Avoidance Of Dental Treatment Research Articles

Prevalence of self-reported fear of intraoral injections and its relationship to dental fear and subsequent avoidance of dental treatment among a group of Egyptian children: A Cross-Sectional Study

Prevalence of self-reported fear of intraoral injections and its relationship to dental fear and subsequent avoidance of dental treatment among a group of Egyptian children: A Cross-Sectional Study

Correlation among Sensitivity to Infection, Dental Care Avoidance, Corona Depression and Infectious Disease Prevention Practice During the COVID-19 Pandemi

The purpose of this study is to prevent diseases for non-infectious oral diseases by examining the sensitivity to infectious diseases and the avoidance of dental treatment. Sensitivity to infectious diseases, avoidance of dental care, depression of corona, and prevention of infectious diseases during the COVID-19 pandemic were investigated, over 20 years old and living in Daegu and Gyeongbuk province since October 2020. During the COVID-19 epidemic, the “non-sensitive group” scored 2.17 points (±0.89), the “intermediate interest group” scored 2.42 points (±0.79), and the “overall sensitive group” scored 2.73 points (±0.99). It was found that the more susceptible group to infectious disease, the higher the degree of avoidance of dental treatment. It is thought that dental workers should strive to lower the disease rate of non-infectious oral diseases by improving the dental visit rate through consideration for the sensitive group and thorough hygiene management. Dental medical personnels must thoroughly wash their hands, wear uniforms, wear personal protective equipment, and thoroughly clean and disinfect the interior of a dental clinic.

Use of Virtual Reality (VR) as an Audio-Visual Distraction Tool in the Reduction of Dental Anxiety during Local Anesthesia

Aims: Dental anxiety is a relatively common problem and it leads to undesirable distresses, such as postponement or avoidance of dental treatment thereby resulting in poorer quality of treatment and reduced oral health related quality of life. Dental anxiety is especially seen in patients undergoing dental injections. To evaluate the effectiveness of audiovisual distraction in the reduction of dental anxiety during la injection.
 Study design: Cross-sectional study.
 Place and duration of study: Patients visiting Penang International Dental College, Malaysia, between June 2017 and July 2018.
 Methodology: A total of 176 patients (88 female and 88 male) requiring endodontic therapy or tooth extraction were recruited for this study. A 14-question long questionnaire using Hamilton anxiety rating scale; and a separate feedback questionnaire was used to evaluate patients’ anxiety level and the severity of anxiety symptoms. Paired t-test was used to analyze the data.
 Results: There was a significant reduction in the anxiety scores (p<0.001) of the patients following the use of VR distraction during the la procedure. On an average, the pre-test scores were 1.932 points higher than post-test scores.
 Conclusion: Virtual reality could be used as a possible non-pharmacologic means of reducing dental anxiety in patients receiving local anesthesia.

Dental Phobia and Its Impact on the Quality of Life of a Ghanaian Adult Population

Aim: Dental phobia is a significant cause of avoidance of dental treatment, which could result in poor oral health. This study sought to determine the prevalence of dental phobia among a Ghanaian adult population and how this affects their quality of life. Materials and Methods: The study was a cross-sectional survey conducted among 329 patients attending the University of Ghana Dental School Clinic. Dental phobia was assessed with the Kleinknecht's Dental Fear Survey (DFS),and Quality of Life measured with the Oral Health Impact Profile (OHIP). Data were analyzed using Stata 14 software and MS Excel. Descriptive statistics and measures of association between DFS and OHIP were done.Results: About 46% of the study population had some level of dental phobia, with 8% having a high level of fear. More males (54.2%) were found to have experienced dental phobia than females (45.8%). Common causes of dental phobia were injection (54.7%), x-ray (24.9%), the dental clinic environment (13.4%), and the sound and feel of the handpiece (0.9%).Conclusion: Dental phobia was common among the dental clinic attendants. While further research is required in the subject area, clinicians and stakeholders should not under-estimate its prevalence and potential effects.

