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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]

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]

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]

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]

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]

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]

Objective: This clinical study aimed to evaluate the effect of virtual reality (VR) technology on anxiety and pain levels in patients undergoing gingivectomy and gingivoplasty procedures. Materials and Methods: The patients were randomized into test (surgery with VR glasses) and control (surgery without VR glasses) groups. Before the surgery, the anxiety level was measured using the modified dental anxiety scale (MDAS), and anticipated pain (AP) was measured by a visual analog scale (VAS). Immediately after the surgery, the pain and discomfort associated with the surgery (VASP), procedure time (T), and time perception (TP) were evaluated. The patients in the test group were requested to assess the immersion (VASI), satisfaction (VASS), perception of reduced anxiety (VASA), and perceived control (VASC). One week after surgery, MDAS was applied to all patients. Results: This trial was conducted with 41 female and 17 male subjects with a mean age of 29.69 ± 12.32. There were no significant differences between the groups in terms of age, sex, preoperative MDAS, or AP. After surgery, MDAS, VASP, T, and TP failed to differ significantly between the groups. The subject age was positively correlated with VASI, VASS, VASA, and VASC (r = 0.60, p = 0.00; r = 0.44, p = 0.02; r = 0.46, p = 0.02; r = 0.50, p = 0.01, respectively) and negatively correlated with VASP (r = 0.47, p = 0.04). Conclusions: VR application did not affect anxiety and pain levels in patients undergoing periodontal surgery. More studies are needed to evaluate VR distraction in periodontal surgeries with diverse age samples and video options. Clinical Significance: VR does not affect anxiety and pain levels during gingivectomy and gingivoplasty surgeries in the young adult population. It should be evaluated in older age groups. Trial registration ClinicalTrials.gov Identifier: NCT06092177. [ABSTRACT FROM AUTHOR]

Background: The Abeer Children Dental Anxiety Scale (ACDAS) source language was developed and validated in an English‐speaking country in the UK to measure dental anxiety among children. The ACDAS also included the child's cognitive assessment, as well as feedback from the parent or the legal guardian and a dental health professional (DHP). This is the first study to validate the application of the ACDAS in Malay or Bahasa Melayu for children aged 6–16 years. Aim: To assess the Malay‐translated version of the ACDAS, postadaptation into the local context and validation by the content and construct experts. Design: The English ACDAS was translated into Malay first through forward translation and then through backward translation. The prefinal translated version of the instrument was designed, with the participation of 61 children and 61 parents or legal guardians. Subsequently, a final cross‐cultural adaptation of the instrument was then made for another group of participants and evaluated for validity and test–retest reliability among 144 children and 144 parents or legal guardians participating in the self‐report feedback process at the Paediatric Dental Clinic, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia. The cross‐cultural adaptation of the instrument considered translating to Malaysian national language and adapting to its culture. Results: The Malay‐translated ACDAS consisted of 19 items. The translated version of Malaysian‐ACDAS (MY‐ACDAS) achieved an acceptable agreement between six expert committee members with an internal consistency (Cronbach's alpha value, αconsistency) of 0.839. The test–retest reliability results of all participants support semantic and conceptual equivalence as an accepted construct validity between the children, parents and DHPs across the multicultural Malaysian population. Conclusion: The MY‐ACDAS is a valid and reliable scale for measuring dental anxiety among Malaysian children. [ABSTRACT FROM AUTHOR]

Background: Dental behavior support (DBS) describes all techniques used by dental professionals to ensure that dental care is safe, effective, and acceptable. There is a need to standardize outcome measures across DBS techniques to reduce heterogeneity, limit selective reporting, promote consistency, and optimize outcomes across DBS research. A comprehensive review of existing measures is a prerequisite to understanding potential outcomes related to the area of interest. Aim: This review had three aims: first, to identify the outcome measures (OMs) reported in trials of dental behavior support; second, to categorize the component DBS techniques reported within interventions according to emerging agreed terminology; and, third, to map outcome measures to intervention type. Methods: A scoping review of trials evaluating DBS techniques was undertaken from 2012 to 2022. The review was prospectively registered. Studies were identified through Medline, Embase, and PsycINFO. Study abstracts were screened by two reviewers. Data were extracted by single selector. Outcome measures were sorted according to measurement domains (physiological, behavioral, psychological, and treatment). Responses were assimilated and summed to produce a refined list of distinguishable outcome measures. Intervention types were categorized according to accepted descriptors. Frequencies were presented; associations between outcome domain and DBS type were also reported (Chi‐square test of independence). Results: A total of 344 trials were included in the review from an initial 14,793 titles / title and abstracts screened. Most involved children (n = 215), most were from India (n = 104), involving basic dental care (n = 117). The median number of outcome measures per trial was four (range = 1–12); 1,317 individual outcomes were reported, categorized as: psychological (n = 501, 38.0%); physiological (n = 491, 37.3%), behavioral (n = 123, 9.3%) or, treatment‐related (n = 202, 15.3%). DBS interventions were split between 239 (45.7%) pharmacological and 283 (54.1%) non‐pharmacological; 96.6% of interventions mapped to accepted descriptors. A significant relationship was noted between the type of intervention and the outcome domain reported. Conclusion: The findings demonstrate massive variation in outcome measures of DBS interventions that likely lead to unnecessary heterogeneity, selective reporting, and questionable relevance in the literature. A large range of DBS interventions were mapped according to BeSiDe list. There is a need for consensus on a core outcome set across the spectrum of DBS techniques. [ABSTRACT FROM AUTHOR]

