Dental Treatment Experience Research Articles

Children's dental anxiety in the United Kingdom in 2003

Background The prevalence of dental anxiety among a representative sample of children in the UK was determined in the Children's Dental Health survey of 2003. Aims This paper is concerned with the extent to which children in the United Kingdom are judged by a parent or carer to be behaviourally affected by dental anxiety and the factors associated with this. Method The information was gathered by self-completion questionnaire distributed to the parents of half of the sample of children who were also clinically examined in the dental survey. Results Dental anxiety that was sufficient to disrupt dental attendance was reported for around 3–4% of the four age groups surveyed (5, 8, 12 and 15 years of age). Children's dental anxiety was associated with parental dental anxiety; a greater experience of invasive dental treatment and general anaesthetic; receipt of free school meals and social class. Conclusions Whilst these findings do not necessarily indicate causal relationships, they do confirm a number of co-factors associated with dental anxiety perhaps most importantly that of anxiety with the experience of general anaesthetic for tooth extractions.

The oral health of older people: general dental practitioners' beliefs and treatment experience

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long-term care (LTC) facility during the previous 2 years. Over three-quarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist-acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.

국내 초등학생의 체내 총수은 농도 및 노출요인 조사

Mercury contamination and its health effects have become major concern of environmental health study in Korea. Mercury exposure of some group were investigated to get the accurate data for policy making and study. About 2,000 children at 26 elementary schools participated in this survey to evaluate the exposure levels and to investigate main exposure source of mercury. Analysis of mercury levels in the whole blood and urine samples were conducted and questionnaire survey was done about the factors influencing exposures simultaneously. Mercury exposure levels of domestic children were N.D. to 17.26 ppb in blood, 0.17 to <TEX>$21.67{\mu}g/g$</TEX>-creatinine in urine. The mean(arithmetic) levels are 2.42 ppb in blood and <TEX>$2.53{\mu}g/g$</TEX>-creatinine in urine. Both of them were below the recommendation levels of US EPA and German CHBM I <TEX>$5.8{\mu}g/l$</TEX> and <TEX>$5{\mu}g/l$</TEX> in blood, <TEX>$5{\mu}g/g$</TEX>-creatinine of German CHBM I in urine. But 1%, 0.51% of levels in blood exceed the level of CHBM I and US EPA, 8%, 0.85% of children were over the level of CHBM I and CHBM II in urine. Multi-valuable regression analysis showed that the existence of road near the residence in addition to the preference for fish have significance with blood mercury exposure level of domestic children. The existence of factory near the house and the experience of dental amalgam treatment had statistical relations with urine mercury level.

A Comparison of Dental Treatment Utilization and Costs by HMO Members Living in Fluoridated and Nonfluoridated Areas

To compare dental treatment experiences and costs in members of a health maintenance organization (HMO) in areas with and without community water fluoridation. HMO members with continuous dental eligibility (January 1, 1990 to December 31, 1995) who resided in Oregon and Washington were identified using administrative databases. Fluoridation status was determined by geocoding subscriber address. Measures were utilization of dental procedures, fluoride dispensings, and associated costs. Costs were based on nonmember fees, adjusted to 1995 dollar values. Data were analyzed using analysis of covariance, controlling for age and interactions. About 85 percent of eligible members (n = 51,683) were classified as residing either in a fluoridated (n = 12,194) or nonfluoridated (n = 39,489) area. Mean age was 40.0 years; 52.3 percent were women. More than 92 percent of members had one or more dental visits. Community water fluoridation was associated with reduced total and restorative costs among members with one or more visits, but the magnitude and direction of the effect varied with locale and age and the effects were generally small. In two locales, the cost of restorations was higher in nonfluoridated areas in young people (<age 18) and older adults (>age 58). In younger adults, the opposite effect was observed. The impact of fluoridation may be attenuated by higher use of preventive procedures, in particular supplemental fluorides, in the nonfluoridated areas. These results are particularly relevant to insured populations with established access to dental care. Differences in treatment costs (savings) associated with water fluoridation should be estimated and included in future cost-effectiveness analyses of community water fluoridation.

