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Objectives: This randomized clinical trial compared the effectiveness of music and informative videos as distraction tools to reduce the anxiety of patients during root canal treatment and retreatment. Method and materials: A total of 90 patients were enrolled in the study. The patients were randomly allocated to three groups: Group 1 listened to music during the treatment (n = 30), Group 2 watched an informative preoperative video (n = 30), and a control group underwent treatment without a distraction method (n = 30). Prior to treatment, the Corah Dental Anxiety Scale (CDAS) and a visual analog scale for pain were used to assess anxiety and preoperative pain. Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded before the intervention (T1), after the local anesthetic (T2), following pulp extirpation or removal of root fillings (T3), and immediately following rubber dam removal (T4). One-way ANOVA, followed by post-hoc Bonferroni tests for multiple comparisons, were used to compare mean values of systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation among the groups. A P value of 5% was considered as significant. Results: Listening to music reduced systolic blood pressure, heart rate (P < .001), and diastolic blood pressure (P = .003) in patients undergoing root canal treatment and retreatment at T4 compared to the baseline (T1). Music (P < .001) and informative video (P = .003) groups had significantly lower postoperative visual analog scale pain scores. Conclusion: Listening to music during root canal treatment and retreatment reduced anxiety levels in patients compared to informative preoperative videos and no distraction technique. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords "music" and "dental anxiety". The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, −0.50; 95% CI, −0.80 to −0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, −0.51; p = 0.0007) than in children (SMD, −0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, −1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, −0.24; p = 0.02). Regarding music styles, classical music (SMD, −0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics. [ABSTRACT FROM AUTHOR]

Background: Individuals with Autism Spectrum Disorder (ASD) frequently encounter increased levels of anxiety and display resistant behaviors during dental examinations, which negatively affects their oral care and maintenance. This study employed a cross-sectional design to evaluate the impact of virtual reality (VR) intervention on the anxiety and level of cooperation in children and adolescents with ASD during dental examinations. Methods: A total of 140 participants diagnosed with ASD, aged from 4- to 18-years-old, were selected from two specialized ASD management centers in Riyadh/Saudi Arabia. The participants were randomly allocated into either the control group or the VR group. Control group participants were subjected to a conventional dental examination, while the VR group utilized VR intervention to immerse themselves in a simulated natural and soothing environment. The Venham anxiety and behavior scale (VABS) was utilized to measure anxiety levels, while the Frankl behavior rating scale (FBRS) was employed to assess the level of cooperation. Data were analyzed using a Mann–Whitney U test with a significance level of p < 0.05. Results: The baseline anxiety and level of cooperation between the groups were comparable (p > 0.05). During the dental examination, the VR group had significantly reduced anxiety scores (2.48 ± 1.76) compared to the control group (1.50 ± 1.74) (p < 0.001). Regarding the level of cooperation, the VR group exhibited significantly greater levels of cooperation (3.41 ± 0.96) than the control group (2.86 ± 1.03) (p = 0.002). Conclusions: These findings suggest that VR intervention is a successful technique for decreasing anxiety and enhancing cooperation among children with ASD during dental examination. Integrating VR technology in dental environments can potentially improve the dental experience and results for children diagnosed with ASD. [ABSTRACT FROM AUTHOR]

Introduction Aim Methods Results Conclusions Dental care avoidance affects individuals' oral health status. There is limited literature examining the context of dental avoidance behavior.The aim of the study is to examine attitudes toward dental care services among adults.Overall, 16 patients participated in semi‐structured interviews. The interviews were analyzed using inductive thematic analysis. Through independent reviews of the themes that comprise the patients' experience, a consensus was established among the researchers.Ten major themes were identified that encapsulate patients' attitudes toward dental care attendance: Effect of environment and equipment, Fear and anesthesia, Procrastination, Dissatisfaction with the dental care system, Expectations of dentists, Quality of dental care, Edentulousness and social status, Financial involvement, Aesthetics, and Dentists' behavior. Compliance with oral health maintenance can be enhanced by specific training for professionals and dentistry students and by fine tuning the dental care system.This is the first comprehensive study in Hungary investigating attitudes among dentist patients toward dental care. The results suggest that there are many factors that may affect dental care attendance. Thus, these findings make a potentially fundamental contribution to the improvement of dental care and support practitioners in enriching their understanding of dental avoidance behavior. [ABSTRACT FROM AUTHOR]

Background: The widely-used Dental Anxiety Scale (DAS) has practical and theoretical limitations. The Index of Dental Anxiety and Fear (IDAF-4C) was developed to overcome these shortcomings but requires more psychometric analysis to determine its utility. Purpose: To compare DAS and IDAF-4C validity and reliability among New Zealand Defence Force (NZDF) personnel. Material and methods: A survey of NZDF recruits and officer cadets collected data on dental anxiety using the IDAF-4C, the DAS and a global dental anxiety item. Results: Some 134 individuals completed the questionnaire. Confirmatory factor analysis for the IDAF-4C showed that a single factor explained 72.4% of the variance. The IDAF-4C showed high internal consistency reliability (α = 0.94). Confirmatory factor analysis for the DAS showed that a single factor explained 69.5% of the variance. The DAS showed high internal consistency reliability (α = 0.85). While the IDAF-4C showed a consistent gradient in mean scale scores across response categories of the global dental anxiety question, the gradient for the DAS was less consistent. The IDAF-4C and DAS showed considerable concordance (r = 0.71). Conclusion: The IDAF-4C demonstrated excellent psychometric properties, validity and reliability, and it is a valid and useful instrument for measuring dental anxiety and fear in Defence Force personnel. [ABSTRACT FROM AUTHOR]