Introduction: Minimal sedation (Anxiolysis) is used in dentistry to reduce stress, manage anxiety, and improve patient comfort during treatment. The oral route of minimal sedation is safe and convenient, but there is limited literature assessing the efficacy of this mode of patient care. This paper aims to evaluate the outcomes of oral sedation use for patients treated in a dental school setting using a retrospective cohort analysis of electronic health record data. Methods: A total of 6872 patient records were selected after screening through the selection criteria. Demographic and treatment variables were obtained and analyzed. The appointment status was identified as a success or failure depending on the treatment codes assigned for that appointment. A multivariate logistic regression was used to evaluate relationships between appointment status and the obtained variables. Results: Less than 3% patients had a 'failure outcome' when this data set was evaluated. Being treated in multiple clinics and being seen by multiple providers were both factors that increased the odds of success. Conclusion: Oral anxiolytics should be considered as a noteworthy option for patient management based on the outcomes reflected in this study. There is some evidence that seeing multiple providers improves the success rate of completing dental procedures carried out under oral sedation. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to assess the effectiveness of anxiety reduction protocol using auditory distraction in alleviating dental anxiety among patients undergoing tooth extraction. Materials and Methods: A randomized controlled trial was conducted at the Oral Surgery Department at Islamabad Dental Hospital from July to December 2022, involving 50 patients scheduled for tooth extraction. Participants were randomly divided into two groups: an interventional group, exposed to auditory distraction, and a noninterventional group, without exposure to auditory distraction before the dental extraction. Dental anxiety was measured using the modified dental anxiety scale (MDAS) questionnaire, which scores anxiety levels on a range from 5 (not anxious) to 25 (extremely anxious). Anxiety levels were assessed in the waiting room and just before extraction, and the results were compared across both groups to evaluate the effectiveness of auditory distraction in reducing dental anxiety. Results: The sample size of 50 was randomly and equally allocated to the interventional and noninterventional groups. The study population consisted of 28 (56%) female and 22 (44%) male participants. No significant difference was observed between the anxiety scores of interventional and noninterventional groups at baseline. A significant reduction in anxiety scores was observed in the intervention group during postintervention assessment, while no significant difference was seen in the noninterventional group's anxiety scores. Conclusions: The study supports the efficacy of anxiety reduction protocol using auditory distraction as a practical tool for reducing dental anxiety among patients undergoing tooth extraction. [ABSTRACT FROM AUTHOR]

Objectives: U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence‐based cognitive‐behavioral treatments for dental fear (CBT‐DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in‐chair time, delivered only in person at a few sites). We developed a disseminable CBT‐DF stepped‐care treatment comprising (Step 1) a mobile‐health application and, for those who remain fearful, (Step 2) a 1‐h, one‐on‐one psychological treatment session that allows practice during exposure to the patient's most‐feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0–3 "no/low fear" zone) and statistically significant changes in global dental fear. Method: Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. Results: As hypothesized, users found the stepped‐care treatment highly usable, credible, and helpful. Critically, this stepped‐care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). Conclusions: This usable, credible, stepped‐care approach to dental fear treatment holds promise for liberating evidence‐based CBT‐DF from specialty clinics, allowing broad dissemination. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9‒16. Methods: The CEDAM was translated into Persian following the guidelines of the IQOLA project. A ‎sample of children completed the measure in a clinical setting, with a subgroup completing it ‎again to assess test–retest reliability. Concurrent criterion validity was evaluated by having all ‎participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the ‎CEDAM. Construct validity was examined using exploratory and confirmatory factor ‎analyses.‎ Results: The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM ‎exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test–retest ‎reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and ‎positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p <.01). Exploratory ‎factor analysis identified two factors, and confirmatory factor analysis confirmed that the ‎instrument aligned well with the factor structure obtained from the exploratory analysis.‎ Conclusion: This study provides evidence supporting the validity and reliability of the Iranian version of ‎CEDAM as a valuable tool for evaluating dental anxiety in Persian‐speaking children between ‎the ages of 9 and 16.‎ [ABSTRACT FROM AUTHOR]

Background: Oral health and its relation to ageing is an important topic often neglected among geriatric populations. Proper oral rehabilitation may aid in alleviating mental health burdens in such populations. Objectives: The present study aimed to explore the association between dental anxiety and ageing anxiety, with regard to the interplay of Oral Health‐Related Quality of Life (OHRQoL) as mediator and subjective accelerated ageing as a moderator. Methods: A total of 577 participants with mean age 72.78 years (SD = 3.832, range = 68–87) were recruited via a survey company in Israel. They completed a self‐report battery of questionnaires about dental anxiety, OHRQoL, subjective accelerated ageing and ageing anxiety, along with their informed consent. Results: The findings revealed that dental anxiety was positively associated with ageing anxiety (direct effect), and that OHRQoL mediated the link between dental anxiety and ageing anxiety (indirect effect). Additionally, subjective accelerated ageing moderated the positive link between dental anxiety and OHRQoL, as well as the positive link between OHRQoL and ageing anxiety. Conclusions: The results provide insight for the roles of OHRQoL and subjective accelerated ageing among older adults between dental anxiety and ageing anxiety. Tailoring oral rehabilitation interventions that focus on these factors are warranted to improve older adults' dental health. [ABSTRACT FROM AUTHOR]

Objectives: Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States‐based prospective cohort. Methods: Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF‐4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts‐based sub‐sample. Associations between high dental anxiety (HDA) (mean IDAF‐4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log‐binomial regression models, including adjustment for potential confounders. Results: Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively). Conclusions: Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Accumulating evidence has revealed that dental anxiety is robustly associated with dental care‐related pain and discomfort, but also with the personality trait of neuroticism (i.e. the relatively stable disposition to experience the world as distressing, threatening and unsafe). However, there is a near absence of research on these risk factors in samples for which genetic information is available. With the aim of arriving at a more refined understanding of dental anxiety, this twin cohort study assessed genetic and environmental influences on neuroticism, dental care‐related pain and dental anxiety, and the relation between these phenotypes. Methods: Participants were recruited from the Norwegian Twin Registry, and data collections were carried out in 1992–98 (Time 1) and 2011 (Time 2). Well‐validated questionnaires were used to assess the study variables, including Corah's Dental Anxiety Scale, the Numerical Pain Rating Scale, the NEO Personality Inventory Revised (Time 2) and Eysenck's Personality Questionnaire (Time 1). Pearson correlation analysis and generalized estimating equations (GEE) were used to investigate phenotypic associations. Analyses of genetic and environmental influences were performed using Cholesky modelling. Results: A total of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50–65 participated in the study. Moderate estimates of heritability for dental anxiety (0.29), treatment‐related pain (0.24) and neuroticism (0.45–0.54) were found. Cholesky modelling showed furthermore that neuroticism assessed at Time 1 and Time 2 was related to dental anxiety and pain via both genetic and individual‐specific environmental pathways, albeit not very strongly. The particularly high phenotypic correlation observed between dental care‐related pain and anxiety (r =.68) was explained by both overlapping genetic and individual‐specific environmental influences (the genetic and environmental correlations were.84 and.63 respectively). Conclusions: The findings provide deeper insight into the aetiology of dental anxiety and confirm that while it is strongly linked to treatment‐related pain experiences, this relation is to a considerable degree independent of general negative affectivity/neuroticism. [ABSTRACT FROM AUTHOR]

