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.

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).

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.

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.

Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits.

Managing the anxiety of children during dental care is a major aspect of a pediatric dentist's work. Only a sparse body of literature is available regarding anxiety during dental care over consecutive visits. The purpose of the study was to investigate anxiety over three consecutive visits for pediatric dental treatment using an electrodermal activity (EDA) device. We also investigated how patient age, gender, the type of dental care performed and previous dental experience, exerted effect on anxiety.This was an observational cohort study. Anxiety was assessed during treatment, using an EDA device. We also recorded Frankl's behavior rating, previous dental experience, behavior guidance technique, heart rate and the type of dental care. Our cohort included 30 healthy children aged 4-6 years who needed dental care over at least three visits. Frankl scale scores, EDA values and heart rate did not differ significantly between visits. Behavior and anxiety during treatment did not differ significantly according to gender and age. At the second visit, the Frankl score was higher in children who received pulp treatments and crowns than those who received restorations (p = 0.012). At the third visit, children who received pulp treatments and crowns had higher heart rates than those who received restorations (p = 0.011). Heart rate was significantly higher in children who had negative dental experiences when compared to those with positive experiences (p = 0.030). The levels of anxiety in children aged 4-6 years did not change significantly over three consecutive dental treatments. Therefore, varied and meticulous behavior management methods should be maintained throughout consecutive visits.

Behavior and anxiety levels in pediatric patient: The behavioral changes and anxiety of pediatric patient in dental clinic.

AIM: The aim of this study is to evaluate the behavioral patterns and anxiety levels of pediatric patients in dental clinics, discern their behavioral expectations, and investigate the associations between these factors and the patient's age and gender. METHODS: In this cross-sectional study, 150 pediatric patients visiting Sharjah Thumbay Dental Hospital for treatment were recruited over a study period of 23 weeks (February 12, 2022 to July 23, 2022). The patient's age ranged from 2 to 14 years. Guardians were informed about the study and their written consent was taken. EXCLUSION CRITERIA: Children over 14 years old, children whose guardians refused to participate in the study, and medically compromised children. Frankl's behavior rating scale, Categorical rating scale, and Venham anxiety and behavioral rating scales were used to evaluate the pediatric patient's behavior and anxiety at the end of the dental visit, the evaluation was done by the same trained dental student for all the patients. RESULTS: When the Mann-Whitney U test was used for gender, no significant differences were observed in behavior and anxiety between male and female patients across all scales employed in this study. Conversely, when examining various age groups for behavior and anxiety using the Kruskal-Wallis test, significant findings emerged across nearly all scales. In the categorical rating scale, the age group of 11-14 years exhibited the most notable results in subscales of crying (p = .034), cooperativeness (p = .002), and apprehensiveness (p = .003). CONCLUSION: The pediatric patients who took part in this study exhibited heightened anxiety when attending dental clinics. This study underscores the importance of understanding child behavior and utilizing effective communication with children and their guardians. Dental professionals should consider implementing strategies to manage child behavior during visits. Further research is required to develop sufficient strategies tailored to different pediatric populations, aiming to enhance dental care outcomes for pediatric patients.

Predictive and Relative factors of Dental Anxiety among Third Molar Disimpaction Patients in a Northern Nigerian Hospital.