C2 Management of a patient exhibiting concomitant supernumerary teeth and hypodontia

Presenting problem: A 9‐year‐old boy was referred by his General Dental Practitioner for the management of supernumerary teeth in the anterior maxilla. The child had little experience of dental treatment but was concerned with the aesthetics of his teeth. He was medically fit and well. Clinical and radiographic examination revealed the presence of a supplemental megadont tooth in the position of 11, an erupted palatal tuberculate supernumerary tooth causing displacement on closure and hypodontia of 35 and 45 with infraocclusion of 75. Orthodontically, the patient had a Class II division 1 incisal relationship on a mild Class II skeletal base. He was severely crowded in the upper arch but the lower arch was well aligned. Oral hygiene was noted to be poor.Clinical management: All treatment was provided under the close supervision of an Associate Specialist in Orthodontics and initially involved extraction of 53 and the palatal supernumerary tooth and thorough oral hygiene instruction and preventive advice. Following further dental development, the megadont tooth and 24 were extracted to facilitate orthodontic alignment with an upper fixed appliance. A heat‐treated gold onlay has been provided for 75 and 85 is currently monitored for signs of infraocclusion.Discussion: There are few reported cases in the literature of concomitant supernumerary teeth and hypodontia. This case describes the multi‐disciplinary management of a child with a complex dental problem.

Patterns of care and service use amongst children in the UK 2003

The 2003 Children's Dental Health Survey is the fourth of the 10-yearly surveys of children's oral health in the United Kingdom. To detail the reported experience of dental services and dental treatment amongst children in the UK. A self-completion questionnaire was distributed to a 50% sub-sample of parents or carers of the children who were clinically examined in the 2003 UK Child Dental Health Survey. This included questions relating to parental and child experience of dental services and dental treatment. The proportion of UK five-year-olds reported as not having visited the dentist fell from 14% in 1983 to 6% in 2003 and the proportion reported as having visited the dentist before the age of two rose from 7% in 1983 to 31% in 2003. Over 80% of all children were reported to seek regular dental check-ups. Around 10% were reported to have had some difficulty in accessing NHS dental care while 5% of five-year-olds were reported to have experienced a general anaesthetic for dental procedures in 2003. Dental attendance was associated with social class and mothers' reported attendance patterns. In line with previously reported trends, the 2003 survey of children in the United Kingdom shows improvements in several areas but some aspects of attendance pattern continue to be associated with social class and mothers' attendance pattern. It is of concern that 10% of five-year-olds reported having experienced extractions and 5% general anaesthesia for dental treatment.

The dental health and preventative habits of cardiac patients attending the Royal Hospital for Sick Children Glasgow

To assess the dental health and preventive practices of child patients with congenital heart disease treated at the Royal Hospital for Sick Children, Glasgow. A retrospective study using an audit data collection sheet. Data collected for 370 paediatric cardiac patients between January 2002 and December 2003 was analysed to obtain an insight into these patients' tooth brushing methods, use of fluoride (F), dental attendance and past dental treatment. An oral examination assessed the patient's caries experience. There were 195 subjects aged between 1 and 5 years, 105 were 6 - 11 years and 70 were 12 -16 years of whom 291 (78%) children were registered for dental care. Of these children 331 (90%) maintained that they brushed their teeth regularly with F- toothpaste. Experience of dental treatment revealed that 132 (36%) children had undergone previous dental treatment. Oral examination showed that out of 370 patients, 236 (64%) had no active caries. The dental health of the cardiac subjects was poor compared with that of Scottish primary school children (5 year-olds) and the 12 year-olds but compared favourably with the 14-year old group. The relationship between caries activity and frequency of toothbrushing was significant (p<0.01). The relationship between caries activity and attendance for dental care was not significant. Children with cardiac problems should be identified in early infancy through liaison with medical colleagues and the family offered all the preventive advice and regular dental care necessary to prevent dental disease.