Objectives: Dental Anxiety Inventory (DAI‐36) questionnaire is an instrument for assessing dental anxiety. The different perceptions of the questionnaire items in the individual at the same level of underlying dental anxiety may lead to different reported dental anxieties. This study aims to determine the differential item functioning (DIF) of the DAI‐36 measure items. Methods: The DAI‐36 was completed by 950 participants. An iterative hybrid ordinal logistic regression model was used to detect DIF across gender, education, and age groups. DIF analysis was done by lordif package in R3.1.3 software. Results: The chi‐square statistics declared 7, 7, and 4 nonuniform DIF items, and 2, 5, and 4 uniform DIF items across gender, education, and age groups, respectively. ΔR2 was always lower than 0.07 in all uniform and nonuniform DIF items. However, Δβ1 revealed significant uniform DIF in items 1 and 8 across gender (Δβ1(item 1) = 0.0137, Δβ1(item 8) = 0.0124) and items 22 and 27 across age categories (Δβ1(item 22) = 0.0110, Δβ1(item 27) = 0.0136). Conclusions: DIF items had no large magnitude or cancel out each other, so statements phrased in the DAI‐36 questionnaire have equivalent meaning across participants, regardless of their gender, education, and age groups. [ABSTRACT FROM AUTHOR]

This systematic review aimed to investigate whether root canal treatment caused greater stress than other dental treatments for patients and dentists. All peer‐reviewed literature published in English between January 1990 and January 2023 was included. This included randomized/non‐randomized control trials, cohort studies, case‐control studies, and cross‐sectional studies. An electronic search used PubMed, Scopus, Medline, Cochrane Collaboration, and Embase. Hand searching supplemented the screening pool. Studies examining physiological or psychological stress measures within patients or providers of dental treatment (dentists, dental specialists, and dental students) were eligible. The study must have reported on the stress outcome for root canal treatment and at least one other dental procedure. After screening 3639 eligible records, there were 23 studies included, varying from very‐low to low certainty of evidence. This review found that root canal treatment was more psychologically stressful for patients than routine restorative or cleaning procedures. However, the stress of root canal treatment relative to other dental procedures, especially extractions, was inconclusive for both dental patients and providers. Since patients regard root canal treatment as more stress‐evoking than other routine dental procedures, providers should endeavour to minimise their own bias toward root canal treatment when providing adequate information for an informed treatment choice. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is a common issue among adolescents. Despite the use of smartphones being an important part of their daily lives, only a few digital‐based interventions for dental anxiety have been tested in randomized controlled trials (RCT). Aim: The aim of this study was to evaluate a new smartphone application (App) named FALE, which was designed to demonstrate interest from the dentist to adolescent and to reduce dental anxiety. Design: This is a RCT in which 184 adolescents aged 10–19 years were randomly allocated into the intervention group (IG) or the control group (CG). The intervention was applied in the waiting room before the consultation at a dental clinic. The IG answered the FALE, which contained 14 questions—of which the first and last questions addressed anxiety, whereas the CG answered the question about anxiety twice with an interval between them. Results: There was a significant difference in the distribution of anxiety rating frequencies before and after the intervention period in both groups. For the IG, there was a reduction in anxiety after the intervention of 16.29%, and, in the CG, a reduction of 2.2% (p <.001). Conclusion: The FALE App effectively reduced dental anxiety before the appointment. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is associated with untreated dental caries. Understanding which childhood behaviours or experiences have the strongest association with later dental anxiety may help focus preventive strategies, subsequently limiting the burden of dental caries and anxiety. Aim: The aim of this study was to explore whether behaviours and experiences during childhood were associated with adolescent dental anxiety. Design: Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multivariable logistic regression was used to explore associations between adolescent dental anxiety and childhood behaviours and experiences. 1791 participants answered questions about oral health behaviours and experiences at 8 years of age and dental anxiety questions aged 17 years. Results: Children with experience of invasive dental treatment were more likely to have dental anxiety at 17 years of age than those who had not experienced dental treatment (OR 1.63; 95% CI: 1.12, 2.37; p =.011). Irregular dental attenders in childhood had over three times the odds of dental anxiety by adolescence, compared with regular attenders (OR 3.67 95% CI: 1.52, 8.88; p =.004). Conclusions: Adolescent dental anxiety is associated with invasive treatment and irregular dental attendance in childhood. A history of irregular attendance or invasive treatment may serve as a useful predictor when considering dental anxiety in young adult patients. Early preventive care supports good attendance and oral health. These actions may have secondary effects of reducing future dental anxiety. [ABSTRACT FROM AUTHOR]

Aims: Sedation and general anesthesia are necessities for the treatment of many individuals within special populations such as those with physical and intellectual disabilities, fear/anxiety, or individuals requiring extensive procedures. This study aims to discover regulatory factors that may be contributing to the limited access to anesthesia services provided by dentist anesthesiologists. Methods and Results: The study included an online survey completed by self‐reported dentist anesthesiologists with 2 or more years of formal anesthesia training. The survey was distributed at the April 2019 American Society of Dentist Anesthesiologists national meeting in Chicago. Participants responded to questions regarding the effect of specific state regulations on decisions to practice in a particular state and how such regulations influenced patient safety and barriers to care. Rules and regulatory restrictions on the mobility of dentist anesthesiologist equipment/supplies and additional state narcotic transportation regulations were deemed statistically significant in failing to improve safety. Requiring airway and sedation training for a facility's provider and staff were not barriers to care. Rules and regulations were not a factor to establishing clinical practice in one state over another state. Conclusion: Individuals and organizations responsible for influencing the regulatory environment of anesthesia services should improve regulations to facilitate the mobility of dentist anesthesiologists. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the effectiveness of two different distraction techniques (Audio Video Distraction/Video Game Distraction) in the management of anxious pediatric patients during dental treatment. Materials and Methods: One hundred and five children were randomly divided into three groups; Group A: active distraction using video games on a tablet device and wireless joystick (VG). Group B: passive distraction using video on tablet, and wireless headphones (AV). Group C (Control group): basic behavior guidance technique Tell Show Do was used (C). The children were selected from the department of pediatric dentistry at the Faculty of Dentistry, Damascus University, who required pulpotomy in primary mandibular molars. All children were assessed by: Simplified Wong‐Baker FACES for pain scale (self‐report), and "HOUPT" Behavior Rating Scale for Overall Behavior (non‐self‐report), at the end of treatment. Results: One hundred and five children completed the study (57 boys and 48 girls) aged between 6 and 10 years (mean age of 7.4 years). The active distraction (VG) group was superior to the passive distraction (AV) group and the control group (C) on the pain scale with statistically significant differences as appeared in Simplified Wong‐Baker Scale (p =.000), The active distraction (VG) group was superior to the control group (C) in overall behavior as appeared in HOUPT scale (p =.041), but it was no statistically significant differences between (VG) group and (AV) group in overall behavior (p =.605). With the use of Bluetooth technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands. Conclusion: Positive distraction with video games by wireless joystick displayed on the portable tablet on the dental chair was the best technique for reducing dental anxiety and reported pain in school children (6‐10 years) and was better than negative distraction by video cartoons on the tablet device. [ABSTRACT FROM AUTHOR]