Exploring dental anxiety among male and female across adolescents, young adults, and middle adults

Introduction: Dental anxiety is a state of uneasiness and worry, making the patient feels that something terrible will happen to him regarding dental treatment and procedure. Research suggests that dental anxiety is a prominent factor in leading to avoidance of dental treatment by the patients. The intensity of dental anxiety varies individually and across gender. Research suggests that adopting healthy dental care habits encourages good oral health, contributing to the quality of life, whereas poor dental habits can lead to dental problems. Therefore, the present study attempts to explore the level of dental anxiety and dental care habits across age groups and gender. Methods: The sample consists of 150 patients from Delhi/National Capital Region. They were divided into three age groups – adolescence (n = 50), young adulthood (n = 50), and middle adulthood (n = 50). Modified Dental Anxiety Scale was used to assess dental anxiety and a semi-structured interview was taken to assess the level of dental hygiene among the patients. Results: there are statistically significant differences in dental anxiety scores between males and females. Our results also point that these gender differences persist across age groups – adolescence, young adulthood, and middle adulthood on dental anxiety. Conclusion: The findings reveal higher dental anxiety levels among adolescents, which gradually increase with age. Furthermore, females are more susceptible to have dental anxiety than males. Thus, dental professionals should provide age and gender-targeted counseling to avoid dental anxiety among their patients.

Brain Over Biceps- Say No to Restraints

Dental fear and anxiety lead to major obstacles and undesirable distresses such as avoidance of dental treatment [1]. Anxiety associated with the thought of visiting the dentist for preventive care and over dental procedures is referred to as dental anxiety. Fear is a reaction to a known or perceived threat or danger. It leads to a fight-or-flight situation. Dental fear is a reaction to threatening stimuli in dental situations. Children often are not able to deal with the threatening dental stimuli which manifest as behaviour management problems to the dentist.

Dental Anxiety and Higher Sensory Processing Sensitivity in a Sample of German Soldiers with Inflammatory Periodontal Disease.

(1) Background: Dental anxiety with disease value usually leads to avoidance of dental treatment. For the initial diagnosis of the level of anxiety, questionnaires such as the Hierarchical Anxiety Questionnaire (HAQ) are suitable. The construct of sensory processing sensitivity (SPS) describes a general trait in which people with a higher degree of SPS perceive information more strongly and process it more thoroughly. (2) Methods: This cross-sectional study evaluated the relationship between dental anxiety and higher levels of SPS in 116 soldiers referred with different stages of periodontitis for mandatory dental fitness before military deployment. (3) Results: The proportion of patients with periodontitis in stage III + IV was 39% and in stage I + II was 27%. The mean cumulative values of the questionnaires were 20.9 ± 10.6 for HAQ and 27.7 ± 16.0 for SPS. Eleven moderately anxious patients had a SPS value of 37.4 ± 13.5 and 10 highly anxious patients had a value of 36.3 ± 14.1. Patients diagnosed with stage III + IV periodontitis showed significantly higher values on the SPS subscale Low Sensory Threshold (LST), which describes overstimulation by external sensory stimuli, compared to patients with stage I + II periodontitis. Dental anxiety showed moderately significant correlations with the SPS subscale Ease of Excitation (EOE), which measures emotional reactivity to physiological stimuli. (4) Conclusions: Due to the frequency of dental anxiety and higher sensitivity in patients with severe periodontitis, it is useful to record said frequency.

Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review

BackgroundDental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps.MethodsA comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions.ResultsSeventeen RCTs with a total of 1788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo.ConclusionsThis review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.

Changes in dental anxiety among 15- to 21-year-olds. A 2-year longitudinal analysis based on the Tromsø study: Fit futures.

