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Dental fear and phobia are prevalent worldwide, with local anesthesia being the most feared procedure. This study aimed to determine whether photobiomodulation therapy (PBMT), used as a pre‐anesthetic, could modulate puncture pain and enhance the effectiveness of local anesthesia. In this controlled, randomized, double‐blind study, 49 participants were divided into an experimental group (n = 24), which received infrared laser therapy (100 mW, at 808 nm, 8 J, 80 s at a single point) immediately before standard anesthesia; and control group (n = 25), which received the standard anesthetic technique and sham laser. Pain levels were measured using the visual analog scale, and anesthetic efficacy was assessed through electrical tests (latency), percentage of failures, and cartridge usage. Anxiety levels were evaluated using the Beck Anxiety Inventory. Cardiovascular parameters were evaluated through blood pressure, oxygen levels, and heart rate. This randomized, double‐blind study found no difference between groups in these experimental conditions. The bias toward a positive PBMT result was sufficiently removed. Autonomic responses of the PBMT group were maintained stable during the procedure. [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]

Dental fear still causes health risks and high costs for health insurances due to the common avoidance of dental visits by dentally fearful patients. Selective attention may be a potential trigger of dental fear. The aim of the present studies was to investigate the influence of threatening dental stimuli in image combinations on the performance in a visual search task. In three studies, we compared the influence of dental stimuli with pictures of weapons or accidents and different distractors, i.e., cutlery, animals, landscapes. In the first two studies, participants had to decide if a target is available in a 3 × 3 matrix or not. In the third experiment, participants had to decide if a threatening or a neutral stimulus was the target. In all three studies we could replicate the finding that there is a threat-superiority-effect as well as a disengagement-effect for dental stimuli in visual search tasks. Dental stimuli were not only detected faster than deciding that no dental stimulus is available with different distractors, but dental stimuli also decreased search performance within the 3 × 3 matrices when presented as distractors. This is the first paper that demonstrates that dental stimuli that are associated with a negative threatening valence attract attention very quickly in the context of non-threatening stimuli. Future studies should investigate if a distraction from these threatening stimuli or a habituation to these threatening stimuli could reduce dental fear. [ABSTRACT FROM AUTHOR]

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

Aim: No comprehensive synthesis of dental anxiety (DA), dental utilization (DU), oral health-related quality of life (OHRQoL), and their relationships have been examined despite various systematic investigations being done on their prevalence and interventions individually. Therefore, this review aims to systematically review the status and relationship between DA, DU, and OHRQoL among adult groups. Materials and Methods: Data collection spanned 6 months, from 1 July to 31 December 2023, involving eight databases. Only cross-sectional (CS) studies with adult participants aged 15-64 years, conducted globally, published in English, and available as full-text articles by December 31, 2023, were included. Two reviewers screened the titles and abstracts and assessed the full-text articles. All studies were CS. The risk of bias was evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist for Analytical CS studies. The quality of evidence for each measured factor was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: The initial search yielded 3333 studies. The 22 final studies included 13 highquality studies with over 80% and nine fair studies with 50% and 79% scored. None of the studies scored below 50%. A negative link between DA and DU was identified in 15 of 16 studies with 35,846 participants aged 22.19-50.21 years. Six studies on DA, DU, and OHRQoL included 22,845 participants aged 15-55 years, mostly in their late and mid-fifties. Four of six verified Berggren and Meynert's (1984) vicious cycle theory's high association between DA, DU, and OHRQoL. Conclusions: A 22-study review reveals a strong association between DA, DU, and OHRQoL. Most moderate to high-quality studies emphasized a negative correlation between DA and DU, which affected OHRQoL.PROSPERO registration number CRD42023455219. [ABSTRACT FROM AUTHOR]

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

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]

Background: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments. Aim: The aim of this study was to compare 1 m/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects. Materials and Methods In this cross-over trial, 15 children aged 6–8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week. Results: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post-treatment. Conclusion: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 m/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children.

