Dental Anxiety Scale Research Articles

Dental anxiety, pain, and quality of life among exodontia patients: A cross-sectional study

Introduction: There are few studies on dental anxiety (DA) among patients who are planned for routine dental extraction compared with a plethora of published reports on DA and oral health-related quality of life (OHRQoL) in patients undergoing third molar surgery. Aim: This study aims to investigate anxiety level, pain experience and OHRQoL of patients scheduled for routine exodontia at a Nigerian tertiary hospital. Materials and Methods: This was a cross-sectional study conducted at the Oral Surgery clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from April to September 2019. DA, pain, and OHRQoL of participants were assessed using Corah’s DA Scale (DAS), Visual Analog Scale (VAS) and 14-item oral health impact profile (OHIP-14) questionnaire, respectively. Just before routine exodontia, the demographic variables of the participants were also recorded. Data were analyzed using R version 4.2.2. Results and Discussion: One hundred fifty-nine participants planned for routine exodontia of one or two permanent tooth/teeth with 41.7 ± 19.8 years mean age. The mean DAS score for the study population was 7.9 ± 3.6 (range: 4–18) with the proportion of dentally anxious patients (DAS score ≥13) being 15.1%. The majority (125; 78.6%) reported preexodontia dental pain VAS score of 4–10. Only 22.6% of the participants had their OHRQoL significantly impaired with OHIP-14 score of 29–56. Conclusion: The prevalence of DA among Nigerian adults scheduled for routine exodontia was 15.1%. At least seven in ten patients had moderate and severe dental pain, while one-fifth presented with significantly impaired OHRQoL.

Evaluation of Children’s Perceptions after Frenectomy: Diode Laser vs. Conventional Scalpel Technique

Objective: The presence of abnormal frenum may cause aesthetic or functional problems, which can be prevented by frenectomy operation. Therefore, the aim of this study is to compare children's perceptions of pain, speech and chewing difficulties after conventional scalpel technique and diode laser-assisted frenectomy operations. Material and Methods: Twenty-one patients, aged 10 to 16 years, who were indicated for Frenectomy were assigned to be treated with conventional scalpel technique or diode laser. In the comparison between both techniques, the Wong-Baker FACES Pain Rating Scale was used to evaluate pain immediately after surgery and pain, speech and chewing difficulties at days 1, 3, 7, and 10 following the procedure. Factors such as duration of surgery, use of anaesthetic, and need for analgesics were also recorded. Moreover, Corah's Dental Anxiety Scale was used to evaluate the dental anxiety levels of parents about their children. Results: When compared to the conventional scalpel technique, it was found that the surgery took shorter, and no postoperative analgesic was needed in the group that underwent Diode laser surgery. In addition, as the age of the children increased, the anxiety levels of the parents decreased. When the postoperative perceptions of pain and functional discomforts were evaluated, there was no significant difference between the groups. Conclusion: According to the results of this study, Diode laser provided benefits such as significantly shortening the operation time and not requiring surgical sutures and analgesics in children. It may also allow the use of less infiltrative anaesthetic during the operation.

Prevalence and factors associated with dental anxiety among pregnant women seeking care at a tertiary care dental institution in Sri Lanka

To determine the prevalence and factors associated with dental anxiety among pregnant women seeking care at the Preventive Oral Health Unit, Institute of Oral Health, Maharagama, Sri Lanka. The participants of this descriptive cross-sectional study were 402 pregnant women seeking care at the Institute of Oral Health, Maharagama for the first time. A validated Sri Lankan version of the Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety and an interviewer-administered questionnaire collected information about demographics, dental service utilization, knowledge, and the importance of oral health during pregnancy. The prevalence of dental anxiety was 61.7% and the mean MDAS score in the dentally anxious and not anxious were 13.4±3.8 and 9.20 ± 1.7 respectively. According to the binary multiple logistic regression model current employment status, household income, dental care seeking pattern, having had a negative experience during a previous visit to a dentist,poor awareness about the importance of oral health in pregnancy, not receiving oral health instructions from health care providers during pregnancy, the perception that oral care should be avoided during pregnancy were independently associated with dental anxiety. The prevalence of dental anxiety was high among this sample of pregnant women.