Background: Maternal anxiety disorders can cause adverse consequences in child's health, cognitive development, and behavior. Aim: To investigate the association of maternal anxiety disorders with the occurrence of dental fear in children aged 24–36 months. Design: This cross‐sectional study is part of a cohort of adolescent mothers and their children (n = 527) in the city of Pelotas, RS, Brazil. Anxiety disorders in mothers were assessed using Mini International Neuropsychiatric Interview (DSM‐IV), whereas the Dental Anxiety Question was used to assess children's dental fear. Clinical oral examinations were performed on the cohort. Poisson regression analysis was used to determine the association of maternal anxiety disorders with maternal perception of dental fear in children (p <.05). Results: The prevalence of dental fear in children was 21.7% (n = 114), and maternal age, agoraphobia, social phobia, and maternal caries experience (p <.05) were associated with the presence of dental fear. After adjusted analysis, children of mothers presenting with agoraphobia (Prevalence ratios [PR] = 1.52; 95% confidence interval [CI] = 1.00–2.32) and social phobia (PR = 1.69; 95% CI = 1.06–2.71) had higher prevalence of dental fear than children whose mothers did not have any of these conditions. Conclusions: In this population of young mothers, agoraphobia and social phobia were associated with children's dental fear. Detection of and treatment for maternal mental disorders may aid in the prevention of dental fear and its oral health‐related consequences. [ABSTRACT FROM AUTHOR]

Aims: To investigate the effectiveness of a cognitive–behavioral intervention that included either a diagnostic interview (DI) or a DI combined with modified one‐session treatment (M‐OST) for dental anxiety among adults in a primary care setting. Methods and results: Nineteen participants were assigned to either a DI before conventional dental treatment (group T1) or DI and M‐OST (group T2). The severity of dental anxiety was measured with three self‐reported measures before and after the intervention: the Modified Dental Anxiety Scale (MDAS), the Index of Dental Anxiety and Fear (IDAF‐4C), and the Visual Analogue Scale‐Anxiety (VAS‐A). Dental care attendance was enquired in a 1‐year follow‐up. The scores for all three scales decreased among both study groups, with the largest decrease recorded in treatment group T1 assessed with the VAS‐A. A higher dental anxiety score measured before the intervention associated most significantly with a higher dental anxiety score after the intervention. At the 1‐year follow‐up, 82% of participants in T1 and 67% in T2 had visited a dentist. Conclusion: A DI alone and combined with M‐OST is potentially effective in reducing dental anxiety and in supporting the engagement of adult patients with dental treatment in primary dental care. [ABSTRACT FROM AUTHOR]

Aims: Dentophobia is a well‐know kind of phobia and psychological problem in dentistry. Although patients might suffer from severe oral pain and have serious health complications, dentophobia is still posing a threat to oral healthcare and remains an unresolved worldwide phenomenon. According to estimates, up to 80% of the general population are affected by this condition. Dentophobia is an unpleasant problem with serious consequences not only for patients but also for dentists and the public health system in general. This umbrella review provides a comprehensive overview of the various aspects of dentophoia as addressed in the published literature, and the current level of knowledge concerning their treatment. Methods and results: Based on 35 reviews of the published literature, addressing various aspects of dentophobia and published between 2008 and 2021, this umbrella review was written. The search was based on the PubMed and PsycINFO databases. The extraction was structured by open coding and each aspect of the subject analyzed according to Ritchie and Lewis. Conclusion: We conclude that the evidence concerning the efficacy of the various interventions is still rather weak and there is an obvious need for further research, because of the yet and unresolved challenges and the lack of standardised guidelines to deal with patients with dentophobia. [ABSTRACT FROM AUTHOR]

This study aimed to explore the factors associated with oral health‐related quality of life (OHRQoL) in a sample with high dental anxiety. Data were obtained from 107 patients attending a therapeutic treatment program for people who have experienced abuse and for those with dental phobia in Norway. Patients completed questionnaires, including the Index of Dental Anxiety and Fear, the Anxiety subscale of the Hospital Anxiety and Depression Scale, and the Oral Impacts on Daily Performance scale, measuring OHRQoL prior to treatment. The various measurement instruments were evaluated psychometrically, and the variables associated with OHRQoL were explored using hierarchical multiple regression. Symptoms of dental anxiety and general anxiety were high, while OHRQoL was poor. Dental anxiety, higher age, higher number of years since the last dental treatment, and higher general anxiety were discernibly associated with lower OHRQoL. The strongest association was found between general anxiety and OHRQoL. In conclusion, several factors were associated with OHRQoL in a sample with high dental anxiety, suggesting a complex picture of dental anxiety. When treating patients with high dental anxiety, dental practitioners should be aware that there may be factors complicating the therapeutic setting, such as general anxiety. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients. Methods: The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance. Results: Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population. Conclusion: Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care. [ABSTRACT FROM AUTHOR]

Objectives: A freedom of choice pilot provided access to private oral health care services without queuing and with fixed public service-fees for participants in Tampere region, Finland in 2018-2019. The aim of this study was to investigate how use of oral health care services differed by demographics, socioeconomic status, dental fear, and self-reported oral health in this pilot. Material and methods: SMS-messages including a link to online questionnaire were sent to participants who had booked an appointment, and to those who had not booked an appointment despite registering to pilot. We categorized participants to (1) those who had booked their first appointment before receiving SMS (visitors), (2) those who booked an appointment after receiving the SMS-message (late-visitors), and (3) those who had not booked an appointment during pilot (nonvisitors). We used regression analysis to estimate the association of age, gender, dental fear, economic situation, Oral Health Impact Profile-14-severity (oral health-related quality of life [OHRQoL]), self-reported oral health and need for oral health care (exposures) with oral health care service use during the pilot (outcome). Results: Out of 2300 participants, 636 (28%) responded. Late-visitors were more likely older and reported more likely need for oral health care, poorer oral health and OHRQoL than visitors or nonvisitors. Nonvisitors were younger and had better OHRQoL than the others. The differences in the service use by gender, economic situation, and dental fear were small. Conclusions: Service use during the pilot depended on the subjective oral health. Our findings highlight the potential of reminders in increasing care use among those with perceived need for services. [ABSTRACT FROM AUTHOR]

