Search

Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL). Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting., Key points People with dental phobia often present with a poorer oral health status which compromises their oral health-related quality of life.An outline of the application of the minimum intervention oral healthcare (MIOC) framework for patients with dental phobia is described, which has the potential to be particularly beneficial for the oral healthcare of this group of patients.An assessment tool is presented which provides an overview of important points for a practitioner to consider when assessing patients with dental phobia using MIOC.

Objectives This study investigated patients' insights into whether virtual reality (VR) technology plays a beneficial role in reducing anxiety levels while undergoing dental extractions.Design Explorative study.Setting Oral Surgery Department of Birmingham Dental Hospital in July 2017.Material and methods Fifty patients were screened for extractions. All participants had previous experience of extractions without VR. Pre-treatment anxiety levels were recorded using the Modified Dental Anxiety Scale (MDAS). During the procedure, each patient wore a Virtoba VR headset, whereby they were involved in an underwater VR experience. A post-treatment questionnaire recorded patient demographics and VR experiences in relation to anxiety levels.Results Participant response on the benefit of the VR system on anxiety reduction during treatment was: 35% (extremely beneficial), 30% (quite beneficial), 25% (of some benefit) and 10% (of little benefit). Responses showed that 87.5% wanted VR to be used again during their next visit. The most benefit was found to be in the following patient groups: males; young adults (aged 18-35); patients with moderate anxiety (MDAS 11-18), and those who underwent surgical extractions.Conclusion The majority of patients (65%) found VR to be extremely or quite beneficial in reducing their anxiety levels. Perhaps after future large scale studies, more dental clinicians could consider VR technology in their practice for anxiety reduction, particularly when treating the patient groups identified in the study who took a greater liking towards VR.

Introduction Little research has been conducted into the relationships between dental anxiety and factors relating to oral health in small children. This research takes advantage of data from the Child Dental Health Survey 2013 to perform a secondary analysis for the five- and eight-year-old age groups.Aim To compare the oral health of groups of children aged five and eight years old, classified into three levels of anxiety.Design Secondary analysis of data from 2,289 children aged five and eight years in the Child Dental Health Survey 2013.Materials and methods Participants were divided into three groups, depending on the parent's report of their child's dental anxiety. Descriptive analyses compared the three groups on social demographic factors, clinical status, self-reported oral health status, oral health-related behaviours and oral health impact.Results Dentally anxious children were more likely to have active decay and decay experience. Parents of children with dental anxiety were more likely to report that the child's oral health had a negative effect on family life. Highly anxious children were less likely to attend the dentist or engage in oral health-related behaviours.Conclusions Dentally anxious children have more dental disease and their parents express that the child's oral health has a greater impact on their family's quality of life.

Introduction A high percentage of people with dental phobia have poor oral health. This may be the result of delayed treatment or differences in care planning by the oral health care team.Aim This study sought to determine the effect, if any, of dental phobia and complexity of dental care on the proposed care plan devised by clinicians for patients.Design An experimental analogue study with independent variables of the presence of phobia and complexity of treatment need. Dependent variables included frequency of care planning elements such as periodontal treatment, prevention, restorations, root canal treatment, extraction and provision of crowns, bridges and prostheses.Participants Seventy-nine UK-based dental practitioners.Analysis The association between the case status (phobic versus non-phobic, simple versus complex) and the outcome variables were assessed using a chi-square test for association. Logistic regression analyses were also used to determine the predictors of care planning elements.Results There were no differences in care planning for phobic and non-phobic patients. Complexity of treatment need had significant effects on advanced periodontal treatment, restorations anterior and posterior, root canal treatment, provision of crowns, and extractions.Conclusions Care planning is influenced by patients' dental needs and not their phobic status.

