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.

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.

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.

Dental anxiety and ageing anxiety: Moderated mediation roles of Oral Health-Related Quality of Life and subjective accelerated ageing.

BACKGROUND: Oral health and its relation to ageing is an important topic often neglected among geriatric populations. Proper oral rehabilitation may aid in alleviating mental health burdens in such populations. OBJECTIVES: The present study aimed to explore the association between dental anxiety and ageing anxiety, with regard to the interplay of Oral Health-Related Quality of Life (OHRQoL) as mediator and subjective accelerated ageing as a moderator. METHODS: A total of 577 participants with mean age 72.78 years (SD = 3.832, range = 68-87) were recruited via a survey company in Israel. They completed a self-report battery of questionnaires about dental anxiety, OHRQoL, subjective accelerated ageing and ageing anxiety, along with their informed consent. RESULTS: The findings revealed that dental anxiety was positively associated with ageing anxiety (direct effect), and that OHRQoL mediated the link between dental anxiety and ageing anxiety (indirect effect). Additionally, subjective accelerated ageing moderated the positive link between dental anxiety and OHRQoL, as well as the positive link between OHRQoL and ageing anxiety. CONCLUSIONS: The results provide insight for the roles of OHRQoL and subjective accelerated ageing among older adults between dental anxiety and ageing anxiety. Tailoring oral rehabilitation interventions that focus on these factors are warranted to improve older adults' dental health.

[Dental care avoidance: catering to four different subtypes of patients]. / Zorgmijdende patiënten: benadering voor 4 subtypen van patiënten.

Only too often, it is automatically assumed that dental checkups or treatments are avoided by a subset of the patient population out of fear. To put it more correctly: to avoid the anxiety associated with dental appointments - anxiety believed to be based on fear of pain and pain increase. Following this assumption, three other subtypes of avoidant patients are being overlooked. These are care-avoiders with fear caused by trauma, self-effacing behavior or depression. Well-informed questions can initiate an understanding conversation which can break and stop this care-avoiding behavior. Patients can be referred to the general practitioner (formental health care), or to special dentistry, in more complex cases.

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment.

OBJECTIVES: To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures. MATERIALS AND METHODS: Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants. RESULTS: Mean age was 48.3 years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT. CONCLUSIONS: Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL. CLINICAL RELEVANCE: Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

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.

The role of Dental Fear, Pain anticipation and Self-efficacy in Endodontic Therapy.

BACKGROUND: Cognitive-behavioural interventions may be important for the prevention and treatment of oral diseases. One cognitive factor that has generated considerable interest as a possible mediator is self-efficacy. METHODS: One hundred patients diagnosed with pulpal or periapical pathology that required endodontic therapy were treated. Data were collected at baseline in the waiting room before therapy and then during treatment. RESULTS: Positive correlations were found between dental fear, pain anticipation and dental avoidance (p⟨0.001). The correlation between dental fear and pain anticipation showed the largest effect sizes. Healthy participants had higher scores in self-efficacy (Mean=32.55; SD=7.15) than those with systemic diseases (n=15; Mean=29.33; SD=4.76, p=0.04). Participants who not taking medication before treatment had lower scores for pain anticipation (Mean=3.63; SD=2.85) than those taking medication. The contribution of pain anticipation to dental avoidance varied at different values of self-efficacy. The indirect effect of dental fear on dental avoidance via dental anxiety was significant in individuals with higher self-efficacy. CONCLUSIONS: Self-efficacy had an essential moderation role between pain anticipation and dental avoidance during endodontic treatment.

Dentophobia and dental treatment: An umbrella review of the published literature.

AIMS: Dentophobia is a well-know kind of phobia and psychological problem in dentistry. Although patients might suffer from severe oral pain and have serious health complications, dentophobia is still posing a threat to oral healthcare and remains an unresolved worldwide phenomenon. According to estimates, up to 80% of the general population are affected by this condition. Dentophobia is an unpleasant problem with serious consequences not only for patients but also for dentists and the public health system in general. This umbrella review provides a comprehensive overview of the various aspects of dentophoia as addressed in the published literature, and the current level of knowledge concerning their treatment. METHODS AND RESULTS: Based on 35 reviews of the published literature, addressing various aspects of dentophobia and published between 2008 and 2021, this umbrella review was written. The search was based on the PubMed and PsycINFO databases. The extraction was structured by open coding and each aspect of the subject analyzed according to Ritchie and Lewis. CONCLUSION: We conclude that the evidence concerning the efficacy of the various interventions is still rather weak and there is an obvious need for further research, because of the yet and unresolved challenges and the lack of standardised guidelines to deal with patients with dentophobia.