Introduction: The child's relationship with the dentist is the product of complex interactions between the patient, parents, and the dentist. Therefore, the aim of this study was to investigate the effect of emotional intelligence and parenting style on the child's dental anxiety and fear. Methods: In this descriptive cross-sectional study, the patients aged 6 to 15 years with their parents who referred to Shahid Sadoughi Dental School in Yazd were selected through simple method. The MCDAS and CFSS-DS questionnaires were used to measure anxiety and fear, respectively, and the level of emotional intelligence and parenting style were measured by the Shering and Baumrind questionnaires, respectively. Data were analyzed via SPSS16, and T_Test, ANOVA were utilized. Results: Out of 120 participants, 39 were boys and 81 were girls. The mean age range of the children was 9.31 ± 2.46 years and parents' mean age was 37.60 ± 4.82. There was no significant relationship between parenting style and child's dental fear and anxiety (P=0.492 and P=0.769, respectively) and between parent's emotional intelligence and child's dental anxiety (P=0.053), but there was an inverse and significant relationship between parent's emotional intelligence and child's dental fear (r=0.274 and P=0.003). Conclusion: The results of the present study showed that the parenting style has no significant relationship with child's dental fear and anxiety and also the parent's emotional intelligence with the child's dental anxiety, but the parent's emotional intelligence has an inverse and significant relationship with the child's dental fear.

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

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

Treatments in dentistry currently consist of an interdisciplinary approach, including (but not necessarily limited to) the holistic perspective. The different fields of allopathic and complementary medicine are used together to ensure not only a high-quality restorative treatment, but also to provide patients with psychological and emotional support. This perspective also applies to dental anxiety, which consists of complex (emotional, vegetative and psychomotor) manifestations. One of the most well-known complementary therapies for reducing dental fear and anxiety is BachTM Flower Therapy. Even if the mechanism of action of this therapy is not yet scientifically documented, notable results have been and continue to be reported in the literature in several clinical studies on patients with dental diseases. It is indicated for both adults and children, in the latter when they go through major biological changes, such as primary and permanent dentition. As a conclusion, BachTM flower therapy is effective and complementary to dental treatments applied to patients, by reducing stress, anxiety, as well as creating a climate of peace, trust and confidence, both for the patient and the doctor. In addition, it is a relatively accessible and cheap form of care, with no significant adverse effects noted so far.

ÖZET Dental anksiyete; her türlü dental işleme karşı kaynağı belli olmaksızın duyulan yoğun endişe olarak tanımlanmaktadır. Çocuklarda dental anksiyete; bilinmeyene karşı duyulan korku ve tedaviyi kontrol etme fırsatının olmamasıyla yakından ilişkilidir. Çocuğun yanısıra hekim için de fizyolojik ve psikolojik problemlere yol açabilen dental anksiyete, çocukların randevularına gelmelerini ve tedavi basamaklarının ideal şekilde uygulanmasını engelleyerek ağız ve diş sağlığı problemlerine neden olmaktadır. Anksiyetenin ve korkunun nörobiyolojisinde rol oynayan en önemli nöroanatomik oluşum amigdaladır. Amigdala potansiyel tehditleri kontrol ederek hipotalamusla yaptığı bağlantılarıyla sempatik sinir sisteminin aktivasyonunu sağlar; merkezi orta beyinle yaptığı bağlantılarıyla da savaş ya da kaç gibi davranışsal savunma yanıtlarını oluşturur. Çeşitli ülkelerde farklı yaş gruplarındaki farklı dental tedaviler uygulanan çocuklarda yapılan çalışmalarda anksiyete prevalansının %5-%20,6 arasında olduğu saptanmıştır. Çocukların dental kaygılarını gösterme şekilleri yaş gruplarına göre değişebilmektedir. Diş tedavilerinin karşısındaki en yaygın küresel engellerden biri olan dental anksiyeteye neden olan faktörler; dental, çevresel ve bireysel olmak üzere 3 başlıkta gruplandırılabilir. Dental kaygıya sahip çocuklarda diş tedavisi esnasında kalp hızında artış, nefes almada değişiklik, terleme, karın ağrısı, titreme, mide bulantısı, ağız kuruluğu, ağlama, huzursuzluk, dikkat dağınıklığı sıklıkla görülmektedir. Dental tedavi işlem basamaklarının ilerleyebilmesi ve tamamlanabilmesi için anksiyete, sedasyon ve genel anestezi gibi farmakolojik, aromaterapi, müzik terapisi, tedavi esnasında video izleterek görsel ve işitsel olarak dikkat dağıtma ve hipnoz gibi yöntemlerle nonfarmakolojik olarak yönetilebilmektedir. Anahtar Sözcükler: dental anksiyete, dental korku, çocuk ABSTRACT Dental anxiety is defined as intense anxiety about any dental procedure without an obvious source. Dental anxiety in children is closely related to the fear of the unknown and the lack of opportunity to control the treatment. Dental anxiety, which can cause physiological and psychological problems for the physician as well as the child, causes oral and dental health problems by preventing children from coming to their appointments and applying the treatment steps in an ideal way. The most important neuroanatomical formation that plays a role in the neurobiology of anxiety and fear is the amygdala. By controlling potential threats, the amygdala provides the activation of the sympathetic nervous system with its connections with the hypothalamus; with its connections with the central midbrain, it creates behavioral defense responses such as fight or flight. The prevalence of anxiety was found to be between 5% and 20.6% in studies conducted with children in different age groups who underwent different dental treatments in various countries. The way children show their dental concerns may vary according to age groups. Factors causing dental anxiety, one of the most common global barriers to dental treatments; can be grouped under 3 headings as dental, environmental and individual. In children with dental anxiety, increased heart rate, changes in breathing, sweating, abdominal pain, tremor, nausea, dry mouth, crying, restlessness, and distraction are frequently observed during dental treatment. In order to progress and complete the steps of dental treatment, anxiety can be managed non-pharmacologically with pharmacological methods such as sedation and general anesthesia, aromatherapy, music therapy, visual and auditory distraction and hypnosis by watching videos during treatment. Keywords: dental anxiety, dental fear, child