Introduction: Individuals with dental phobia have poorer oral health. This study sought to evaluate the extent to which service level restrictions are perceived to exist in the provision of dental treatment, through a survey of the frequency of dental treatments believed to be offered for patients with dental phobia by the dentists who provide sedation and dental care services.Methods:Questionnaire survey of 70 dental practitioners working within services providing treatment under sedation for individuals with dental anxiety phobia.Results:The majority of dental care for dentally phobic patients were simple restorations (amalgam and tooth coloured filling) (64, 91%), scaling (50, 71%) and extractions (65, 94%). More complex dental treatments (such as molar endodontic, crowns and bridges and implant replacement of missing teeth) was either never provided or were referred to a specialist clinic. Participants perceived limitations (for example restrictions to type of treatment episodes and availability/commissioning of services in particular for patients with diagnosis of dental anxiety and phobia alone) for provision of dental care under intravenous sedation. Conclusion:Most dentists routinely provided simple restorative and periodontal treatment indicating that gingivitis and periodontal disease is present in this group. The increased rates of extractions in comparison to complex dental treatments (such as root canal therapy, implant, crowns and bridges) might indicates advanced disease (therefore basic treatment), patients’ and dentists’ treatment preference, or service limitations as a result of specific commissioning restrictions. Few participants mentioned dentists’ factors (lack of ability, competence or skill) as barriers for provision of complex care.

Introduction Dental anxiety and fear is widely prevalent in the population, including children. This research is a further analysis of the Child Dental Health Survey 2013, to explore the impact of dental anxiety on factors relating to oral health. Aim To explore the relationship between dental anxiety and oral health and the impact dental anxiety has on the quality of family life. Design Regression analysis of data of 4,916 children aged 5 years and 8 years who participated in the Child Dental Health Survey 2013. Setting National Epidemiological Survey in schools in the UK. Materials and methods A series of logistic regression analyses was carried out for markers of oral health and impact of the child's oral health on the family's quality of life. The variables entered as predictors in the models included dental anxiety, socio demographic status and oral health-related behaviours. Results Dental anxiety was associated with poorer oral health on nearly all measures (decay experience p =

Introduction Dental phobia has been widely studied but there is limited research on the effect of dental phobia on oral health. This research is an analysis of the 2013 Child Dental Health Survey, to explore the impact of dental anxiety on factors relating to oral health in the adolescents. Aim To examine if dental anxiety predicts poor oral health in 12- and 15-year-olds. Design Regression analysis of data from 4,950 children aged 12 years and 15 years who participated in the Child Dental Health Survey 2013. Setting National epidemiological survey of UK schools. Materials and methods A series of logistic regressions was carried out to examine if dental anxiety, socio demographic factors and oral health-related behaviour could predict oral health status, the impact of the child's oral health on their own quality of life and the impact of their oral health on the family's quality of life. Additional outcomes examined were self-perceived dental health and general health. Results Dental anxiety was not a predictor of poor oral health but did predict a greater impact of the child's oral health on everyday life. Adolescents with dental anxiety had negative thoughts regarding their dental and general health. Conclusions Dental anxiety affects the everyday life and psychological wellbeing of adolescents.

Introduction Dental anxiety has been shown to be related to poorer oral health. Limited data exist exploring the relationship between oral health status and dental anxiety in non-clinical populations in children. Aim To compare the oral health of phobic and non-phobic children aged 12 and 15 years. Design Secondary analysis of data from 12-year-old and 15-year-old children in the Child Dental Health Survey 2013. Materials and methods Participants were grouped into non-phobic and phobic groups, depending on their self-reported dental anxiety (MDAS). Descriptive analyses compared the two groups on social demographic factors, clinical status, self-reported oral health status, oral health-related behaviours and oral health impact. Results A total of 601 children were classed as dentally phobic with 4,144 classed as non-phobic. Dental phobic children were more likely to be female, had more active decay and untreated dental disease, and rated their dental health as poorer. Phobic children were more likely to report that their oral health had a negative effect on their everyday life. This group were less likely to brush their teeth regularly or attend the dentist for check-ups. Conclusions Dentally phobic children have more dental disease and express greater impact on their everyday life.

Aim To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. Methods A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). Results Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P

Objective\ud To investigate children's ongoing experiences of dental care and use of strategies to manage their dental anxiety following cognitive behavioural therapy (CBT).\ud \ud Design\ud A child self-completed postal questionnaire.\ud \ud Settings\ud Hospital, community and general dental practice.\ud \ud Subjects\ud Questionnaires were sent to 44 children, aged 10–17 years who had been referred to specialist services due to their dental anxiety.\ud \ud Intervention\ud Children had all previously received a guided CBT self-help intervention to reduce their dental anxiety and, on completion of treatment, had been discharged to their referring dentist. Questionnaires were sent out 12–18 months later to ascertain dental attendance patterns and application of any strategies learnt from the previous CBT intervention.\ud \ud Results\ud 22 responses (50%) were received from 16 girls and six boys. Eighty-two percent had subsequently accessed follow-up care with a general dental practitioner and over half of these had undergone a dental procedure, other than a check-up. Ninety-one percent reported feeling less worried about dental visits, than previously, and described a change in cognition, behaviours, and feelings that allowed them to manage their anxiety better.\ud \ud Conclusions\ud CBT has positive immediate and longitudinal effects in reducing children's dental anxiety. The challenge of adopting this evidence-based approach within primary care settings remains.