Study of dental phobia, psychological resilience, and related factors in children aged 8-9 years in Weifang city.

OBJECTIVES: To investigate the influencing factors of children's dental fear (CDF) and the relationship of CDF with resilience in children aged 8-9 years in Weifang city to provide evidence for the early prevention and intervention of CDF. METHODS: Random cluster sampling method was applied. A total of 1 995 children aged 8-9 years from 10 primary schools in four districts of Weifang city were selected from June to October 2021 as the survey objects. General information questionnaire, the children's fear survey schedule-dental sub-scale, and adolescent resilience scale were used in the investigation. RESULTS: The CDF detection rate was 31.78% (634 cases) in children aged 8-9 years in Weifang city, including 28.41% (296 cases) in boys and 35.47% (338 cases) in girls. Multivariate logistic analysis showed that female gender [odds ratio (OR)=1.329, 95% confidence interval (CI)=1.062-1.665], dental caries (OR=1.961, 95%CI=1.330-2.891), dental pain (OR=2.133, 95%CI=1.700-2.676), and dental treatment experience (OR=3.621, 95%CI=2.888-4.540) are risk factors for CDF. Parents with tertiary education or higher (OR=2.123, 95%CI=1.546-2.916; OR=3.304, 95%CI=2.368-4.612), high scores in the positive cognition factor of the psychological resilience-personal strength dimension (OR=1.520, 95%CI=1.141-2.025), high scores in the interpersonal assistance factor of the psychological resilience-support strength dimension (OR=3.819, 95%CI=2.743-5.318), and high scores in the family support factor (OR=5.634, 95%CI=4.047-7.844) were protective factors for CDF occurrence (P<0.05). CONCLUSIONS: Children with high psychological resilience scores have low CDF incidence, and good parenting practices are beneficial in reducing CDF incidence.

Knowledge, Dental Anxiety, and Patient Expectations During the COVID-19 Pandemic

Abstract Objective: To assess the knowledge, dental anxiety, and expectations regarding dental services during the COVID-19 pandemic. Material and Methods: The respondents were Indonesian citizens above 18 years old. An online Google survey was administered using a structured questionnaire with a snowball sampling technique. Survey items comprised knowledge related to COVID-19, dental anxiety assessed using the modified DAS (Dental Anxiety Scale) and expectations regarding dental services using four dimensions of dental service quality. All questionnaires were tested for reliability and indicated acceptable and good agreement. The data were analyzed descriptively. Results: A total of 553 responses were analysed. Most respondents were female (72.9%), 76.7% knew of recommendations to postpone dentist visits and 86.8% knew methods of preventing COVID-19 transmission. More than 70% of respondents knew the precaution procedures in the dental office during COVID-19, and only 27.9% had moderate-severe anxiety. Most respondents' expectations regarding dental services during the pandemic era were related to the quality domain of reliability and responsiveness. Conclusion: Respondents knew about COVID-19 transmission and prevention, emergency conditions warranting a visit to the dentist and the procedures used at the dental office. Most respondents stated that they were not anxious about visiting a dentist during the pandemic. The respondents expect the dentist to provide sufficient information to improve oral health and treatment plan.

Dental Fear/Anxiety in Children and Child Emotional and Behavioural Problems

ABSTRACT Objective: To investigate the association between emotional and behavioural problems and dental fear/anxiety (DFA) in children aged four to 12 years treated at a clinic in southern Brazil. Material and Methods: In this cross-sectional study where mother-child dyads were interviewed, emotional and behavioural problems were investigated using the Strengths and Difficulties Questionnaire (SDQ) (considering five subscales). Children's DFA was evaluated through the Venham Picture Test. For each SDQ subscale, Poisson regression model was explored. Prevalence ratios (PR) were estimated, considering a significant level of p ≤ 0.05. Results: Overall, 128 children participated in this study. Most children were female (54.7%) and aged between 7 and 9 years (39.8%). The prevalence of emotional problems was 47.7% and behavioural problems were 46.1%. The prevalence of DFA was 18.8%. Children with emotional problems had a 2.3 higher prevalence of DFA (95%CI 1.06-5.04). In general, behavioural problems were not associated with DFA (95%CI 0.84-3.34) only when conduct problems were considered (2.20; 95%CI 1.02-4.70). Conclusion: Children aged between 4 and 12 years who present emotional and conduct problems tend to show higher DFA.

