Fearful Dental Patients Research Articles

Comparison of Aversion to Visual Dental Stimuli Between Patients and Dentists: A Preliminary Study.

Fearful dental patients often cite various dental instruments or procedures as triggers for their dental fear. Thus, visual dental stimuli provoke anxiety. This preliminary study aimed to assess the level of aversion to visual stimuli in dental patients and compare it with that in dentists. A total of 43 dental patients (25 women, 18 men; average age, 29.9 ± 13.3 years; patient group) and 13 dentists (4 women, 9 men; average age, 28.2 ± 2.0 years; dentist group) were included. All participants had previously undergone dental treatment. The dental fear level was assessed using the self-reported Dental Fear Survey (DFS). Thirty-two images associated with dental treatment were prepared and classified into three categories: dental instruments, dental procedures, and the dental environment. All participants rated their level of disgust toward each image on a visual analog scale with scores ranging from 0 to 100. In the patient group, the disgust ratings for tooth extraction, dental drilling, and local anesthesia were >60, which were significantly different from those in the dentist group (Mann-Whitney U-test, p<0.001, p=0.001, and p=0.001, respectively). The ranking order of the disgust ratings for the 32 images showed significant correlation between the patient and dentist groups (Spearman correlation coefficient, r=0.80, p<0.001). In the patient group, the disgust ratings for dental impressions and the interdental brush, dental light, and dental chair were significantly correlated with DFS scores (r=0.61, p<0.001; r=0.47, p=0.001; r=0.41, p=0.006; and r=0.40, p=0.008, respectively). This study revealed that patients have more negative feelings toward invasive procedures than dentists. However, a significant correlation was identified between the ranking of aversion-provoking dental stimuli by patients and dentists. Furthermore, the level of aversion to several dental-related items that do not cause pain was correlated with the dental fear level.

10-year follow-up study on attendance pattern after dental treatment in primary oral health care clinic for fearful patients

BackgroundDental fear may lead to avoidance of regular dental treatment. The scope of this long-term practe-based study was to monitor the dental attendance of patients who received chair-side dental and fear treatment.MethodsIn 2000–2006, patients in the City of Oulu, Finland, received treatment for dental fear in the Clinic for Fearful Dental Patients (CFDP) from primary health care dentists trained on this subject. Of the originally treated patients (n = 163), 152 (93%) with sufficient information in dental records made up the study population. Information on their age and sex was available. The number of dental examinations, emergency visits and missed appointments was collected covering the follow-up period of 10 years 2006–2016. For analyses, data were dichotomized according to age at baseline and preliminary outcome baseline condition of dental fear treatment evaluated in 2006. To investigate association further, Poisson regression as well as binary logistic regression models were conducted. As register keeper, the City of Oulu gave permission for this retrospective data-based study.ResultsPatients receiving dental fear treatment at younger age (2–10 y) had significantly more dental examinations than those treated at > 10 years. Preliminary success was associated with the number of examinations, but not with emergency visits and missed appointments. Sex was not a significant factor in later dental attendance. There was an association between few dental examinations and dental emergency care need with unsuccessful baseline outcome of dental fear treatment.ConclusionsSuccessful dental fear treatment especially at an early age is beneficial for future dental attendance measured by the number of examinations and consequently, less need for emergency care than in the opposite case. Successful fear treatment has positive impact on later dental care and regular dental attendance.

Dental Anxiety and Fear among Patients in Jazan, Kingdom of Saudi Arabia: A Cross-sectional Study

The current study aims to address the patient's dental anxiety (DA) And dental fear (DF) under the treatment of a general practitioner (GP) among different parameters. The cross-sectional study included 500 patients recruited from different clinics in Jazan, Saudi Arabia. Data were collected through a questionnaire-based form consisting of three parts; the first part was personal and demographic questions whereas the second and third parts were a modified dental anxiety scale (MDAS) and a dental fear survey (DFS) to measure DA and DF among patients. Spearman's correlation was used to measure the relation between DA and DF as well as Chi-square tests and logistic regression analyses for analyzing the effect of each variable on DA and DF. All patients fulfilled their eligibility criteria. A high percentage was found in moderate anxiety (36.8%) as well as in moderate fear (46.2%) among different anxiety and fear scales. The association between DA and DF was positively significant (p <0.01). There was a significant effect of gender, age, education, khat use, marital status, monthly income, and type of clinic on patients' DA and DF. There is a positive relation between MDAS and DFS, thus the DA affects the DF. Female patients had a lower DA and DF than male patients. Furthermore, the government clinics had the highest DA and DF prevalence levels for patients. Moreover, the high school-graduated patients seem to have a high DA and DF vs other patient educational levels. It would be beneficial to include an educational training program about psychological patient management in the study curriculum as well as to be offered as a special course to newly graduated dentists. This modification will aid to improve the GPs to get rid of DA and DF patients. How to cite this article: AlDhelai TA, Al-Ahmari MM, Adawi HA, et al. Dental Anxiety and Fear among Patients in Jazan, Kingdom of Saudi Arabia: A Cross-sectional Study. J Contemp Dent Pract 2021;22(5):549-556.