Objectives: The management of early childhood caries is challenging and the impacts of its treatment on child oral health‐related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). Methods: Consenting Aboriginal communities in the North‐West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow‐up. The questionnaire sought information on COHRQoL using the proxy‐reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self‐reported Caries Impacts and Experiences Questionnaire for Children (CARIES‐QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow‐up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow‐up within groups were evaluated using appropriate paired (t‐test, Wilcoxon paired test), and between groups with unpaired tests (t‐test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. Results: Twenty‐five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow‐up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6–4.1;control = 3.3 years, 95% CI 3.1–3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8–5.0;control dmft = 3.1, 95% CI 2.5–3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow‐up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. Conclusions: The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health‐related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main‐stream service delivery programmes. [ABSTRACT FROM AUTHOR]

Aims: This qualitative study aimed to assess people with congenital bleeding disorders (CBDs) perspectives on why their dentists refused to treat them. Methods: Using validated and reliable questions, people with CBDs were asked about their attitude toward dental visit and teeth brushing, perceived thought about dentists' knowledge and skill in treating them, perceived dental anxiety, and perceived barriers toward receiving dental services. Free text responses were added to report reasons of why people with CBDs could not brush their teeth sometimes and why the dentists refused to treat them. An open card sorting method was used to analyze participants free text reports. Results: A total of 30 participants were recruited for the purpose of this qualitative study (70% adults and 30% children). Hemophilia A affected the majority of both groups. The majority of participants (n = 20, 67%) reported that they have been refused to be treated by their dentists (71% of adults versus 56% of children, as reported by their parents, p‐value = 0.398). Adult participants reported that they have been refused to be treated by dentists due to fear of dentists from uncontrolled gingival bleeding, their dentists' beliefs that no dental treatment required for them, their thoughts that their dentists will refuse to treat them and difficulty of accommodating the dental visit with other medical appointments. Parents of children reported other reasons such as parents did not ask for dental treatments, difficulty of dental treatment to dentists, young age of patient, and poor accessibility to dental services due to long waiting list. Fear of adult participants from uncontrolled gingival bleeding (n = 4, 57%) and poor compliance of children toward teeth brushing (n = 2, 29%) were the reasons behind why they could not brush their teeth sometimes. Conclusions: Among several reported reasons, fear of dentists from uncontrolled gingival bleeding was the most reported reason of why dentists refused to treat adults with CBDs. While other reasons were reported by parents of children with CBDs such as parents did not ask for dental treatment to their children, difficulty of dental treatment to dentists, young age of patients, and poor accessibility due to long waiting list. [ABSTRACT FROM AUTHOR]

Absract: Background: Personal protective equipment (PPE) gained particular importance during the COVID‐19 pandemic. Aim: To assess child and parent preferences for dentists' appearance concerning their PPE and to determine the relationship between the child and parent preferences. Design: A total of 250 children aged 6–12 years and their parents were enrolled in the study. Standardized pictures with different sexes, attires, eye protectors, hair protectors, masks, and gloves were shown to children and their parents separately, and they were asked to choose their preferences. The dental anxiety of the children and their parents was determined using the MCDASf and MDAS, respectively. Decayed, missing, and filled tooth (DMFT) indices were employed for the children. Results: Children and parents preferred a dentist of the same sex as themselves (p <.05). Anxious children preferred cartoon‐printed attire, and children with low anxiety mostly preferred white coats (p =.001). Children who preferred colored coats had higher DMFT (p <.001). Statistically significant differences were found in the attire and glove preferences between children and parents (p <.001). Conclusions: The production of white and child‐friendly fluid‐resistant disposable gowns should be considered. PPE with colored or cartoon print was preferred under the influence of factors that could positively affect anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Behavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety. Methods: The aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS‐DS), Wong‐Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness. Results: CFSS‐DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p =.02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p =.015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p =.35, p =.305). Conclusion: The use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness. [ABSTRACT FROM AUTHOR]

Background: The software, which was developed according to the principle of perceived control, can be installed on tablets and smartphones and used by patients to help them control their anxiety. Objective: The aim of this study was to evaluate the effectiveness of a specially designed mobile application developed to provide patients with a sense of anxiety control during the various stages of endodontic treatment. The patients' anxiety was assessed by measuring their salivary cortisol levels. Methods: A total of 46 patients requiring endodontic treatment were recruited. The patients were randomly assigned to two groups. The experimental group used the special communication application, while the control group did not. Salivary samples were collected from all patients preoperatively, postanaesthesia, and postoperatively. The samples were analysed with an enzyme‐linked immunosorbent assay to measure the cortisol levels. Results: A significant difference in cortisol levels was observed between the experimental and the control group (Mann–Whitney U‐test, p <.05). This difference was significant in the experimental group in each step (p <.01). No difference was found in the control group steps (p >.05). Conclusions: Perceived control of anxiety using the specially designed software was effective in reducing salivary cortisol levels. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine caries prevalence, oral health practices/behaviours and dental anxiety levels amongst dental hygiene students. Materials and Methods: A self‐administered questionnaire was used to determine students' oral hygiene practices/behaviours. The students were subjected to oral examinations to determine their decayed, missing, filled teeth (DMFT) scores according to the WHO criteria. In addition, the Corah's Dental Anxiety Scale (CDAS) was used to measure the students' dental anxiety levels. Results: A total of 280 students (mean age: 20.8 years) participated in this study. Amongst the students, 52.8% brush their teeth twice a day, and 17.48% and 15.17% use floss and mouthwash daily, respectively. Moreover, the defined smoking rate was 22.85%. The mean DMFT scores of the preclinical and clinical students were 3.39 ± 3.22 and 3.55 ± 3.19, respectively. Most of the students (82.6%) preferred fluoride toothpaste, and the DMFT scores of those who use and do not use fluoride toothpaste significantly differed (p = 0.031). Furthermore, junk‐food consumption affected the scores for decayed teeth (p = 0.048) and missing teeth (p = 0.039). Most students had low or moderate CDAS scores (CDAS <13), and anxiety scores were lower amongst the clinical students than amongst the preclinical students. Conclusions: Although the students demonstrated favourable oral health behaviours/practices and low caries prevalence, their adherence to oral hygiene instructions and to healthy dietary and lifestyle habits should improve. The importance of this topic should be strongly emphasized in the undergraduate curriculum. For this purpose, professional behavioural control methods that suit students' individual capacities, motivations and therapeutic needs may be employed. The principal findings of similar studies should be evaluated by lecturers to help students adopt optimal oral health practices/behaviours, reducing their dental anxiety levels and improving their professional competencies. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review and meta‐analysis was to evaluate the association between sense of coherence (SOC) and dental fear/dental anxiety. Methods: Computerized searches were performed in six databases. Gray literature and manual searches were also conducted. Study selection, risk of bias assessment, and meta‐analyses were performed. The results of meta‐analyses were reported in odds ratio (OR), mean difference (MD), and confidence interval (CI). Results: After removing duplicates, 131 references were retrieved and the full texts of 12 were evaluated. Nine references met the eligibility criteria and were included. The results of meta‐analyses demonstrated that individuals with a weaker SOC had a score in the dental anxiety/dental fear scale 6.04 times higher than individuals with a stronger SOC (OR = 6.04, CI = 2.62–13.91). Individuals with no dental anxiety/dental fear had a mean score of the SOC scale higher than individuals with dental anxiety/dental fear (MD = 5.39, CI = 2.21–8.56). Sensitivity analysis demonstrated that the result of a higher mean score of the SOC scale among individuals with no dental anxiety/dental fear remained (MD = 7.38, CI = 3.79–10.98). Risk of bias ranged from low to high. The certainty of evidence was very low. Conclusion: Individuals with stronger SOC have lower levels of dental fear/dental anxiety. [ABSTRACT FROM AUTHOR]

