Dental Stimuli Research Articles

Postoperative recovery after removal of a lower third molar: role of trait and dental anxiety

The aim of this study was to evaluate trait and dental anxiety influence on postoperative recovery after lower third molar surgery and to determine the effect of anxiety on surgery duration. A prospective study was performed of 145 patients who underwent lower third molar extractions. Dental anxiety was evaluated using the Corah Dental Anxiety Scale (DAS), Kleinknecht Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. Surgery duration, postoperative pain, swelling, and trismus were also recorded. Patients with high trait anxiety showed more pain according to all of the postoperative measures and to a significant degree in the last 2 postoperative days evaluated. Patients with high dental anxiety had greater trismus according to the DAS and to the dental stimuli dimension of the DFS. The average surgery time was higher in patients with high anxiety, for all of the measures used, although this difference was not statistically significant. Patients with high trait or dental anxiety may tend to require longer surgery times and have poorer postoperative recovery.

Longitudinal behavioral analysis during dental care of children aged 0 to 3 years

'When' and 'how' the dentist intervenes have repercussions on children's physical and emotional patterns. The objective of the present study was to conduct a longitudinal behavioral analysis during dental care of babies aged 0 to 3 years. A total of 216 patients seen at the Baby Clinic of the School of Dentistry at Araçatuba, São Paulo State University (UNESP), were selected. The selection criterion was attendance at ten dental care sessions at bimonthly intervals for routine procedures such as clinical examination and oral hygiene. There was a predominance of cooperative behavior compared to uncooperative behavior when each visit was analyzed separately. The behavior of the patients must have been directly influenced by their psychomotor development. Constant attendance and exposure of the baby to non-stressful dental stimuli are factors that favor a cooperative behavior.

What are people afraid of during dental treatment? Anxiety‐provoking capacity of 67 stimuli characteristic of the dental setting

Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.

A possible role of LIM mineralization protein 1 in tertiary dentinogenesis of dental caries treatment

Dental caries is a slowly progressive infectious disease with high risks. In response to dental caries stimuli, the tertiary dentin might be formed, protecting the dental pulp. Tertiary dentinogenesis contributes greatly to the treatment of carious lesions as well as the preservation and restoration of entire tooth function. A number of studies have found that application of exogenous growth factors such as transforming growth factors and bone morphogenetic proteins on unexposed pulps are able to signal tertiary dentinogenesis. Since precise mechanism of tertiary dentinogenesis is still not clear, more potential signaling factors might contribute to this process. Dentinogenesis shares many similarities with osteogenesis. The factors involved in osteogenesis and bone repair such as bone morphogenetic proteins 2, 7 and core binding factor alpha1 play important roles in dentinogenesis. LIM mineralization protein 1 is a critical positive regulator of osteoblast differentiation, bone formation and repair. It is logical to postulate that LIM mineralization protein 1 might be involved in odontoblast differentiation and dentin formation both in normal and in pathological conditions. Application of LIM mineralization protein 1 might be a promising approach for inducing tertiary dentinogenesis in dental caries treatment.

Factors influencing the use of behavioral management techniques during child management by dentists.

Dental anxiety develops from a vicious cycle of bodily arousal from dental stimuli, cognitive interpretation and ineffective coping all working in a runaway feedback loop. Behavioral management strategies (BMT) aim at cognitive reorientation, which results in better compliance with instruction. This paper therefore tried to find out possible factors that influence the effective use of BMT during child dental management during treatment by dental operators in Nigeria. The levels of anxiety pre and post treatment were assessed using the short form of the dental version of the Child Fear Survey Schedule. Also, the type of treatment given to the child, the types and number of behavioral strategies employed during dental management as well as the gender and age of the child were noted. The professional status of the attending dental operator was also noted. Prior to the commencement of the study, the five students in the final year, who were to attend to the children in this study received one week training on the psychological management of dental anxiety in children. Results obtained from the dental operators were compared. The type of treatment received by the child did not significantly affect the dental anxiety score. The number of techniques combined by house officers and senior registrars were significantly higher than would be expected by chance (chi2=16.030, P=0.0001 and chi2=9.000, P=0.0001 respectively). Combination of techniques was also more frequent during invasive procedures and when dental anxiety levels were high. Combining techniques also tended to decrease dental anxiety more significantly than otherwise. Training has a role to play in the basic and efficient use in the management of the child dental patient. The training of dentists should thus entail the full spectrum (content and instructional effectiveness) of all psychological techniques.

Blood–injury–injection phobia and dental phobia

The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent of the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.

