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Background: Dental phobia is covered by medical insurance; however, the diagnostic methods are not standardized in Japan. Therefore, the aim of this study was to investigate the methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology. Methods: We conducted an online survey to obtain information from the members of the Japanese Society for Disability and Oral Health (JSDH, n = 5134) and the Japanese Dental Society of Anesthesiology (JDSA, n = 2759). Response items included gender, qualification, affiliation type, methods of diagnosis and management of dental phobia, use of questionnaire, need to establish standardized diagnostic method for dental phobia, and others. The chi-squared test was used to compare answers between the three groups: JSDH only, JDSA only, and both JSDH and JDSA. Multiple logistic regression analysis was conducted to identify factors associated with the use of an assessment questionnaire. Results: Data were obtained from 614 practitioners (JSDH only, n = 329; JDSA only, n = 195; both JSDH and JDSA: n = 90, response rate: 7.8% [614/7,893], men: n = 364 [58.5%]). Only 9.7% of practitioners used questionnaires to quantify the level of dental anxiety. The members of both JSDH and JDSA group used questionnaires more frequently than members of the JSDH only (19% and 7.1%, respectively; Bonferroni corrected p, BMC Oral Health, 22, art. no. 38; 2022

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.

Background Coronavirus disease 2019 (COVID‑19) continues to affect dental emergency services worldwide. Dental anxiety (DA) is described as a common and distressing problem in terms of oral health maintenance. Objectives The present study aimed to evaluate DA levels as well as the COVID‑19 fear and perception of control (COVID‑19 FPC) in patients attending dental emergency clinics during the COVID‑19 pandemic. Material and methods Sociodemographic, dental and medical data was obtained from the participants. A face-to-face questionnaire with questions referring to the reasons for the emergency dental visit, the visual pain scale, the Modified Dental Anxiety Scale (MDAS), and the COVID‑19 Fear and Perception of Control Scale (COVID‑19 FPCS) as well as additional questions concerning bruxism and a previous diagnosis of anxiety/panic attacks or depression was administered. The χ2 test was used to analyze the data. Results A total of 1,439 patients were included in the study. The most common reason for the dental visit was pain (47.5%). The prevalence of DA was 5.1% (74/1,439). A significant association was found between DA and gender (p = 0.020). The incidence of severe pain was higher in patients with DA than in those without DA (p = 0.002). No significant differences in the MDAS scores were found between patients with and without a chronic disease (p = 0.804), with regard to the educational status (p = 0.364), or between the age groups (p = 0.600). The prevalence of a 'strongly agree' response to all questions in COVID‑19 FPCS was higher in patients with DA as compared to those without DA. Conclusions Females and patients with severe pain were more likely to exhibit DA. In general, patients with DA strongly agreed with the statements of COVID‑19 FPCS, which may indicate a correlation between the 2 scales.

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.

Aim: This study aimed to understand the causes of dental anxiety that prevent optimal treatment in pediatric dental clinics and to examine the relationship between the child's dental anxiety level and the dental anxiety level of his or her parents. It also aimed to understand how the oral health of children whose parents have dental anxiety is affected by their parents’ feelings. Methodology: This study was conducted by evaluating the answers given to the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) questionnaire, which was applied to 248 children without mental or developmental retardation who consulted the Dicle University Faculty of Dentistry between January and October 2020. The Modified Dental Anxiety Scale (MDAS) questionnaire was applied to their parents. In addition, dmft+DMFT scores were determined by performing oral examinations on the children. Results: While a statistically significant relationship was found between the dental anxiety levels of the 248 children included in our study and the dental anxiety levels of their mothers, no significant relationship was found between the dental anxiety levels of their fathers and those of the children. Those children whose mothers had high dental anxiety scores had higher dmft+DMFT scores, compared to others involved in the survey. The dmft+DMFT scores of the children with high dental anxiety were found to be higher than those of other children. Conclusion: Parents, especially mothers, play an important role in the development of children’s dental anxiety. The fact that parents with dental anxiety often avoid taking their children to the dentist prevents necessary treatments from being performed on time and causes the children’s oral health to deteriorate over time. Informing parents about reducing dental anxiety and dentists’ efforts to teach coping strategies can be helpful for minimizing the impact of parents' dental concerns on their children. By increasing mothers’ awareness of oral and dental health, it can be ensured that both they and their children will benefit more from dentistry services. How to cite this article: Çelenk S, Kol Ş. An evaluation of the relationship between dental anxiety and oral health in children based on maternal dental anxiety. Int Dent Res 2021;11(Suppl.1):86-90. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.14 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

The purposes were to evaluate if gagging can affect children’s cooperation with treatment, investigate possible changes in gagging and study factors that can predict children's behaviour over dental treatment. 255 children aged 4–12 years, needing at least three consecutive dental appointments, completed the Children’s Fear Survey Schedule-Dental Subscale before examination. The Gagging Problem Assessment was performed before the initial examination and after the third/final appointment. Frankl’s Behaviour Rating Scale (FBRS) was used to rate children’s behaviour. Multivariate Mixed Linear and Logistic Regression Models were used. Children with definitely positive behaviour were significantly older, less fearful and less likely to gag before treatment. Girls and older children had lower odds of gagging over time, while fearful children had higher odds. There were no statistically significant associations between gagging over time, FBRS and the type of dental treatment at the third appointment. The percentage of children who gagged after the third appointment (27.05%) was significantly lower as compared to the percentage found at the initial appointment (32.54%; p = 0.004). Among the variables studied, age, dental fear, initial GPA and type of treatment were good predictors of children's behaviour during dental treatment.

Introduction: In dentistry, local anesthetic (LA) administration in children is often associated with behavioral problems. Hence, the present study evaluated the efficacy of aromatherapy in reducing the dental anxiety and pain during LA procedure. Methods: This clinical trial was conducted upon 150 children in the age range of 8-12 years. Subjects were randomly divided into five groups; Group 1: Lavender essential oil using nebulizer; Group 2: Lavender essential oil using inhaler; Group 3: Orange essential oil using nebulizer; Group 4: Orange essential oil using inhaler; Group 5: Control (without aromatherapy). For all the children, baseline anxiety was recorded followed by aromatherapy (except for children in the control group). Following the standard protocol, LA was administered. The procedural pain was assessed using Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). Finally, anxiety was again recorded. Data were analyzed using SPSS version 17.0. Results: A significant difference in ANOVA test was observed among anxiety scores after LA in aromatherapy groups 1, 3, and 4 compared to control. When the FLACC scores were analyzed using Kruskal-Wallis, there were significantly lower values in aromatherapy groups compared to the control group. The pain scores, as reported in FPS-R, were also lower in aroma groups 1, 3, and 4. Conclusion: Aromatherapy with lavender or sweet orange, using either nebulizer or inhaler, decreased the dental anxiety of children, whereas, only sweet orange could reduce the pain as self-reported by children.