THE EFFECT OF THE EDUCATION LEVELS OF DENTAL STUDENTS ON THEIR DENTAL ANXIETY

The purpose of this study was to compare dental anxiety levels among first-, second-, third-, fourth- and fifth-year dental students. To evaluate the level of dental anxiety against dental interventions, online questionnaires were applied to first year (n=96), second year (n=96), third year (n=109), fourth year (n=107) and fifth year (n=92) dental students. The students' demographic information (age, gender) was also recorded. These questionnaires included the Modified Dental Anxiety Scale (MDAS). The students whose MDAS score was ≥19 were considered as highly anxious. The statistical analysis was performed using IBM SPSS Statistics 24 (IBM SPSS, USA). This study was conducted with a total of 500 students including 220 male and 280 female students. The students with an MDAS score of 19 (having dental anxiety) were 23 people (4.6%) in total. No statistically significant difference was found between the class years of the students in terms of their mean MDAS scores (p: 0.387). When the responses given to the 5 items in MDAS were evaluated, only the responses given to the 1st and 5th questions had statistically significant differences (p

Dental Anxiety Among Physicians: Relationship with Oral Problems, Dental Visits, and Socio-Demographic Factors.

The purpose of study was to investigate dental anxiety (DA) and its relationship with oral health problems, dental visits, and socio-demographic factors among physicians. This cross-sectional study was conducted on physicians working in Dhahran, Khobar, Dammam, and Qatif cities of the kingdom of Saudi Arabia. The study included physicians (general practitioners, residents, specialists, and consultants) working in the public and private sectors. Modified Dental Anxiety Scale and World Health Organization's Oral Health Questionnaire for Adults were used to evaluate DA, oral health problems, and dental attendance. The study included data from 355 participants with a mean age of 40.13 ± 10.45 years. There were 57.2% of non-Saudi and 42.8% of Saudi participants in the study. Bad dental experience in the previous dental visit was reported by 40% of participants, which was significantly related to DA (P = 0.002). Only 9.60% of participants had no DA, whereas 41.10% demonstrated low DA, 23.4% moderate DA, 18.9% high DA, and 7% extreme DA. Common oral problems included tooth sensitivity (65.40%), tooth cavities (45.90%), bleeding gums (43.10%), and bad breath (36.90%). More than half of participants (58.3%) visited the dentist during the last year and dental pain was the most common reason for dental visits (31.3%). Saudi participants demonstrated significantly increased DA than non-Saudis (P = 0.019). DA was significantly related to tooth sensitivity (P = 0.001), tooth cavities (P = 0.002), dry mouth (P = 0.044), and bad breath (P = 0.005). The participants with difficulty in biting foods (P > 0.001) and feeling embarrassed due to the appearance of teeth (P < 0.001) demonstrated significantly higher DA. This sample of physicians showed a high prevalence of DA, oral problems, and dental visits due to pain. DA was significantly related to physicians' negative dental experience, tooth sensitivity, dental decay, dry mouth, and bad breath.

Dental pain perception and emotional changes: on the relationship between dental anxiety and olfaction

BackgroundThe purpose of the study was to determine to what extent olfactory aromatherapy reduces the intensity of dental pain and the level of dental anxiety. It also attempted to corelate between olfactory aromatherapy, stages of dental visits, and various dental procedures.MethodsFemale patients were enrolled in a randomized controlled study. Olfactory aromatherapy was performed using lavender oils. Patients were randomly assigned to one of two groups: the lavender group, in which patients inhaled 2% lavender vapors, and the control group, in which patients inhaled water vapors. Pain score, anxiety score, and changes in vital signs were among the predictable variables. Anxiety and pain were assessed using the Modified Dental Anxiety Scale (MDAS), Speilberger State-Trait Anxiety Inventory (STAI), and visual analog scales (VAS). The vital signs were systolic (SBP) and diastolic (DBP), heart rate (HR), respiratory rate (RR), and oxygen saturation (Spo2). Variables were evaluated before inhalations, 20 min after inhalations, at the end of settings, and on the following day.ResultsEach group had 175 participants. Pain and anxiety scores were significantly reduced, and all vital signs improved, except for DBP. The MDAS, STAI, and pain scores are reduced by 3.4, 4.2, and 2.4 times, respectively, compared to the control group. Olfactory aromatherapy had the greatest impact during the phase of waiting rooms.ConclusionWhen compared to the control group, olfactory aromatherapy reduces anxiety scores three to four times more. Pain perception is reduced by twice as much as in the control group. It also significantly reduces the anxiety associated with minor to moderately stressful dental procedures.

Investigation of the effect of music listened to by patients with moderate dental anxiety during restoration of posterior occlusal dental caries.