Outcome of Chair-Side Dental Fear Treatment: Long-Term Follow-Up in Public Health Setting.

Aim Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000–2005. Methods A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. Results The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. Conclusions A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.

Dental Care-Related Fear and Anxiety: Distress Tolerance as a Possible Mechanism.

Distress tolerance, the degree to which one is able to cope with and endure negative emotional states, has been broadly applied to understand and treat a variety of health (including behavioral) problems, but little is known about its role in oral health care and specifically dental care-related fear and anxiety, making it a novel construct in the oral health care literature. This cross-sectional study examined distress tolerance as a possible predictor of dental fear and anxiety among a sample of adults with and without diagnoses of dental phobia, investigated possible differences in levels of distress tolerance between adults with and without dental phobia, and determined possible associations between distress tolerance and fear of pain, anxiety sensitivity, and depression. Using 52 volunteers (n = 31, dental phobia group; n = 21, healthy comparison group), this investigation used self-report measures of distress tolerance, fear of pain, anxiety sensitivity, dental fear, and depression. The Anxiety Disorders Interview Schedule, a semi-structured interview, was used to assess for dental phobia and other psychological disorders. Distress tolerance significantly predicted dental fear and anxiety, even after controlling for age, sex, fear of pain, anxiety sensitivity, and depression. In addition, the dental phobia group had lower distress tolerance than the healthy comparison group. Distress tolerance was significantly associated with fear of pain, anxiety sensitivity, and depression. Findings indicate that low distress tolerance plays a unique and distinct role as a possible mechanism in the genesis of dental care-related fear and anxiety and phobia and may exacerbate the experience of other states, including fear of pain and anxiety sensitivity. Knowledge Transfer Statement: Results indicate that patients who have a lower ability to tolerate emotional and physical distress may have higher levels of dental care-related fear and anxiety and even dental phobia, as well as associated sequelae (e.g., avoidance of dental care). Treatment of highly fearful dental patients may helpfully include a focus on increasing distress tolerance.

The dentist's care-taking perspective of dental fear patients - a continuous and changing challenge.

The aim was to analyse the care taking of dental fear patients from the perspective of the dentist, using a qualitative methodology. In total, 11 dentists from both the private and public dental service were selected through a purposive sampling according to their experience of treating dental fear patients, their gender, age, service affiliation and location of undergraduate education. Data were obtained using one semi-structured interview with each informant. The interviews were taped and verbatim transcribed. The text was analysed using qualitative content analysis. The theme, 'The transforming autodidactic process of care taking', covering the interpretative level of data content was identified. The first main category covering the descriptive level of data was 'The continuous and changing challenge', with the subcategories 'The emotional demand' and 'The financial stress'. The second main category identified was 'The repeated collection of experience', with the subcategories 'The development of resources' and 'The emotional change'. The dentists' experience of treating dental fear patients was considered a challenging self-taught process under continuous transformation. The competence and routine platform expanded over time, parallel to a change of connected emotions from frustration towards safety, although challenges remained.

Dental fear affects adolescent perception of interaction with dental staff

The main purpose of this study was to explore whether subjective perception of interaction with dental staff is associated with dental fear in a population-based sample of 18-yr-old adolescents (n = 773). The interaction was measured using the Patient Dental Staff Interaction Questionnaire (PDSIQ), validated with exploratory and confirmatory factor analyses, which yielded the factors of 'kind atmosphere and mutual communication', 'roughness', 'insecurity', 'trust and safety', and 'shame and guilt'. Dental fear was measured using the Modified Dental Anxiety Scale (MDAS). Gender and sense of coherence (SOC) were included as potential confounding variables. Adolescents with high dental fear more often perceived their interaction with dental staff negatively and more often felt insecure than others. This difference persisted after adjustment for gender and SOC. In conclusion, adolescents with high dental fear may perceive their interaction with dental staff more positively if the staff succeed in creating a positive, trusting, approving, and supportive atmosphere with kindness, calmness, and patience. The communication and interaction skills of dental staff may play a particularly important role when encountering highly fearful dental patients.