Torture victims struggling with post‐traumatic stress often experience elements in the dental treatment situation that may trigger trauma‐related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture‐exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma‐reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma‐informed care, and the patients' individual needs; (ii) Recognize the trigger‐potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture‐exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma‐informed approach. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Purpose: Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures. Patients and Methods: This randomized clinical trial, 42 children between the ages of 5–6 years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale – Anxiety (VAS-A) score. Results: In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group. Conclusion: Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures. [ABSTRACT FROM AUTHOR]

Purpose: To assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions. Methods: In this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children's Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%. Results: The mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0–25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8–13.3; p value = 0.027). Conclusion: Children with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH. [ABSTRACT FROM AUTHOR]

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques. [ABSTRACT FROM AUTHOR]

Background: Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators. Methods: A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration's bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610. Results: The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate. Conclusion: In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future. [ABSTRACT FROM AUTHOR]

Background: The present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients. Methods: This study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used. Results: The questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p < 0,000). Germans were more susceptible to signs of Anxiety (p < 0,000), Depression and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index (p < 0,000) than Albanian patients. Additionally Albanian patients scored significantly lower on the preventive care index (p < 0,000). Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients. Conclusion: The results showed that between both populations differences in dental anxiety, psychological distress and oral health exists. Patients from Germany report more psychological distress and described more dental anxiety compared to Albanian patients. Albanian patients reported not utilization on oral health care.The implementation of educational programs and preventive measures, would contribute to raising awareness about the importance of oral health and increased use of dental services. [ABSTRACT FROM AUTHOR]

Featured Application: This research can be directly applied in the development of more efficient dental biofilm management techniques, enhancing the effectiveness of preventive dental care. Specifically, the insights from our study could be used to improve the protocols of Guided Biofilm Therapy, potentially reducing the anxiety associated with dental hygiene visits and improving patient outcomes. Fear and anxiety during dental visits are common issues that can lead to avoidance of appointments and deterioration of oral health. Effectively managing patients' emotions during dental treatments is crucial to improving their experiences, increasing adherence to regular visits, and achieving better treatment outcomes. This study aimed to assess the levels of fear and anxiety in patients undergoing hygiene treatments utilizing Guided Biofilm Therapy (GBT) and identify factors that could reduce these negative emotions. A total of 247 patients were evaluated using standardized questionnaires (MDAS, STAI X1, STAI X2, and Gatchel), custom questions, and heart rate monitoring as a physiological stress indicator. Clinical factors, including dental status confirmed by AI-based radiographic analysis (Diagnocat system), as well as sociodemographic influences, were analyzed. Results indicated significant reductions in fear and anxiety after the procedure, as shown by both heart rate and questionnaire scores. Factors such as pain, the presence of caries, and implants were linked to higher anxiety, while strategies like avoiding visible needles and postprocedure interaction with staff were associated with lower stress levels. The findings underscore the importance of personalized care and emotional support to enhance patient experiences. [ABSTRACT FROM AUTHOR]

Background: While cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample's oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach. Methods: The study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study. Results: All patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2). Conclusions: TADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes. Trial registration: The study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority. [ABSTRACT FROM AUTHOR]

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self‐control, randomized, and double‐blind clinical trial evaluated 30 children aged 6–12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong–Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong–Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p = 0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection. [ABSTRACT FROM AUTHOR]

Background: Children’s fear and distress in dental settings often lead to anxiety and behavior issues. This study delves into why some children experience dental anxiety, whereas others do not, attributing differences to child-rearing and personality traits. Emotional intelligence (EQ), the ability to comprehend, generate, and manage emotions, is explored as a factor influencing a child’s dental experience. This novel intelligence theory accommodates the intricacies of human–environment interactions. AIM: The study aimed to investigate the relationship between EQ and a child’s dental anxiety, fear, and behavior in children aged 8–12 years. MATERIALS AND METHODS: The Trait Emotional Intelligence Questionnaire-Child Short Form, specifically developed for children aged between 8 and 12 years, was used among 100 participants reporting to the department outpatient department. The Frankl’s Behavior Rating Scale, Modified Child Dental Anxiety Scale, and Children’s Fear Survey Schedule-Dental Subscale were used to evaluate behavior, anxiety, and fear, respectively. Results: Results show a positive correlation between EQ and dental behavior (P = 0.002) whereas a negative correlation between EQ and dental anxiety and fear (P < 0.001). Conclusion: This study sheds light on the intricate interplay between emotional intelligence, dental behavior, anxiety, and fear among children. By recognizing the impact of EQ, dental practitioners could adopt personalized strategies to alleviate anxiety and enhance cooperation, improving overall dental experiences for young patients.

Abstract Background Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators. Methods A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration’s bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610. Results The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate. Conclusion In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future.

Abstract Background The present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients. Methods This study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used. Results The questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p

Abstract Background While cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample’s oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach. Methods The study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study. Results All patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2). Conclusions TADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes. Trial registration The study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority.