The aim of this randomized controlled study was to investigate the effect of music therapy during restorative dental treatments on patients with moderate dental anxiety. Seventy patients were determined to have moderate dental anxiety by the Modified Dental Anxiety Scale (MDAS) and were divided randomly into two groups (n = 35). The first group did not listen to music during their restorative treatment (control group), and the second group listened to music of their choice (experimental group). Systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and body temperature were measured three times for each patient: once before the treatment, once after their dental caries were removed, and once at the end of the treatment. Salivary cortisol samples were taken from each patient before and after the treatment. The MDAS was re-administered to the patients at the end of the treatment, and the data were analyzed statistically. Only the diastolic blood pressure (P = 0.042) and the MDAS scores of the experimental group (P = 0.001) were significantly lower than the control group at the end of the treatment. While music listening did not have an effect on the physiologic parameters of the patients during restorative treatment, it decreased the MDAS scores of the patients. Although music therapy did not affect the physiological parameters during the restorative dental treatment, it may help to reduce patients' self reported anxiety level.

Does Modifying the Consent Process Based on the Dominant Intelligence Type Reduce Anxiety During 3rd Molar Operations?

Third molar surgery is one of the most commonly performed operations, usually associated with high anxiety. The purpose of this study was to determine if patients' anxiety would reduce if consent was modified to match their dominant intelligence type (DIT). A single center, prospective randomized clinical study was conducted in the Maxillofacial Surgery Clinic of Ordu University on patients admitted for lower third molar removal between October 2020 and June 2021. The participants were randomly assigned to a study group where consent was based on DIT or a control group where consent was obtained in the standard fashion. DIT was determined using the multiple intelligence test and was further categorized as visual/spatial, verbal/linguistic, and bodily/kinesthetic. The consent method was the primary and the type of DIT was the secondary predictor variable. The primary and secondary outcome variables were the salivary cortisol level and Modified Dental Anxiety Scale (MDAS) scores measured before and after the consent, and after the operation. Mann-Whitney U, Friedman, Kruskal Wallis, Pearson correlation, and χ2 tests were conducted for statistical analysis. Eighty patients (55 females and 25 males; mean age 23.5±6.2) were included. No significant difference was observed between the study and control groups for the change in cortisol levels and MDAS scores before-after consent (-11.15±62.64; -6.84±32.9) (P=.389), (-0.6±3.46; -0.7±2.49) (P=.832) and before consent-after operation (-39.80±108.2; -39.72±77.04) (P=.987), (-4.31±5.97; -3±4.34) (P=.867). The change in MDAS scores and cortisol levels was not correlated after consent (P=.587, r=0.62) and operation (P=.406, r=0.94). Providing consent based on DIT is not statistically different than providing consent in the standard fashion. The role of consent strategy in managing anxiety and lack of correlation between salivary cortisol and MDAS requires further investigation.

The impact of oral health literacy on dental anxiety and utilization of oral health services among dental patients: a cross sectional study

BackgroundLow oral health literacy levels and deficient oral health knowledge jeopardize the communication between dentists and patients in different communities. This study aimed to examine the impact and association of oral health literacy with patients’ levels of dental anxiety and their utilization of dental health services.MethodsThis cross-sectional study was conducted at the Misr International University (MIU) dental clinics. The study utilized a structured, interview led questionnaire that was administered by second year dental students, over the period of two successive academic years 2018–2019 and 2019–2020. A total of 440 student interviewed a convenience sample of 440 dental patients: including 269 females (61.1%) and 171 males (38.9%). The questionnaire consisted of four sections; a demographic section, a modified Arabic Rapid Estimate of Adult Literacy (ARELAD-30) Tool that measures the ability of the participants to read 30 commonly used dental terms. This questionnaire was modified by the authors to measure the participants’ knowledge by asking them to choose the most accurate meaning for each word based on their previous knowledge. Scoring was dependent on the participant’s immediate correct pronunciation, as well as comprehension of each word. The Arabic Modified Dental Anxiety Scale (AMDAS) was used to measure the level of dental anxiety, and the dental health service utilization was measured using the Utilization of oral health services questionnaire.ResultsOne quarter (24.1%) of the participants read the 30 items of the A-REALD correctly. The average percentage of correct responses to the meaning of the dental terms was 71.2%. There was no statistically significant association between A-REALD and knowledge scores (Spearman’s Correlation coefficient ρ = -0.008, p-value = 0.872). There was a statistically significant inverse correlation between age and MDAS (Correlation coefficient ρ = -0.146, p-value = 0.002). A-REALD scores were inversely correlated with time since last visit (Regression coefficient = -0.027, p-value = 0.036, with 95% CI: -0.052 – -0.002).ConclusionWithin the limitations of this study, it can be concluded that oral health literacy is significantly associated to dental health services utilization, while, dental anxiety is related to other variables, such as age and gender.

Interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety: a Chinese cross-sectional study

BackgroundChildren's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children’s self-reported and their mothers’ proxy-reported dental anxiety and its affecting factors.MethodsIn this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children’s self-reported and their mothers’ proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children’s dental anxiety were analyzed using univariate and multivariate logistic regression models.ResultsOne hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children’s self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1–5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother’s presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514–0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190–0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114–0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535–0.908, p = 0.007) and 0.362-fold (95% CI = 0.135–0.967, p = 0.043) decreases in the risk of children’s dental anxiety during dental visits and treatment, respectively.ConclusionThere was no significant agreement between elementary school students’ self-reported dental anxiety and mothers’ proxy ratings of children’s dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother’s presence during dental visits is strongly recommended.

The Influence of Family Milieu on Dental Anxiety in Adolescents—A Cross-Sectional Study

Parents play a significant role in the development of dental anxiety in their adolescent children. This cross-sectional study aimed to evaluate the influence of family milieu on adolescents' dental anxiety. The level of dental anxiety (Dental Anxiety Scale-DAS) was evaluated in 100 adolescent dental patients (ages 13-18 years) and their parents. Parents supplied information about family demographics and their personal experiences of dental treatment. Concomitantly, the family's behavior was observed during the dental encounter. The adolescents' mean DAS score was 9.83 ± 2.05. Adolescents' DAS was higher when their parents' memories from their own dental encounters were negative. A positive correlation was found between adolescents' dental anxiety and that of their father (r = 0.52, p < 0.001) and mother (r = 0.79, p < 0.001). The following variables showed a significant ability to predict adolescents' dental anxiety (stepwise regression): mother's DAS (B = 0.57), adolescent's behavior at the dental visit (B = 0.87), being the firstborn child (B = -0.44), father's DAS (B = 0.13), and mother's level of education (B = -0.10). The results showed that intra-family relationships and behavior, parents' education, dental fear, and memories from previous treatments play an important role in defining the level of dental anxiety in their adolescent children.

Evaluation of dental anxiety in school going children using modified dental anxiety scale and facial image scale

Background: Dental anxiety refers to patient’s response toward stresses associated with dental procedures. It can present problem for both dentist and patient, particularly in paediatric dentistry. Hence, it is important to identify anxious patients for improved patient management and development of better treatment strategies. Objectives: To evaluate the prevalence of dental anxiety in schoolchildren using Modified Dental Anxiety Nepali version (MDAS-N) and Facial Image Scale (FIS). Methods: An analytical cross-sectional study was carried out in 401 schoolchildren (11.34 ± 1.85 years) using convenience sampling method from 2022 June to 2022 August after ethical approval was obtained from Nepal Medical College. The dental anxiety was assessed by questionnaire provided in MDAS-N and FIS. Independent t-test was done in SPSS v.20.0 to analyse the data. Results: The data have shown that 375 (93.52%) had dental anxiety (mean MDAS-N = 11.83 ± 3.59) with low and moderate anxiety in 153 (38.15%) and 140 (34.92%) respectively. Seventy (36.08%) females presented with moderate anxiety and 92 (44.44%) males had low anxiety. The mean score difference was statistically significant (p-value &lt;0.001) between the genders. Statistically significant difference (p-value = 0.023) was found between FIS mean score of primary and middle school level students. Injection and drilling the tooth were the procedures with high anxiety score in both scales. There was a moderate positive correlation between MDAS-N and FIS (r = 0.574). Conclusion: Assessing dental anxiety and factors provoking fear and anxiety in dental clinic is useful, as behaviour management can be applied accordingly for child patients.