Response characteristics of tooth pulp-driven postsynaptic neurons in the spinal trigeminal subnucleus oralis of the cat.

Neuronal activity in the spinal trigeminal subnucleus oralis in response to electrical tooth stimulation was recorded in the anaesthetized cat in order to compare the electrophysiological characteristics of the oralis neurons with those of subnucleus caudalis and interpolaris neurons recorded in previous studies. The most sensitive oralis neurons had lower thresholds and shorter latencies than the most sensitive caudalis and interpolaris neurons. The thresholds of the oralis neurons were lower and their strength-duration curves flatter than those depicting liminal dental pain in man but similar to those depicting liminal jaw reflexes in the cat. Noxious conditioning stimulus elevated the threshold of only 1 of 10 neurons tested. The converging input from the skin and oral mucosa was from low-threshold mechanoreceptors. The results indicate that the response properties of the subnucleus oralis neurons differ significantly from those of other spinal subnuclei. Human pain thresholds cannot be explained by the liminal response properties of oralis neurons. These neurons might be important in the mediation of liminal reflex events evoked by dental stimuli.

The effects of medetomidine, an α-2-adrenoceptor agonist, and cocaine on the tooth pulp-evoked jaw-opening reflex in cat

In the pentobarbitone-anesthetized cat, the threshold of the tooth pupl-elicited jaw-opening reflex was elevated in a dose-dependent way (30–100 μg/kg, IP) following the administration of medetomidine, an α-2-adrenoceptor agonist. This elevation was significantly reduced by atipamezole (1 mg/kg, IP), an α-2-adrenoceptor antagonist. The inhibitory interaction between two successive dental stimuli applied to the same tooth (in-field inhibition) was suppressed by a lower dose of medetomidine (30 μg/kg) than the threshold elevation to single electrical pulses (55 μg/kg). Only the highest dose of medetomidine used (100 μg/kg) significantly influenced the temporally facilitated (in-field facilitation) response. In comparison, cocaine, a nonspecific monoaminergic agent, did not produce a significant threshold elevation of the tooth pulp-elicited jaw-opening reflex (1–25 mg/kg, IP). It is concluded that medetomidine, through an action on α-2-adrenoceptors, can suppress a predominantly nociceptive trigeminal reflex in anesthetized cats. The threshold evoked by single electric pulses, in-field inhibition, and in-field facilitation display differential sensitivities to medetomidine effects.

Establishment of Latent Ganglionic Infection with Herpes Simplex Virus via Maxillary Gingiva and Viral Re-activation in vivo after Trauma

Herpes simplex virus can remain latent for months or years in sensory and automatic ganglia of animals and man, and can be re-activated in vivo by several procedures such as neurectomy, irritation of epithelial surfaces, and administration of immunosuppressive agents. The objective of this study was to determine whether dental stimuli can cause re-activation of the latent herpes simplex virus. Homogenization and explanation of ganglia from mice showed that herpes simplex virus (type 1) traveled from maxillary gingiva to trigeminal ganglia, and remained latent. It was also shown that mice passively immunized with rabbit antibody to herpes simplex virus, following the inoculation of herpes simplex virus by the maxillary gingiva route, developed a latent infection in the trigeminal ganglia. Neutralizing antibody was cleared from the circulation and could not be detected in most of these animals after five weeks. A neutralizing test showed that antibody-negative mice with latent infection were able to produce antibody to re-infection with herpes simplex virus, suggesting that re-activation can be identified by measurement of serum antibody. By use of this mouse model system, it was shown that when maxillary gingiva was traumatized with dry ice, viral re-activation occurred in 58% of these animals, as demonstrated by the appearance of neutralizing antibody. Irradiation by a Stomalaser beam had no effect on the re-activation of latent herpes simplex virus. Our mouse model system may serve as a useful model for obtaining new information on re-activating or inhibitory factors in dentistry.

Effect of naloxone on tooth pulp-evoked jaw-opening reflex in the barbiturate-anaesthetized cat.

The threshold of the tooth pulp-evoked jaw-opening reflex was uninfluenced by administration of 0.5 or 5.0 mg kg-1, i.v. naloxone, a specific opioid antagonist, in the barbiturate-anaesthetized cat. Furthermore, facilitatory or inhibitory interactions between two successive tooth pulp-evoked jaw reflex responses were not influenced by naloxone. It is concluded that naloxone-sensitive opioid receptor-mediated mechanisms do not contribute to the modulation of tooth pulp-evoked reflexes by conditioning dental stimuli. Also they do not exert a tonic inhibition on the sensory or motor part of the tooth pulp-driven reflexes. Experiments performed for comparison showed that the non-nociceptive polysynaptic reflex discharge in the flexo-motor neurons of the limb was not influenced by naloxone either.