Child Stress and Behaviour During Restorative Treatment under Non-Pharmacological Techniques and Sedation: A Case Series

ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.

Comparative study about the factors associated with parental dental anxiety in a peruvian hospital / Estudio comparativo de factores asociados con la ansiedad dental parental en un hospital peruano

Background: Dental anxiety is a source of problems in the dental treatment that can lead to dental avoidance. Objective: Determine and compare the factors associated with dental anxiety in Peruvian parents. Material and Methods: An observational, descriptive and cross-sectional study was carried out. The sample consisted of children from 3 to 6 years old and their companions, who attended the Instituto Nacional de Salud del Niño in Lima, Peru. The Corah anxiety scale, the dental fear questionnaire and the Frankl scale were used to assess anxiety, parental dental fear, and children's collaboration. The following variables were also evaluated: negative dental experience, treated tooth and treatment of the children. Chi-square statistical tests, Mann-Whitney U and the binary logistic regression model were used. Results: The sample consisted of 325 children and their companions. An association was found between gender (OR = 2.456; 95% CI: 1.037 - 5.818), child collaboration (OR = 0.044; 95% CI: 0.044 - 0.543) and maternal anxiety (p<0.05). Furthermore, there was an association between dental fear (OR = 3.569; 95% CI: 1.136 - 11.218), child collaboration (OR = 0.023; 95% CI: 0.003 - 0.172) and paternal anxiety (p<0.05). Conclusion: The factor associated with maternal dental anxiety was the sex of the child, and on the father's side, it was the dental fear experienced by them. Moreover, the component affiliated with both parents was the child's collaboration.

Introducción: La ansiedad dental es una fuente de problemas en el tratamiento odontológico que puede conducir a la evitación dental. Objetivo: Determinar y comparar los factores asociados a la ansiedad dental en padres peruanos. Material y Métodos: Se realizó un estudio observacional, descriptivo y transversal. La muestra estuvo compuesta por niños de 3 a 6 años de edad y sus acompañantes que asistieron al Instituto Nacional de Salud del Niño en Lima, Perú. Se usó la escala de ansiedad de Corah, el cuestionario de miedos dentales y la escala de Frankl para evaluar ansiedad, miedo dental parental y colaboración de los niños respectivamente. También se evaluaron las siguientes variables: experiencia dental negativa, pieza dental tratada y tratamiento de los niños. Se utilizaron las pruebas estadísticas de Chi-cuadrado, U de Mann-Whitney y el modelo de regresión logística binaria. Resultados: La muestra estuvo conformada por 325 niños y sus acompañantes. Se encontró una asociación entre el sexo (OR =2.456; 95%IC: 1.037 ­ 5.818), colaboración del niño (OR=0.044; 95%IC: 0.044 ­ 0.543) y la ansiedad materna (p<0.05). Se encontró una asociación entre el miedo dental (OR= 3.569; 95% IC: 1.136 ­ 11.218), colaboración del niño (OR= 0.023; 95% IC: 0.003 ­ 0.172) y la ansiedad paterna (p<0.05). Conclusión: El factor asociado a la ansiedad dental materna fue el sexo del niño, y en el padre, fue el miedo dental experimentado por el mismo. El factor asociado a ambos padres fue la colaboración del niño.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Associação entre características infantis e estresse de alunos de graduação durante atendimento odontopediátrico / Association between childhood characteristics and stress in undergraduate students during pediatric dental care

Objetivo: O objetivo desse trabalho foi avaliar a associação entre as características das crianças com o estresse apresentado por estudantes de graduação em Odontologia durante o atendimento odontopediátrico. Materiais e métodos: Participaram 48 crianças com idade entre 6 e 10 anos e 37 alunos voluntários do 7º, 8º e 9º semestres de um curso de Odontologia. Foi realizado um questionário sobre aspectos socioeconômicos e também coletados dados sobre comportamento, percepção de dor e ansiedade da criança e do responsável. Ainda, foram coletados dados relacionados aos alunos da graduação: sexo, semestre, nível de estresse, tipo de procedimento realizado. Foram obtidas as frequências absolutas e relativas por meio da análise descritiva dos dados. As comparações nos desfechos de interesse foram feitas utilizando o teste quiquadrado para variáveis dicotômicas e categóricas, teste linear por linear para variável ordinal e teste exato de Fischer para contagens menor do que 5. Foi adotado um nível de significância de 5%. Resultados: Os resultados mostraram que a maioria dos operadores que atenderam crianças não colaboradoras relataram nível de estresse alto (83,33%) (p<0,001). Os operadores que atenderam crianças com nível de ansiedade médio ou alto relataram nível de estresse alto (p= 0,043) e em pacientes com dor, o nível de estresse da maioria dos operadores foi considerado alto (75%) (p=0,001). Conclusão: as características das crianças influenciaram no estresse apresentado pelo aluno operador durante o atendimento odontológico infantil. Crianças ansiosas, não colaboradoras e que estavam sentindo dor durante o atendimento deixaram o operador mais estressado.