Background Managing a child's anxiety is most critical for the success of treatment in the pediatric dental setup. Present trend advocates the use of non-aversive behavior management techniques. Aim and objective To compare and evaluate the efficacy of aromatherapy using orange essential oil with that of music distraction in the management of anxious pediatric dental patients. Design One hundred and fifty children of the age 6-8 years were divided into three groups of 50 each and performed restorative treatment under aromatherapy, with music distraction, without aromatherapy, or music distraction, respectively. Venham's picture test and facial image scale (FIS), pulse rate, respiratory rate, and oxygen saturation were recorded before and after the procedure. Results Compared with controls, both the aromatherapy group and music distraction group showed significant posttreatment change in anxiety levels with respect to Venham's picture test and FIS, along with the reduction in pulse rate and respiratory rate. When compared between music distraction and aromatherapy, it did not yield statistical significance, though music distraction showed better results compared to aromatherapy. Conclusion Both music distraction and aromatherapy using orange essential oil are effective in anxiety management of which music distraction presents a comparatively better result. Either these non-invasive techniques alone or a combination of both may be employed in the dental setup of pediatric dentists for molding cooperative patients. How to cite this article James J, Retnakumari N, Vadakkepurayil K, e t a l. Effectiveness of Aromatherapy and Music Distraction in Managing Pediatric Dental Anxiety: A Comparative Study. Int J Clin Pediatr Dent 2021;14(2):249-253.

Aim and objective To analyze the impact of Indian instrumental music on children with intellectual disability (mild) exhibiting dental anxiety during dental procedures using electrical skin resistance measured by a biofeedback machine. Materials and methods A total of 20 children of 6-14 years having an intellectual disability (mild) were randomly divided into two groups comprising of 10 each. The study was carried out in a cross-over design, with and without music distraction in two appointments spaced out at a gap of 1 month. The children were subjected to a dental examination, oral prophylaxis, and auditory operative stimuli in both appointments. The electrical skin resistance during each procedure was measured using a galvanic skin response (GSR) biofeedback machine and the values were statistically analyzed using paired and unpaired t-tests. Results A statistically significant increase in electrical resistance was observed during music distraction, which indicated an anxiety reduction when music distraction was employed. Conclusion The increased electrical skin resistance due to low anxiety proves the positive impact of music distraction in intellectually disabled children. Clinical significance Music can be employed as a distraction technique to reduce anxiety in intellectually disabled children. How to cite this article Gowdham G, Shetty AA, Hegde A, et al. Impact of Music Distraction on Dental Anxiety in Children Having Intellectual Disability. Int J Clin Pediatr Dent 2021;14(1):170-174.

Muhammad Nazir,1 Khalid S Almulhim,2 Ziyad AlDaamah,3 Salman Bubshait,3 Mohammed Sallout,3 Salman AlGhamdi,3 Jehan Alhumaid1 1Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 2Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi Arabia; 3College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, 31441, Eastern Province, Saudi ArabiaCorrespondence: Muhammad Nazir Tel +966-543569615Email manazir@iau.edu.saPurpose: Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.Materials and Methods: Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June–July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.Results: The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.Conclusion: Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.Keywords: dental anxiety, emergency treatment, dental visits, pandemic

Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences. A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardized exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages. In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable. Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardized exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

Background Dental fear is a prevalent phenomenon among children and adolescents globally. Aim To investigate dental fear among 18-year-olds with cleft lip and/or palate (CLP) at their final follow-up cleft clinic visit, and to evaluate the association between dental fear and OHRQoL. Design This cross-sectional study included the cohort of children with CLP treated at the Oulu University Hospital Cleft Lip and Palate Center, in northern Finland since 1995. A total of 62 of 64 individuals participated in this study. The validated Finnish version of the Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. Dental fear was studied using the validated Modified Dental Anxiety Scale (MDAS) and cognitive vulnerability model (CVM). Results Almost two fifths of the participants reported moderate dental fear. Participants with cleft including lip and participants reporting impact on OHRQoL reported higher mean MDAS scores. In an unadjusted model, adolescents with cleft including lip had risk for higher dental MDAS scores compared with the ones with cleft including only palate. Conclusions Dental fear is common among adolescents with CLP, specifically among those with clefts involving the lip. OHRQoL and dental fear seem to be associated.

Objective Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria. Methods A dataset of 1549 mother–child (6–71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis. Results The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23–13.79; p Conclusion The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

Background Virtual reality (VR) has been used successfully in medicine both as a distraction tool during procedures, and as an acclimatisation tool to prepare for a procedure or experience. It has not yet become widely used in dentistry, but could theoretically have a role in exposure-based acclimatisation for dental experiences. Methods To examine the use of VR or bespoke dental smartphone applications pre- or perioperatively in dentistry, to decrease anxiety in a paediatric population attending for dental examination or treatment, compared with children/adolescents who receive no intervention, or more conventional behavioural management techniques. Searches were made of eight electronic databases: the Cochrane Oral Health Group’s Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE(PubMed), EMBASE, PsycINFO, CINAHL, Scopus and Web of Science. Further searches reference cross‐checks were performed to identify studies that were not discovered online. Results Systematic reviews and randomised control trials have demonstrated the successful use of VR to both distract patients perioperatively during medical procedures, and also preoperatively to prepare them for these interventions. However, to date, VR has only been applied to dentistry in a very limited number of studies. Three studies using virtual reality in a dental setting demonstrated decreased pain and anxiety compared with no intervention. All three of these studies were carried out in the perioperative period. A fourth study used a bespoke dental app and imagery to prepare patients with Autism Spectrum Disorder (ASD) for dental treatment, finding statistically significant decreases in both the number of appointments and number of attempts required to carry out a procedure. Conclusion VR is a promising tool which to date has been under-utilised in dentistry. High quality, clinical studies are required to assess the use of preoperative VR and smartphone applications to prepare patients for dental examination and procedures under local or general anaesthetic.

Objective: To determine the level of dental anxiety in dental patients from two hospitals managed by the Ministry of Health of Peru, between August-September 2015. Material and Methods: Cross-sectional, comparative, and observational study, carried out between August and September 2015, including a total of 660 adult patients from the Dental Service of the Hospitals Regional Docente de Trujillo and Belén de Trujillo, Peru. A questionnaire based on the Modified Dental Anxiety Scale (MDAS) (Cronbach's Alpha=0.77) was applied to the participating subjects. Student's t test for independent groups and the Mann-Whitney U test were used for the analysis of the results, considering a significance level of 5%. Results: The mean total anxiety score for the population was 12.05 (SD=3.76). Females (mean=12.56) presented greater anxiety than males (mean=11.53) (p

Background Drama and role play can be unlisted as methods to allow children to view problems from a range of different perspectives that may differ from their own experience. Application of drama technique to assess the cause of dental fear and anxiety in a school setting is novel. Aim The aim of this study was to engage primary school children in the core investigation via participatory arts methodologies, namely, process drama to gain understanding of the causes of dental anxiety. Design Sixty-three children, aged 7–10 years from three primary schools participated in this study. A 90-min drama workshop was carried in each school. The children were encouraged to identify the causes of dental anxiety using key concepts from process drama. The sessions were audio-recorded and transcribed. Results Four key concepts emerged: (1) fear of the unknown; (2) unpleasant sensory experience; (3) society’s perception and portrayal of the dentist; and (4) learnt negative associations with the dentist. Within each four key concepts, two sub-themes were identified. Conclusions Role-playing and use of drama are a novel application and can reveal a considerable amount of information from the child’s perspective on the cause of dental fear and anxiety.