Dentists' skills with fearful patients: education and treatment

The aims were to explore dentists' skills in dental fear, current strategies when treating fearful adult patients, and the possible need for additional education among dentists working in Sweden. A sample of 1,293 members of the Association of Public Health Dentists in Sweden were asked to respond to a Web survey concerning dental fear. The response rate was 69% (n = 889); 91% trained in Sweden and 9% trained in another country. The most frequently used pharmacological anxiety-reducing techniques were medication with a midazolame mixture (72%) and benzodiazepine tablets (77%), and the most commonly used psychological techniques were relaxation (68%), distraction (66%), and Tell-Show-Do (86%). A larger proportion of dentists trained in Sweden, compared with dentists who were trained in other countries, reported that they had received undergraduate training in dental fear. Dentists trained in Sweden more often reported competence in pharmacological and psychological anxiety-reducing techniques, compared with dentists who were trained in other countries. Higher levels of self-rated efficacy in treating fearful patients accompanied additional education in dental fear after graduation. In conclusion, Swedish dentists use a variety of techniques to meet the needs of fearful dental patients. Competence in anxiety-reducing techniques is associated with self-efficacy and the site of education.

Conservative treatment of periodontal recessions with class v-defects using gingiva-shaded composite – a systematic treatment concept

Periodontal recessions can cause aesthetic and functional problems, especially in the anterior region or when combined with exposed crown margins. A combination of periodontal disease, recession with exposed root surface, hard-tissue defects and age emphasizes the need for treating these defects. If crown margins are exposed and surgical treatment is not possible, aesthetics and function can only be improved by replacement of the restoration. The restorative treatment option with a gingiva-shaded composite is especially valuable for dental fear patients or older patients with general or local risk factors, surgical contra-indications or Class III and IV recessions with questionable prognosis of surgery. The step-by-step-approach described in this article is an alternative, minimal-invasive treatment concept for cervical lesions in combination with all kinds of periodontal recessions, that is especially suitable for wedge-shaped defects next to exposed crown margins. With this treatment concept, the reader should be able to use gingiva-shaded composite for different indications, such as exposed root surfaces or crown margins in combination with recessions.

Dental beliefs: factor structure of the revised dental beliefs survey in a group of regular dental patients

The aim of this study was to investigate the factor structure of the revised dental beliefs survey (DBS-R) in a group of regular dental patients. The study group consisted of 278 patients (mean age 54 yr), 61% of whom were women. The DBS-R item mean value was 1.6. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were performed. The initial PCA among the 28 DBS-R items showed four factors with eigenvalues of > 1 explaining 67% of the total variance. Five different CFA models were tested. The final model revealed a four-factor solution with one second-order factor (i.e. a hierarchical CFA). Thus, the latent second-order variable, 'dental beliefs', explains the variance from all DBS-R items through the four first-order factors labeled 'ethics', 'belittlement', 'communication and empathy', and 'control and anxiety'. The results suggest a somewhat different factor structure of DBS-R than previously reported for dental-fear patients. Hence, the underlying factor structure of the DBS-R may differ between different patient groups. The results point towards the use of the original 28-item DBS-R and interpreting the scale as measuring an overall construct of 'dental beliefs' and thus patients' attitudes and feelings related to dentists and dentistry.

ANXIETY CONTROL OF DENTAL PATIENTS BY CLINICAL COMBINATION OF ACUPUNCTURE, BI-DIGITAL O-RING TEST, AND EYE MOVEMENT DESENSITIZATION WITH SEDATION VIA SUBMUCOSAL ROUTE