Aim: The pathways to post‐operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient‐related predictors of post‐operative pain following root canal treatment. Methodology: A total of 154 patients received a single‐visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post‐operative pain was assessed using the Numeric Rating Scale at multiple time‐points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient‐related predictors on a theoretical model of post‐operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). Results: Dental anxiety (coefficient 0.028; p <.01), dental fear (coefficient 0.007; p =.02) and irrigant solution (coefficient 0.004; p =.03) exerted a direct effect on post‐operative pain. SOC exerted an indirect effect on post‐operative (coefficient 0.006; p =.01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p =.04) exerted an indirect effect on post‐operative pain through dental anxiety. Conclusions: Dental anxiety, dental fear, previous negative experiences and SOC are patient‐related predictors of post‐operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post‐operative pain. [ABSTRACT FROM AUTHOR]

Abstract Background Identifying the risk indicators of parental dental anxiety (PDA) and oral health literacy (OHL) can help oral healthcare professionals recognise challenges in this field. Armed with the appropriate information, they can effectively engage with parents to build trust and promote early and regular child dental visits. Objectives This study aimed to investigate the association between PDA and OHL with the sociobehavioural characteristics of families, self-reported child oral health (presence of ≥ 1 untreated decayed teeth) and the dental visit patterns amongst children living in Al Jouf Province, Kingdom of Saudi Arabia. Subjects and methods A total of 430 parents with children aged ≥ 14 years were invited using a systematic random sampling method. PDA was assessed using the Dental Anxiety Scale-Revised (DAS-R) scale, and parents’ OHL was measured using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30). The relationships amongst participant characteristics, PDA and OHL were evaluated through the Chi-square and ANOVA. Additionally, binary regression analysis was conducted to identify predictor variables associated with PDA and OHL. A P value of 12 months ago (AOR = 34.94; P

Background/purpose: Dental anxiety is prevalent and may result in the avoidance of periodontal therapy and maintenance. This study aimed to explore the impact of non-surgical periodontal treatment (NSPT) on dental anxiety among patients with periodontitis. Materials and methods: In this study, 122 patients with periodontitis participated. The Chinese version of the Modified Dental Anxiety Scale (MDAS) gauged baseline dental anxiety during the initial appointment. Patients receiving non-surgical periodontal treatment (NSPT) in subsequent appointments formed the NSPT group, while those with a delayed NSPT of at least two months constituted the delayed group. In the NSPT group, the second termination questionnaire was administered one month post the last NSPT visit, just before the periodontal re-evaluation. In the delayed group, the second questionnaire was completed before the delayed NSPT initiation. Results: Baseline MDAS scores were comparable between the delay and NSPT groups. However, the NSPT group exhibited lower total scores and scores for each of the five MDAS items at termination compared with the delay group. At baseline, MDAS total scores were inversely associated with age and were lower in males. A reduction in MDAS total scores between observation points was correlated with NSPT, sex, and age after adjustment. Regarding MDAS item 4 (teeth scaled/polished), score reduction consistently correlated with NSPT and age. Conclusion: Participation in NSPT may alleviate dental anxiety, and consequently enhance the patients' conceptiveness to undergo periodontal maintenance or surgery.

Background: Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. Objective: To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Methods: Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3–8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005–2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. Results: A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Conclusion: Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3–8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. Funding: None. Registration: PROSPERO (Ref no.: CRD42021245874).

Abstract Background Mothers usually have the primary role in raising children and developing health-related behaviors. This study aims to evaluate the relationship between dental anxiety and oral hygiene status of mothers and children’s dental anxiety and gingival health. Methods The study included 305 children, aged 4–12 years, who came to the dentist for the first time and their mothers. All the demographic and oral hygiene information were collected through a questionnaire. The dental anxiety of the mothers and children was assessed using the Modified Dental Anxiety Scale (MDAS) and Venham Picture Test (VPT), respectively. The oral examination of the mother and children was performed, and their PI, GI, and DMFT scores were recorded. Results While the correlation between MDAS and VPT was positive and strong in children aged 8–12, it was positive but weak in the 4–7 age group. A significant relationship was detected between the mother’s PI, GI, DMFT, and the child’s VPT score. According to the mothers’ dental anxiety, there were no statistically significant differences in PI, GI, and dmft values in children aged between 4 to 7. A moderately positive and statistically significant relationship between maternal dental anxiety and children’s DMFT was identified in children aged 8–12. Conclusions Children’s dental anxiety was significantly influenced by maternal dental anxiety, post-treatment complications experienced by the mother, and the oral health status of the mother. Trial registration Clinical Trials-ID: NCT05563532; Registration Date: 17.09.2022.

The study aimed to comparatively assess dental anxiety and trends in accessing dental care in students majoring in dentistry and other fields. Methods A cross-sectional study was conducted on a convenience sample of university students from Bucharest. Data were collected through the Google form platform, from 2023 to 2024. Dental anxiety was recorded through the Index of Dental Anxiety and Fear (IDAF-4C+) and Dental Anxiety Scale (DAS). Results. Dental anxiety of dental students was statistically significantly lower than for students majoring in other fields. The most anxiety-provoking stimuli were painful or uncomfortable procedures, the cost of dental treatments, needles or injections, and having an unsympathetic dentist. Dental students attend dental care for periodical control more often than non-dental students (66.34% vs 35.19%, p < 0.001). Conclusion. Dental students, compared to students majoring in other fields, had lower levels of dental anxiety and went more frequently for periodical dental control.