Objective:The present study aimed to define the experience and stages of dental anxiety in oral and maxillofacial surgery patients using real-time biometric data collection tools.Materials and Methods:In this study, the patient-dentist interaction was divided into three sessions: The pre-surgery, oral surgery and post-surgery sessions. A software algorithm was used to record the galvanic skin response signals and heart rate data of patients when they sat on the dental chair for a tooth extraction procedure.Results:A total of 38 patients with a mean age of 24.8 years were included in the study. Fifteen of the participants were men (39.5%) and 23 were women (60.5%). In the operative phase, which is the second of the three oral surgery phases, there was a statistically significant difference between the mean values of the op galvanic skin response and op heart rate (p

Background The purpose was to analyse the associations between dental and trait anxiety, fear of COVID-19 and the duration and frequency of spontaneous hand-to-face contact (self-contact). Methods A cross-sectional design was carried out with 128 adult patients from four dental clinics in Madrid, during the confinement, from March 15 to May 15. The patients’ movements in the waiting room were monitored with Microsoft Kinect Software, also completed the Trait anxiety subscale of the STAI, the COVID-19 Fear and the S-DAI questionnaire. Results Associations were observed between the duration and frequency of facial, mask and eye contact with trait anxiety and dental fear was determined only by the frequency of this self-contact. Trait anxiety is associated with dental anxiety and with fear of COVID-19. Although facial self-contact is higher in women, it also rises in men as dental fear increases. Moreover, dental anxiety is a good predictor of trait anxiety and the incidence of facial self-contact. Conclusions Understanding the possible associations between biopsychosocial factors, such as trait anxiety, dental anxiety and self-contact is important. It may help to prevent the spread of COVID-19 in the population as well as enabling the formulation of effective interventions to improve oral health care through the implementation of dental care programmes.

Introduction Sexual and oral health are important areas of focus for adolescent wellbeing. We assessed for the prevalence of sexual abuse among adolescents, oral health factors associated with this history, and investigated whether sexual abuse was a risk indicator for dental anxiety, caries experience and poor oral hygiene. Methods This was a cross-sectional study conducted between December 2018 and January 2019 among adolescents 10–19 years old in Ile-Ife, Nigeria. Survey data collected included respondents’ age, sex, and socioeconomic status, oral health risk factors (dental anxiety, frequency of tooth brushing intake of refined carbohydrates in-between-meals, flossing, dental visits, smoking, alcohol intake, use of psychoactive substances), caries experience, oral hygiene status, history of sexual abuse, and sexual risk behaviors (age of sexual debut, history of transactional sex, last sexual act with or without condom, multiple sex partners). Regression models were constructed to determine the association between outcome variables (dental anxiety, presence of caries experience and poor oral hygiene) and explanatory variables (oral health risk factors and history of sexual abuse). Results The prevalence of sexual abuse in our cohort was 5.9%: 4.3% among males and 7.9% among females. A history of sexual abuse was associated with alcohol consumption (p = 0.009), cigarette smoking (p = 0.001), and a history of transactional sex (p = 0.01). High/severe dental anxiety was significantly associated with increased odds of a history of sexual abuse (AOR = 1.81; 95% CI 1.10, 2.98), but not with caries experience (AOR = 0.66; 95% CI 0.15, 2.97) nor poor oral hygiene (AOR = 1.68; 95% CI 0.95, 2.96). Dental anxiety was associated with increased odds of alcohol intake (AOR = 1.74; 95% CI 1.19, 2.56), twice daily tooth brushing (AOR = 1.48; 95% CI 1.01, 2.17) and daily consumption of refined carbohydrates in-between-meals (AOR = 2.01; 95% CI 1.60, 2.54). Caries experience was associated with increased odds of using psychoactive substances (AOR = 4.83; 95% CI 1.49, 15.62) and having low socioeconomic status (AOR = 0.40; 95% CI 0.18, 0.92). Poor oral hygiene was associated with increased odds of having middle socioeconomic status (AOR = 1.43; 95% CI 1.05, 1.93) and daily consumption of refined carbohydrates in-between-meals (AOR = 1.38; 95% CI 1.08, 1.78). Conclusion Adolescents who are highly dentally anxious need to be screened for a history of sexual abuse to facilitate access to professional care and support.

Objective: To develop, validate, and apply an instrument for assessing the children’s perception regarding pediatric dentist’s appearance, based upon the influence of age, gender, previous dental experience, and anxiety. Study design: Images and a nine-item questionnaire were developed. The acceptability, convergent-construct validity, and reliability based on reproducibility and internal consistency were evaluated. The validated instrument was applied in a cross-sectional study, with children (n=120) aged 7–12 years asked to evaluate images of pediatric dentists wearing different dental attire (A:all-white (control); B:printed coat and cap, colorful face mask; C:printed coat, cap and face mask; and D:white coat and cap, printed face mask). Children’s age, gender, and previous dental experiences were collected with the guardians. The Children’s Fear Survey Schedule–Dental Subscale assessed children’s anxiety. Descriptive and inferential statistics were carried out (p0.40), satisfactory reproducibility (ICC >0.70), and internal consistency (Cronbach’s alpha coefficient >0.70). Considering only the attire, the children’s perceptions were more positive with the use of attire C and D (p0.05). In the intragroup analysis, compared to attire A: younger children have higher perception scores to attire D; girls, children with previous experience and without anxiety favored attire C and D; and children without previous experience showed no difference in comparison to A but did between B and C (p

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.

