (CPI) 2013, Pain perception via Visual Analogue Scale (VAS Scores) and Short Version of Spielberger State-Trait Anxiety Inventory (STAI) Self-evaluation Questionnaire (Y-6 item) were assessed. Mean ± SD and Spearman correlation for pain and anxiety were computed. RESULTS: Only 10% of the study participants had healthy gingiva and 12% had periodontal pockets. Pain perception and dental anxiety was present in the participants. The participants experienced very little pain (6.75 ± 10.65) during periodontal probing. The overall anxiety score was 13.37 ± 1.81. There was a very weak correlation between the VAS Scores and the anxiety scores of the participants. CONCLUSION: This study concludes that pain perception and anxiety are low during periodontal probing. There was no correlation between bleeding on probing with pain and anxiety among the people visiting community oral health programmes of BPKIHS.

Assessment of dental anxiety and dental phobia among adults in Lebanon.

BACKGROUND: Dental anxiety continues to be a widespread problem affecting adult populations. The primary aim of our study was to evaluate the psychometric properties of the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A) and to identify the optimal cut-off for assessing dental anxiety and dental phobia among adults in Lebanon. In addition, we sought to assess dental anxiety and phobia as well as their correlates among Lebanese adult patients. METHODS: A cross-sectional study was carried out on a sample of 451 dental adult patients aged between 18 and 65 years old. Information about demographic characteristics, previous bad dental experience, trauma's experience period, perception of a periodontal problem, sensation of nausea during dental treatment, the MDAS-A scale, and the Visual Analogue Scale for anxiety (VAS-A) were collected. RESULTS: MDAS-A exhibited evidence of adequate psychometric properties. The optimal cut-off was 12 for dental anxiety and 14 for dental phobia. Out of the total sample, 31.5% suffered from dental anxiety while 22.4% had a dental phobia. Multivariable analysis showed that the odds of dental anxiety and phobia were higher among females compared to males. Also, patients suffering from periodontal problem perceptions, bad dental experiences during childhood and adolescence, and the sensation of nausea during dental treatment were at a higher risk of developing dental anxiety and phobia compared to their counterparts. However, a higher level of education was found to be a protective factor against dental phobia among Lebanese adult patients. CONCLUSION: The MDAS-A scale is a suitable tool for the routine assessment of dental anxiety and phobia among Lebanese adult patients. Identifying patients with dental anxiety at the earliest opportunity is of utmost importance for delivering successful dental care.