INTRODUCTION: Various factors influence the expression of dental anxiety (DA) among patients. Knowledge of these factors may aid the management of mandibular third molar (M3) dis-impaction patients. AIM: The study aimed to determine the predictive and relative factors of DA among Mandibular third molar (M3) dis-impaction patients at the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. METHODOLOGY: The study was a cross-sectional type conducted at the Oral Surgery clinic of AKTH, Kano among M3 dis-impaction patients between September 2016 and August 2017. Biodata and information on the past dental history of the participants were collected and recorded. The level of anxiety of participants was assessed with the Modified Dental Anxiety Scale (MDAS). Data were analyzed using Statistical Package for Social Sciences (SPSS) for windows (IBM SPSS statistic version 23). The significance level in the study was set at p ≤ 0.05. RESULTS: One hundred and sixteen patients comprising 62(55.2%) males and 54(44.8%) females were recruited. The sample's median age was 27 years and the majority of the participants were students (n=49,42.2%). The participants' MDAS scores ranged from 5 to 22 with a median score of 11. Females (median MDAS score of 12.50) were significantly (p<0.0001) more anxious than males (median MDAS score of 9.00). Bivariate analysis showed statistically significant differences in DA of the categories of the following independent variables - gender (p<0.0001), ethnicity (p=0.041), occupational status (p=0.044), previous surgical extraction experience (p=0.006), previous bad dental treatment experience (p<0.0001) and history of postponement of dental treatment due to anxiety(p<0.0001). Binary logistic regression analysis with these variables as independent predictors of DA showed that only gender (p=0.013) and previous surgical extraction experience (p=0.042) had statistically significant odds of predicting dental anxiety among the patients. Females had significantly higher odds of being anxious than males [adjusted odds ratio (OR) = 4.180, 95% Confidence Interval (CI)=1.359 to 12.852] and patients with previous surgical extraction experience had higher odds of being anxious than those without surgical extraction experience [adjusted OR=3.65, 95% CI=1.02 to 13.03]. CONCLUSION: The predictors of DA in the study are female gender and previous surgical extraction experience. These and other DA-related factors such as patients' occupation and previous bad dental treatment experiences should be considered preoperatively to identify and manage anxious M3 dis-impaction patients.

INTRODUCTION: Divers facteurs influencent l'expression de l'anxiété dentaire (AD) chez les patients. La connaissance de ces facteurs peut aider à la prise en charge des patients subissant l'extraction des troisièmes molaires mandibulaires (M3). OBJECTIF: L'étude visait à déterminer les facteurs prédictifs et relatifs de l'AD chez les patients subissant l'extraction des troisièmes molaires mandibulaires (M3) à l'Hôpital Universitaire Aminu Kano (AKTH) de Kano, au Nigeria. MÉTHODOLOGIE: L'étude était de type transversal et a été menée à la clinique de chirurgie buccale de l'AKTH, à Kano, auprès de patients subissant l'extraction des M3 entre septembre 2016 et août 2017. Les données biométriques et les antécédents dentaires des participants ont été recueillis et enregistrés. Le niveau d'anxiété des participants a été évalué à l'aide de l'Échelle d'Anxiété Dentaire Modifiée (MDAS). Les données ont été analysées à l'aide du logiciel Statistical Package for Social Sciences (SPSS) pour Windows (version IBM SPSS 23). Le seuil de signification de l'étude a été fixé à p ≤ 0,05. RÉSULTATS: Cent seize patients, dont 62 (55,2 %) hommes et 54 (44,8 %) femmes, ont été recrutés. L'âge médian de l'échantillon était de 27 ans et la majorité des participants étaient des étudiants (n=49, 42,2 %). Les scores MDAS des participants variaient de 5 à 22, avec un score médian de 11. Les femmes (score MDAS médian de 12,50) étaient significativement (p<0,0001) plus anxieuses que les hommes (score MDAS médian de 9,00). L'analyse bivariée a montré des différences statistiquement significatives dans l'AD des catégories des variables indépendantes suivantes : le sexe (p<0,0001), l'ethnicité (p=0,041), le statut professionnel (p=0,044), l'expérience d'extraction chirurgicale antérieure (p=0,006), l'expérience antérieure de mauvais traitement dentaire (p<0,0001) et l'histoire du report du traitement dentaire en raison de l'anxiété (p<0,0001). L'analyse de régression logistique binaire avec ces variables comme prédicteurs indépendants de l'AD a montré que seul le sexe (p=0,013) et l'expérience d'extraction chirurgicale antérieure (p=0,042) avaient des cotes de prédiction statistiquement significatives de l'anxiété dentaire chez les patients. Les femmes avaient des chances significativement plus élevées d'être anxieuses que les hommes [rapport de cotes ajusté (OR) = 4,180, intervalle de confiance à 95 % (IC) = 1,359 à 12,852] et les patients ayant déjà subi une extraction chirurgicale avaient des chances plus élevées d'être anxieux que ceux n'ayant pas d'expérience d'extraction chirurgicale [OR ajusté = 3,65, IC à 95 % = 1,02 à 13,03]. CONCLUSION: Les facteurs prédictifs de l'AD dans l'étude sont le sexe féminin et l'expérience antérieure d'extraction chirurgicale. Ces facteurs liés à l'AD et d'autres facteurs tels que l'occupation des patients et les expériences antérieures de mauvais traitement dentaire devraient être pris en compte en préopératoire pour identifier et prendre en charge les patients anxieux subissant l'extraction des M3. Mots-clés: anxiété dentaire, facteurs, troisième molaire, extraction.