Identify predictive variables related to the development and continuation of high dental anxiety among young people over 2years and assess differences between youth experiencing increased, decreased or unchanged dental anxiety scores over time. An observational panel study of 15- to 21-year-old people in Tromsø and Balsfjord region followed students from their first to their last year of upper secondary school (2010/11-2012/13). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) of possible predictive variables assessed at baseline when using dental anxiety score from the second wave as a dichotomous dependent variable. Variables measured at baseline: Sex, Dental Caries Experiences (DMFS index), Dental Anxiety (Corah's Dental Anxiety Scale/DAS), Psychological Distress (Hopkins Symptom Checklist/HSCL-10), Avoidance of dental treatment, Pain Estimation at the dentist and motivational questions related to tooth brushing and caries (Self and Social Motivation). Wilcoxon signed-rank tests and Kruskal-Wallis tests were used to test whether changes in DAS score between waves were associated with changes in Pain Estimation between waves and HSCL-10 scores at baseline. Hopkins Symptom Checklist, DMFS and DAS scores at baseline predicted high dental anxiety scores after 2years. Sex, motivation related to oral hygiene and avoidance due to fear at baseline did not contribute significantly to our model. DMFS and HSCL-10 were higher among young people who reported a substantial change in DAS score (2.0>Interquartile range/IQR), irrespective of the direction of change. Pain Estimation changed consistently with a change in DAS score. Mental health symptoms, pre-existing dental anxiety and dental health status are important contributors to the development of dental anxiety in youth. Estimations of pain at the dentist are central when it comes to changes in dental anxiety over time in this study.

The effect of symphonic and lounge music upon anxiety and pain in a sample of Romanian dental patients

One of the most common fears is known to be dental anxiety (van Wijk & Hoogstraten, 2005). Only a minority of patients declare not having any sign of anxiety in the dental environment. As the prevalence of dental anxiety is pretty high, many patients with dental anxiety avoid dental visits (Haugejorden & Klock, 2000; Gatchell, Ingersoll, Bowman, Robertson, & Walker, 1983). Avoidance of dental treatment is highly correlated with anxiety scores and with increased caries morbidity (Eitner, Wichmann, Paulsen, & Holst, 2006; Li & Lopez, 2005). Highly anxious patients have a higher probability of irregular dental visits or total avoidance of dental care (Eitner et al., 2006; Doerr, Lang, Nyguist, & Ronis, 1998). Almost two thirds of dentists believe that anxious patients are challenging to treat (Weiner & Weinsten, 1995). Several methods have been proposed in order to help the patients to feel more comfortable, while enduring dental procedures such as: altering surgery set-up - the dental assistant can place instruments where they are blocked from view or covered, introducing relaxation methods, provision of extra control during procedures, using distraction techniques, e.g., music, video glasses, virtual reality glasses (Hmud & Walsh, 2009), providing more efficient anesthesia or referral to cognitive or behavioral specialists or psychologists for anxiety management (Armfield, Spencer, & Stewart, 2006 as cited in Hmud & Walsh, 2009) and behavior therapy (Hmud & Walsh, 2009).Listening to music is an effective distraction method known to reduce anxiety in laboratory settings (Blood & Zatorre, 2001; Burns, Labbe, Williams, & MicCall, 1999; Khalfa, Bella, Roy, Peretz, & Lupien, 2003; Nyklicek, Thayer, & Van Doornen, 1997; Sleight, 2013). Music is frequently chosen by people in real life situations, as a method to reduce their anxiety, before an exam, or a sport competition (Afzal, Afzal, Siddique, & Nagvi, 2012; Elliott, Polman, & Taylor, 2014). Also, music has been used to decrease intervention associated - anxiety in clinical settings (Good, Anderson, Ahn, Cong, & Staton-Hicks, 2005; McCaffrey & Locsin, 2006; Nilsson, Unosson, & Rawal, 2005; Twiss, Seaver, & McCaffrey, 2006; MacDonald, Mitchell, Dillon, Serpell, Davies, & Ashley, 2003; Nilsson, 2008; Allen, Golden, Izzo, Ching, Forres, & Niles, et al., 2001). More specific, music has been used in (ambulatory) hospital patients, undergoing a variety of invasive medical procedures [for a review, see Cooke, Chaboyer, & Hiratos, 2005]. Studies show that listening to patients selected (Wang, Kulkarni, Dolev, & Kain, 2002; Lee, Henderson, & Shum, 2004; Cooke, Chaboyer, Schluter, & Hiratos, 2005; El-Hassan, McKeown, & Muller, 2009) or investigator-chosen (Lee, Chao, Yiin, & Chiang, 2011; Lee, Henderson, & Shum, 2004), music immediately before the intervention for 10-40 min significantly reduces anxiety levels from before to after music listening as compared with a control group. Few studies have been performed in dental settings. Parkin (1981) explored the effects of music on 25 children and found significant reduction in the perceived level of anxiety in the music-on mode compared to music-off mode. Corah, Gale, Pace, and Seyrek (1981) found that relaxation music had only a moderate effect in reducing patient anxiety. The studies investigating the impact of music in reducing anxiety in clinical settings have some methodological issues such as lack of randomization, very small sample sizes, lack of physiological data to measure anxiety levels or very specific samples (e.g., only male patients). Also, most of these studies were performed in USA or Asian countries and there might be come culturally biased findings (some of them may not be applicable to European samples) as the authors of a recent study with German dental patients found no clinically relevant effect of music on anxiety (Lahmann et al. …