An investigation of language used by children to describe discomfort expected and experienced during dental treatment

A study of dental pulp testing has shown that children's linguistic comprehension and chronological age independently influence their descriptions of pain. The present study sought first to demonstrate this for expectations and experience of routine dental treatment, and secondly, to determine whether the effect of age was the result of previous dental and medical experience. Forty-six children between 6 and 17 years of age attending two paediatric dental clinics for routine invasive procedures comprised the study sample. To describe their expectations of forthcoming treatment, each child selected words from a published list, and gave ratings on scales describing the degree of severity as 'sore' or 'tingly'. They also completed the Child Dental Anxiety Scale and the Spielberger State-Trait Anxiety Scale for Children. After treatment, they described the treatment with the same list and scales, then completed the British Picture Vocabulary Scale and a dental-medical history questionnaire. The children, especially the most anxious ones, chose more words from the list for their expectations than for their experience of treatment, suggesting, as in previous studies, that they expected more discomfort than they experienced. Ratings of 'sore' and 'tingly' did not show this discrepancy. For both expectations and experience of treatment, the children with the largest vocabularies chose the fewest words, thus being more discriminating in their choices. However, vocabulary had no effect on ratings of 'sore' and 'tingly'. There were no significant relationships among age, estimates of discomfort and medical-dental histories. The results suggest that a list of adjectives provides the most discriminating measure of discomfort. They also show that it is necessary to take into account children's linguistic development to evaluate their estimates of pain so as not to entertain the belief of many clinicians that children exaggerate such reports.

Regular dental visits and dental anxiety in an adult dentate population

The objective of this study was to investigate factors associated with regular dental visits in an adult population. A representative sample of non-institutionalized dentate adults (aged 18 through 69 years) from the Detroit tricounty area (Wayne, Macomb and Oakland counties) was randomly selected using list-assisted random digit dialing. The authors collected the data through a self-administered questionnaire that asked for information about regular dental visits, private dental insurance, perceived oral health status and dental treatment experience. The authors used Corah's Dental Anxiety Scale to measure respondents' dental anxiety level. They also conducted a descriptive analysis and a logistic regression analysis. A final sample of 630 adults who resided in 368 households participated in this study. Seventy-two percent of respondents had dental insurance (excluding Medicaid). About 63 percent reported that they visited a dentist regularly. About 12 percent of adults had high dental anxiety (a score of 13 or higher on the Corah scale). A logistic regression model found that dental anxiety, dental insurance status and perceived oral health status were significantly associated with regular dental visits after accounting for sociodemographic factors such as sex, age and income. Among those who had dental insurance, dentally anxious adults were significantly less likely to visit dentists regularly. However, this association was not significant among respondents without dental insurance. Dental insurance, perceived oral health status and dental anxiety were associated with regular dental visits. Dental anxiety was an influencing factor in regular dental visit behavior, especially among adults who had private dental insurance. Practitioners need to be educated about the causes of dental anxiety and receive training in how to treat the problem.

The relationship between anxiety and dental treatment experience in 5-year-old children.

To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined and dmft and its components were recorded. A postal questionnaire was sent to parents of participating children to identify whether children attended the dentist on a regular asymptomatic basis or only when experiencing problems. Additionally parents were asked to judge whether they and their child were anxious about dental treatment. The socio-economic status of the family was measured using the Townsend Material Deprivation Index of the electoral ward in which they resided. The bivariate relationships between anxiety and reported attendance experience, past extraction and restoration history were using chi-square and t-tests. Multiple logistic regression analyses identify predictors for dental anxiety. A total of 1,745 children received both a clinical examination and a questionnaire and 1,437 parents responded, a response rate of 82.3%. One in ten parents (10.8b) judged their child to be dentally anxious. Anxious children had significantly (p<0.001] more caries experience (dmft 2.58 vs 1.12). Multiple logistic regression analyses confirmed that anxious children were more likely to be irregular attenders (OR 3.33, 95% Cl 2.22, 5.00), have anxious parents (OR 1.60,95% Cl 1.09, 2.36), and to have undergone dental extraction in the past[OR 3.50, 95% CI 2.10, 5.85), after controlling for gender and socio-economic status. A past history of restoration was not a significant predictor of anxiety after controlling for other factors. Dental anxiety is a fairly common condition in 5-year-old children in the North West of England. It is closely associated with asymptomatic, irregular attendance pattern, a history of extraction and having a dentally anxious parent. The cause and effect dynamics of these relationships need to be determined.