Lidocaine hydrochloride (HCl) 2% with 1:100,000 epinephrine (LW/E) is widely used to prevent pain during dental procedures and has been associated with injection sting, jittering effects, slow onset, and a bitter aftertaste. Since LW/E's introduction in 1948, no significant modifications have been proposed. This study aims to design and characterize an improved dental lidocaine HCl injectable formulation without epinephrine (LW/O/E) via buffers, sweeteners, and amino acids. LW/O/E injections were prepared with pH and osmolality values of 6.5–7.0 and 590–610 mOsm/kg. Using the electronic tongue (ETongue), the LW/O/E injectable formulations were characterized for viscosity, injectability, and taste analysis. The results were compared with the LW/E control. In vivo efficacy and anesthetic duration of the samples were measured through radiant heat tail-flick latency (RHTFL) and hot plate (HP) tests and local toxicity was assessed after a single intra-oral injection in Sprague Dawley rats (SDR). The viscosity and injectability values of the LW/O/E samples were found to be comparable to the LW/E injection. ETongue taste analysis showed an improvement in bitterness reduction of the LW/O/E samples compared to the LW/E formulation. Toxicity studies of samples in SDR showed minor and transient signs of erythema/eschar and edema. Anesthetic duration via RHTFL and HP paw withdrawal latency time in SDR were found to be comparable for the LW/O/E Sample 3A and the LW/E injection (p < 0.05). In conclusion, the buffered, higher osmolality and reduced bitterness developed LW/O/E formulation (Sample 3A) could be considered a promising alternative to the LW/E formulation for dental use. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to evaluate effect of parental absence or presence on anxiety level of children in dental clinic.. Materials and Methods: 130 children who 6-9 years old were randomly divided into two groups as absence of parents (PA) (n=65) and presence of parents (PP) (n=65). Children in both groups were examined by the pediatric dentist as only clinical and radiographical without any dental treatment on first visit. The primary molars of children in both groups were restored with compomer resin with using the rubber dam on second visit. Before and after the dental procedures The Abeer Children Dental Anxiety Scale (ACDAS) was applied to all participants in both groups. All data were analysed with two sample t test and p value set at <0.05 for significance level. Results: The mean age of participants was 6.9±1,18 years. The ACDAS score of PP on first visit was significantly lower than ACDAS score of PP on second visit (p<0.001). When comparing the mean ACDAS score of PA group, score of second visit with 26.23±1.82 significantly lower than first visit with 28.52±1.96 (p<0.001). There were no significant differences between mean ACDAS score of females and males in both groups and visits (p>0.05). Conclusions: According to results of current study, parental absence is efficient method for developing to behaviours of children during the dental procedures such as composite restorations under local anaesthesia in children who 6-9 years old. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. Materials and Methods: This randomized controlled split‐mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. Results: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = −0.48, p = 0.01). Conclusions: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to investigate the prevalence of dental anxiety, its association with self-reported oral health, and sociodemographic factors in adults that are critical for improving oral health and well-being. Materials and Methods: An online survey was conducted via social media, with 1551 adults (76.5% women, 23.5% men) participating nationwide. Data collected included demographic data, Modified Dental Anxiety Scale (MDAS) scores, and associations between dental anxiety, negative experiences, and self-reported oral health. The analysis included psychophysiological, behavioural, and emotional responses and avoidance of dental visits, using descriptive and generalised linear regression models. Results: This study found that the mean score of the MDAS was 9.70 ± 5.11 out of 25, 19.1% of the participants reported no dental anxiety, and 7.8% suffered from dental phobia. Gender, age, and socioeconomic status had no significant effect on the prevalence of anxiety. Although more than half of the participants reported negative dental experiences, particularly in childhood, anxiety levels were unaffected. However, those who rated their oral health as excellent or very good had lower anxiety scores (p = 0.008, p = 0.024). Among the dental procedures, oral surgery (58.7%) and prosthetic (restorative) dental treatments (15.2%) caused the most anxiety. Avoidance behaviour correlated with increased anxiety (p ≤ 0.001), as did postponing dental visits until severe pain occurred (p = 0.011). Conclusions: These results emphasise the significant prevalence of dental anxiety in adults, particularly for surgical procedures and drilling, posing challenges in patient management. Tailored strategies are essential to reduce anxiety, improve patient well-being, and optimise dental service delivery and treatment efficacy. [ABSTRACT FROM AUTHOR]

PURPOSE. This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF). MATERIALS AND METHODS. Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day). RESULTS. The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days. CONCLUSION. The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care. [ABSTRACT FROM AUTHOR]