High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10- to 16-yr-old children.

The present study aimed to: (i) estimate the prevalence of self-reported high fear of intra-oral injections, high blood-injury fear, and injection fear; (ii) explore the overlap between high fear of intra-oral injections and high fear of dental treatment; and (iii) evaluate the possible consequence of high fear of intra-oral injections in terms of avoidance of dental care. The sample included 1,441 subjects, 10- to 16-yr of age, attending elementary schools in a county of Norway. Data were collected using questionnaires that were completed in classrooms. The survey instruments used were the Intra-Oral Injection Fear-scale, the Children's Fear Survey Schedule-Dental Subscale, the Injection Phobia scale for children, and the Mutilation Questionnaire for children. In total, 13.9% of the children reported high intra-oral injection fear. A strong association was found between fear of intra-oral injections and dental fear. When an intra-oral injection was needed, 10.6% would avoid dental treatment. In multiple regression analysis, high intra-oral injection fear was found to be associated with avoidance of dental treatment (OR = 6.52; 95% CI: 3.99-10.67). It was concluded that high fear of intra-oral injections was prevalent and might lead to avoidance of necessary dental treatment. Hence, intra-oral injection fear should be addressed before treatment of dental fear.

Effects of audiovisual distraction on children’s behaviour during dental treatment: a randomized controlled clinical trial

Aim: Dental anxiety leads to undesirable distresses such as avoidance of dental treatment and increase stress among caregivers that consequently affect the treatment quality. The aim of this study was therefore to evaluate the effectiveness of viewing videotaped cartoons using an eyeglass system (i-theatre™) as an audiovisual (AV) distraction technique on behaviour and anxiety in children receiving dental restorative treatment.Methods: Fifty-six consecutive children patients who presented for treatment and met inclusion criteria were included and randomly divided into two groups; a control group without distraction (CTR-group) and a distraction-group (AV-group). Three dental treatment visits were provided for each patient. Anxiety and cooperative behaviour were assessed with the Facial Image Scale (FIS) and the Modified Venham’s clinical ratings of anxiety and cooperative behaviour scale (MVARS). The vital signs, blood pressure and pulse were also taken.Results: The AV-group showed significantly lower MVARS scores than the CTR-group (p = 0.029), and the scores decreased significantly during treatment in the AV-group (p = 0.04). Further, the pulse rate was significantly increased in the CTR-group during injection with local anaesthesia (p = 0.02), but not in the AV-group.Conclusion: AV distraction seems to be an effective method in reducing fear and anxiety in children during dental treatment. Further, children who used eyeglass goggle display as a distraction tool during dental treatment reported not only less anxiety than control groups but also showed more positive responses after injection with local anaesthesia. Hence, AV-distraction seems to be a useful tool to decrease the distress and dental anxiety during dental treatment.