The data presented in this article was collected after reviewing clinical findings gathered from using various anxiety control methods on apprehensive patients. We examined clinical applications of the eye movement (EM) component of Eye Movement Desensitization (EMD) on fearful dental patients who have histories of traumatic dental experiences. We also used Bi-Digital O-Ring Test (BDORT) to select the proper dosage of sedative to minimize the adverse side effects. For patients who did not respond well to EM, we used BDORT to select the proper sedative medication and its dosage. In certain difficult cases, we supplemented these techniques with acupuncture to augment the sedative effects. Findings were based on the clinical impressions and assessments of both the patients and the operating team. Results showed that EM, although effective in enabling patients to undergo non-invasive dental procedures such as clinical examination and simple prophylaxis, had only limited beneficial effect with invasive procedures such as extraction, drilling, and injections, etc. We also found that BDORT greatly reduced adverse side effects of sedatives such as hypertension, hypotension, hypoxia, tachycardia, bradycardia, nausea, and vomiting. For most apprehensive patients, we found that EMD and acupuncture combined with BDORT predetermined dosage for the submucosal sedation enabled these patients to undergo the complete dental treatment. The authors try to explain the mechanism of BDORT and EM in terms of visual awareness (or consciousness) and preferred patterns, where neurons in the brain respond to the actions and/or direction of movement. The authors believe that BDORT and EM could have better results if the persons performing BDORT have visual awareness and are focused on the task; whereas in EM, the patient's eye on the therapist's hand movements. A more focused approach via visual pathway will result in more favorable results in EM. Likewise, performing BDORT absentmindedly could lead to false results if visual awareness (or consciousness) is absent. "Preferred pattern" will arouse neurons in the brain to cause conscientiousness, and performing BDORT with 'open eyes' arouse the necessary visual awareness that is necessary for the successful performance of BDORT tasks.

Beliefs about professional ethics, dentist–patient communication, control and trust among fearful dental patients: the factor structure of the revised dental beliefs survey

The revised version of the Dental Beliefs Survey (DBS‐R), intended to measure three dimensions of the patient–dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5‐factor solution, basically including the 3 assumed dimensions as well as the re‐introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS‐R, i.e. items 3, 11, 18, and 28. The reduced DBS‐R is recommended for clinical use when assessing the patient's perception of the relationship to the dentist, including both trust and ethical behavior.

The impact of childhood sexual abuse on dental fear.

Dental fear is a risk factor for poor oral health. Thus, treatment of dental fear is a challenge to dentists. The consequences of childhood sexual abuse (CSA) may include dental fear. A history of CSA complicates dental fear treatment, and it is often a secret. The aim of this study was to explore differences in subjective evaluations of use of dental services, experiences of dental treatment situations, dental appearance and dental problems in women who report both CSA and dental fear, and women who report dental fear only. In an anonymous survey, 58 women with dental fear and a history of CSA were compared with 25 women with dental fear without CSA. Twenty-five women without dental fear acted as a control group. No differences between dental fear patients with and without a history of CSA were found in subjective evaluations of use of dental services, dental appearance and dental problems, or in the scores on the Dental Fear Scale (DFS). Women who reported a history of CSA and dental fear had statistically significant higher scores on the Dental Belief Scale (DBS). The results suggest that women who report dental fear and a history of CSA assess interpersonal factors concerning communication, trust, fear of negative information and lack of control as more fear evoking than women who report dental fear without a history of CSA.

A Qualitative Analysis of Patient-Centered Dentistry in Consultations with Dental Phobic Patients

Dental phobia is regarded as one of the greatest obstructions to adequate dental care. It has long been established that fearful dental patients are particularly sensitive to dentists' behavior and performance of dental care. There is a need for the establishment of a systematic theory of dentist-patient communication and new methods analyzing how dentists interact with their patients. In this qualitative study, thirty semi-structured interviews were conducted in 1998 and 1999 with five dentists (three male and two female). Dentists consulted on two occasions with 15 newly enrolled, consecutive dental phobic patients (2 male and 13 female) in a Swedish clinic specializing in the treatment of odontophobia. The time interval between consultation one and two was approximately 2-3 weeks. Analysis of the transcribed interviews was based by the principles of Grounded Theory. The study identified one core category, "Holistic perception and understanding of the patient", two categories, "The dentist's positive outlook on people" and "The dentist's positive view of patient contact", and six further subcategories. Findings support previous models of patient-centered medicine and contribute to a better understanding of how patient-centered dentists interact with dental phobic patients.