Background: Identifying the risk indicators of parental dental anxiety (PDA) and oral health literacy (OHL) can help oral healthcare professionals recognise challenges in this field. Armed with the appropriate information, they can effectively engage with parents to build trust and promote early and regular child dental visits. Objectives: This study aimed to investigate the association between PDA and OHL with the sociobehavioural characteristics of families, self-reported child oral health (presence of ≥ 1 untreated decayed teeth) and the dental visit patterns amongst children living in Al Jouf Province, Kingdom of Saudi Arabia. Subjects and methods: A total of 430 parents with children aged ≥ 14 years were invited using a systematic random sampling method. PDA was assessed using the Dental Anxiety Scale-Revised (DAS-R) scale, and parents' OHL was measured using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30). The relationships amongst participant characteristics, PDA and OHL were evaluated through the Chi-square and ANOVA. Additionally, binary regression analysis was conducted to identify predictor variables associated with PDA and OHL. A P value of < 0.05 was considered statistically significant. Results: Children with ≥ 1 untreated decayed tooth were 2.5 times more likely to have PDA (95% confidence interval [CI] = 1.37, 4.37). Children who visited the dentist in < 6 months had 93% lower likelihood to have PDA (adjusted odds ratio (AOR) = 0.07; 95% CI = 0.03, 0.18). Parents aged 20–25 years were 81% less likely to have OHL than those above 30 years (AOR = 0.19; P = 0.038). Similarly, parents with medium family income were 52% less likely to have OHL than the high-income group (AOR = 0.48; P = 0.013). Finally, parents of children who visited the dentist within < 6 months were 34 times more likely to have OHL than those whose children visited the dentist > 12 months ago (AOR = 34.94; P < 0.001). Conclusion: PDA and OHL were significantly affected by parental age, family income, the presence of ≥ 1 untreated decaying tooth and the child dental visit patterns. During a child's first dental visit, paediatric dentists should always assess the PDA, OHL and sociobehavioural characteristics of a family by using appropriate scales and semistructured interviews. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE:This study investigates gender differences in dental anxiety among Pakistani undergraduate students to enhance their oral health awareness and help reduce the avoidance of necessary dental care. To study the gender variations in dental anxiety among Pakistani undergraduate students. METHODOLOGY: Data was collected from 350 students by using cross-sectional study design and the age of the students was 18-24 years. A non-probability convenience sampling technique was utilized. After getting institutional ethical permission, the study was carried out. Every participant provided their consent, and confidentiality was maintained. The significance level was set at 0.05, and a 95% confidence level was determined. RESULTS: There were 350 students responded to the survey. Dental anxiety was more prevalent in females than males and found to be associated with other risk factors like visits to the dentist (<0.001), fear of dental pain (0.021), dental treatment (0.030), fear of white coat (0.006) and concerns (0.002). The findings emphasized the need for stress-reduction techniques and exercises done by the doctor before starting the dental treatments. Furthermore, it is crucial to minimize, if not completely avoid, the causes of dental anxiety through effective counseling and communication. CONCLUSION: Dental fear is more common among female students, which is a barrier to receiving dental treatments. Therefore, decreasing dental anxiety could be accomplished by offering frequent dental education and public awareness regarding oral health. [ABSTRACT FROM AUTHOR]

Dental anxiety poses challenges for providing effective oral healthcare. While therapy dogs have shown promise in various medical and mental health contexts, their use for alleviating dental anxiety in adults remains underexplored. This study aimed to investigate the emotional and physiologic effects of therapy dogs on self-reported dental anxiety. Adults with dental anxiety were randomly assigned to an intervention group (DOG: n = 19) or a standard care group (SC; n = 14). Standard self-report measures were used to assess dental anxiety (Index of Dental Anxiety and Fear [IDAF-46+]), depression (Patient Health Questionnaire 9), and generalized anxiety (Generalized Anxiety Disorder 7) prior to the intervention. Participants in the DOG group received a 10-minute therapy dog intervention before dental procedures in sessions 1 and 2, while participants in the SC group rested quietly for 10 minutes before their procedure. The SC participants received the 10-minute therapy dog intervention before dental procedures in the third and final session, while patients in the DOG group received no intervention prior to their third procedure. After the dental procedures, patients completed a questionnaire about their satisfaction with the dog therapy (Therapy Satisfaction Scale) and recorded their anxiety and comfort levels on visual analog scales. Continuous electrocardiographic recording measured heart rate variability during the intervention and dental procedure. Prior to the intervention, most participants (90.9%) met the IDAF-46+ criteria for dental anxiety, with 7 (21.2%) meeting the criteria for dental phobia. The DOG group participants expressed high satisfaction with the therapy dog intervention. No significant differences in heart rate variability were observed between the groups during dental procedures. Therapy dogs can effectively manage dental anxiety in adults with mild to moderate dental anxiety, offering potential benefits for oral healthcare. [ABSTRACT FROM AUTHOR]

Dental anxiety is prevalent and may result in the avoidance of periodontal therapy and maintenance. This study aimed to explore the impact of non-surgical periodontal treatment (NSPT) on dental anxiety among patients with periodontitis. In this study, 122 patients with periodontitis participated. The Chinese version of the Modified Dental Anxiety Scale (MDAS) gauged baseline dental anxiety during the initial appointment. Patients receiving non-surgical periodontal treatment (NSPT) in subsequent appointments formed the NSPT group, while those with a delayed NSPT of at least two months constituted the delayed group. In the NSPT group, the second termination questionnaire was administered one month post the last NSPT visit, just before the periodontal re-evaluation. In the delayed group, the second questionnaire was completed before the delayed NSPT initiation. Baseline MDAS scores were comparable between the delay and NSPT groups. However, the NSPT group exhibited lower total scores and scores for each of the five MDAS items at termination compared with the delay group. At baseline, MDAS total scores were inversely associated with age and were lower in males. A reduction in MDAS total scores between observation points was correlated with NSPT, sex, and age after adjustment. Regarding MDAS item 4 (teeth scaled/polished), score reduction consistently correlated with NSPT and age. Participation in NSPT may alleviate dental anxiety, and consequently enhance the patients' conceptiveness to undergo periodontal maintenance or surgery. [ABSTRACT FROM AUTHOR]