BACKGROUND The presence of parents during the dental appointment can affect the child's behaviour and, consequently, the success of the treatment. AIM This systematic review aimed to evaluate whether parents' presence in the operatory room influences children's behaviour, anxiety and fear during dental treatment. DESIGN EMBASE, Cochrane Library, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, OpenGrey and ProQuest Dissertations and Theses Databases were searched. Randomized and non-randomized clinical trials in which some measure assessing children's behaviour and/or anxiety and fear during dental treatment with the presence and absence of parents were included. Two reviewers assessed studies for selection, extracted data, evaluated bias (Joanna Briggs Institute) and graded the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Random-effects meta-analyses using mean difference (MD) and narrative synthesis were performed. RESULTS A total of 2846 papers were identified, and after a 2-phase selection, sixteen studies were included (five in meta-analyses). There was no difference in children's behaviour in the presence or absence of parents (P = .23, P = .40, P = .60 and P = .89, respectively). The presence or absence of parents did not influence children's anxiety (P = .94 and P = .97) or fear (DM: -0.08; CI:-0.34-0.19, P = .24). All included studies presented a high risk of bias, and the certainty of evidence was considered to be very low. CONCLUSION It is concluded that parents' presence in the operation room does not influence children's (up to 12 years old) behaviour, anxiety and fear during dental treatment with very low certainty of evidence. Methodological limitations of included studies, however, suggest that better designed trials are needed to adequately understand this issue.

To evaluate pain, disruptive behavior, and anxiety in children undergoing different local dental anesthetic techniques. This randomized/parallel clinical trial analyzed three groups of patients (9–12 years old) (n = 35) who received infiltrative anesthesia using conventional (CA), vibrational (VBA), and computer-controlled techniques (CCLAD). The outcomes were pain self-perception (Wong-Baker Faces Pain Rating Scale (WBF); Numerical Ranting Scale (NRS)), disruptive behavior (Face, Legg, Activity, Crying, Consolability Scale (FLACC)), anxiety (Corah’s Dental Anxiety Scale; modified Venham Picture test (VPTm)), and physiological parameters (systolic (SBP)/diastolic pressure (DBP); heart rate (HR); oxygen saturation (SpO2); respiratory rate (RR)). Statistical analysis was accomplished using Kruskall-Wallis test and ANOVA for repeated measures (α = 0.05). Dental anxiety levels at the baseline were similar for all patients. CA promoted less pain than VBA in WBF (p = 0.018) and NRS (p = 0.006) and CCLAD in WBF (p = 0.029). There were no differences in disruptive behavior (FLACC p = 0.573), anxiety (VPTm p = 0.474), blood pressure (SBP p = 0.954; DBP p = 0.899), heart rate (p = 0.726), oxygen saturation (p = 0.477), and respiratory rate (p = 0.930) between anesthetic techniques. Conventional technique resulted in less pain perception for dental local anesthesia. Conventional technique reduces the self-reported pain in children 9–12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.

© 2020 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons LtdBackground: Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions Oral Function, Orofacial Pain and Orofacial Appearance, has been proposed to cover the different areas of OHRQoL. Objective: The objective of the study was to collect further scientific support for the new four-dimensional structure of OHRQoL. This study is one out of a series of four and focuses on the PI in patients with dental anxiety, oral cancer and periodontitis (PROSPERO registration number: CRD42017064033). Methods: Five databases (Pubmed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO) were electronically searched on 8 June 2017 and updated on 14 January 2019, to identify the studies that measure OHRQoL using the Oral Health Impact Profile (OHIP) for oral health conditions. In this review, studies were included if the mean/median domain scores from OHIP-14 or OHIP-49 were available for patients with dental anxiety, oral cancer or periodontitis. The score of the handicap domain from the OHIP was used to assess patients` PI. The handicap domain includes 6 items for OHIP-49 with a domain score ranging from 0 to 24 and 2 items for OHIP-14 with a domain score ranging from 0 to 8. For comparison between the 2 versions of the OHIP, the domain score of OHIP-49 was conversed into a 0 to 8 metric. The domain scores of the included studies were then pooled, separately for each of the included dental disorders. Results: A total of 2104 records were identified based on the search strategy. After screening of titles and abstracts, 1607 articles were reviewed in full text. Twenty-three articles met the inclusion criteria for this review and were included in the study. The 23 articles contained 3884 patients, grouped in 30 patient populations and 42 patient samples. The pooled mean scores of PI for dental anxiety, oral cancer and periodontitis were 3.2, 1.9 and 0.8, respectively, on the 0 to 8 metric. Conclusion: This review provides standardised information about the OHRQoL impact for three dental disorders as a model for the PI dimension. Dental anxiety tends to show the strongest effect on the PI dimension, while periodontitis tends to show the weakest effect on the PI dimension. Future studies need to confirm whether the reported differences in PI scores between the three dental disorders are statistically significant.

Background: Dental treatment remains question of fear and anxiety among most of the patients. Aim: This study was done to assess dental anxiety among patients requiring dental treatment. Materials & Methods: 240 patients requiring dental treatment were subjected to Corah’s Dental Anxiety scale to assess anxiety level which comprised of four questions and response was recorded. Results: Out of 240 patients, males were 110 (45.8%) and females were 130 (54.2%). In response to question of feeling of subjects to visit dentist tomorrow, 66.6% had feeling of painful, unpleasant and scary. In response to question, How do you feel during sitting in waiting’s area of dental office, 50% responded that they are so anxious that they feel physically sick or sometimes break out in a sweat, 20.8% were anxious and 25% were tensed. In response to question, How do you feel when dentist is getting ready his drill to work on teeth, 33.3% responded that they are so anxious that they feel physically sick or sometimes break out in a sweat. In response to question, How will you feel when the dentist or hygienist is getting out the instruments which will be used to scrape your teeth around the gums, 27% were uneasy. Conclusion: Authors found that most of the patients were highly anxious about dental treatment. Assessment of patient anxiety may be helpful in adopting alternative methods such as behavior modification, biofeedback mechanism etc. before starting dental treatment.

Introduction The present study aimed to evaluate anxiety in patients and to monitor their heart rate (HR) and blood oxygenation (SpO2) before, during, and after a root canal treatment (RCT) during the state of alarm in 2 different periods of strict and partial confinement. Methods The patients who required a primary RCT were selected. Demographic, preoperative, and postoperative variables were registered, including perceived dental anxiety, fear, HR, and SpO2. Spearman correlation, chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for frequency distribution and variable interaction, and Wilcoxon and Mann-Whitney tests were used to compare HR and SpO2 between groups and different treatment points. Results Ninety-six patients were included. The median Modified Dental Anxiety Scale scores were 8 (interquartile range [IQR], 6–9.25) and 6 (IQR, 5.5–8) in patients treated during the strict and partial confinement periods. The median fear scores were 2 (IQR, 0–5) and 3 (IQR, 1–5), respectively. Having a previous dental bad experience resulted in higher dental anxiety and fear (P < .05). HR was increased in patients with higher MDAS and fear scores and in those treated during the strict confinement (P < .05). In treatment time points T6 (x-ray taking), and T7 (post-treatment), HR decreased compared with the other evaluated treatment time points (P < .05). No clinical differences were found regarding SpO2. Conclusions Self-perception on dental anxiety and fear was similar to other studies in a nonpandemic context. Patients with higher levels of dental anxiety and those treated in the strict confinement period presented an elevated HR. However, it can be stated that RCT performed by endodontists does not result in a significant alteration in patients.