Background: Regular dental attendance is important in order to receive preventive care, maintain good oral health and identify oral and dental disease at an early stage; however, many people do not visit their dentist regularly. Barriers to regular attendance have been studied in small patient groups but not in the wider general population. Objective: To outline concerns about visiting the dentist and suggestions about how dentists could help using a general population sample. Method: A survey was constructed using Qualtrics XM software and circulated. Respondents completed questionnaires about dental anxiety and about their concerns and suggestions around dental appointments including the option for free‐text answers. Results: One hundred and fifty‐four people completed the survey. Common concerns were the unknown element (62.58%) and worries about 'bad teeth' (60.54%). The most popular request for change was for dentists to inform patients of the condition of all their teeth including those in good health (86.30%). A thematic analysis of qualitative responses identified themes of control, shame, discomfort, long‐term impact and cost. Several concerns and suggestions for improvement were expressed. Conclusion: Although the pain associated with dental treatment was identified as important, concerns about the unknown and feeling vulnerable were seen as a higher priority. People in the general population want dentists to help them to feel informed and in control at dental appointments and to be involved in discussions about how they are feeling and what is important to them. [ABSTRACT FROM AUTHOR]

Objective: To compare static computer‐aided implant surgery (s‐CAIS) and conventional implant surgery (CIS) for single‐tooth replacement in posterior sites in terms of patient‐reported outcome measures (PROMs). Methods: Forty patients were divided into two groups for treatment with s‐CAIS (Test) and CIS (Control). Patients' anxiety level was measured using the modified dental anxiety score before implant surgery. After surgery, patients completed two questionnaires for 7 days. The first questionnaire assessed pain level using a visual analog scale (VAS) and the incident rate of pain using a 5‐point Likert scale; analgesic intake was also recorded. The second questionnaire investigated patients' oral health‐related quality of life (OHRQoL) including postoperative symptoms, oral function, and daily activity. The difference between data was compared at significance level (α = 0.05). Results: There was no statistically significant difference in pretreatment dental anxiety level, postoperative pain scores, and OHRQoL between treatment groups. Overall, mild or moderate dental anxiety was reported by 70% and 20% of patients, respectively. Pain score was significantly reduced by postoperative Day 3 in the test group and Day 4 in the control group, compared with baseline. Both groups significant reduced analgesic intake by postoperative Day 5. Most OHRQoL‐related complaints subsided approximately 3 days after surgery. Conclusions: Overall, PROMs between s‐CAIS and CIS were not significantly different for the single‐tooth implant surgery in the posterior area. Postoperative symptoms after implant surgery still inevitably occurred, reflecting the normal process of oral wound healing. [ABSTRACT FROM AUTHOR]

Objective: To explore the association of racism in oral healthcare settings and dental care-related fear/anxiety with dental utilization among Black/African American women in Appalachia.Methods: We analyzed self-report measures of racism in oral healthcare settings, dental care-related anxiety and fear, recency of a dental visit, and demographic information from 268 pregnant women participating in the Center for Oral Health Research in Appalachia (COHRA) SMILE cohort. All participants self-identified as African American or Black and resided in Appalachia (i.e., either West Virginia or Pittsburgh, PA).Results: Over one-third of the participants reported at least one instance of racism in oral healthcare settings, with "not being listened to" due to their race or color as the most frequent issue (24.4%). Clinically significant levels of dental care-related anxiety and fear were reported by 14.3% of the sample. A mediational model demonstrated that the experience of racism in oral healthcare settings was a significant predictor of dental fear/anxiety, and that dental fear/anxiety was a significant predictor of dental utilization. There was a significant relationship between racism in oral healthcare settings and dental utilization only when mediated by the presence of dental care-related fear and anxiety.Conclusions: Together, experiences of racism in oral healthcare settings and dental care-related fear/anxiety are predictive of decreased dental utilization for Black/African American women living in Appalachia. This study provides insight into racism in oral healthcare settings as a social determinant of dental anxiety/fear and inequities in dental utilization. [ABSTRACT FROM AUTHOR]

Background: Many children experience dental anxiety during dental treatment. Conscious sedation is used to alleviate anxiety and enhance a child's cooperation. Aim: This study aimed to compare the efficacy of intranasal versus sublingual dexmedetomidine. Design: Forty‐two healthy, uncooperative children participated in the study. They were divided randomly into two groups: In the first visit, Group I received intranasal dexmedetomidine and group II received sublingual dexmedetomidine, whereas at the second visit, the alternate route was implemented in a crossover design. The child's acceptance of drug administration method was assessed using a 4‐point rating scale. Time until optimum sedation was measured. Anxiety during local anesthesia administration was scored using Venham's rating scale. Postoperative response was recorded through Vernon et al's questionnaire. Results: The sublingual dexmedetomidine route was better accepted than the intranasal route (P=0.01), while the latter acted faster (P>0.001). No significant difference in anxiety scores was found between groups at baseline (P=0.84) or during local anesthetic administration (P=0.44). No negative effect was recorded by the parents who answered the Modified Vernon et al questionnaire 24 hour after the dental visit compared to before the dental visit (P=1.00). Conclusions: Both routes prevented the increase in anxiety scores equally during local anesthesia and do not have negative effect on postoperative behavior of children. However, the sublingual route showed better acceptance with longer onset time of action than the intranasal route. [ABSTRACT FROM AUTHOR]