Phobic avoidance and regular dental care in fearful dental patients: a comparative study

The present investigation was a comparative study of 169 highly fearful dental patients, some of whom received regular dental care (n = 28) and some who never, or only when absolutely necessary, utilized dental care (n = 141). It was hypothesized that phobic avoidance is related to anticipatory stress and anxiety reactions, negative oral health effects, psychological distress, and negative social consequences. Background factors (sex, age, education, and dental attendance pattern), dental anxiety, general fears, general state and trait anxiety, mood states, depression, and quality of life effects were studied. Data were analyzed with descriptive statistics and with exploratory factor and multiple logistic regression analysis. It was shown that dental anxiety is significantly higher among the avoiders and this is in particular evident for anticipatory dental anxiety. Oral health differed between the groups, and it was shown that avoiders had significantly more missing teeth, whereas regular attenders had significantly more filled teeth. The avoiders reported a stronger negative impact on their daily life, whereas there were no significant differences between the groups with regard to general emotions. The logistic regression analysis showed that phobic avoidance was predicted only by anticipated dental anxiety and missing teeth. It was concluded that differences between high dental fear patients with regular dental care and phobic avoidance were mainly related to anticipated fear and anxiety, oral health effects, and concomitant negative life consequences. These results are discussed in terms of subjective stress, negative cognitions, social support, and coping-strategies.

Characteristics of adult dentally fearful individuals. A cross-cultural study.

This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Goteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more 'active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more 'passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry.

Psychosocial aspects of dental and general fears in dental phobic patients

Phobic reactions can often be a significant health problem for fearful dental patients. This is true in particular for individuals with long-time avoidance and elevated general psychological distress. The aim of this study was to investigate the expression of dental fear among 67 dental phobic individuals with a low versus high degree of general fear. Reported etiologic background factors, avoidance time, general psychological distress and psychosocial manifestations and consequences of dental phobia were studied. No significant difference in dental anxiety level between individuals with low versus high general fear was found, and both groups reported high frequencies of negative dental experiences. The low-fear group reported a longer (though not statistically significant) average avoidance time than the high-fear group. However, patients with a high level of general fear showed a significantly higher degree of psychological distress, and also reported stronger negative social consequences from their dental anxiety. These results indicate that the character of dental fear might be different between different groups of fearful patients, which makes the condition psychologically handicapping. Such aspects should be assessed in the diagnostic analysis of patients with severe dental anxiety. In particular, assessments of signs of general psychological distress are warranted.

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ANXIETY: Its Manifestation and Role in the Dental Patient

Anxiety-induced emergencies such as vasodepressor syncope and hyperventilation are well known to most practitioners. Despite advances in pain control, reconstructive dentistry, and behavior management techniques, the prevalence of dental fear in the general population remains fairly high. Fearful dental patients, who exist in each of our practices, are often expected to submit to dental treatment with little consideration given to their emotional state. Although many are capable of enduring their own high arousal state with various behavioral or cognitive distraction methods, the occasional young adult succumbs to syncope or hyperventilation. The practitioner should be able to prevent the onset of most psychogenic emergencies by amending the medical and dialogue history to include questions that preoperatively explore dental fears. Additionally, a brief physical examination should be incorporated into the initial visit and at the onset of subsequent treatment visits. When a positive history of fainting or panic attack is obtained, the practitioner should consider numerous available modalities to prevent recurrence during dental treatment. Behavioral modification strategies provide the greatest long-term benefit; however, pharmacologic sedation may be necessary to accomplish short-term dental goals. Emergencies that arise out of psychophysiologic responses are rarely lifethreatening and can be managed readily by the alert dental office team. It is imperative, however, to use all available information during the emergency assessment. Inaccurate diagnosis and treatment as a result of confusion between presyncope and hyperventilation may result in an accelerated onset of the emergency episode. Rapid recognition of an impending alteration of consciousness should minimize the progression toward or reduce any period of unconsciousness. If unconsciousness occurs, basic life support and supine positioning with supplemental oxygen should be provided immediately. Finally, the dental team should be prepared to treat other life-threatening emergencies that might initially present as syncope, such as cardiac arrest, stroke, or anaphylactic reactions.

A radiographic study of dental health in adult patients with dental anxiety

The objective of this study was to compare the dental health in a group of 90 patients with severe dental fear (FP), aged 20-41, with that of a matched control group of ordinary dental patients (OP). All registrations were made from radiographic intraoral full mouth surveys. Mean number of missing teeth among FP and OP patients was 4.4 and 2.5, respectively. On average, FP patients had 19.5 decayed surfaces compared to 7.9 in OP patients. Mean number of filled surfaces was 13.1 and 8.1 in OP and FP patients, respectively. FP patients, on average, had significantly more periradicular bone lesions as well as pronounced marginal bone loss than OP patients. This study showed that dental fear patients in general have a substantially deteriorated dental health compared to ordinary dental patients. Moreover, different dental care habits were evident between FP and OP patients. A progressive severity in dental disease pattern was found among FP patients.