Aim To describe the characteristics of patients attending a psychologist-led cognitive behavioural therapy (CBT) service for individuals with dental phobia and the outcomes of treatment. Method Analysis of routinely collected assessment and outcome data from 130 patients attending a single secondary service providing CBT for dental phobia. Findings The patients comprised 99 women and 31 men, with an average age of 39.9 years (SD 14.8). Approximately 77% of the patients scored at levels suggestive of dental phobia on the Modified Dental Anxiety Scale (MDAS). Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Ninety four percent of patients reported one or more impacts of their mouth, teeth and gums on their life using the OHIP-14. A minority of patients had co-morbid psychological conditions – 36.9% had high levels of general anxiety and 12.3% had clinically significant levels of depression. Suicidal ideation was reported by 12% of patients and four (3%) reported recent intent to commit suicide. Of all patients referred 79% went on to have dental treatment without sedation and 6% had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five. Conclusions CBT offers an effective technique for helping dentally anxious patients receive treatment without sedation. Those interested in running such services should be cognizant of the moderately high level of co-morbid psychological conditions in this group.

Does active engagement by the dentist exploring their patient's fear, allay dental anxiety?

The oral health of individuals with dental phobia: a multivariate analysis of the Adult Dental Health Survey, 2009.

Background Adults with dental phobia have been reported to have poorer oral health and oral health-related quality of life. The aim of this study is to explore the social and demographic correlates of oral health and oral health-related quality of life (OH-QoL) of people with dental phobia compared to the non-phobic population in the United Kingdom using the data from Adult Dental Health Survey (ADHS, 2009).Method Secondary analysis of data from the ADHS, 2009. A series of logistic regression analyses was performed with outcome measures of: presence of decayed teeth; presence of missing teeth; pulp exposure ulceration fistula abscess (PUFA) score; periodontal health indices (plaque, bleeding and loss of attachments); and quality of life (oral health impact profile [OHIP14] and oral impacts on daily performance [OIDP]). Predictors included in the models were: the presence of dental phobia; age; gender; occupational status; oral health-related behaviour; dietary intake of sugars; and perception of their last visit.Results People with dental phobia are more likely to have one or more decayed (caries) teeth/missing teeth. Furthermore, their self-reported oral health-related quality of life (OH-QoL) is poorer. There were no differences in PUFA scores or periodontal disease.Conclusion The impact of dental phobia on oral health appears to operate largely through the increased likelihood of the presence of caries, since there is an increased likelihood of the presence of teeth with active caries and missing teeth when other predictors of disease experience are controlled in the analysis.

Objectives To identify whether dental general anaesthesia (DGA) status is informative in assessing risk of caries or dental anxiety by (a) describing long-term oral health and dental anxiety for people who underwent DGA in childhood and (b) testing whether DGA status in childhood is associated with incident future dental caries or anxiety independently of preconceived risk factors.Design Analysis of prospectively obtained data.Setting An established population based cohort in the UK, the Avon Longitudinal Study of Parents and Children.Participants and methods In total 1,695 participants with dental data in childhood and adolescence were included in analysis. DGA status by age 7 and oral health measures at age 17 were identified from questionnaire data.Main outcome measures Filled or extracted permanent teeth at age 17, Corah Dental Anxiety Scale.Results One hundred and twenty-eight (7.6%) participants underwent DGA in childhood. Individuals who underwent DGA had higher measures of filled or extracted permanent teeth in adolescence (0.36 more affected teeth in fully-adjusted model [95% confidence interval: 0.27, 0.55; P0.001]).Conclusions DGA in childhood predicts burden of treated caries in adolescence, independently of other risk factors. DGA status may be a clinically useful adjunct in identifying young people at high risk of further disease.