Purpose: The "Profile and Competences for the European Dentist" document addresses some competencies as a must for graduating dentists, some of which are stated as providing humane and compassionate care to all patients and administering local anesthesia for pain management. Within this perspective, this study aims to investigate the effect of self‐efficacy and empathy characteristics of post‐graduate residents (post‐grads) on the perceived pain and anxiety scores of children during local anesthesia administrations. Materials and methods: Ten pediatric dentistry post‐grads and 91 children aged between 5 and13 years participated in the study. Post‐grads performed 120 injections as part of their routine dental treatment in children. Demographic data, self‐efficacy, and empathy scale scores of post‐grads, anxiety, and pain scores of children were recorded during injections. Results: Self‐efficacy scale scores of residents ranged between 66 and 74 with a mean score of 69.80 ± 2.69. Empathy scale scores were between 77 and 97 and the mean was 89.20 ± 6.24. Significant and negative correlations were observed between self‐efficacy scores of post‐grads and pain scores of children (r = –0.205 and p = 0.025). Empathy scores of post‐grads established a significant and positive correlation with children's anxiety scores (r = 0.244 and p < 0.007). Conclusions: Self‐efficacy and empathy characteristics of post‐grads were found to have an impact on the perceived pain and anxiety scores of children during local anesthesia administrations. Empathetic post‐grads with higher self‐efficacy provided an enhanced local anesthesia experience for child patients. Therefore, educational programs should also be organized aiming to develop self‐efficacy and empathy characteristics of post‐grads for a more humane and compassionate dental experience in child patients. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to assess the effects of dentist–patient communication via social media on dental anxiety and to determine the appropriate timing of such communications. In this randomized, double‐blinded and controlled trial, we used Instagram's quick replies system to answer patients' questions to alleviate dental anxiety for patients undergoing impacted teeth extraction under local anesthesia. Patients were assigned randomly into four groups according to the timing of such communications: only after (group 1, n = 36), only before (group 2, n = 35), before and after the operation (group 3, n = 36), and a control group who received no communication on social media (group 4, n = 36). Dental anxiety was evaluated one week before (pre‐op) and after the operation (post‐op) using recognized assessment scales –the Spielberger's State‐Trait Anxiety Inventory, Modified Dental Anxiety Scale (MDAS), and Visual Analogue Scale (VAS). The results showed that the post‐op values of group 4 had higher anxiety scores than the groups 2 and 3 according to VAS (p < 0.05). Within the groups, the anxiety levels showed a decreasing trend after surgery according to MDAS and VAS scores (p < 0.05). The results of this study suggest that communication with patients before the operation is sufficient to reduce their dental anxiety. [ABSTRACT FROM AUTHOR]

Background: Problem‐orientated dental attenders account for around one‐third of the UK population, these being patients who do not seek regular dental care, instead only attending with dental pain. In order to develop intervention(s) to encourage regular dental attendance in these patients, any previous intervention development should be identified to aid idea generation or retrofitting of interventions. Objective: To identify previous interventions which have been developed targeted at problem‐orientated dental attenders to facilitate the development and co‐design of a new intervention. Methods: Eight electronic databases were searched for studies which included an intervention targeted at adult problem‐orientated or irregular dental attenders to encourage regular dental attendance. Data on the intervention design mapped to the theoretical domains framework were extracted, alongside effectiveness and patient views where available. Results: Three studies fitted the inclusion criteria for the review. Interventions identified were attendance at a dental anxiety clinic, and a large advertising campaign promoting a free dental update where members of the public could visit local dental practices to look around and meet the dentists. One study looked at the effect of policy change by introducing free dental check‐ups in Scotland. Interventions were poorly reported, with significant omissions in their description and a lack of clear identification of what composed the intervention. Conclusion: There are very few interventions developed targeted at problem‐orientated dental attendance, but important areas to consider in future intervention development include the following: dentist communication; dentist‐patient relationship; increasing the awareness of need; the effect of free dental check‐ups. [ABSTRACT FROM AUTHOR]

Aim: To investigate and compare the effects of clinical and self‐perceived oral conditions on oral health‐related quality of life (OHRQoL) among young adults. Materials and methods: Adults enrolled in the 1982 Pelotas birth cohort were included in this study. OHRQoL was assessed by the Oral Health Impact Profile‐14 (OHIP‐14) instrument. Clinical parameters such as dental caries, periodontitis, aesthetics, and occlusal characteristics, and tongue coating were collected through clinical evaluation, while dental anxiety and halitosis were self‐reported. Direct and indirect effects of clinical and self‐perceived oral conditions on OHRQoL were assessed using structural equation modelling. Results: Five‐hundred and thirty‐nine individuals participated in this study. Dental caries (β = 0.12) and periodontitis (β = 0.11) were directly and indirectly (via halitosis, β = 0.05 for periodontitis only) associated with greater OHIP‐14 scores, while the other clinical conditions did not influence the OHIP‐14 scores. Dental anxiety and halitosis were also associated with higher OHIP‐14 scores (β = 0.31 and β = 0.27, respectively). Conclusions: This study found a positive association between clinically diagnosed and self‐reported oral conditions and OHRQoL; however, the self‐reported conditions had a higher impact on OHRQoL. [ABSTRACT FROM AUTHOR]

It is important to understand children's perceptions of dentists in order to improve child–dentist communication. The aim of this mixed‐methods study was to develop and validate a conceptual model of individual determinants of children's perceptions of dentists. A total of 1014 children completed an oral health behaviour form, a metaphor form, the Children's Fear Survey Schedule‐Dental Subscale, the Dental Trust Scale, and the Early Childhood Oral Health Impact Scale. A conceptual model, which included five endogenous and two exogenous variables, was developed and validated. Qualitative (metaphor analysis) and quantitative (path analysis) analyses were conducted. The metaphors that were used to describe dentists were classified into seven conceptual categories: chaotic and unlovable; scary; artistic; protective and alleviative; restorative; scientific; and educative. Better oral health behaviours, greater trust in dentists, and lower dental anxiety were associated with positive perceptions of dentists. Oral health behaviours, trust in dentists, and dental anxiety had the strongest direct effects on perceptions of dentists, but age had the strongest indirect effect. The developed model should help dentists to understand pathways between children's individual determinants and perceptions of dentists. Coupled with behaviour management, this understanding can be an important part of improving dental visit behaviours and fostering positive post‐visit attitudes among children. [ABSTRACT FROM AUTHOR]