Background Dental anxiety continues to be a widespread problem affecting adult populations. The primary aim of our study was to evaluate the psychometric properties of the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A) and to identify the optimal cut-off for assessing dental anxiety and dental phobia among adults in Lebanon. In addition, we sought to assess dental anxiety and phobia as well as their correlates among Lebanese adult patients. Methods A cross-sectional study was carried out on a sample of 451 dental adult patients aged between 18 and 65 years old. Information about demographic characteristics, previous bad dental experience, trauma’s experience period, perception of a periodontal problem, sensation of nausea during dental treatment, the MDAS-A scale, and the Visual Analogue Scale for anxiety (VAS-A) were collected. Results MDAS-A exhibited evidence of adequate psychometric properties. The optimal cut-off was 12 for dental anxiety and 14 for dental phobia. Out of the total sample, 31.5% suffered from dental anxiety while 22.4% had a dental phobia. Multivariable analysis showed that the odds of dental anxiety and phobia were higher among females compared to males. Also, patients suffering from periodontal problem perceptions, bad dental experiences during childhood and adolescence, and the sensation of nausea during dental treatment were at a higher risk of developing dental anxiety and phobia compared to their counterparts. However, a higher level of education was found to be a protective factor against dental phobia among Lebanese adult patients. Conclusion The MDAS-A scale is a suitable tool for the routine assessment of dental anxiety and phobia among Lebanese adult patients. Identifying patients with dental anxiety at the earliest opportunity is of utmost importance for delivering successful dental care.

Objectives:The aim of this study is to evaluate the effects of the position of the impacted third molar teeth on preoperative anxiety and possible pain levels of patients. Material and Methods:Fifty patients with impacted third molar teeth (full bone retention) in the horizontal and vertical positions were included in the study. Sociodemographic data of the patients were recorded. The patients have watched the impacted third molar surgery videos which were the position of horizontal and vertical. Subsequently, preoperative anxiety levels of patients were evaluated with The Spielberger State-Trait Anxiety Inventory-STAI part of the state anxiety inventory. In addition, pain levels that patients thought they might feel after the surgeries were evaluated with Visual Analogue Scale (VAS). P Results:The study included 50 patients (25 males and 25 females) who mean the age of was 21.00 ± 2.08. A statistically significant difference was found between the levels of anxiety created by the positions of the impacted third molar teeth (p Conclusion:The position of the third molars are associated with anxiety, stress, and postoperative pain in patients undergoing impacted third molar surgery. Addressing these factors preoperatively may reduce anxiety, probable postoperative perception of pain, and provide more positive treatment results.

Background: Dental fear and anxiety (DFA) is considered the main reason of dental negligence which can lead to detrimental oral health as well as overall health including psychological well-being and quality of life in an individual. Aims: The present trial was aimed to assess the skill and knowledge of dentists in managing DFA in adult subjects, to evaluate the available strategies used in treating such subjects, and to find the need for further education. Materials and Methods: The present study was an original survey and questionnaire trial, which was distributed to the 82 dentists. The collected data were subjected to statistical evaluation and the results were formulated. Results: Educating and motivating subjects was found to be effective by 62.19% (n = 51) of dentists followed by successive approximation, and muscle relaxation was considered highly ineffective by one responder (1.21%). Music and reduced waiting time in the clinic appeared to be the most effective strategy as responded by 56.09% (n = 46) of dentists. Attempting treatment in various visits than a single seems to be a highly ineffective technique by 4 dentists (4.87%). Conclusion: Within its limitation, the study showed that the application of various behavior modification techniques can be effective in alleviating DFA in adult patients.

Introduction: Endodontic microsurgery is a treatment option if previous procedures have been unsuccessful. As a result, many patients may suffer from a high level of dental anxiety. Dental anxiety impacts different aspects of life, so it is important to measure it with psychometric scales to avoid its underestimation. Previous studies related to dental anxiety used visual analogue scale (VAS), which is a quick and simple non-verbal measurement instrument. Objectives: The aim of this study was to measure and compare pre- and post-endodontic microsurgery dental anxiety using VAS.Material and methods: Thirty-five patients, who met the inclusion criteria and were previously scheduled to undergo endodontic microsurgery, answered VAS related to dental anxiety before and after the procedure. Microsurgery was performed by postgraduate students and monitored by a clinical supervisor. VAS values were analyzed with descriptive statistics. Shapiro-Wilk test determined to use Wilcoxon rank-sum test. Confidence level of the study was 95% and p < 0.05. Results: Anxiety levels showed no significant change over the analyzed period. Pre- and post-endodontic microsurgery anxiety levels did not markedly change in relation to gender either. Nevertheless, women's anxiety median values tended to decrease after the endodontic microsurgery. On the contrary, men tended to increase their anxiety levels after the procedure. Conclusions: Within the limits of the present study, there was not a statistically significant difference in the pre- and post-endodontic microsurgery anxiety values

Background/Aim. The dental anxiety in children is commonly measured applying the Dental Anxiety Scale (DAS) and the level is statistically treated. However, there are no studies on prediction of development of dental anxiety. The aim of this study was to develop a mathematical procedure for dental anxiety prediction based on the statistical values. Methods. Mathematical relation between the dental anxiety and aging was developed using the interpolation method based on the statistical values. It was supposed that the anxiety level is a polynomial function of the age. The obtained function was tested on the healthy children and those with inherited bleeding disorders. By mathematical fitting procedure using statistical data, the analytical relation for prediction of dental anxiety as a function of aging was developed. Results. According to prediction function, it was found that for healthy population the dental anxiety has the tendency to increase quite slowly or to remain almost constant after the age of 18. In the patients with inherited bleeding disorders, the DAS score would increase even after age of 18. The treatment of the anxiety in children with inherited bleeding disorders is optimal at about the age of 12 when they become aware of their illness. Conclusion. The introduced prediction function gives the tendency of DAS score development which enables timely adequate action in reducing dental anxiety. The predicted DAS score may be used as a control measure of oral health.

Objective: Fear of dental procedures is a common barrier to effective dental care. A promising technique to overcome dental anxiety is needle-free jet injection, which involves delivering local anaesthetic as a high-speed jet capable of penetrating the oral mucosa without a needle. Previous efforts have used loud, uncontrolled injectors designed for transdermal delivery that have failed to achieve significant uptake in dental practice. Methods: In this work, we present and validate a controllable jet injection device driven by a silent electric motor for the delivery of dental local anaesthetic. The injector includes a novel tubular attachment at its distal end, which allows the delivery to be performed comfortably throughout the mouth. The expected pressure loss resulting from the use of this attachment is analysed. This analysis predicted that a 75 mm long tubular attachment of 0.53 mm radius would result in negligible pressure loss. To validate delivery in human tissue, the injection system was used to perform 18 injections into the mouths of two Thiel-embalmed human cadavers. These injections were visualised using cone-beam computed tomography (CBCT). Results: Benchtop testing of the prototype injector verified the expected pressure loss along the attachment. The CBCT scans demonstrated that the fluid was successfully delivered to the desired locations, adjacent to the root apex of the teeth, at every injection site. Conclusion: These outcomes validate the performance of this novel needle-free injector, demonstrating its potential as a tool to reduce dental anxiety. Clinical and Translational Impact Statement— Our controllable jet injection device overcomes key limitations associated with previous attempts to deliver dental local anaesthetic needle-free. This could greatly reduce barriers to effective dental care.