Dental drilling sounds can induce anxiety in some patients. This study aimed to use functional magnetic resonance imaging (fMRI) to assess the relationship between dental fear and auditory stimuli. Thirty-four right-handed individuals (21 women and 13 men; average age, 31.2 years) were selected. The level of dental fear was assessed using the dental fear survey (DFS). Based on a threshold DFS score > 52, participants were categorized into two groups: dental fear (DF) group (n = 12) and control group (n = 22). Two types of stimuli were presented in a single session: dental and neutral sounds. Cerebral activation during the presentation of these sounds was evaluated using contrast-enhanced blood oxygenation level-dependent fMRI. In the DF group, dental sounds induced significantly stronger activation in the left inferior frontal gyrus and left caudate nucleus (one-sample t test, P < 0.001). In contrast, in the control group, significantly stronger activation was observed in the bilateral Heschl's gyri and left middle frontal gyrus (one-sample t test, P < 0.001). Additionally, a two-sample t test revealed that dental sounds induced a significantly stronger activation in the left caudate nucleus in the DF group than in the control group (P < 0.005). These findings suggest that the cerebral activation pattern in individuals with DF differs from that in controls. Increased activation of subcortical regions may be associated with sound memory during dental treatment. [ABSTRACT FROM AUTHOR]

Background: Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. Objective: To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Methods: Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. Results: A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Conclusion: Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. Funding: None. Registration: PROSPERO (Ref no.: CRD42021245874). [ABSTRACT FROM AUTHOR]

Dental anxiety and phobia are prevalent issues worldwide, significantly impacting individuals' oral health and contributing to reduced dental care. The present review examines the assessment, prevalence, and treatment of dental anxiety, focusing on recent developments in cognitive-behavioral therapy (CBT), mindfulness techniques, and pharmacological interventions. Research indicates that psychological approaches such as CBT and mindfulness are effective in reducing anxiety, while pharmacological methods continue to be explored for their efficacy in clinical settings. Additionally, the review highlights the emerging technologies, like internet-based therapy and hypnosis, as promising adjuncts to traditional treatments. Understanding the multifactorial causes of dental anxiety can guide individualized care plans and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of waiting room based multisensory adapted dental environment (SADE) as a novel, non‐invasive behavior management technique in alleviating anxiety levels in children with Down syndrome. Materials and Methods: This study was conducted in the Department of Pediatric and Preventive Dentistry, D.Y. Patil University School of Dentistry, Nerul, Navi Mumbai. A total of 40 children between 8 and 13 years of age diagnosed with Down syndrome were included in our study. Prior to the first dental evaluation, they were divided equally into two groups using simple randomization via lottery system. Group A (Intervention group): Patients were subjected to a sensory adapted environment (SADE) in the waiting room for 10 min prior to dental evaluation. Group B (Control group): Patients were subjected to a regular dental environment (RDE) in the waiting room for 10 min prior to dental evaluation. Outcome parameters evaluated at baseline and post dental evaluation were anxiety and behavior, using a pulse oximeter and the Modified Venham's Scale respectively. Data were subjected to statistical analysis using SPSS version 21.0 (SPSS Inc. Chicago, IL). The 'p' value <.05 was taken as significant at 95% confidence interval. Results: Mann‐Whitney U test was used to carry out the inter group analysis which showed a significant increase in the heart rate (26.00, p =.00) in Group B and a significant decrease in the Modified Venham Scale score (90.00, p =.001) in Group A. The Wilcoxon Signed ranks test was used to carry out the intra group analysis for which a significant difference between the two time intervals for heart rate (−3.69, p =.00) and Modified Venham Scale score (−1.46, p =.03) was obtained in Group A whereas a significant difference was obtained only in the heart rate (−3.04, p =.002) in Group B. Conclusion: Multisensory‐adapted dental environment (SADE) in the waiting room effectively improves behavior, reduces anxiety and sensory discomfort among children with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: Mothers usually have the primary role in raising children and developing health-related behaviors. This study aims to evaluate the relationship between dental anxiety and oral hygiene status of mothers and children's dental anxiety and gingival health. Methods: The study included 305 children, aged 4–12 years, who came to the dentist for the first time and their mothers. All the demographic and oral hygiene information were collected through a questionnaire. The dental anxiety of the mothers and children was assessed using the Modified Dental Anxiety Scale (MDAS) and Venham Picture Test (VPT), respectively. The oral examination of the mother and children was performed, and their PI, GI, and DMFT scores were recorded. Results: While the correlation between MDAS and VPT was positive and strong in children aged 8–12, it was positive but weak in the 4–7 age group. A significant relationship was detected between the mother's PI, GI, DMFT, and the child's VPT score. According to the mothers' dental anxiety, there were no statistically significant differences in PI, GI, and dmft values in children aged between 4 to 7. A moderately positive and statistically significant relationship between maternal dental anxiety and children's DMFT was identified in children aged 8–12. Conclusions: Children's dental anxiety was significantly influenced by maternal dental anxiety, post-treatment complications experienced by the mother, and the oral health status of the mother. Trial registration: Clinical Trials-ID: NCT05563532; Registration Date: 17.09.2022. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the relationship between adverse childhood experiences (ACEs) and dental anxiety among Chinese adults in Hong Kong. Methods: A cross-sectional survey was conducted at a university in Hong Kong. The recruiting period and data collection started in January 2023 and ended in June 2023. Participants completed an online questionnaire that assessed ACEs (using the Adverse Childhood Experiences International Questionnaire -- ACE-IQ) and dental anxiety (using the Modified Dental Anxiety Scale -- MDAS and Dental Fear Survey -- DFS). The study examined the impacts of both cumulative (i.e., total number) and independent ACE components on dental anxiety. To explore the relationships between cumulative ACEs, individual ACE components and dental anxiety (MDAS and DFS score), Pearson correlations, linear regression and logistic regression were conducted. Results: Significant associations were observed between ACEs and dental anxiety among 171 subjects. Cumulative ACEs were positively correlated with MDAS scores (r = 0.169, p = 0.027) and DFS scores (r = 0.253, p < 0.001). The odds of an individual having high dental anxiety increased by 26-43% for every additional increase in the number of ACEs. Individual types of ACEs, such as emotional and physical neglect, sexual abuse, and household substance abuse, significantly influenced the likelihood of having high dental anxiety. Discussion: The results showed a positive association between ACEs and dental anxiety, highlighting the impact of ACEs on dental anxiety. Dental practitioners should consider inquiring about a patient's ACE history to develop personalized treatment plans. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. Methods: Longitudinal data from the Australian National Study of Adult Oral Health (2004–06 and 2017–18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. Results: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. Conclusions: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship. [ABSTRACT FROM AUTHOR]