Evaluation of fear of injections and its association with avoidance of dental treatment

Aim: The aim of this study was to assess the intensity of needle phobia and to evaluate the different dimensions of fear of dental injections to help provide better care to the patients. Materials and Methods: A simple random technique was used and 250 adult patients above 18 years of age were selected who attended outpatients Department of Operative Dentistry, Baqai Dental College. A modified form of the structured questionnaire used by Milgrom et al. was generated. The items were scored based on the 5-point traditional Likert scale ranging from strongly disagree to strongly agree. Data were analyzed for descriptive analysis (mean, standard deviation) using the software SPSS version 19. Association of gender with fear of dental injections was evaluated using Chi-squared test (P = 0.05). Results: There was a statistically significant difference in fear of dental injections among male and female subjects. The most fearful aspect of dental injection was found to be fear of cross-infection. Fears associated with local anesthesia, for example, inadequate numbness, adverse reaction, and trouble in breathing or swallowing were the least common fears reported by the patients. Conclusion: This study highlighted that understanding the nature and extent of patients' fear of injection is important for dentists to expand their knowledge of the association of fear of dental needles for the impact on the treatment outcome and reluctance of the patients intervene.

What is the Most Effect Treatment for the Management of Dental Anxiety among Adults? A Systematic Review of Interventions

This review aimed to find the most effective intervention for the management of dental anxiety among adults by way of a systematic review of Randomised controlled trials. Compared to European and US counterparts, the number of studies concerning the management of dental anxiety in the United Kingdom is limited. Several interventions have been reported with varying modes of action and duration. Two main groups of interventions: pharmacological and psychological/behavioural have been implemented. The pharmacological interventions employ the use of centrally acting sedatives whereas the psychological/behavioural interventions serve to change the behavioural and learning effects of dental anxiety. A third group operationally defined as “Complementary” for the purpose of this review consists of holistic therapies such as acupuncture, music distraction and aromatherapy for in the management of dental anxiety. Although reduction of dental anxiety before and after dental treatment has been recorded historically in the majority of trials, these have mainly investigated psychological/behavioural interventions. Exploring more recent trials, this study uncovers the benefits of complementary interventions for managing dental anxiety in adults and computer based variants of psychological/behavioural interventions. None compared the efficacy of one type or group against the other. Also, outcomes such as avoidance of dental treatment and economic implication of interventions were scarcely evaluated thus evidence on this remains inconclusive. The need for further investigation of these outcomes as well as those in Complementary Therapies is justified.

The anterior insula and anterior cingulate cortex are associated with avoidance of dental treatment based on prior experience of treatment in healthy adults.

BackgroundFear concerning stressful medical or dental procedures is one of the major factors that distance patients from health care. Fear and avoidance of dental treatments can be shaped by a patient’s prior experience with receiving dental procedures or by imagining the procedures.MethodsWe performed two functional magnetic resonance imaging (fMRI) experiments to investigate the role of the anterior insula (aINS) and dorsal anterior cingulate cortex (dACC), which are both critical to threat perception, in dental avoidance. Dental avoidance based on both prior treatment experience and imagination was assessed using a customized questionnaire. In an fMRI task-based study, we investigated brain activation in 17 healthy participants when they viewed images depicting dental procedures that evoked a moderate degree of fear. Region-of-interest analysis was performed to assess the association between dental avoidance and aINS as well as dACC activation. In a resting state fMRI study, we investigated 18 healthy participants for the association between the intrinsic functional connectivity of the aINS and dACC and dental avoidance.ResultsWe found that (1) the participants showed a higher activation of the right aINS and bilateral dACC when they viewed images of dental procedures compared with the brain activation observed when they viewed scrambled images (p < 0.05 corrected for small volume and family-wise error). (2) The avoidance ratings based on prior experience of dental treatment were significantly positively correlated with the activation in the right aINS (r = 0.67, p = 0.003), right dACC (r = 0.65, p = 0.005) and left dACC (r = 0.63, p = 0.007). (3) The intrinsic functional connectivity between the aINS and the orbitofrontal cortex was positively correlated with the avoidance ratings based on experience (uncorrected p < 0.001).ConclusionsThe findings highlight prior experience of dental treatment as a predominant factor in shaping patients’ avoidance behavior. Individual differences in threat perception may play a key role in the development of dental avoidance.