Introduction: Dental fear and anxiety pose a significant problem for the practice of dentistry, especially in children. Therefore, it is necessary to identify and quantify this anxiety, to implement, and to monitor the effectiveness of treatment interventions. Materials and Methods: A cross-sectional study was conducted on children in the age group of 3–14 years. The children who had sound health and visited outpatient department of a Dental College, Lucknow, India with their parents for dental care were considered for study purposes. Children’s dental fear and anxiety were measured by using three scales. Result: Out of the total 220 respondents, 118 (53.6%) were males and 102 (46.4%) females. The outcome of the study showed that the dental fear among children was 13.3%, 22.9%, 7.8%, respectively, in existence measured by the three scales, viz., (a) facial image scale (FIS), (b) dental fear scale (DFS), and (c) children’s fear survey schedule-dental subscale (CFSS-DS). About 70.2% of the children showed Frankl’s behavior rating of 3, i.e. positive. Conclusion: Dental fear and anxiety are the most common problems of children and because of this, they are afraid of undergoing any dental treatment. By using the above scale, we can know about those factors which can enhance their fear so that we can modify our treatment approach. Altering in a treatment modality not only leads the children to get the treatment done easily but also removes the fear for dental treatment in the future.

In children, dental fear is not only associated with fear of pain or invasive procedures, but it is also correlated with separation from parents or confronting unfamiliar people or environments. The Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) was developed to evaluate dental fear in children, and this scale is now used across the world for evaluating dental fear. The aim of this study was to evaluate dental fear in children between 7–11 years of age and to find out the association between caries and fear of dental treatment. A total of 300 subjects of both sexes were enrolled in the study. Prior to the oral examination, all patients’ attendants were informed about the study, and the subjects were asked to fill in a questionnaire regarding the CFSS-DS scale. The data obtained through the questionnaires were analyzed using the Chi-Square test. Fear scores were highest for “injections” (3.91±0.17), “dentist drilling” (3.91±0.10) and “choking” (3.65±0.82). It was also observed that subjects who had already visited a dental clinic or those who were familiar with the dental environment at an early stage of life were less anxious than patients who were receiving dental treatment for the first time. In this study, we found that female subjects were more anxious in comparison to male patients. Once the child’s fear is identified, the dentist can use various behavior modification techniques to eliminate fear, explain the steps, and use the instruments accordingly until fear has vanished.

Objective:Anxiety is a temporary emotional state of tension, nervousness, fear and high autonomic nervous system activity. We aimed to investigate the anxiety status of patients before maxillofacial surgery and to analyse the relationship between anxiety and demographical/clinical data.Materials and Methods:In this retrospective study, we reviwed the files of 333 patients aged 16-60 years, who were scheduled for oral-maxillofacial surgery. The patients were interviewed before the surgery to determine their levels of preoperative anxiety using the Beck anxiety inventory. Demographic information was collected using a structured questionnaire [age, sex, American Society of Anesthesiologists (ASA) score, civil status, educational status, having major/minor surgery, informed about the surgery, history of previous surgery, job status, economic status, health insurance and having a child in need of care]. The levels of anxiety were allocated into 3 groups: 0 to 15, low to mild anxiety; 16 to 25, moderate anxiety and 26 to 63, severe anxiety. Multivariate conditional regression modelling was used to determine independent predictors of preoperative anxiety and to analyse the relationship between anxiety and risk factors.Results:High preoperative anxiety was associated with female gender [odds ratio (OR): 2.29], ASA-II (OR: 1.38), more than 12 years of education (OR: 1.68), major surgery (OR: 1.52), being a housewife (OR: 1.76), being single (OR: 1.93), absence of health insurance (OR: 2.01) and having a child in need of care (OR: 2.18). Previous surgery (OR: 0.61) and being informed about the surgery (OR: 0.58) were associated with a lower risk for preoperative anxiety.Conclusion:It is highly important in surgical practice to carefully observe patients and provide an appropriate preoperative anxiety management in order to avoid the bothersome intra- and postoperative results of preoperative anxiety.

The aim of this study was to investigate the prevalence of dental fear and to evaluate its association with dental caries and molar incisor hypomineralization (MIH) in schoolchildren aged 8-10 years from a municipality in Northeastern Brazil. Data from 466 students enrolled in urban public schools in a cross-sectional study were collected. Parents/guardians answered a questionnaire addressing sociodemographic characteristics, dental fear was measured by means of the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and clinical examinations were performed by three calibrated examiners for diagnosis of dental caries, using the International Caries Detection & Assessment System - ICDAS II and a previously validated index for MIH. Descriptive data analysis was performed, and associations between dental fear, dental caries and MIH were analyzed using robust Poisson regression for complex samples (p

BACKGROUND: The relationship between dental anxiety and mucosal wound healing, especially the inflammatory response, has not been well studied. This study aimed to examine the relationship between anxiety prior to dental treatment and short-term inflammation following impacted mandibular third molar (IMTM) surgery. METHODS: Fifty-nine patients who required IMTM surgery were recruited for this study. Sample demographics (gender, age) and surgical extent (Pederson classification, duration) were collected. Psychological stress towards surgery was assessed by the Dental Fear Survey (DFS). All surgeries were conducted according to an identical surgical protocol and all patients were given the same medical prescription. Correlations between short-term inflammation (swelling and trismus after 2 days) and DFS, demographics and surgical extent were statistically analysed. RESULTS: The results showed that patients with a higher DFS score demonstrated more severe swelling (s = 0.36, P = 0.016) and trismus (s = 0.37, P = 0.008) 2 days after surgery. In addition, more severe trismus occurred following more difficult surgery (s = 0.29, P = 0.016) or that with a longer duration (s = 0.21, P = 0.081). Neither gender nor age showed any significant relationship with swelling or trismus. CONCLUSION: Short-term inflammatory response following IMTM surgery correlated with the preoperative dental anxiety and this correlation was independent of gender and surgical extent.