Background: Fear and anxiety are common psychological responses to unpleasant stimuli, with dental fear being the fourth most prevalent type of fear or phobia. However, not all dental procedures cause the same level of anxiety, with dental surgery and tooth extraction being among the top five most frightening procedures in the field. Tooth extractions are also the most common surgical procedure in dental surgery. It is important to manage anxiety in the dental office by identifying the main factors. Methods: The study was conducted on a group of 250 patients. The survey technique and the Beliefs about Pain Control Questionnaire (BPCQ) were used in the study. Pain and stress intensity on a Visual Analog Scale (VAS) were measured in each patient before and after tooth extraction procedures. Results: Young women and people from small towns had the highest levels of anxiety. The factor causing the highest level of anxiety was fear of complications. Patients undergoing extraction of retained teeth were characterized by higher levels of anxiety. Conclusions: Perioperative stress is strongly dependent on numerous factors. For patient comfort, it may be crucial for dentists to have knowledge about these factors and the ability to utilize them to reduce stress before and after tooth extractions. [ABSTRACT FROM AUTHOR]

Dental treatment anxiety is highly prevalent worldwide. This is particularly important in the field of implantology since, in daily clinical practice, it translates into an increase in the difficulty of treatments, extending surgical times and having repercussions in the postoperative period. The aim of this multicentre, cross-sectional, epidemiological study was to determine the influence of anxiety levels in the postoperative period of an implant treatment on patients treated at two dental departments in Extremadura (Spain). To analyse anxiety levels, the modified Corah's Dental Anxiety Scale questionnaire was administered before surgical treatment. To analyse the postoperative period, another questionnaire was provided 7 days after surgery. The study was conducted on a total of 102 patients (55 men and 47 women), with a mean age of 47.99 years. The results indicated that patients with a high and severe degree of anxiety had a poorer quality of life in general. Patients with a higher degree of anxiety perceived greater swelling at 24, 48, 72 h and one week after surgery. [ABSTRACT FROM AUTHOR]

Background: Severe early childhood caries (S-ECC) is recognized as a significant chronic disease which affects the quality of life starting at very young ages and has a very rapid evolution towards pulp complication and loss of dental tissue. Children with a high caries index DMFT are more likely to develop high levels of dental anxiety, which will influence the degree of cooperation during dental procedures. Emotions play an important role in the psychosomatic development of children, and all the factors that contribute to the modeling of these emotional states must be known and taken into consideration. Aim: The aim of this study was to assess the association between dental anxiety in children with S-ECC and the color preferences for the components of the dental environment to reduce the levels of dental anxiety during medical visits. Material and Method: For this study, 91 children between 3 and 6 years of age diagnosed with S-ECC were selected from the Pediatric Dentistry Department of UMFST from Targu Mures and from a private dental office. The level of dental anxiety was determined by measuring the pulse rate, and a questionnaire was completed to establish the color preferences for the dental office environment and the dentist's attire. For this purpose, six different colors and their variants with three shades less intensity were chosen by using RGB (Red, Green, and Blue) identification codes for each color. Result: The results showed that there was a statistically significant difference between the age of the subjects and dental anxiety levels, but there was no significant correlation between the DMFT score and dental anxiety. Also, the results showed that there was no significant difference between girls and boys when choosing the colors preferred by them for the dental office, but when comparing the colors that represented happiness, significant statistical difference was found between the girls' and boys' groups (p = 0.0039). For all the subjects, the colors associated with happiness were light yellow and pink, while the colors associated with anxiety were red and dark blue. Conclusion: The data obtained showed that dental anxiety is strongly influenced by age, and an important role in inducing positive emotions is played by the dental environment if dressed in specific colors in order to reduce dental anxiety and create familiar conditions, especially for young children with S-ECC. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is a prevalent issue that affects a significant portion of the population, leading to avoidance of dental care. The study aimed to identify and compare the self-perceived triggering and relieving factors of dental anxiety among patients of private and public dental institutes in Punjab. Methods: This analytical cross-sectional study was conducted between Dec 2021 and Oct 2022, on a sample of 711 physically and mentally healthy patients reporting to three private and two public dental hospitals in Punjab with a score of 11 and above on MDAS, using consecutive sampling. The former section of the questionnaire included demographics, while the latter part focused on self-reported triggers and relieving factors of dental anxiety. The data was analyzed using SPSS, and compared using the chi-square test. A p-value of ≤0.05 was taken as significant. Results: The study included 51.3% females (n=365) and 48.7% males (n=346). Dirty instruments were a major trigger (67.1%, n=477, p=0.001), followed by stressful waiting rooms (54.4%, n=387, p=0.007) and complex procedures (49.2%, n=350, p=0.001) in public hospitals. Delayed appointments were a common trigger (41.1%, n=292) in both settings. Reassurance from the dentist (68.5%, n=487, p=0.087) and minimal waiting times (64.8%, n=461, p=0.012) were key relieving factors in both settings. Conclusion: Dental anxiety triggers were more frequent in public settings, including dirty instruments, stressful waiting room environments, and complex procedures. In contrast, private settings showed fewer triggers. However, both public and private patients valued reassurance from the dentist and minimal waiting times as major relieving factors.