Associations between maternal mental health, child dental anxiety, and oral health of 6- to 12-year-olds in Nigeria.

Maternal mental health affects their children's oral health. This study assessed the associations between maternal mental health and dental anxiety level, dental caries experience, oral hygiene, and gingival status among 6- to 12-year-old children in Nigeria. This was a cross-sectional study that recruited mother-child dyad participants through a household survey conducted in Ile-Ife, Nigeria. Data collected included the independent (maternal mental health risk, depressive symptoms, and child's dental anxiety), and dependent (caries experience, oral hygiene status, and gingival health status) variables. Multivariate logistic regression analysis was conducted to determine the associations between dependent and independent variables after adjusting for confounders (mothers' age, child's age, sex, and socioeconomic status). Statistical significance was set at p < 0.05. Of the 1411 mothers recruited, 1248 (88.4%) had low mental health risk, and 896 (63.5%) had mild depressive symptoms. As for the children, 53 (3.8%) had caries, 745 (52.8%) had moderate to high dental anxiety, 953 (63.0%) had gingivitis and 36 (2.6%) had poor oral hygiene. The maternal mental health risk was not significantly associated with the child's caries experience (AOR: 1.012; 95%CI: 0.860-1.190; p = 0.886), poor oral hygiene (AOR:1.037; 95%CI: 0.975-1.104; p=0.250), and moderate/severe gingivitis (AOR:0.887; 95%CI: 0.764-1.030; p = 0.115). Maternal depression status was not significantly associated with the child's caries experience (AOR: 0.910; 95%CI: 0.802-1.033; p = 0.145), poor oral hygiene (AOR: 1.016; 95%CI: 0.976-1.057; p = 0.439), and moderate/severe gingivitis (AOR: 0.963; 95%CI: 0.861-1.077; p = 0.509). Maternal mental health risk and depression do not seem to be risk factors for schoolchildren's oral health in Nigeria. Further studies are needed to understand these findings.

Prevalence and Socio-Demographic Correlates of Dental Anxiety among a Group of Adult Patients Attending Dental Outpatient Clinics: A Study from UAE.

OBJECTIVES: The aims of this paper were twofold: first, to evaluate dental anxiety levels among patients undergoing oral surgery procedures; second, to assess how dental anxiety and fear are connected to age, gender, educational background, past traumatic experiences, and the frequency of dental appointments. METHODS: A cross-sectional Likert-scale questionnaire survey was conducted to collect quantitative data from 206 patients at the Oral Surgery Clinics at Dubai Dental Clinics, Dubai, United Arab Emirates. The reliability and validity of the questionnaire were tested using Cronbach's alpha. The normality of the MDAS score was tested using the Kolmogorov-Smirnov test. The chi square and Kruskal-Wallis tests were used to determine the association between categorical variables. Descriptive statistics were used to describe continuous and categorical variables. The statistical significance was set at p-value ≤ 0.05. RESULTS: The evaluation of the degree of dental anxiety among patients who visited the Dubai Dental clinics revealed that there was a considerably high level of moderate or high anxiety (72.3%). Tooth extraction and dental surgery procedures (95%), followed by local anesthetic injection in the gingiva (85%) and teeth drilling (70%), were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety (35%). There was no substantial difference in dental anxiety between male and female patients or among patients with different marital statuses. A total of 70% of patients preferred the tell-show-do method, whereas 65% chose communication strategies to reduce dental anxiety. CONCLUSIONS: The evaluation of the degree of dental anxiety among patients who visited Dubai Dental clinics revealed that there was a considerably high level of anxiety. Tooth extraction and dental surgery procedures, followed by local anesthetic injection and teeth drilling, were the primary causes of anxiety, whereas scaling and polishing resulted in the lowest degree of anxiety. Despite the use of a modified anxiety scale and a large and representative sample of oral surgery patients, more research is necessary to investigate the impact of various factors on dental anxiety.

Relationship between dental anxiety levels and oral health among dental patients in Turkey: a cross-sectional study.