Dental anxiety is a crucial problem for dentistry because it may represent a significant risk to oral health. Different factors, whether non‐cognitive (e.g., traumatic dental events) or cognitive (e.g., the patient's subjective perceptions), may cause dental anxiety. However, previous studies have assessed these factors as independent predictors of dental anxiety, without providing any exploration of potential mediational pathways. The current study assessed the role of certain cognitive dimensions (i.e., the dentist's perceived professionalism and communicational attitudes, and the patient's perceived lack of control) as mediators between traumatic dental events and dental anxiety. The sample comprised 253 patients who had accessed a public university hospital dental surgery. The mediation analysis used a structural equation modeling. Traumatic dental events were positively associated with dental anxiety but, among the cognitive factors, only lack of control was. Furthermore, lack of control mediated the relationship between traumatic dental events and dental anxiety, although this mediation was only partial. This study sheds light on the mechanisms through which non‐cognitive and cognitive factors may affect dental anxiety. The clinical implications for dental practice, in terms of improving the psychological well‐being of patients, are discussed. [ABSTRACT FROM AUTHOR]

Background: The psychosocial impact of receiving the diagnosis of oral epithelial dysplasia, which presents up to 3.5% increased annual risk of mouth cancer, remains unknown. Using validated instruments, the present study aimed to investigate the prevalence and existing correlations between anxiety, depression and dental anxiety symptoms and burden on oral health‐related quality of life. Methods: A clinical cohort of 82 patients with oral dysplasia was asked to complete the Hospital Anxiety and Depression Scale, the Modified Dental Anxiety Scale and the shortened version of the Oral Health Impact Profile. Spearman's correlation coefficient and regression analyses were performed. Results: The participants' scores were in keeping with the presence of anxiety, depression and emotional distress symptoms in 30%, 16% and 26%, respectively. However, 69% experienced anxiety related to procedures that may be required as part of long‐term management of oral dysplasia (e.g. local anaesthetic injection). The oral health‐related quality of life scores showed 41.5% reporting a recent daily problem due to their oral or dental health. Significant correlations [p >0.05] were found among and between all of the used instruments. Being a female with oral dysplasia also predicted increased odds of indicating higher anxiety and dental anxiety scores than males [p >0.05]. Conclusion: Oral dysplasia can adversely impact on the psychosocial well‐being of affected persons. Establishing a causal relationship between the measured variables may, however, be challenging and would need further longitudinal studies. [ABSTRACT FROM AUTHOR]

Background and objective: Dental patients often experience the fear of pain induced by injectable anesthesia. This study aimed to investigate the impact of hypnosis on relieving the pain of injected dental infiltration anesthesia. Materials and methods: This single‐blind clinical trial was conducted on 32 healthy volunteers to assess the pain perception in mucosal injection. The visual analog scale was applied for the measurement of one‐sided pain intensity in the maxilla without hypnosis. When hypnosis was implemented, the same procedure was performed on the other side of the maxilla reversely within one session. Results: Hypnosis implementation significantly decreased the intensity of the perceived pain before anesthesia injection (p = 0.05). Conclusion: Hypnosis before the injection of dental infiltration anesthesia could decrease the pain intensity caused by the injection. Therefore, hypnosis therapy is recommended as an effective approach to pain control for anesthesia injection. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of aromatherapy on dental anxiety. Methods: A detailed protocol was registered a priori (PROSPERO: CRD42019141093). PubMed, EMBASE, CDSR, CENTRAL, CNKI and grey literature databases were searched from inception to 10 January 2020. Randomised controlled trials (RCTs) and quasi‐randomised controlled trials (CCTs) that examined the effects of aromatherapy on dental anxiety, compare to either negative control (i.e. no aromatherapy) or other positive control approaches (e.g. music), were included. The risk of bias of the selected studies was evaluated using the Cochrane Collaboration's tool and ROBINS‐I, while the certainty of evidence was assessed using GRADE. A narrative synthesis was performed, rather than meta‐analysis, due to the high level of heterogeneity across studies. Results: Eleven RCTs and six CCTs were included. The risk of bias was identified as either high or unclear in RCTs, and moderate to serious in CCTs. Performance bias and detection bias were the most prevalent in RCTs, followed by selection bias and reporting bias. As to CCTs, greater risk of bias was found in the selection of participants into the study and in the measurement of outcomes. Based on the selected studies, the most commonly used aromatherapy for dental anxiety management was lavender fragrance, followed by orange. Compared to the negative control condition, aromatherapy might reduce the anxiety‐related physiological parameters and psychometric rating, pain, and mood, alertness, and calmness compared to the negative control condition; and there might be no intergroup difference in such outcomes between aromatherapy and music. However, GRADEs of the relevant evidence were judged as low to very low. Conclusions: Compared to the negative control condition, aromatherapy is more effective to reduce dental anxiety and has comparable effects on dental anxiety compared to music intervention; however, the certainty of evidence is relatively limited. Further high‐quality randomised trials with robust study design and large sample size are warranted to confirm our findings and to confirm the role of aromatherapy in relieving dental anxiety. [ABSTRACT FROM AUTHOR]

Aims: Identifying whether providing third molar extraction (TME) patients with pre‐consultation internet guidance influences: (1) shared decision‐making (SDM); (2) TME knowledge, dental anxiety, clinicians' satisfaction and count of TME. Methodology: Equal arm, parallel groups randomized controlled trial. Participants were public TME patients with internet access. The Study group received best online resources identified in a previous study before the consultation. SDM was measured using the dyadic SDM‐9Q‐Pt (Patient) and SDM‐9Q‐Doc (Doctor). TME knowledge and dental anxiety (using the IDAF‐4C) were collected before the consultation. Other outcomes were collected during the consultation. Results: We randomized 120 eligible participants and we did not observe any difference at the baseline. At the consultation, we followed‐up 37 patients from the study group (61%) and 35 from the control group (58%). TME knowledge was associated with SDM‐9Q‐Pt and SDM‐9Q‐Doc (P < 0.05). Resources used did not improve TME knowledge (t = −.32, P = 0.753) which resulted in no difference in SDM‐9Q‐Pt (t = 1.76, P = 0.083) or SDM‐9Q‐Doc (t = −0.78, P = 0.436). IDAF‐4C scores were significantly higher than Australian norms (mean = 17.0, SD = 9.0, 95% CI: 16.2, 20.5). Resources used did not influence the IDAF‐4C scores (t = −.32, P = 0.753). No differences were observed in clinicians' satisfaction with consultation time, patients' knowledge and the count of TME. Conclusion: TME knowledge is associated with SDM. The best available online resources used as an intervention did not improve the participants' knowledge and therefore, the RCT outcomes were not affected. This suggests a need for developing patient‐centred resources. The high levels of dental anxiety among TME patients need clinicians' attention. Trial registration: ACTRN12614000593639. [ABSTRACT FROM AUTHOR]