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20‐item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment‐related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment‐related dental anxiety. The association between trait‐like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety. [ABSTRACT FROM AUTHOR]

Background: In China, most of the citizens experienced SARS-CoV-2 infection since the end of 2022. The Coronavirus disease 2019 (COVID-19) pandemic affected people’s physical health and also had a significant impact on mental well-being. The present study aims to discover if the experience of SARS-CoV-2 infection influences patients’ anxiety toward third molar surgery in the Chinese population. Materials and methods: The present study took the form of a questionnaire survey. From January 1, 2023, to June 30, 2023, patients who went to the Stomatology Center of China-Japan Friendship Hospital (Beijing, China) for the third molar extraction were included according to the inclusion criteria. The information on COVID-19 infection and the Modified Dental Anxiety Scale (MDAS) was collected. The software SPSS 22.0 was used for the statistical analyses. Results: A total of 574 survey results were harvested in the present study. The infection rate of COVID-19 was 86.6% (p >  0.05). The Average MDAS scores between patients who had been infected with COVID-19 and patients who were never infected were not significantly different (11.65  ±  4.41 vs. 11.42  ±  4.41, p >  0.05). The subgroup analysis was conducted according to the length of time after the recovery of COVID-19 (Model 1), and the highest temperature during the infection (Model 2). In Model 1 and Model 2, the one-way ANOVA test did not find statistical significance between the groups (Model 1 p =  0.114; Model 2 p =  0.481). The MDAS scores in female patients were significantly higher than in male patients (12.29  ±  4.53 vs. 9.91  ±  3.80, p <  0.001). Patients who extracted double teeth got significantly higher MDAS scores than those who extracted single teeth before the surgery (12.03  ±  4.74 vs. 11.24  ±  4.18, p =  0.037). Conclusion: The present study did not establish a significant impact of SARSCoV-2 infection on the anxiety levels associated with third molar surgery among Chinese patients. The potential long-term biopsychological effects of the virus warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments. Aim: The aim of this study was to compare 1 μ/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects. Materials and Methods: In this cross‑over trial, 15 children aged 6–8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week. Results: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post‑treatment. Conclusion: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 μ/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/ kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between dental fear and dental caries in children aged 6 to 12 years in a systematic review and meta-analysis. Methods: Systematic review search terms were selected according to medical subject headings (MeSH) or non-MeSH. An electronic search of studies published in English assessing the relationship between dental fear (children’s fear survey schedule–dental subscale) and dental caries (DMFT or dmft index) was carried out of the Scopus, Web of Science, PubMed, Embase, Cochrane and Proquest databases up to March 2022. Of 5,759 articles retrieved initially, 16 were eligible for inclusion in the study, and 5 of these were included in the quantitative analysis. The quality of studies was evaluated based on the Newcastle-Ottawa scale. Begg tests were employed to assess the publication bias. Results: According to the meta-analysis, the results revealed no statistically significant difference in mean of DMFT score in low and high fear score groups, with a mean difference of 1.28 (95% confidence interval −0.132 to 2.693) (P = 0.076). A statistically significant difference was found in the mean dmft score for the low and high fear score groups, with a mean difference of 0.227 (95% confidence interval 0.058 to 0.395) (P = 0.008). The mean dmft was significantly higher in the high fear score group. Conclusion: Dental fear has a significant relationship with caries in primary teeth, but not in permanent teeth. [ABSTRACT FROM AUTHOR]