Objective: The aim of this study was to evaluate the association between the characteristics of children and the stress presented by undergraduate dentistry students during pediatric dental care. Materials and Methods: Participants were 48 children aged between 6 to 10 years old and 37 volunteer students from the 7th, 8th and 9th semesters of a Dentistry course. A questionnaire on socioeconomic aspects was carried out and data on behavior, perception of pain and anxiety of the child and the guardian were also collected. Also, data related to undergraduate students were collected: sex, semester, stress level, type of procedure performed. Absolute and relative frequencies were obtained through descriptive data analysis. Comparisons in the outcomes of interest were made using the chi-square test for dichotomous and categorical variables, linear by linear test for ordinal variable, and Fisher's exact test for counts less than 5. A significance level of 5% was adopted. Results: The results showed that students who assisted non-cooperative children reported a high level of stress (83.33%) (p<0.001). Students who assisted children with medium or high levels of anxiety reported high levels of stress. (p=0.043) and in patients with pain, the students' stress level was considered high (75%) (p=0.001). Conclusion: The characteristics of the children influenced the stress presented by the student during child dental care. Anxious children, noncooperative and who were in pain during care left the student more stressed.

Genome-wide Scan of Dental Fear and Anxiety Nominates Novel Genes.

Dental care-related fear and anxiety (DFA) is prevalent, affects oral health care utilization, and is related to poor oral health and decreased quality of life. In addition to learned and cultural factors, genetics is hypothesized to contribute to DFA. Therefore, we performed a genome-wide association study to identify genetic variants contributing to DFA. Adult and adolescent participants were from 4 cohorts (3 from the US-based Center for Oral Health Research in Appalachia, n = 1,144, 1,164, and 535, and the UK-based Avon Longitudinal Study of Parents and Children [ALSPAC], n = 2,078). Two self-report instruments were used to assess DFA: the Dental Fear Survey (US cohorts) and Corah's Dental Anxiety Scale (ALSPAC). Genome-wide scans were performed for the DFA total scores and subscale scores (avoidance, physiological arousal, fear of dental treatment-specific stimuli), adjusting for age, sex, educational attainment, recruitment site, and genetic ancestry. Results across cohorts were combined using meta-analysis. Heritability estimates for DFA total and subscale scores were similar across cohorts and ranged from 23% to 59%. The meta-analysis revealed 3 significant (P < 5E-8) associations between genetic loci and 2 DFA subscales: physiological arousal and avoidance. Nearby genes included NTSR1 (P = 3.05E-8), DMRTA1 (P = 4.40E-8), and FAM84A (P = 7.72E-9). Of these, NTSR1, which was associated with the avoidance subscale, mediates neurotensin function, and its deficiency may lead to altered fear memory in mice. Gene enrichment analyses indicated that loci associated with the DFA total score and physiological arousal subscale score were enriched for genes associated with severe and persistent mental health (e.g., schizophrenia) and neurocognitive (e.g., autism) disorders. Heritability analysis indicated that DFA is partly explained by genetic factors, and our association results suggested shared genetic underpinnings with other psychological conditions.

Held still or pressured to receive dental treatment: self-reported histories of children and adolescents treated by non-specialist dentists in Hordaland, Norway.