A case experience of dental treatment for a patient with fibrodysplasia ossificans progressiva

A case experience of dental treatment for a patient with fibrodysplasia ossificans progressiva

Predicting the experience of dentinal caries or restorative dental treatment in adolescents using D1 and D3 visual caries assessments.

Standardised epidemiological caries assessments used in oral health surveys have been shown to be poor at predicting whether a tooth surface will be treated restoratively when a patient visits a dentist. However, it has been argued that oral health surveys may be more relevant in determining needs at the level of an individual or groups of individuals. The objective of this study was to determine the discriminatory power of visual caries assessments at two thresholds (D1 & D3) in adolescents of average age 12.1 years to predict experience of dentinal caries 3 years later or the experience of restorative treatment (not re-treatment) during the 3-year period. The data was derived from a prospective 3-year longitudinal study in which the dental care provided by 41 dentists for 403 adolescents was monitored. Dental caries experience was monitored by annual standardised assessments of caries undertaken by a single trained examiner. ROC analysis showed that caries assessed visually at the D1 threshold in 12-year-olds was a better predictor (P < 0.001) of experiencing some dentinal caries after 3 years (Az = 0.781) than was caries assessed visually at D3 threshold in 12-year-olds (Az = 0.670). Assessing caries visually at either the D1 or the D3 threshold had no discriminatory power for predicting whether an individual would experience some restorative treatment during the ensuing 3-year period (Az for D1 = 0.507; Az for D3 = 0.518).

Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood.

Most studies examining the origins of dental fear and anxiety have relied on cross-sectional data. These are subject to several problems, such as recall and uncertainty concerning temporal relationships. This paper uses longitudinal data from the Dunedin Multidisciplinary Health and Development Study to assess risk factors for the development of dental anxiety in persons between the ages of 18 and 26 years. It was hypothesized that psychological factors would be as important as conditioning experiences in the genesis of dental anxiety over this period. The eight-year incidence of dental anxiety was 16.5%. Five variables entered models predicting onset: multiple fears, symptoms of substance dependence, previous experience of invasive dental treatment, dental visiting pattern, and the extraction of one or more teeth. Separate analyses for those avoiding and those using dental services resulted in different explanatory models. These results indicated that both psychological and conditioning variables contributed to the development of dental anxiety in this population of young adults.

Patterns of dental caries and treatment experience in elderly Lithuanians.

The aim of the study was to evaluate patterns of caries experience in a representative sample of Lithuanians, aged 65-74. This cross-sectional study included 301 participants (response rate 54%). Information was obtained from a clinical examination (caries experience, stimulated salivary flow rates and oral hygiene levels) and a questionnaire. The questionnaire comprised questions about oral, general, physical, mental and social health and about background, knowledge, attitudes and lifestyle. The study had a multidimensional approach to negative consequences of disease and positive aspects of health. For bivariate testing, t-test, ANOVA and Spearman's correlation were used. Factor analysis was combined with linear multiple regression for a multivariate study of caries experience patterns. Elderly Lithuanians were found to have lower levels of edentulousness (range 11-15%) than elderly people in other European countries. The mean number of missing teeth was also lower than in any of the neighbouring countries. A comparison of dentate and edentulous groups did not show any major differences. Those who reported that they had general disease had higher levels of oral health maintenance. In dentate elderly, caries experience differed according to place of residence, fluoride content in the drinking water, socioeconomic status, gender, lifestyle, and many other factors. The multivariate approach explained 52%, 61% and 55% of the variation in the number of filled or sound teeth (FS-T), decayed (DT) and missing teeth (MT) respectively. Levels of oral health maintenance and caries experience show substantial variation among elderly Lithuanians, according to many health-related characteristics. These elderly people require appropriate oral care, just as much as people in other population sub-groups.