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients. [ABSTRACT FROM AUTHOR]

Introduction: Stress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments. Methods: Studies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes). Results: A total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects metaanalysis was used to quantify the results of the pooled studies, while a fixedeffects meta-analysis was used for studies in the pediatric population. The metaanalysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety--stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001). Conclusion: Music therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more welldesigned randomized clinical studies are needed to validate its efficacy. [ABSTRACT FROM AUTHOR]

Dental fear and anxiety are highly prevalent among children and have been shown to lead to irregular use of dental services. Previous research has suggested that while touch can alleviate the patient's stress and help in accomplishing dental procedures, it can also be a source of stress or used to restrain the patient. In this study, we explore the emergence and intertwine of controlling and comforting touch in pediatric dental clinic settings in which patients show signs of resistance, distress, or fear. We use microanalysis of video-recorded interactions to unveil how the adults in the room—any combination of the dentist, dental assistant, hygienist, and caregiver(s)—deploy various types of touch on the child patient to perform the dental procedure while simultaneously comforting the child. Our data set covers video-recordings of naturally occurring dental clinic visits of 3- to 12-year-old child patients from four cultural contexts: Finland, China, Iraq, and the United States. Drawing on Merleau-Ponty's writings on intercorporeality and the interaffectivity of bodies, the study proposes that touch in pediatric dentistry unfolds as complex intercorporeal formations where the interaffectivity emerges not only through touch but also via vocal resonance. In contrast to clear boundaries between comforting and controlling touch, our analysis indicates that the line between comforting and controlling touch can be blurred. We suggest that touching a pediatric patient showing resistance toward a dental procedure requires careful affective attention to the patient's subtle and moment-by-moment bodily expressions and reactions to the touch. [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]

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother–father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072–0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety preceding dental appointment is a common problem among both children and adult patients. It is frequently the reason of avoiding visits what often results in poor oral health and deterioration of general well-being. There is a number of methods regarding patients’ relaxation as well prior the appointment as amid one, virtual reality among them. Material and methods: The study was carried out among 100 adult dental patients while they waited for their appointment in the waiting room. Interviewees completed the multiple-choice, uncompelled questionnaire containing four questions. Results: The results show that the most frequently chosen answer was projection of landscapes (40%) or an interactive journey like beach walk or mountain trekking (35%). No differences were observed between men and woman, in both groups projection of landscapes was the most common answer. The vast majority of interviewees (87%) was willing to try virtual reality during dental treatment while the remaining 13% did not want to experience virtual reality at all. Conclusions: Most of the participants were eager to try virtual reality amid dental appointment and they rather chose calm and relaxing contend instead of interactive quizzes or games. It is promising that dental patients are willing to be ready to try out innovative technologies in the fight against dental anxiety.

Objective To investigate the clinical efficacy and effects of periodontal endoscope (PE)-assisted subgingival scaling and root planning (SRP) and traditional SRP on the psychological and quality of life of patients with periodontitis. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Patients with periodontitis who were treated in the Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University from April 2018 to December 2022 with residual periodontal pockets (PD ≥ 5 mm) 6 weeks after traditional SRP treatment were enrolled, and the residual periodontal pockets were further treated with PE-assisted SRP (PE+SRP). After 6 weeks of traditional SRP treatment and 3 months of PE+SRP treatment, clinical indicators, including plaque index (PLI), probing depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP), were measured, and periodontal tissue self-awareness scale scores, oral health impact profile-14 (OHIP-14) score and dental fear scale (DFS) score were collected. Moreover, visual analog scale (VAS) scores were collected after traditional SRP and PE-assisted SRP treatments. Results Twenty-three patients with periodontitis, including 832 sites of 486 affected teeth, were included in the clinical study. Three months after PE+SRP treatment, all clinical periodontal indicators, PLI (t = 9.254, P