Dental anxiety is prevalent across a broad spectrum of the population. Dental phobia is extreme dental fear, which interferes with normal functioning. For any dental treatment, it is an ethical, legal and professional duty of dentists to obtain valid informed consent from their patients. The question arises as to how dental phobia impacts on patients' ability to give valid informed consent. Extreme fear may impair patient ability to understand information about the procedure, their capacity to make balanced decisions, and to make these decisions voluntarily. A trusting rapport between dentist and patient, supporting patient understanding by providing useful information material, and keeping regular appointments, may help overcome these obstacles. Other factors impacting on the informed consent process are institutional in nature. Implementing ways to overcome these is part of the dentist's duty to obtain valid consent.

The importance of understanding barriers to dental attendance of adults in the UK was acknowledged in the first Adult Dental Health Survey in 1968 and has been investigated in all subsequent ADH surveys. In 1968, approximately 40% of dentate adults said they attended for a regular check-up; by 2009 this was 61%. Attendance patterns were associated with greater frequency of toothbrushing, use of additional dental hygiene products, lower plaque and calculus levels. Just under three-fifths of adults said they had tried to make an NHS dental appointment in the previous five years. The vast majority (92%) successfully received and attended an appointment, while a further 1% received an appointment but did not attend. The remaining 7% of adults were unable to make an appointment with an NHS dentist. The majority of adults were positive about their last visit to the dentist, with 80% of adults giving no negative feedback about their last dentist visit. Cost and anxiety were important barriers to care. Twenty-six percent of adults said the type of treatment they had opted for in the past had been affected by the cost and 19% said they had delayed dental treatment for the same reason. The 2009 survey data demonstrated a relationship between dental anxiety and dental attendance. Adults with extreme dental anxiety were more likely to attend only when they had trouble with their teeth (22%) than for a regular check-up.

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

A diagnosis of amelogenesis imperfecta can present challenges for patient and clinician alike. This can be further complicated in a child due to cooperation and the ever-changing dentition. This paper looks at the ideals for management at various stages of the developing dentition but also considers the compromises which may have to be made depending on the child's ability to cope. The importance of early diagnosis, prevention and the benefits of a multi disciplinary approach are also discussed.

Objectives To review paediatric dental anxiety measures (DAMs) and assess the statistical methods used for validation and their clinical implications. Method A search of four computerised databases between 1960 and January 2011 associated with DAMs, using pre-specified search terms, to assess the method of validation including the reliability as intra-observer agreement 'repeatability or stability' and inter-observer agreement 'reproducibility' and all types of validity. Results Fourteen paediatric DAMs were predominantly validated in schools and not in the clinical setting while five of the DAMs were not validated at all. The DAMs that were validated were done so against other paediatric DAMs which may not have been validated previously. Reliability was not assessed in four of the DAMs. However, all of the validated studies assessed reliability which was usually 'good' or 'acceptable'. None of the current DAMs used a formal sample size technique. Diversity was seen between the studies ranging from a few simple pictograms to lists of questions reported by either the individual or an observer. Conclusion To date there is no scale that can be considered as a gold standard, and there is a need to further develop an anxiety scale with a cognitive component for children and adolescents.

Background This is the third paper in a series of four examining a tool which could be used to determine sedation need among patients. Aim The aim of this paper was to assess the reasons why people do not attend the dentist regularly, in order to understand the potential need for sedation services among both attending and non-attending patients. Methods and results A large telephone survey conducted across 12 primary care trusts (PCTs) found that 17% of participants did not attend the dentist regularly. One of the top reasons given for non-attendance that could be considered a barrier was fear/anxiety. The figure reached in paper 2 (Br Dent J 2011; 211: E11) stated that approximately 5% of attending patients will, at some time, need sedation services. However, the data from this survey have suggested that anxiety accounts for 16% of people who do not attend the dentist regularly. Conclusion It could be assumed that if non-attending patients were included, with high levels of anxiety, the sedation need would rise to 6.9% throughout the entire population.

Objective To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia.Aim To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia.Method Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years.Results Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period.Conclusion This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research. © 2011 Macmillan Publishers Limited. All rights reserved.

Objective To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand®) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children.Design Randomised controlled trial.Setting Secondary dental care practice specialised in treating children.Subjects and Methods Children were selected and randomly allocated to the Wand® or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection.Intervention Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand®.Outcome measures The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children.Results One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand® over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p Conclusion No clear difference in the response of referred children could be found between an injection with the Wand® or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection.