Advantages of Sedation With Remimazolam Compared to Midazolam for the Removal of Impacted Tooth in Patients With Dental Anxiety

Although midazolam is commonly used to sedate patients with dental anxiety, it has shortcomings that reduce the satisfaction of patients and doctors. The aim of this study was therefore to explore the advantages of remimazolam as a sedative. The study design was a prospective randomized controlled trial. Patients with dental anxiety and who were to undergo impacted tooth removal were randomized into remimazolam and midazolam groups. They were sedated with remimazolam or midazolam prior to receiving nerve blocker. The predictor variable was the type of sedative, while the primary outcome variables were the onset time, awakening time, recovery time, and postoperative side effects. Secondary outcome variables were the Modified Dental Anxiety Scale score before and after surgery, patient satisfaction and comfort levels scores, and doctor satisfaction level scores. Other variables included the patient demographics and the operation time. Data were analyzed using the Student's t-test, Mann-Whitney test, χ2 test, and two-way repeated measurement ANOVA test (SPSS Version 25.0). A total of 83 patients were included in this study, with 42 randomized to the remimazolam group and 41 to the midazolam group. There were no significant differences between the two groups in terms of demographic features and operation time. Patients in the remimazolam group had significantly shorter onset time, awakening time, and recovery time compared to those in the midazolam group (each P<.001). Postoperative side effects were more frequent in the midazolam group (P<.001). Following surgery, the Modified Dental Anxiety Scale scores in both groups were significantly lower than prior to surgery (P<.001). Satisfaction levels scores for the patients and doctor were higher in the remimazolam group than in the midazolam group (P<.001). The use of remimazolam results in faster onset, more rapid recovery, and lower incidence of postoperative side effects compared to midazolam, leading to improved satisfaction for patients and doctors. Remimazolam therefore appears to have several advantages over midazolam for the sedation of patients with dental anxiety associated with the removal of impacted teeth.

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

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. 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. 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. 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). 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.

Web-Based Interventions Reduced Dental Anxiety among Adults in Lithuania and Norway: A Pilot Study

Dental anxiety (DA) is a prevalent public health issue. However, there is a lack of self-administered DA interventions. The aim of this study was to evaluate the short-term effects of web-based interventions aiming to reduce DA in adults in two European countries. A pretest posttest design was used. Tailor-made websites were developed in Lithuania and Norway. Volunteers who self-reported DA were invited to participate. DA levels measured by the Modified Dental Anxiety Scale (MDAS) were assessed at baseline and after two weeks via online questionnaires. The interventions were completed by 34 participants in Lithuania and 35 participants in Norway. In Lithuania, the median posttest MDAS score (9.5, IQR 5.25) decreased compared to the median pretest MDAS score (14.5, IQR 8; Z value = -4.246, p < 0.001). The same was found in Norway-the median posttest MDAS score (12, IQR 9) was lower compared to the median pretest MDAS score (15, IQR 7; Z value = -3.818, p < 0.001). The present study demonstrated that two tailor-made web-based interventions had the potential to reduce dental anxiety levels when assessed in the short term in Lithuania and Norway. Studies with more controlled designs assessing long-term outcomes are needed to validate the results of this pilot study also in other cultures.

Should Preoperative Information Before Impacted Third Molar Extraction Be Visual, Verbal, or Both?

Offering preoperative information is one option to help patients cope with the anxiety associated with oral and maxillofacial surgical procedures. Although this information is commonly delivered verbally, written information, audio recordings, and videos are also recommended. This study aimed to evaluate the effects of different preoperative information techniques on patients' anxiety levels before and after third molar tooth extraction. A single-blind randomized controlled clinical trial with parallel groups was performed. 92 patients who fulfilled the inclusion criteria were randomly assigned to one of four groups. Group 1 was provided information via a silent video with subtitles. Group 2 was informed via a video with background audio. Group 3 was provided a written information brochure. Group 4, designated as the control group, was informed verbally. The Spielberger state anxiety inventory (STAI-S), dental fear scale (DFS), modified dental anxiety scale (MDAS), and visual analog scale (VAS) were used pre- and postoperatively to evaluate the dental anxiety of patients. The primary predictor variable was the preoperative information method. The primary outcome variables were the scores of STAI-S, DFS, MDAS, and VAS. Gender was also set as a covariate variable. Data analysis was performed with the IBM SPSS Statistics 25.0 software program. Unless otherwise stated, P<.05 was considered statistically significant. A total of 86 patients scheduled for impacted third molar extractions under local anesthesia were included in the study. There was no statistically significant difference among the groups in the mean age (P=.275) or distribution of gender (P=.070). Compared to preoperative values, the postoperative scores of MDAS and VAS were decreased significantly in group 1 (P=.002, P=.003, respectively) and group 3 (P=.007; P=.009, respectively). No statistically significant differences were found between the preoperative and postoperative scores of STAI-S, DFS, MDAS, and VAS in group 2 (P=.300, P=.028, P=.063, P=.038, respectively) and group 4 (P=.127, P=.587, P=.072, P=.016, respectively). The findings indicate that visual or written material, without audio or oral delivery, substantially reduced the anxiety associated with oral and maxillofacial surgery. Therefore, clinicians should preferentially provide information via written methods to control patients' anxiety before impacted third molar surgery.