Dental Pain Perception In Different Genders: Pscychological Evaluation And Pain Control Strategy

ABSTRACT Aim This study aims at evaluation and discussion of differences in pain perception, anxiety and behavior of male and female dental patients and highlight its significance in treatment planning and management, in the clinical set ups in Riyadh city, Saudi Arabia. Material and methods A comparative cohort study was carried out in 880 patients from various dental clinics in Riyadh city, Saudi Arabia. They were given a 23-question questionnaire based on extended DFAS(dental fear and avoidance scale) and DAS(dental anxiety scale). The variables included brief demographic data, medical history, pscychological assessment, pain catastrophe, previous dental experiences and avoidance of dental treatment. Descriptive statistics were used to describe the categorized study and outcome variables in male and female patients and comparing the differences in pscychology and pain perception. Results and conclusion Female subjects reported with less pain and phobiafor dental treatment compared to male subjects.91.6% femalesresponded positively for DFAS-1 score(not afraid) against 45.8% of male subjects and 50.6%male subjects agreed that they are terrified of dental pain against 25.7% female subjects for DFAS score 4(terrified of dental pain),which is statistically highly significant.

Dental Fear under Rated Yet Significant

Background: Extreme dental fear is a universal problem among children. The dental condition of patients with dental fear is generally worse than the condition of those without dental fear. The aim of the study was to assess the intensity of dental fear in children using Wong-Baker faces pain scale. Materials and Methods: A total of 110 patients in the age range of 8-11 years were recruited for the study. Dental fear was assessed using a structured questionnaire. Data was gathered, computed and statistically analysed to determine the most and the least fearful dental situation for children. Results: Younger children expressed more fear than older children. Fear of injections and sound of drill was most common among children of all the age groups. Conclusion: Dental fear leads to avoidance of dental treatment. The child should be taught that the dental office is not a place to fear and dentistry should never be employed by the parents as a threat or punishment.

Comparison of anxiety levels associated with noise in the dental clinic among children of age group 6-15 years

Fear or anxiety due to noise produced in the dental clinic is rated third among the reasons to avoid dental visits. The aim of the present study was to determine anxiety levels associated with noise in a dental clinic. The study was done using a survey questionnaire containing 10 questions and was divided into two parts. The first part included demographic information such as name, age, gender, and school; the second half included questions regarding patient's feelings toward noise in the dental clinic and its possible link to dental anxiety. Two-hundred and fifty children and adolescents of age group 6-15 years participated in the study. Results of the study showed that 50% of females, 29% males avoided a visit to the dentist because of anxiety and fear, 38% subjects of age group 6-11 years reported that sound of the drill makes them uncomfortable, followed by having to wait in the reception area. Gender gap was also observed with more females feeling annoyed than males on the 1-10 annoyance level scale. More than 60% felt "annoyed" to "extremely annoyed" by noise in the dental clinic. 45% of subjects preferred watching television to cope with such noise. This study concludes that the noise produced in dental clinic is anxiety provoking and significantly contributes to avoidance of dental treatment and the best way opted by the majority of subjects to overcome this anxiety was audiovisual distraction method.

Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia

Objective. To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. Materials and methods. Subjects were 55 patients (mean age 35.5 ± 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. Results. Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. Conclusions. Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.

Management of the Petrified Dental Patient

Fear and anxiety are common responses to anticipated or actual dental treatment. This may range from slight feelings of unease during routine procedures, such as an injection or cavity preparation, to feelings of extreme anxiety long before treatment is happening. There is general agreement that anxiety constitutes a major problem for the dentist, and a barrier to optimal care for the patient, as one of the most significant consequences is avoidance of dental treatment. Common triggers include local anaesthetic injection and the dental drill. This paper uses the term anxiety to encompass both fear and anxiety and reviews current strategies for managing anxious people in the dental setting, with a focus on non-invasive operative techniques. Being able to recognize fear and anxiety in dental patients is an important part of overall patient management. Knowledge of various behaviour management techniques, and the use of less-invasive operative techniques, enable the clinician to treat a large proportion of anxious people and help them to cope with dental treatment in the primary care setting. Those who remain anxious and unable to cope in the dental setting may require pharmacological techniques, such as conscious sedation, to enable them to receive dental treatment. These techniques are not always readily available, require appropriate training, are more time consuming and costly. In extreme cases, general anaesthesia may be a last resort option.