Characteristics of children attending for dental general anaesthesia in 1993 and 1997.

To confirm clinical observations and to investigate the characteristics (demography, dental anxiety status, dental health status, treatment experiences and dental health behaviours) of children attending for dental general anaesthesia (DGA). A case series design was used in which each consecutive parent and child, referred for DGA, were invited to take part. Identical protocols for the selection of the sample, administration of the questionnaire and clinical examination were used to ensure comparability. To account for seasonal variation the data were collected during and between the months of January and May in both 1993 and 1997. Two hundred children and their parents were selected in 1993 and 200 in 1997. The parent completed a questionnaire. It enquired of the parent and child demography, parental dental anxiety status, and the child's treatment experiences. Children were asked to complete the Children's Fear Survey Schedule (CFSS) to assess their dental anxiety. The child's caries experience was assessed using the guidelines to standardise the collection of epidemiological data throughout the UK. Children studied in 1997 compared with 1993 were younger, had more decayed but fewer filled teeth, were more dentally anxious, more likely to present in pain and came from families who were in receipt of Government benefits. A linear regression analysis showed that the children with previous experience of DGA had higher levels of dental caries, fewer filled teeth, were older and attended in 1997. An individual regression for 1993 showed that an additional predictor was child attendance pattern. These findings confirmed the clinical observations and suggested that children who attend in pain and present for repeated DGA represent a group of children with special dental healthcare needs. There is a need for an integrated dental healthcare service to identify such children and provide appropriate dental care facilities for them.

Incidence of dental anxiety in young adults in relation to dental treatment experience.

To document the incidence of dental anxiety among individuals aged 18 years at baseline and 26 years at follow-up, and to determine if dental treatment experience continues to play a significant etiological role with respect to the onset of dental anxiety in young adults. Dental anxiety scale (DAS; Corah, 1969) scores at ages 15, 18 and 26 were obtained for Study members in the Dunedin Multidisciplinary Health and Development Study. Dental examinations were conducted, and sociodemographic and dental service-use data were collected using a self-report questionnaire. Using a case definition of a DAS score of 13 or more, age 18-26 incident cases were identified and their dental treatment experience and service-use characteristics compared with the remainder. DAS scores at 18 and 26 were available for 792 (80.8%) of the 980 26-year-old Study members. An increase in dental anxiety prevalence was observed over the eight-year period, with an annualized incidence of 2.1%. Fewer incident cases had visited a dentist in the previous eight years, and there were no differences between incident cases and others in their eight-year DFS, FS or tooth-loss increments. A subgroup of "recurrent" cases was identified who were dentally anxious at 15 and 26 but not at 18, and their eight-year incidence of tooth loss due to caries was substantially higher than non-cases. Aversive conditioning experiences appear to be unrelated to the adult onset of dental anxiety, and it may be that particular temperamental or psychological traits are associated with the condition.

Behind the screens: care staff observations on delivery of oral health care in nursing homes.

To identify qualitatively carer staff attitudes, practices and critical comments related to oral health care of functionally dependent nursing home clients. Open-ended questions included in a longer quantitative questionnaire. 22 randomly selected nursing homes in the Bristol area. 416 carers employed in these homes. The majority of carers thought that clients had a right to good oral health, accepted the carers' role in helping clients with oral and denture hygiene, but recognised that oral health care provision was deficient. However, some carers believed oral health care to be solely the clients' responsibility despite high disability levels. Main barriers to providing oral health care were low prioritization of oral health by nursing management, lack of co-operation from cognitively impaired clients, and lack of training. Carers were critical of homes' lack of arrangements for routine professional dental checks, lack of commitment to staff training, low standards of oral health care by colleagues, and lack of provision of oral hygiene aids and cleansing materials for clients. Many responses indicated ways in which nursing home oral health care could be improved. Carers reported contrasting experiences of dental treatment, and deplored recent decreased availability of subsidized dental care. Carers' generally positive attitudes towards clients' oral health care should encourage health educators. Insights gained from qualitative data can help to identify the less obvious causes for poor oral care delivery, which can then be addressed in education and training initiatives in nursing home settings.