Selectivity of analgesic effects of angiotensin and bombesin against dental and cutaneous nociceptive stimuli

During the action of nociceptive stimuli of varied nature the secretion of different peptides and, in particular, of somatostatin and substance P, has been demonstrated at the level of relay neurons of the spinal cord [7], and certain peptides, notably neurotensin and ca!citonin, have been shown to have a selective analgesic action, depending either on the nature of the nociceptive stimulation [3] or on its localization [4]. Angiotensin II and bombesin, which are endogenous nonopioid peptides [5, 8], are widely represented in structures of the CNS and, in particular, in the region of the posterior horn of the spinal cord, the brain stem, thalamus, and so on, and also in the descending supraspinal tracts running to the posterior horn [6]. This indicates their possible participation in the physiological mechanisms of modification of nociceptive sensation, and differences in their localization both with each other and with the opioid peptides have given rise to the suggestion that they may have different influences on nociception depending on the genesis or location of the nociceptive stimulation. In the investigation described below two types of nociceptive stimulation were studied: electrocutaneous and electrodental, for differences in their perception are well known from clinical practice. Since the most adequate parameter of nociception in animals is a change in evoked potentials (EP) of brain structures [2], and because of the considerations expressed above, the aim of the present investigation was to study the action of angiotensin II and bombesin on changes in somatosensory cortical EP of rabbits in response to electrodental and electrodermal nociceptive stimulation. EXPERIMENTAL METHOD Experiments were carried out on 40 conscious and loosely restrained make chinchilla rabbits weighing 2.5-3 kg, previously scalped under procaine anesthesia. EP were recorded from the surface of the cranial bones in the region of the somatosensory cortex in response to electrocutaneous stimulation of the contralateral hind limb (ECS), causing limb withdrawal, and electrodental stimulation (EDS), causing a licking reflex, which could be produced with the aid of electrodes inserted into the pulp of the upper incisors (sinBle square pulses, 0.5 msec, 4-20 mA). One animal was used in each experiment. By means of a cannula fixed beforehand to the skull, a solution of bombesin (from "Serva") in a dose of 20 ~g/kg (14 experiments), and a solution of angiotensin II (A II) in a dose of 50 mg/kg ("Sigma") (20 experiments), were injected in a volume of i0 ~I into the third ventricle; naloxone ("Endo") was injected ina dose of 0.15 mg/kg in a volume of 1 ml intravenoulsy (six experiments). EP were analyzed on an NTA-1024 amplitude-phase analyzer in I0 realizations. The amplitude of the component (AC) P2o-~o of EP, the one most associated with nociception [2], was determined in the animals in the initial state and at 10-min intervals after injection of the peptides. For each experiment the average background values of AC of P2o-~o of EP were determined, and taking this value as 100%, deviations at different times were calculated. The significance of differences between the results was estimated by nonparametric statistical tests and by StudentTs test.

Pain perception decrement produced through repeated stimulation

Pain responses (pain detection and pain discomfort) to electrical dental stimulation were studied in 16 normal subjects. The repetition of the dental stimuli induced a significant and long-lasting (60 min) decrease in pain sensitivity at both sensory levels (after 60 min of repetitive stimulation, 79% increase in pain detection, P < 0.0001, 45% increase in pain discomfort, P < 0.0004). The sensory response decrement through repeated elicitation was not influenced by naloxone administration (1.2 mg i.m.). This study clearly demonstrates the induction of pain sensory decrease through repetitive stimulation which differs from peripheral sensory receptor adaptation, from the inhibitory gating mechanism or from diffuse inhibitory controls activation; its unresponsiveness to naloxone suggests that this phenomenon is not opioid-dependent. A technique has been standardized which will enable the systematic study of pain decrease under sustained nociceptive stimulation in chronic pain patients.

Electrodermal activity, dental anxiety, and fear of dentistry in a group of parenteral drug addicts.