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

Amaç: Çocuk diş hekimleri, dental tedaviler sırasında hastalarının ağrı ve anksiyetesini kontrol altına almak için pek çok yöntem kullanmaktadır. Dikkat dağıtma yöntemi, çocuk hastalarda bu amaçla sık kullanılan davranış yönlendirme tekniklerinden biridir. Bu çalışmanın amacı, görsel ve işitsel dikkat dağıtma sağlayan 3D video gözlüğün 6-10 yaş arası çocuklarda süt molar dişlerin çekimi sırasında kullanımının anksiyete ve ağrı üzerine olan etkinliğinin değerlendirilmesidir. Gereç ve Yöntem: 6-10 yaş aralığındaki 60 çocuk, her grupta 15 kız, 15 erkek olacak şekilde rastgele 2 gruba ayrıldı. 1. grupta bulunan 30 hastaya “Anlat-göster-uygula” yöntemi uygulanarak; 2. grupta bulunan 30 hastaya ise 3D video gözlük ile çizgi film izletilerek diş çekimi yapıldı. Çocukların anksiyete değerlendirmeleri tedaviye başlamadan önce, lokal anestezi sırasında ve lokal anestezi yapıldıktan sonra nabız ve oksijen saturasyon ölçümleri ve MCDAS (Modified Child Dental Anxiety Scale) skorları ile yapıldı. Ağrı algısı, hem lokal anestezi sonrası hem de diş çekimi sonrasında Wong-Baker (W-B) skalası ile kaydedildi. Bulgular: “Anlat-göster-uygula” ve “3D video gözlük” grupları karşılaştırıldığında nabız ve MCDAS skala değerleri bakımından aralarında anlamlı farklılık bulunmadı. Tüm zamanlarda yapılan ölçümlerde “3D video gözlük” grubunun saturasyon değerleri, “Anlat-göster-uygula” grubuna göre anlamlı derecede daha düşük bulundu. “3D video gözlük” grubunda diş çekimden sonra kaydedilen W-B değerlerinin “Anlat-göster-uygula” grubuna göre anlamlı derecede düşük olduğu görüldü. “3D video gözlük” grubunda diş çekiminden sonra ölçülen W-B değerinin lokal anestezi sonrasındaki değere göre düşük olduğu gözlendi. Sonuç: Çocuklarda diş çekimi sırasında “3D video gözlük” kullanımının anksiyete değerlerinde beklenen azalmayı sağlamadığı; ağrı algısını ise başarılı bir biçimde azalttığı görülmüştür.

Background: We report a case in which effective dental anesthetic management was achieved using procaine hydrochloride for a patient who had an unknown history of allergic reactions to lidocaine. Case Presentation: Because the patient refused to undergo screening tests using any of the amide-type local anesthetics because of her extreme fear against local anesthetics that she had been administered previously, procaine hydrochloride, which is an ester-form local anesthetic, was the only agent to be tested on this patient at the department of dermatology. Consequent to a negative allergy test, we performed complete dental treatment using procaine hydrochloride after additional chairside drug challenge tests using minimum test dose under vital sign monitoring. Conclusion: The success of dental treatment using procaine hydrochloride may have relieved the patient’s fear of local anesthesia. We discuss an important aspect of treatment planning for patients with a history of complications during local anesthesia., Local and Regional Anesthesia, 13, pp.99-103; 2020

Introduction: Odontectomy is a minor surgical procedure that often results in dental anxiety. Dental anxiety can interfere during odontectomy treatment. Dental anxiety can be examined using the Modified Dental Anxiety Scale (MDAS) and through the level of the salivary alpha-amylase enzyme, both of which are dental anxiety biomarkers. The objective of this study was to analyse the correlation between anxiety values with salivary alpha-amylase levels using MDAS as an indicator of anxiety in pre-odontectomy patients. Methods: This study was conducted on 60 research samples of women aged 18-40 years who came to the minor surgery clinic of Department of Oral and Maxillofacial Surgery, Universitas Padjadjaran Dental Hospital, to have odontectomy treatment of maxillary or mandibular third molars impaction, not having systemic and oral diseases, and willing to participate in this study. Patients who met the inclusion criteria then required to sign the research consent statement; afterwards, the MDAS data was taken. The salivary alpha-amylase enzyme data was taken using the Cocoro meter (Nipro, Japan) tip which was kept under the tongue for 30 seconds, then the tip was inserted into the monitor, and the enzyme levels would be counted. The data obtained will be analysed using the Spearman rank correlation test. Results: The results showed that there was a significant relationship (p < 0.01) with a strong positive correlation (r = 0.85). Conclusion: There is a correlation between MDAS value and salivary alpha-amylase enzyme as an indicator of dental anxiety.

Objective: The term general anaesthesia refers to a state of unconsciousness under control using pharmacological or non pharmacological agents in which patient reflexes are compeletely or partially lost. Concious sedation is a drug-induced state in which the conscious patient is rendered free of fear, anxiety, and apprehension while remaining comfortably relaxed. Both of these methods are used for various reasons in dental clinics for many years and their use in dentistry practice is increasing. Aim of this study is to quantify the number and demographic data of patients that received a dental general anaesthesia (DGA) or conscious sedation (CS) following referral from a general dental practice. Study also aimed to determine the reasons of referral and dental treatment modalities performed during the sessions. Methods: This study includes patient records who had undergone dental general anaesthesia and conscious sedation in Medipol University Dental Hospital General Anaesthesia Clinic. Data were collected from records of the University Dental Hospital. The collected information included gender, age, type of DGA/ CS, reason for DGA, treatment modalities as tooth extraction, restorative, endodontics, periodontics and pedodontics. Results: 896 patients were referred for DGA/CS during the two-year period. The mean age was 15.5 years and 27.3% were underaged children. The most common reason for DGA was dental anxiety (46.5%). 79.4% of patientd received DGA, while only 20.6% received CS. The highest mean in treatments is for decidious pulp capping (4.57) followed by decidious pulp amputation (3.57).Conclusion: Majority of the patients receiving DGA/CS are formed by dental anxiety patients. Also, the rate of underaged children were very high (27.3%).

Objectives This cross-sectional study assessed the correlation between individual and school-related social environment variables with dental anxiety in Brazilian schoolchildren aged 8-12 years. Methods A sample of children from 20 private and public schools (n = 1211) from Pelotas, Brazil, were selected. Socioeconomic data were collected from parents, and data regarding children characteristics were collected using a questionnaire. Dental anxiety (the outcome) was assessed by the following question: 'Are you afraid of going to the dentist?' Dental examinations were performed to assess caries experience (DMFT ≥ 1). The social school environment was assessed by a questionnaire administered to schools' coordinators and considered: type of school, verbal violence between students, presence of gangs at school and cyberbullying episodes. Multilevel Poisson regression was used to investigate the association between school social environment and dental anxiety. Results The prevalence of dental anxiety was 9.1% (95%CI 7.5-10.8). For the individual variables, anxiety was more prevalent in girls [1.85 (1.21-2.81)], in children with less-educated mothers [1.50 (1.00-2.27)] and in children who never attended to the dentist [2.48 (1.65-3.72)]. For contextual variables, episodes of cyberbullying in school increased the prevalence of dental anxiety by almost 80% [1.78 (1.14-2.78)]. Conclusions The school social environment influences dental anxiety. The results suggest that it is important to establish strategies focused on promoting healthier environments and preventing cyberbullying in order to reduce the occurrence of dental anxiety.