BACKGROUND: This study aimed to determine the relationship between dental anxiety and oral health in adult patients who applied to the Department of Restorative Dentistry at the Faculty of Dentistry at Suleyman Demirel University. METHODS: The study included 500 subjects. The dental anxiety levels of the patients were determined using a modified dental anxiety scale (MDAS). Information on sociodemographic details, oral hygiene and nutritional habits were recorded. Intraoral examinations of the subjects were performed. Caries prevalence of individuals was determined using the decayed, missing or filled teeth (DMFT) and decayed, missing, or filled surfaces (DMFS) indices. Gingival health was evaluated using the gingival index (GI). Statistical analyses were performed using the Mann-Whitney U, Kruskal-Wallis and Chi-square tests and Spearman correlation analysis. RESULTS: The ages of the 276 female and 224 male participants ranged from 18-84 years. The median MDAS value was 9.00. The median DMFT and DMFS values were 10.00 and 23.00, respectively. The median MDAS values ​​of women were higher than those of men. Individuals who postponed their appointment had a higher MDAS median value than those who did not (Mann-Whitney U test, p < 0.05). No statistically significant correlation was found between dental anxiety level (MDAS) and GI, DMFT and DMFS index scores (Spearman correlation analysis, p > 0.05). CONCLUSION: The MDAS values of individuals who did not remember the reason for their dental visit were higher than those who visited the dentist for routine control. Based on the findings of this study, further research on the relationship between dental anxiety and oral health is necessary to determine the factors that pose a risk for dental anxiety and to ensure the regular benefits of dental services.

Pathways to dental fear from childhood to adolescence: A 10-year cohort study.

BACKGROUND: Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence. AIM: This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time. DESIGN: This is a prospective cohort study, with 10 years of follow-up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1-5 years from Southern Brazil. For this study, the follow-up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Socio-economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS-DS scores at T2. RESULTS: Of the 639 children, 429 were re-evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow-up. CONCLUSION: Our findings suggest that socio-economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence.

Caracterización de la ansiedad al tratamiento estomatológico en pacientes adultos de La Habana / Characterization of anxiety to stomatological treatment in adult patients from Havana

Introducción: La ansiedad al tratamiento estomatológico es un evento psicológico presente en pacientes de diferentes continentes y culturas. Objetivo: Describir características epidemiológicas de la ansiedad al tratamiento estomatológico en una población cubana. Método: Estudio descriptivo, transversal en 240 pacientes adultos de La Habana. Como instrumentos de medida se utilizó la escala ansiedad al tratamiento estomatológico, versión cubana, y un cuestionario referido a datos sociodemográficos y etiológicos. Los instrumentos se aplicaron en la sala de espera de las unidades asistenciales seleccionadas. La prueba ji al cuadrado se utilizó para establecer asociaciones entre variables y el coeficiente de contingencia para expresar la intensidad de la relación. Resultados: Se obtuvo una prevalencia de 88,7 por ciento y un predominio de ansiedad moderada y severa del 34,6 por ciento y 30,4 por ciento, respectivamente. El grupo etario de 20 a 34 años predominó en la categoría de ansiedad severa y las mujeres en la moderada. Los pacientes que viven sin pareja, con nivel educacional de secundaria y preuniversitario presentaron ansiedad moderada y severa. Los factores etiológicos tipo de tratamiento y relación médico-paciente inadecuada se agruparon en su mayoría en la categoría de ansiedad moderada. Conclusiones: La ansiedad al tratamiento estomatológico tiene una alta prevalencia en la población cubana. Epidemiológicamente se caracterizó por niveles moderado y severo, en el sexo femenino, trabajadores y en el nivel medio escolar. Todos los factores etiológicos estuvieron relacionados con el desarrollo de la ansiedad al tratamiento estomatológico(AU)

Introduction: Anxiety to dental treatment is a psychological event present in patients from different continents and cultures. Objective: To describe epidemiological characteristics of anxiety to dental treatment in a Cuban population. Method: A descriptive, cross-sectional study was conducted in 240 adult patients from Havana. As measurement instruments, a Cuban version of the anxiety scale to stomatological treatment and a questionnaire referring to sociodemographic and etiological data were used. The instruments were applied in the waiting room of the selected care units. The Ji-square test was used to establish associations between variables and the contingency coefficient to express the intensity of the relationship. Results: A prevalence of 88.7 percent and a predominance of moderate and severe anxiety of 34.6 percent and 30.4 percent, respectively, were obtained. The age group from 20 to 34 years prevailed in the category of severe anxiety and women in moderate. Patients who live without a partner, with secondary and pre-university educational levels, showed moderate and severe anxiety. The etiological factors type of treatment and inadequate medical-patient relationship were mostly grouped in the category of moderate anxiety. Conclusions: Anxiety to dental treatment has high prevalence in the Cuban population. Epidemiologically, it was characterized by moderate and severe levels, in the female sex, workers and in the middle school level. All the etiological factors were related to the development of anxiety to dental treatment(AU)

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting.