The present study was undertaken in order to evaluate whether electrodermal activity was a useful tool with which to measure dental anxiety in a group of drug addicts. Electrodermal activity was compared to the subjects' self-reported feelings during ordinary dental treatment sessions. In the first part of the study the level of electrodermal activity during treatment sessions was videotaped and recorded on paper by means of a polygraph. The patients were interviewed using a semi-structured questionnaire dealing with the addicts' dental anxiety and fear. In connection with the interviews the addicts completed Corah's Dental Anxiety Scale (CDAS). There was no recognizable pattern in electrodermal activity when this was compared with the patients' feelings during the treatments. Median CDAS was 9.5. In the second part of the study, electrodermal activity was recorded on the polygraph only. This group also completed a CDAS questionnaire. No correlation between the patients' self-reported highest level of anxiety and level of electrodermal activity, number of fluctuations or amplitude in relation to specific dental stimuli was found; agreement was found in two, three and none of 10 cases respectively. Median CDAS was 10.0. It could be concluded that, although the study revealed apprehension and situational anxiety among the addicts, no correlation to electrodermal activity was found. This discrepancy between the physiological and cognitive data probably reflects the uncertainty of these measures under the given circumstances.

Flooding and coping skills training in the management of dental fear

Abstract The effects of flooding and coping skills training in reducing fear and avoidance of dental treatment were examined by using a crossover design. Results showed that flooding and coping skills training were equally effective in increasing approach behavior, reducing subjective anxiety, and increasing level and strength of perceived self-efficacy. The combination of these treatments resulted in further clinical improvement which was maintained at 4-month follow-up. It was observed that dental appointments were more effectively promoted when coping skills training preceded rather than followed exposure to dental stimuli. The possibility that perceived self-efficacy could be a useful predictor of making and keeping dental appointments is raised.

Effects of ethanol on evoked potentials elicited by painful dental stimuli

1Department of Anesthesiology, University of Washington, Seattle, WA 98195, USA 2Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA 3Oral Medicine, University of Washington, Seattle, WA 98195, USA

Factor analysis of the dental fear survey with cross-validation

Factor analysis of the Dental Fear Survey disclosed three stable and reliable factors. The first factor related to patterns of dental avoidance and anticipatory anxiety. The second factor related to fear associated with specific dental stimuli and procedures. Factor three concerned felt physiologic arousal during dental treatment. Cross validation showed these three factors to be consistent across four demographically and geographically diverse groups.

Reflex and cortical responses to dental stimuli.

Tooth pulp stimulation may evoke reflex responses in the orbicularis oculi, temporal, masseter and retronuchal muscles, which may to a varying degree contaminate the cortical evoked responses. The use of repetitive stimulation reduces the amplitude of the cortical responses but avoids the onset of the majority of the muscle reflexes. The appearance of a silent period in the temporal muscle is hard to avoid and it alters the signal recorded from S1 for the first 60-70 msec. In the center-posterior leads, more protected from the EMG signal of the temporal muscle, a first negative deflection is recorded at 43 msec in 60% of subjects.

The limits of tooth pulp evoked potentials for pain quantitation

Tooth pulp evoked potentials (TPEPs0 and subjective evaluation of painful dental stimuli have been recorded in healthy volunteers. The amplitude of TPEPs late components and the subjective rating have been studied in different psychological states, by changing the expectancy of pain with a placebo and by providing foreknowledge of stimulus timing with self-stimulation. The placebo induced a significant depression of TPEPs and pain sensation. The amplitude of TPEPs evoked by self-delivered stimuli was reduced but the subjective report remained unchanged. These results demonstrate that TPEPs are not a stable correlate of the pain perceived or of the painful input.

Comparative effects of acupuncture and transcutaneous stimulation on the perception of painful dental stimuli

The effects of acupunctural stimulation on the perception of induced dental pain were compared with those of placebo acupuncture and transcutaneous electrical stimulation (TES) at an acupuncture site. Each of 4 groups of 15 subjects received one of the following treatments: acupuncture, placebo acupuncture, TES, or control conditions. Every subject was tested twice, once in a baseline session and on another day in a test session. Four levels of painful dental stimuli were delivered repeatedly and in random order to each subject in each session, who rated the perceived intensity of each stimulus on a pain category scale. All three treatment groups showed a significant reduction in magnitude of stimulus ratings after treatment. A Sensory Decision Theory analysis of the data was employed to assess the sensory sensitivity of each subject to each of 4 levels of dental stimulation and the willingness of the subject to label the strongest stimulus as painful. Acupuncture and TES groups showed a small but significant sensory analgesic response to treatment and a significant reduction in willingness to identify the strongest stimulus as painful when contrasted to controls, but placebo acupuncture subjects failed to show significant change on either of the response measures. The effects of acupuncture were most pronounced at the lowest level of stimulation, while TES affected the perception of all levels of dental stimuli. The observed effects appeared to be small, reliable, and dependent on the stimulation of a particular anatomical locus.