Dental anxiety and dental neglect are interconnected constructs with profound consequences for oral health and corresponding challenges for dental professionals. Meanwhile, other literature has indicated that mindfulness and self-compassion relate negatively to different forms of anxiety, and propose elements of potential interventions. This study aimed to explore the potential impact of dental anxiety as a mediator on the relationships between mindfulness or self-compassion and dental neglect. The results showed significant negative associations between mindfulness and self-compassion with dental anxiety and dental neglect. Mediation analyses supported the hypothesis that dental anxiety mediates the positive associations between mindfulness or self-compassion and dental neglect, providing preliminary evidence for the potential effectiveness of mindfulness and self-compassion interventions in addressing dental anxiety and dental neglect. Future research and potential clinical implications are discussed.

Background/AimManaging young children with negative behaviors can be challenging in dental settings. Moderate sedation (MS) is often used as a treatment option for such children. However, children's behavior during MS may vary depending on several variables. These variables include parental factors, such as parental anxiety, coping strategies, and pain catastrophizing. However, this area, particularly in Saudi Arabia, remains underexplored. Therefore, this study aimed to assess the association among parental anxiety, coping style, pain catastrophizing, and children's behavior during MS among Saudi children.MethodsBased on sample size calculation, this cross-sectional observational study included 85 children aged 3–5 years undergoing dental treatment under MS at King Saud University, Riyadh, Saudi Arabia. Parental anxiety, coping styles, and pain catastrophizing were assessed using the Modified Dental Anxiety Scale, Brief Coping Orientation to Problems Experienced Scale, and Pain Catastrophizing Scale. Child behavior was evaluated using the Houpt scale during sedation visits, which was video-recorded and independently analyzed by a single evaluator. Data were analyzed using Pearson's chi-squared test, Mann–Whitney U test, and stepwise multivariate logistic regression analyses.ResultsThe results showed no significant association among parental dental anxiety, pain catastrophizing, and child behaviors during MS. Specific parental coping strategies, such as acceptance, were positively associated with positive sedation outcomes (P = 0.03), while active coping strategies were linked to less favorable outcomes (P = 0.03). Female children had higher sedation failure rates (P = 0.02), and the number of dental treatments was positively associated with success rates (P = 0.03).ConclusionParental anxiety and pain catastrophizing did not significantly affect the success of sedation. However, acceptance as a coping strategy was significantly associated with sedation success in pediatric dental care under MS, whereas active coping strategies were associated with less favorable outcomes.

Objectives: To assess self-reported population oral health conditions amid the COVID-19 pandemic using user reports on Twitter. Method and materials: Oral health-related tweets during the COVID-19 pandemic were collected from 9,104 Twitter users across 26 states (with sufficient samples) in the United States between 12 November 2020 and 14 June 2021. User demographics were inferred by leveraging the visual information from the user profile images. Other characteristics including income, population density, poverty rate, health insurance coverage rate, community water fluoridation rate, and relative change in the number of daily confirmed COVID-19 cases were acquired or inferred based on retrieved information from user profiles. Logistic regression was performed to examine whether discussions vary across user characteristics. Results: Overall, 26.70% of the Twitter users discussed "Wisdom tooth pain/jaw hurt," 23.86% tweeted about "Dental service/cavity," 18.97% discussed "Chipped tooth/tooth break," 16.23% talked about "Dental pain," and the rest tweeted about "Tooth decay/gum bleeding." Women and younger adults (19 to 29 years) were more likely to talk about oral health problems. Health insurance coverage rate was the most significant predictor in logistic regression for topic prediction. Conclusion: Tweets inform social disparities in oral health during the pandemic. For instance, people from counties at a higher risk of COVID-19 talked more about "Tooth decay/gum bleeding" and "Chipped tooth/tooth break." Older adults, who are vulnerable to COVID-19, were more likely to discuss "Dental pain." Topics of interest varied across user characteristics. Through the lens of social media, these findings may provide insights for oral health practitioners and policy makers. [ABSTRACT FROM AUTHOR]