Background Healthcare professionals often rely on parents to provide accurate dental anxiety assessment for their children. To date no studies have reported on inter-rater agreement between children's self-reported and their parents'/guardians' proxy-reported dental anxiety in the UK. Aims To assess the frequency of self-reported dental anxiety in 7–16-year-old children and the inter-rater agreement between children's self-reported and parent/guardian proxy-reported dental anxiety for their children. Methods Data were collected prospectively from 7–16-year-old children and their parents/guardians attending two community dental clinics in Fife, Scotland (July 2012–January 2013). Dental anxiety was assessed using faces version of Modified Child Dental Anxiety Scale. Questionnaires were separately and independently completed by children and their accompanying parent or guardian. Results One hundred and thirty-two child-parent/guardian pairs participated in this study. Children's self-reported dental anxiety was 18% (n = 24, 95% CI 12–25). Inter-rater agreement between children and their parent/guardian was poor for dental filling (linear weighted kappa coefficient 0.17) and tooth extraction (0.20), whereas other questions had fair inter-rater agreement (0.21–0.34). Parents' proxy-reported assessments significantly failed to recognise dental anxiety in 46% (n = 11) dentally anxious children (p = 0.0004). Conclusion Parent/guardian proxy-reported dental anxiety differs from children's self-reported dental anxiety suggesting children should be encouraged to self-report their dental anxiety.

Objective Dental anxiety is a barrier to attendance. Dental non-attenders may seek emergency care and may prefer to receive anxiety management measures for treatment required. Little is known about the preferences of these dental non-attenders for different anxiety management techniques. Understanding such preferences may inform management pathways, improve experiences, alleviate anxieties and encourage a more regular attendance pattern. As such, the aim of this study was to gain a greater understanding of the dental anxiety of patients attending a dental access centre for emergency dental treatment and to ascertain preferences for different anxiety management techniques. Design Cross-sectional study involving self-completed questionnaires and clinical observation. Setting NHS Dental Access Centre, York, UK. Subjects and methods Two hundred participants not registered with a general dental practitioner, aged 18 years or over, experiencing pain and self-referred were recruited on a consecutive sampling basis. Participants completed a questionnaire eliciting demographic and dental history details, dental anxiety and preferences for dental anxiety management options. Main outcome measures Correlation of the modified dental anxiety scale with preference for different dental anxiety management techniques. Results No significant predictive factors were found that explained preferring local anaesthetic to sedation, or general anaesthesia for restorations or extractions. Those highly anxious were less likely to consider tell-show-do techniques (p = 0.001) or watching explanatory videos (p = 0.004) to be helpful for overcoming their anxieties than the low or moderate anxiety groups. Conclusions People attending access centres may represent a group who are unwilling to explore non-pharmacological methods to overcome their anxieties. This supports the need for sedation to provide treatment. Future work may include exploring in more depth the thoughts and opinions of this group of patients to improve understanding of their complex dental attitudes. From this, more effective strategies may be developed to encourage regular dental attendance.

Healthcare professionals often rely on parents to provide accurate dental anxiety assessment for their children. To date no studies have reported on inter-rater agreement between children's self-reported and their parents'/guardians' proxy-reported dental anxiety in the UK.To assess the frequency of self-reported dental anxiety in 7-16-year-old children and the inter-rater agreement between children's self-reported and parent/guardian proxy-reported dental anxiety for their children.Data were collected prospectively from 7-16-year-old children and their parents/guardians attending two community dental clinics in Fife, Scotland (July 2012-January 2013). Dental anxiety was assessed using faces version of Modified Child Dental Anxiety Scale. Questionnaires were separately and independently completed by children and their accompanying parent or guardian.One hundred and thirty-two child-parent/guardian pairs participated in this study. Children's self-reported dental anxiety was 18% (n=24, 95% CI 12-25). Inter-rater agreement between children and their parent/guardian was poor for dental filling (linear weighted kappa coefficient 0.17) and tooth extraction (0.20), whereas other questions had fair inter-rater agreement (0.21-0.34). Parents' proxy-reported assessments significantly failed to recognise dental anxiety in 46% (n=11) dentally anxious children (p=0.0004).Parent/guardian proxy-reported dental anxiety differs from children's self-reported dental anxiety suggesting children should be encouraged to self-report their dental anxiety.