BACKGROUND: Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. OBJECTIVE: The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting. METHODS: This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program. RESULTS: The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2  = 53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR = 1.052, p = 0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR = 10.990, p < 0.001). CONCLUSION: It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

A Cross-Sectional Study on Cognitive Vulnerability Patterns in Dental Anxiety: The Italian Validation of the Dental Fear Maintenance Questionnaire (DFMQ).

Dental anxiety is a crucial problem for dentistry because it may represent a significant risk to oral health. Within the framework of the Cognitive Vulnerability Model (CVM), which sheds light on the cognitive vulnerability patterns that may cause dental anxiety, this study aimed to assess the psychometric characteristics of the Italian version of the Dental Fear Maintenance Questionnaire (DFMQ). The DFMQ is a 32-item questionnaire that assesses four cognitive vulnerability patterns, i.e., dangerousness, disgust, unpredictability, and uncontrollability. In a sample of 200 dental patients who had accessed public-university-hospital dental surgery, this study assessed the model fit of the DFMQ and different types of validity (i.e., predictive, convergent, construct, and discriminant validity). In addition, potential differences between DFMQ dimensions were assessed based on gender (men vs. women) and age ranges. All indicators of cognitive vulnerability were significantly associated with high dental anxiety when each variable was included independently. In contrast, when the DFMQ subscales were considered together, only unpredictability and uncontrollability were found to be associated with high dental anxiety. Women had higher scores for unpredictability, uncontrollability, and general dangerousness than men. In addition, older patients had higher scores for some vulnerability cognitive patterns than younger patients. This study provides Italian dentists and researchers with a valid questionnaire to assess cognitive factors associated with dental anxiety.

Relation between anxiety disorders in adolescent mothers and dental fear in children.

BACKGROUND: Maternal anxiety disorders can cause adverse consequences in child's health, cognitive development, and behavior. AIM: To investigate the association of maternal anxiety disorders with the occurrence of dental fear in children aged 24-36 months. DESIGN: This cross-sectional study is part of a cohort of adolescent mothers and their children (n = 527) in the city of Pelotas, RS, Brazil. Anxiety disorders in mothers were assessed using Mini International Neuropsychiatric Interview (DSM-IV), whereas the Dental Anxiety Question was used to assess children's dental fear. Clinical oral examinations were performed on the cohort. Poisson regression analysis was used to determine the association of maternal anxiety disorders with maternal perception of dental fear in children (p < .05). RESULTS: The prevalence of dental fear in children was 21.7% (n = 114), and maternal age, agoraphobia, social phobia, and maternal caries experience (p < .05) were associated with the presence of dental fear. After adjusted analysis, children of mothers presenting with agoraphobia (Prevalence ratios [PR] = 1.52; 95% confidence interval [CI] = 1.00-2.32) and social phobia (PR = 1.69; 95% CI = 1.06-2.71) had higher prevalence of dental fear than children whose mothers did not have any of these conditions. CONCLUSIONS: In this population of young mothers, agoraphobia and social phobia were associated with children's dental fear. Detection of and treatment for maternal mental disorders may aid in the prevention of dental fear and its oral health-related consequences.

Perceived experiences of racism linked to dental fear and anxiety among Black women.

OBJECTIVES: Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort. METHODS: Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders. RESULTS: Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively). CONCLUSIONS: Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.

Associations between oral habits, dental anxiety, dental service utilization, and maternal mental health status among 6- to 12-year-old children in Ile-Ife, Nigeria.