Children's electronic screen time exposure and its relationship to dental anxiety and behavior

ObjectivesThe purpose of this study was to assess the association between electronic screen time and dental anxiety and behaviour among children aged six to twelve years during dental examination, prophylaxis, and topical fluoride application. Material and methodsThis was a cross-sectional study which included 402 paediatric dental patients aged six to twelve years who came to King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The data was collected from September 2020 to December 2021. Self-constructed questionnaire was used to collect data from the patient and his/her guardian. It was comprised of eight demographic questions as well as 13 multiple-choice questions regarding the patients' screen time. Child dental anxiety was assessed by using Abeer Children Dental Anxiety Scale (ACDAS). Assessment of child's behaviour was done by using Frankl Behavioural Rating Scale. ResultsThis study had a response rate of 100%. Out of the 402 participants, 248 (61.7%) were found to have anxiety while 154 (38.3%) were not. Of all participants 274 (68.2%) were cooperative and 128 (31.8%) were not. A Significant relationship between anxiety and behavioural problems during a dental visit and the participant's total exposure hours to electronic devices was found (p < 0.001). Children exposed to electronics at the age of two years or before displayed more anxiety and uncooperative behaviour (p < 0.001). Conclusionsearly exposure to electronic screens, especially for entertainment purposes and longer exposure can be associated with increased dental anxiety and uncooperative behaviour in children age 6–12 years. RecommendationsParents should be educated about the risks of permitting their children to use electronic devices and encouraged to replace such devices with activities that incorporate physical activity.

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

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

Concurrent changes in dental anxiety and smoking in parents of the FinnBrain Birth Cohort Study.

We evaluated associations between changes in dental anxiety and tobacco use, adjusted for general anxiety and depressive symptoms. The FinnBrain Birth Cohort Study data, collected at gestational weeks 14 and 34 and at 3months postpartum, were used. Questionnaires included the Modified Dental Anxiety Scale (MDAS), the Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Symptom Checklist-90 (SCL). Smoking was categorized as "stable non-smoking", "started smoking", "quit smoking", and "stable smoking". Changes in smoking and dental anxiety were evaluated "during pregnancy" (i.e., from gestational week 14 to gestational week 34) in 2442 women and 1346 men and "after pregnancy" (i.e., from gestational week 34 to 3 months postpartum) in 2008 women and 1095 men. Changes were evaluated in three smoking categories (stable non-smoking, fluctuating, and stable smoking), using data from all three time-points (1979 women and 1049 men). Modeling used repeated measures analysis of covariance. Stable smoking mothers had statistically significantly higher levels of dental anxiety (mean MDAS 12.3-12.6) than non-smoking mothers (mean MDAS 10.1-10.7) or mothers who smoked at some point during pregnancy (mean MDAS 10.8-11.5). A similar tendency was observed in fathers. However, no systematic change in dental anxiety by changes in smoking habits was observed. Those smoking during pregnancy and with high dental anxiety may need special support for smoking cessation.

Dental Anxiety and Its Determinants in Adult Patients of Gilgit Baltistan

Objective: To evaluate the frequency of dental anxiety and its relationship with age, gender, marital status, education,occupational status, place of residence and previous dental injury experience in patients belonging to Gilgit-Baltistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Psychiatry Department, Combined Military Hospital, Gilgit and 99 Military Dental Center,Gilgit Pakistan, from Jul to Dec 2017.&#x0D; Methodology: A total of 270 patients aged 18 to 65 years were selected for the study. The proforma was used to determine basic patient information, including past dental experience. Coral's Modified Dental Anxiety Scale (MDAS) was used to measure the level of dental anxiety.&#x0D; Results: The mean anxiety score was 8.95±2.53. Dental anxiety was common in 33.1% of the study population. Correlational analyses showed a significant positive relationship between younger age, female gender, single marital status, rural residence and negative past dental experience with dental anxiety.&#x0D; Conclusion: Within the Gilgit-Baltistan population, it was seen that younger patients, single females, people from rural areas and patients with a past negative dental experience had more Dental anxiety.