Objective To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress. Design A prospective national study. Setting Twenty-five Scottish DGA centres in 2001. Subjects and method Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Results The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r= 0.43, p

A small number of fully trained Chinese doctors practise Traditional Chinese Medicine (TCM) in western cities. Use of these services by British citizens is extremely limited, mostly due to lack of any knowledge on the effectiveness of acupuncture or exposure to complementary medicine in this country. Common situations where British patients seek the help of TCM are when medical therapy has failed; in relapsing chronic diseases like asthma, rheumatoid arthritis; and in pain management (mostly headache, migraine and back pain). Patients often appreciate that only limited interventions are available for treatment of these conditions in western medicine. At least one in 10 UK specialist physicians are actively involved in complementary and alternative medicine treatments.(1) A large number of westerners offer acupuncture therapy but lack basic medical training. It is likely that people are reluctant to use these services largely because of hygiene and safety reasons. Moreover, it has been demonstrated that the serious side effects reported are five times more frequent when treatments are provided by non-medically trained therapists compared with professionally registered health care providers.(2).

Objective To evaluate factors affecting modulation of dental anxiety among adults. Methods A total of 183 adult members of a closed communal society (Kibbutz), who have been treated since childhood only by the dentists employed in their community, were investigated concerning their past and present dental anxiety, evaluation of their past and present dentists, psychopathologic symptoms and individual pattern of attachment. Results The best predictor of subjects' evaluation of their present dental anxiety was the scale of anxiety as recorded by the SCL-90R questionnaire. The best predictors of the decrease in subjects' dental anxiety over time were the evaluation of their past and present dentists and the secure and avoidant patterns of attachment. Patterns of attachment (avoidant and ambivalent) were the best predictors of subjects' evaluation of their present dentist. Conclusions While psychopathologic traits are involved in subjects' present dental anxiety, pattern of attachment may have a dominant affect as to whether anxiety persists throughout life or can be modulated through a corrective emotional experience.

In 1999 South Lancashire Health Authority published their Oral Health Improvement Plan in which they specifically identified drug users as a target group. In this paper the authors outline the development of a project, which aimed to improve access to dental services for this group. Essential to the relative success of the project was the inclusion of drug users and service providers at the outset. In addition perceived barriers, which exist between drug users and the profession have started to be broken down.

When confronting a defiant or pre-co-operative young patient with extensive dental decay the dentist must decide between treatment under conscious sedation with passive restraint or general anaesthesia. Although some practitioners prefer to attempt and exhaust sedative techniques in most cases and use general anaesthesia as a last resort, many others do not mandate that alternate approaches first be attempted before treating under general anaesthesia and routinely recommend it as their first choice. What are the considerations involved in this decision-making process? Should the use of conscious sedation with restraint be revisited and perhaps even be considered the preferred method? What is the role of the dentist in the decision-making process? The purpose of this opinion-based paper is to present to the UK dentist a dilemma that paediatric dentists face in the US and in other countries as well and allow the reader to establish an opinion.

Objectives To examine the relationship between dental anxiety, dental attendance and past treatment history in 5-year-old children after taking into account confounding influences. Methods 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, caries experience, past extraction and restoration history were assessed using chi-square and t-tests. Multiple logistic regression analyses were used to identify predictors for dental anxiety. Results 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 (10.8%) judged their child to be dentally anxious. Anxious children had significantly (p

Objectives To compare the effect of topical skin anaesthetic agents on the discomfort and anxiety associated with venous cannulation. Design Randomised, double-blind, placebo-controlled, within subject, volunteer trial. Methods 20 healthy volunteers underwent venous cannulation on three separate occasions having received topical skin application of either 4% amethocaine gel (Ametop), 5% eutectic mixture of lidocaine and prilocaine (EMLA) or E45 cream (placebo). Visual analogue and verbal rating scales were used to assess pain and anxiety associated with the venous cannulation, and anticipated anxiety for future cannulation, under each drug condition. Results Subjects were aged 22-53 years (mean 32.8 years). The mean visual analogue scores (VAS) for discomfort were found to be significantly lower (p