Background and Objectives: One of the professional goals of pediatric dentistry is to promote a positive attitude and improve the dental health of society. The percentage of unmet medical needs in primary and permanent teeth in children is high, and dental fear and anxiety are some of the factors involved in this. The present study aimed to assess the relationship between 4-11-year-old children's dental anxiety and their behavior during treatment. Materials and Methods: This cross-sectional study was conducted on 272 children referred to pediatric dental clinics. After obtaining their consent, the children's parents completed a questionnaire containing the children's demographic information. In the waiting room, the child's fear and anxiety were evaluated based on two standard scales: Facial Image Scale and the Children's Fear Survey Schedule-Dental Subscale. After the treatment, the Frankle index was recorded by the dentist to assess the child's behavior. The obtained data were analyzed in SPSS software (version 20) using the chi-square test. Results: The average score obtained in the CFSS-DS test for children was 28.08. Anxiety Levels showed a statistically significant relationship with age (P=0.008) and history of dental visit (P=0.006). Children in the very happy group in the FIS and those in the anxious group in the CFSS-DS test displayed more negative behavior with the FBRS index (P=0.000). Conclusion: As evidenced by the obtained results, dental anxiety is lower in children with older age and a history of dental visits. The fear of injection and the sound of dental instruments were, respectively, the most important causes of dental anxiety in children.

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

Aim: To assess the prevalence of dental avoidance due to dental fear and economic burden and its distribution by utilization of dental care and socio‐behavioural characteristics. Method: A sample of 9052 Norwegian adults aged 25–35 years was invited to participate, and 2551 completed electronic questionnaires regarding lifetime prevalence of dental avoidance due to fear and last year prevalence of dental avoidance due to economic burden. Results: Cancelled‐ and avoided ordering appointments due to fear amounted to 14.7% and 30.5%, respectively. Avoidance of dental visits due to cost was 37.7%. Frequency of cancelled appointments due to fear was 30% and 16.6% among participants attending dental care several times annually and seldom, respectively. Multiple logistic regression revealed that avoiding dental visits due to cost was less likely among participants with higher household income (OR 0.4, 95% CI 0.3–0.5) and more likely among participants with dental care need (OR 1.8, 95% CI 1.2–2.7). Cancelled and avoided appointments due to fear was most likely among those with need for dental care and lower education. Early unpleasant experience with dental care remained a covariate of avoidance behaviour due to fear. Conclusion: 14.7%, 30.5%, and 37.7% confirmed cancelled appointments due to fear, avoided ordering appointments due to fear, and avoided visiting the dentist due to cost. Avoiding dental care due to fear and economic burden was more and less common among participants with respectively, frequent and seldom use of dental care. Dental avoidance behaviours were highest among socially disadvantaged groups, indicating a hole in the welfare state model that needs political consideration. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Prevention & Treatment For Stomatological Diseases is the property of Journal of Prevention & Treatment For Stomatological Diseases Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dentophobia is a significant problem in oral health management. In the conditions of the COVID-19 pandemic, with the associated sanitary measures (quarantine, social distancing) at national level, the fear and dental anxiety are supposedly increased, especially in children. Pediatric patients are emotionally affected when they faced with the need for emergency dental intervention. The current study seeks to assess the emotional state of children aged 8-12, who needed dental care during quarantine, at the regional level, as well as the degree of anxiety of their parents. Dental anxiety was assessed independently by the dentist, parents and children themselves. If in children, the level of dental anxiety increased insignificantly, compared to the pre-pandemic period, the levels of parental anxiety were higher. The boys in the pandemic group had a higher level of anxiety, especially in the parental assessment. The results suggest that the reorganization of oral care in the pandemic scenario did not have a major effect on children's dental anxiety. However, the results of the assessment in boys show that they may be more vulnerable and need special care to alleviate their anxiety and reduce their risk of dentophobia in the future. These conclusions should be treated with caution, given the small sample size, which requires further confirmation. It is also important to convince parents of the safety of a visit to the dentist during a pandemic, to minimize their anxiety about their children's dental fears. [ABSTRACT FROM AUTHOR]