Dental anxiety affects many people worldwide and interferes with oral health. Beyond emotional distress, avoidance of dental care visits can lead to serious dental and health consequences. Although emerging research implicates anxiety, pain, and disgust sensitivities in the etiology and maintenance of dental anxiety, no studies to date have concurrently investigated the unique contribution of these vulnerabilities in dental anxiety. As a step toward elucidating salient mechanisms of dental anxiety, the present study investigated the aggregate contribution of anxiety, pain, and disgust sensitivities in dental anxiety, after controlling for relevant covariates. In this study, participants (

High dental anxiety is a major barrier to accessing dental care and has been found to be experienced to a greater extent in the homeless population. No studies have investigated the extent and nature of dental anxiety in Australians experiencing homelessness and was the aim of this study. Participants were recruited from four not-for-profit organisations in inner Brisbane using convenience and snowball sampling. The Dental Anxiety Questionnaire (DAQ) and the Index of Dental Anxiety and Fear (IDAF-4C+ ) questionnaire and oral health screening were completed by people experiencing homelessness in Brisbane, Australia, and compared to population norms. Descriptive statistics were calculated, and non-overlapping confidence intervals considered significantly different. The majority of the participants (n = 66) were male, a current smoker, unemployed and living in government supported housing. Most of the participants rated their oral health as poor/fair (n = 46, 71.9%) and their oral function as good or higher (n = 34, 53.1%). Using the single-item DAQ, 28.2% (n = 19) of people experiencing homelessness had high dental anxiety, compared to 16% of the general Australian population. The mean summed IDAF-4C+ fear module score was 18.02 (CI 15.60-20.43), which was significantly higher than the Australian population (µ = 14.40, CI 13.93-14.86). The highest mean score in the IDAF-4C+ stimulus module was feeling embarrassed or ashamed as anxiety inducing (µ = 2.27, CI 1.89-2.64) and was significantly different from the general Australian population (µ = 1.40, CI 1.33-1.47). The poorer overall self-rated oral health by the homeless population may induce feelings of embarrassment or shame, highlighting the differing psychosocial aspect to dental anxiety experienced by this population. Managing dental anxiety is needed to improve accessing to dental care for this population. Multidisciplinary care from social workers, mental health workers and dental practitioners may be beneficial in managing fear.

No studies are available in paediatric samples evaluating gagging during toothbrushing, radiographic and/or intraoral photographic examinations. The aims were to collectively examine potential factors associated with gagging during radiographs and intraoral photographs in 4–12-year-old children. Parents/guardians of 395 children (aged 4–12 years old) completed questionnaires asking about their children’s toothbrushing habits. Children completed Greek versions of the Gagging Assessment Scale (GAS) and the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), while the dentist used the shorter version of the Gagging Problem Assessment (GPA-de-c/SF) to objectively assess gagging. X-ray and Photo Rating Scales were created to evaluate gagging during X-rays and photographs, respectively. Multivariate logistic regression was used to examine the relationship between the potential factors and gagging. 59 of 275 patients (21%) and 56 of 276 patients (20%) who needed X-rays and intraoral photographs, respectively, gagged. Children who gagged during X-rays had significantly higher GAS scores (p = 0.007). Boys, younger children, and those who gagged on GPA-de-c/SF were more likely to gag during X-rays, and children who gagged on GPA-de-c/SF were more likely to gag during photographs. Brushing habits were not related to dental fear or gagging. Of the variables which we studied, GPA-de-c/SF most strongly affected the odds of gagging during taking radiographs and/or intraoral photographs.

Purpose/objectives: Dental anxiety is common and can propagate a vicious cycle of dental neglect and anxiety-provoking treatment. Patient, procedural, and operator factors are important contributions. This review aims to explore risk factors for dental anxiety in adult patients treated by dental students, in order to improve awareness of relevant factors and aid patient management. Methods: Systematic searching of PubMed and Scopus databases was performed. Inclusion criteria were: studies assessing at least 1 risk factor for dental anxiety in patients aged 18 years and above treated by dental students, with use of a specific measurement scale for dental anxiety. Exclusion criteria were: duplicates, non-English publications, non-full-text publications, studies with a pediatric sample. Results: Nine hundred thirty-one articles were identified. Eight eligible articles representing 1702 patients were included. Seven studies had a cross-sectional design and 1 study had a pretreatment/posttreatment design. Sixteen factors for dental anxiety were assessed. A significant correlation (P < 0.05) was found for: age (younger), gender (female), general/waiting room anxiety, irregular dental attendance, invasive treatment, poor emotional well-being, postponement of dental visit due to anxiety, previous negative dental experience and village residence. No significant correlation was found for: education, employment, income, perceived oral health, presence of a previous dental visit, symptom duration and time since last dental visit. Conclusions: These findings provide a good foundation for future research, but clinical generalization is limited by the heterogeneity among included studies. A well-structured comparison of risk factors for dental anxiety between patients treated by dental students and dentists is required.

It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents’ OHRQoL. Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents’ educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents’ OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis. 1207 adolescents (46.6% females) participated in this study. The mean total CPQ11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p

Dental anxiety about extraction of impacted mandibular third molars changes the activity of the autonomic nervous system. Thus, to provide safe dental treatment, it is important that a surgeon be aware of a patient's pretreatment anxiety and autonomic nervous system state. Therefore, we analyzed how a scheduled treatment to extract mandibular third molars affects the pretreatment electroencephalogram (EEG), autonomic nervous system, and psychological state of patients. We compared their findings with those of volunteers not scheduled to undergo dental treatment.The study enrolled 30 patients who were scheduled to undergo impacted mandibular third molar extraction (ie, pretreatment group) and 30 volunteers who were not (ie, control group). Heart rate variability and an EEG were recorded during the experiment. The State Anxiety Inventory-State Anxiety scale (STAI-S) scores were recorded before the procedure. For the statistical analysis, P .05 was deemed statistically significant.High-frequency (HF) variability was significantly decreased and the STAI-S score was significantly increased in the pretreatment group compared with the control group (P .01 for both). The low frequency (LF)/HF ratio and alpha-wave activity showed a significant negative correlation on both sides in the control group (P .01); however, no correlation existed in the pretreatment group. The LF/HF ratio and STAI-S score showed a significant positive correlation in the pretreatment group (P .05); however, no correlation existed in the control group.Predicting a patient's autonomic nervous system state before dental treatment based on the EEG was difficult. The STAI-S psychological test was a useful method.

BACKGROUND Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. AIM To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. DESIGN A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. RESULTS Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making. CONCLUSION Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.