Aim To determine the frequency of use of dental anxiety assessment questionnaires and factors associated with their use in a group of UK dental practitioners. Method A postal questionnaire to all 328 dentists whose names appear in the British Society for Behavioural Sciences in Dentistry Directory. Information collected for each practitioner included gender, year of qualification, type of practice in which anxious dental patients were treated, treatment used to manage anxious dental patients, type and frequency of use of dental anxiety assessment indices. Results Questionnaires were returned from 275 (84%) practitioners. 269 were analyzed. Only 54 practitioners (20%) used adult dental anxiety assessment questionnaires and only 46 (17%) used child dental anxiety assessment questionnaires. Male practitioners were more likely to report questionnaire use in comparison with females (P < 0.05), when treating dentally anxious adults (26% v 14%). In addition, practitioners providing intravenous sedation were more likely to use an adult dental anxiety questionnaire (P < 0.04) than those who did not use intravenous sedation (29% v 15%). The type of treatment provided had a significant association with the use of child dental anxiety. Those providing general anaesthesia (P = 0.03) and hypnosis (P = 0.01) for dentally anxious children were more inclined to use a questionnaire. Conclusion The use of pre-treatment dental anxiety assessment questionnaires was low in this group of dentists. Male practitioners and those providing intravenous sedation, general anaesthesia or hypnosis seem more likely to use dental anxiety assessment questionnaires.

The 1998 survey of Adult Dental Health in the UK was carried out under the auspices of the Office of National Statistics together with the Universities of Birmingham, Dundee, Newcastle-upon-Tyne and Wales. A key behavioural indicator in these decennial surveys is whether people say they go to a dentist for a regular dental check-up, an occasional dental check-up or only when they have trouble with their teeth. The proportion of dentate adults in the UK who report attending for regular dental check-ups has risen from 43% in 1978 to 59% in 1998. Older adults (over 55 years old) in 1998 were the most likely to say they attend for regular dental check-ups. Many younger adults (16-24) in 1998 said they went to a dentist less often than 5 years previously, they were also the least likely to say they attend for regular dental check-ups. Dental anxiety remains a problem for many dental patients but another factor of importance to many is their want to be involved in the treatment process and especially to be given an estimate of treatment costs.

Context This study was part of a successfully completed PhD and was presented at the IADR/AADR General Session (2013) in Seattle, Washington, USA. The report of this clinical trial conforms to the CONSORT statement. Objectives A randomised controlled trial to investigate if video modelling can influence a child's anxiety before the administration of local anaesthesia (LA). Method A sample of 180 (6- to12-year-old) children due to have dental treatments under LA were randomly allocated to the modelling video or the control video (oral hygiene instruction). The level of anxiety was recorded before and after watching the video on the Abeer Children Dental Anxiety Scale (ACDAS) and the child's ability to cope with the subsequent procedure was assessed on the visual analogue scale (VAS). A two group chi-square test was used as the basis for the sample size calculation; a significance level of 0.025 was chosen rather than the conventional 0.05 to avoid spurious results arising from multiple testing. Results Children in the test group had significantly less anxiety after watching the video than children in the control group throughout the subsequent dental procedure; in particular at the time of the LA administration (p

Aim To explore the impact of dental anxiety on daily living. Method Twenty people attending a dental sedation clinic completed the Modified Dental Anxiety Scale, and were interviewed privately using a reflexive, in-depth technique. All interviews were audio-tape recorded and transcribed. The transcripts were analysed to identify the impact of dental anxiety upon the participants' daily lives. Twenty-five per cent of the qualitative data was reviewed by an independent researcher to ensure the reliability of the analysis. Results The mean age of participants was 41 years (range 23 to 60). The mean MDAS score was 21.5 (range 14 to 25). Five main impacts of dental anxiety were identified: physiological; cognitive; behavioural; health; and social. Subsumed under these broad categories were: the fright response; a vast array of negative thoughts, feelings and fears; avoidance behaviour and behaviours related to eating, oral hygiene, and self-medication; and other manifestations of anxiety in the dental environment including muscular tension, crying and aggression were all identified. Dental anxiety was also found to disturb sleep and to have a profound affect socially, interfering with work and personal relationships. Conclusion The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