Tell-show-do: reducing anticipatory anxiety in emergency paediatric dental patients

Tell-show-do is widely used as a means of managing paediatric dental patients. Although widely used, the ability of this technique to prepare, acclimatise and reduce child anxiety remains an area for research. Two hundred children referred in pain for general anaesthetic extractions were invited to take part. They were randomly divided into intervention and control groups. Anticipatory anxiety was assessed using an observational schedule and by monitoring heart rate prior to and during treatment. The children in the intervention group had lower observed anxiety and heart rate prior to treatment compared with the control children. However, tell-show-do was unable to reduce heart rate in children who had previous experience of general anaesthesia. The work presented here has important implications for all those involved in providing invasive health care for children. This study illustrates the role of tell-show-do for preparing new child patients while demonstrating its limitations in reducing anticipatory anxiety in those who have previous experience of dental treatment.

Dental anxiety, optimism–pessimism, and dental experience from childhood to adolescence

94 adolescents, 58% of the original study group, participated in a 5-yr follow-up questionnaire study to assess the predictive power of self-reported dental anxiety, optimism-pessimism dimension, and previous dental experience on dental anxiety level over the 5-yr period. The mean values on Corah's Dental Anxiety Scale (DAS) and Dental Anxiety Question (DAQ) had increased for the girls and remained stable for the boys. The predictive power of DAS and DAQ on anxiety levels as measured by these same scales 5 yr later was weak to moderate, although statistically significant. The optimism-pessimism dimension and dental treatment experiences did not have any effect on dental anxiety changes from childhood to adolescence. DAS had an independent, weak, but statistically significant negative effect on optimistic disposition over the period. The internal reliability of DAS was high and highly similar results using DAS and DAQ were found. Except for significantly more dental experience in the drop-out group (n = 69) than in the current study group in the first study, there were no statistically significant differences in mean scores between the groups with respect to self-reported and clinical dental anxiety, and optimism. Methodological complications are discussed.

中華民国台湾省における幼児・学童のう蝕り患状況と生活習慣，環境に関する疫学的研究

An epidemiological study of 2, 012 children by oral examination and questionnaire was undertaken to study the dental caries prevalence in one kindergarten and two elementary schools in an urban area and in one kindergarten and two elementary schools in a country area in 1989. The data showed that the dental health status was poor and that living habits and public medical service were unsatisfactory when compared with the results of other dental surveys in Taiwan R.O.C..In the urban area caries prevalence in deciduous teeth in the kindergarten was 74.2%, and in permanent teeth in the two elementary schools it was 56.3% and 57.1%. In the country area caries prevalence in deciduous teeth in the kindergarten was 95.0% and in permanent teeth in the two elementary schools it was 68.0% and 56.4%, respectively. The dft index was 6.30 in the urban area and 9.00 in the country area, and the DMFT index was 1.87 and 1.58 in the urban area, and 2.02, 1.52 in the country area. The FT rate showed a low restorative treatment rate in both deciduous and permanent teeth. The ft rate was from 1.4% to 6.3% in kindergarteners and FT rate in elementary school children was from 10.5% to 35.6%.The results of the questionnaire regarding living habits, living environment and medical service were as follows:1. Subjects who received topicl fluoride application or regular dental examination were few and there was a high percentage of experience of toothache and dental treatment. But because of the deficient public health system, the treatment of dental caries was mostly temporary treatment only, and therefore experience of both toothache and dental treatment were frequent.2. The answers to the questionnaire showed that the parents know and acknowledge the use of fluoride.Our dental survey showed that dental caries is increasing in Taiwan and is near the level of Japan. There is no obvious difference in the public dental health situation or the living environment between the regions surveyed, and no definite direction could be observed between caries prevalence and living habits or living environment. The knowledge and acknowledgement of parents concerning fluoride will help to establish a community dental policy and contribute to the developement of school dental health.