AIM: This study aimed to estimate the prevalence of a self-reported history of restraint in children and adolescents when receiving dental care by non-specialist dentists and to assess differences in dental fear and anxiety (DFA), intra-oral injection fear, and trust in dentists between patients with and without a self-reported history of restraint. METHODS: An electronic cross-sectional survey was distributed to all 9 years old (n = 6686) and 17 years old (n = 6327) in the Public Dental Service in Hordaland County, Norway, in 2019. For statistical evaluation, we generated descriptive statistics and Mann-Whitney U tests. RESULTS: The response rate ranged between 43.5 and 59.9% for the different questions. The prevalence of a self-reported history of being held still against one's will during dental treatment and pressured to undergo dental treatment against one's will was 3.6% and 5.1%, respectively. In general, these patients reported higher DFA, and higher intra-oral injection fear compared with those without such histories of restraint. Patients who had reported being held still against their will during dental treatment had significantly higher distrust in dentists than those who did not report restraint (p < 0.001). CONCLUSION: To feel pressured to receive dental treatment and to be held still against one's will overlap with the concepts of psychological and physical restraint. Patients with a self-reported history of restraint recorded significant differences in DFA, intra-oral injection fear, and trust in dentists compared to those who did not report restraint. Future studies should explore the role that restraint may play in relation to a patient's DFA, intra-oral injection fear, and trust in dentists.

Dental fear and anxiety in Asian youths: response components and inducing stimuli.

OBJECTIVES: This study estimated the prevalence of dental fear/anxiety (DFA) and phobia in Asian youths and investigated the fear/anxiety response components and triggers for those with DFA. MATERIALS AND METHODS: A convenience sample of youths, aged 17 to 24 years old, was recruited from a local polytechnic. The Index of Dental Anxiety and Fear-4C + (IDAF-4C +) was employed to assess the occurrence of DFA (IDAF-4C) and phobia (IDAF-P) as well as to ascertain fear/anxiety-inducing stimuli (IDAF-S). Psychological distress was determined with the Patient Health Questionnaire-4 (PHQ-4). Sociodemographic, IDAF-4C + , dental attendance patterns, and PHQ-4 data were gathered electronically. Statistical analyses were conducted with chi-square, Kruskal-Wallis, and relevant post hoc tests (α = 0.05). RESULTS: A total of 215 participants were enrolled (mean age of 18.9 ± 2.0 years; 87.4% women). Of these, 12.6/6.0% had moderate-to-high (MH)/high-to-extreme (HE) DFA and 0.9% experienced dental phobia. Significant differences in scores were observed between the HE/MH and no-to-moderate (NM) groups for all IDAF-4C components. Apart from the cost of dental treatment, IDAF-4S scores varied significantly among the three DFA groups. The two most highly rated DFA stimuli were painful/uncomfortable procedures and needles/injections for the HE group, while they were needles/injections and the cost of dental treatment for the MH and NM groups. CONCLUSIONS: Moderate-to-extreme DFA existed in 18.6% of the Asian youths examined. The emotional and physiological components of the IDAF-4C appear to contribute more to the DFA response. Dental pain including needles/injections and the cost of dental treatment troubled Asian youths the most. CLINICAL RELEVANCE: DFA is a common problem among Asian youths, and understanding its extent, nature, and triggers is central for effective interventions.

Are dental-related psychological variables important for dental attendance in China? A cross-sectional study.

OBJECTIVE: Dental services are expanding in China, yet there is little evidence available on the dental-related psychological factors contributing to the uptake of dental services. Our study explored whether beliefs, anxiety, and cognitions significantly differ across different levels of attendance, and whether dental-related psychological variables can independently predict dental attendance in Chinese adults. We also explored the extent to which cognitions and beliefs relate to attendance as a function of dental anxiety. METHOD: In our cross-sectional study 480 adult participants in China completed a questionnaire including dental attendance and measures of dental-related psychological variables (dental cognitions, beliefs, anxiety, and fear of dental pain). RESULTS: Only 25.8% of participants visited the dentist regularly. There was a significant difference for all dental-related psychological variables (p < 0.001), across all three levels of dental attendance (never; irregularly or regularly attend). Thus, fear of dental pain and dental anxiety are higher, and cognitions and beliefs are more negative, for those who have less favorable dental service utilization. All these variables, except fear of dental pain, were also independent predictors of dental attendance (p < 0.05). Moreover, how individuals think, and what they believe, about the dentist (and the dental context) were only partially explained through dental anxiety. Thus, beliefs (ß = 0.579, SE = 0.035, p < 0.001) and cognitions (ß = 0.594, SE = 0.045, p < 0.001) are impacting on dental attendance, mostly independent of whether the individual is anxious. CONCLUSION: Our preliminary findings show dental-related psychological factors are related to dental attendance and these should be explored further in a larger sample.