Objectives To compare the effects of nitrous oxide and midazolam on cognition and mood. Design A three-way, counterbalanced, cross-over study, using patients receiving conscious sedation for routine dental treatment. Methods On each of three separate visits, patients performed a computerised test battery to determine baseline cognitive performance. Then, following administration of either midazolam, nitrous oxide, or no drug, patients re-performed the test battery. Finally, patients completed visual analogue scales assessing their subjective mood state. Results Relative to baseline performance, midazolam administration produced significantly slower reaction times compared with nitrous oxide and no-drug conditions. Furthermore, patients receiving midazolam were impaired in accuracy relative to the other conditions on many of the cognitive tasks, particularly those assessing the recall of information. Patient performance in nitrous oxide and control conditions did not significantly differ. These results could not be explained by differences in mood between the conditions, as subjective mood ratings during midazolam or nitrous oxide administration were very similar. Conclusions It is important for clinicians to be aware that peri-operative recall of information is reduced in patients who have undergone midazolam sedation. This is an advantage for patients who are anxious, and do not wish to be aware of the operative treatment being performed. However, as the cognitive impairment is enduring, an adult escort and written post-operative instructions should be mandatory for midazolam sedation patients. In contrast, the use of nitrous oxide sedation does not significantly impair higher cognitive tasks and thus patients receiving nitrous oxide sedation can resume normal activities in the post-operative period.

Over the past eleven years, we have worked together to treat children who are dentally phobic. This has enabled us to develop an understanding of how children come to be dentally fearful. We have constructed a model of child dental fear which helps us in our work. It is important to acknowledge that fear is a normal phenomenon when any of us are exposed to threat. Helping dentally fearful children appraise or evaluate threat, face their fear and build upon their strengths is the task facing dentists and, occasionally, psychologists. The consequences for children of not doing so are extreme difficulty with accepting and ultimately total avoidance of treatment. Both of these can persist into adulthood.1 First, we propose to discuss the normality of fear in children, placing dental fear within a developmental context. We will then outline a model for assessing and treating dental fear which identifies five discrete but interrelated factors. Each of the factors and its treatment is illustrated with examples.

The argument for and against the presence of the mother in the surgery while her child undergoes a dental procedure has been contentious. Using a psychodynamic framework, this paper suggests that the mother's presence is necessary for the dentist-child relationship to function correctly.

This paper describes various elements of the dentist-patient relationship, how they interact and illustrates them with case studies.

Objective To assess differences among highly anxious dental patients assigned to different treatment modes (ie behavioural management (BM), nitrous oxide sedation (NOS), intravenous sedation (IVS)). Patients were compared with regard to psychological and dental variables before treatment (eg number of decayed teeth), and dental variables after treatment (eg number of fillings made). Design Dentists experienced in the treatment of highly anxious patients allocated patients to a treatment mode based upon their clinical judgement. Setting Centre for Special Dental Care, Amsterdam, The Netherlands. Subjects 211 patients from this dental fear clinic. Measures General psychopathology, as measured by the Symptom Checklist 90 (SCL-90), and dental anxiety (DAS, S-DAI, 10-point scale) were measured prior to treatment. From the panoramic radiograph the following pre-treatment dental variables were assessed: number of teeth, number of decayed teeth, number of retained roots, and number of root-filled teeth. After treatment, number of fillings, extractions, endodontically treated elements, number of visits, and treatment duration, were determined from the patients' records. Results Of the 144 patients who received dental treatment at the clinic, 46.5% was treated using a BM approach, 27.8% with NOS, 22.9% with IVS, and 2.8% under GA. No differences among the treatment groups were found with regard to SCL-90 and dental anxiety. The results showed that patients in the IVS group had statistically significant more decayed teeth than patients in the BM group. Furthermore, more fillings were made in the IVS group than in the BM group. Conclusion Since it appeared possible to treat a large proportion of patients by BM alone, training dentists in the application of psychological methods for the treatment of anxious patients should be stimulated. In addition, future research should seek for variables that, besides oral health, are better able to discriminate between groups of highly anxious patients than measures of dental anxiety and psychopathology.

This paper: Local anaesthetic failure is an unavoidable aspect of dental practice. A number of factors contribute to this, which may be related to either the patient or the operator. Patient-dependent factors may be anatomical, pathological or psychological. This paper considers the reasons for unsuccessful dental local anaesthetic injections and describes techniques which may be useful in overcoming failure.

Cardiac arrhythmias are not uncommon in dental practice, depending on many factors, including patient features, dental treatment and drugs administered. We describe a case of isolated atrial fibrillation (IAF) developed, in a young patient, soon after a supraperiosteal injection. The patient was admitted to hospital and recovered spontaneously. Since stress is a possible cause of IAF, this may has been triggered by endogenous and/or exogenous epinephrine. We highlight the need for careful preoperative evaluation, including anxiety assessment and treatment in all dental patients.