PURPOSE: The current study sought to determine the associations between maternal mental health and oral habits, dental anxiety, and dental service utilization of 6- to 12-year-old children in Ile-Ife, Nigeria. METHODS: Data were obtained from a household survey involving 1411 mothers and their 6- to 12-year-old children. Data collected were the confounding (maternal age, child's age at last birthday, sex at birth and socioeconomic status), independent (maternal psychological distress, and depression status) and dependent (child's non-nutritive oral habits, dental anxiety level, and most recent dental visit) variables. Bivariate analyses were conducted to test the associations between the dependent and independent variables. After controlling for confounding variables, the associations between the dependent and independent variables were determined using multivariable linear and logistic regression analyses. RESULTS: Overall, 479 (33.9%) reported one oral habit, 189 (13.4%) reported two and 99 (7.0%) children reported three or more oral habits. Only 25 (1.7%) children reported a dental visit in the year preceding the study. Higher maternal psychological distress was associated with higher dental anxiety in children (AOR: 0.094; 95% CI - 0.080 to - 0.293; p < 0.001). There was no significant association between maternal psychological distress, child's non-nutritive oral habits, and the child's most recent dental visit. There was also no association between maternal depression and the child's non-nutritive oral habits, dental anxiety level, and most recent dental visit. CONCLUSION: Maternal psychological distress was a significant risk indicator for dental anxiety, but not for dental service utilization or non-nutritive oral habits among children in Ile-Ife, Nigeria. Maternal educational status was also associated with dental anxiety. Further research is needed to elucidate the study's findings.

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.

Prevalence of Dental Fear and its Association with Painful Oral Conditions in Adolescents

ABSTRACT Objective: To estimate the prevalence of dental fear and evaluate its association with dental caries and with Molar Incisor Hypomineralization (MIH) in schoolchildren aged 11-14 years. Material and Methods: A cross-sectional study was conducted with 375 adolescents in Campina Grande, Brazil. Socioeconomic and oral health information was collected, while dental fear was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The diagnosis of dental caries and MIH was performed by three trained examiners (κ ≥ 0.61) using the International Caries Detection & Assessment System - ICDAS II and a previously validated index, respectively. Data were descriptively analyzed using the Chi-Square, Fisher's Exact, and Poisson regression tests with robust variance (p<0.05). Results: The prevalence of dental fear was 18.4%, and the mean CFSS-DS total score was 28.96 ± 8.92. After adjusting for covariates family structure, schooling of parents/guardians, type of dental health service and dental pain in the last six months, the prevalence of dental fear was associated with dental pain in the last six months (PR=2.03; 95%CI=1.31-3.16; p=0.002). Conclusion: Although no association was found between dental fear, dental caries and MIH in adolescents, those who experienced dental pain in the last six months had a higher prevalence of dental fear.

Prevalence of dental anxiety among adults in China: a Meta-analysis.

OBJECTIVES: This study aimed to systematically evaluate the prevalence of dental anxiety in Chinese adults and to provide references for decision making on oral healthcare. METHODS: We searched PubMed, Web of Science, Ebsco, Embase, The Cochrane Library, WanFang Data, CNKI, and VIP database to collect cross-sectional studies on dental anxiety in Chinese adults from the establishment of the databases to 30 September 2022. After literature screening, data extraction, and evaluation of the risk of bias in the included studies by two researchers independently, R 4.0.4 software was used to perform a Meta-analysis. RESULTS: A total of 39 studies were included, including 24 309 subjects. Meta-analysis showed that the prevalence of dental anxiety in Chinese adults was 35.39% [95%CI (31.31%, 40.01%)]. Subgroup analysis showed that the prevalence rates of male and female adults were 32.92% and 44.78%, respectively. The prevalence rates of adults aged 16-39,40-59, ≥60 were 49.37%, 47.13%, and 37.41%, respectively. The prevalence rates of mild, moderate, and severe patients were 13.81%, 15.15%, and 9.24%, respectively. The prevalence rates of adults with elementary school and below, middle school, and university and above education levels were 33.81%, 35.84%, and 36.24%, respectively. The prevalence rates were 39.45% and 45.90% in adults with and without dental-treatment history, respectively. The prevalence rates of adults surveyed in dental and non-dental clinics were 27.10% and 39.31%, respectively. CONCLUSIONS: The prevalence of dental anxiety in Chinese adults was relatively high, primarily moderate anxiety, and it was more likely to occur in women, young people, and groups with no history of dental treatment. Early intervention should be performed for adults with dental anxiety to improve their awareness of oral healthcare and treatment compliance and thus to promote the oral-health level of adults in China.