Treatments in dentistry currently consist of an interdisciplinary approach, including (but not necessarily limited to) the holistic perspective. The different fields of allopathic and complementary medicine are used together to ensure not only a high-quality restorative treatment, but also to provide patients with psychological and emotional support. This perspective also applies to dental anxiety, which consists of complex (emotional, vegetative and psychomotor) manifestations. One of the most well-known complementary therapies for reducing dental fear and anxiety is BachTM Flower Therapy. Even if the mechanism of action of this therapy is not yet scientifically documented, notable results have been and continue to be reported in the literature in several clinical studies on patients with dental diseases. It is indicated for both adults and children, in the latter when they go through major biological changes, such as primary and permanent dentition. As a conclusion, BachTM flower therapy is effective and complementary to dental treatments applied to patients, by reducing stress, anxiety, as well as creating a climate of peace, trust and confidence, both for the patient and the doctor. In addition, it is a relatively accessible and cheap form of care, with no significant adverse effects noted so far. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: A patient‐centered care (PCC) paradigm undergirds modern dental education. PCC is particularly relevant in the management of patient dental fear. The aims of this study were three‐fold: (a) to examine the preliminary psychometric properties of an author‐designed survey administered to explore dental fear knowledge and perceptions, (b) to assess how 4th‐year dental students regard dental fear, (c) and to investigate the relationship between students' knowledge and perceptions of dental fear and their clinical behavior. Methods: In 2022, 4th‐year dental students (N = 453) participated in a cross‐sectional study. Participants completed a 16‐item survey that assessed (a) knowledge and perceptions about dental fear, (b) common biases in patient fear assessment, and (c) patient management behaviors when fear is encountered. Exploratory factor analysis, descriptive statistics, and logistic regressions were run to address the study's aims. Results: Exploratory factor analysis revealed three factors, with the two strongest factors pertaining to beliefs about the importance of dental fear (α = 0.87) and self‐efficacy in managing fear (α = 0.74). Participants indicated that it is important to assess for dental fear and rated their self‐efficacy in ability managing it as high. Ratings on both factors slightly increased the odds of engaging in routine patient screening for dental fear. Students also displayed assessment biases commonly seen among practicing dentists. Conclusion(s): Results indicate educational gaps within the current behavioral‐science training for dental students. Changes to improve advanced dental students' appreciation of their patients' dental fear are warranted. [ABSTRACT FROM AUTHOR]

Copyright of Selcuk Dental Journal is the property of Selcuk Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Mental distress is highly reported in cancer patients, resulting in anxiety and depression most of the time. Both conditions, in turn, are recognized to be related to dental fear in adults; however, there are no studies on patients suffering from head and neck cancer. Thus, the present study aimed to investigate whether newly diagnosed patients with head and neck cancer are more prone to self-reported dental fear. Material and Methods: This dual-center cross-sectional study was conducted with 25 healthy outpatients and 25 patients with a recent diagnosis of head and neck cancer, all requiring dental care. The patients were informed at the first appointment about their dental therapy planning and the Brazilian Portuguese Version of the Dental Fear Survey (DFS) questionnaire was then applied after appropriate instructions. Results: The DFS total scores did not differ statistically between the groups (Mann-Whitney U test, P = 0,120) but the Cancer Group presented a slightly higher mean score (32.2 ± 10.0) than the Control Group (30.0 ± 14.2). Conclusion: Within the limitations of this study, newly diagnosed patients with head and neck cancer and healthy individuals seem to experience similar self-reported dental fear. [ABSTRACT FROM AUTHOR]

Abstract Objective The primary objective of this study was to validate an Urdu translation of Kleinknecht’s Dental Fear Survey (DFS) for use in Pakistan and to explore which items contribute the most to the variance in dental fear scores based on patient perceptions and lived experiences during dental care. Methodology This mixed-method study was conducted at Dow Dental Hospital from February 2022 to June 2022. For quantitative analysis, a total of 273 participants were enrolled through convenience sampling. After obtaining signed consent, participants were asked to self-report their dental fear. In-depth interviews with 25 patients displaying moderate to high dental fear were conducted to clarify the elements of dental fear scores through the lens of individual perceptions and experiences. Results The prevalence of moderate dental fear was significantly higher among female participants than males. The mean dental fear score was higher among females (39.47 ± 14.23) as compared to males (30.83 ± 10.50). Most of the female participants reported an increase in breathing rate and heartbeat during dental treatment. The highest mean fear score was reported by participants who underwent oral surgical treatment (42.98 ± 14.21), followed by participants who received restorative care (36.20 ± 12.60). Approaching the dentist’s office was the significant factor that contributed the most to the variance in dental fear scores. Four themes were generated through the content analysis of the interviews: physical reactions to dental procedures, perceptions and fears about surgical and restorative procedures, and gender and environmental factors in dental fear and interaction with dentists. Conclusion The Urdu translation of DFS is a reliable and valid instrument for assessing dental fears in Pakistan based on the findings of this study. Patients perceive surgical and restorative procedures as unpleasant and threatening. It was noted that “the heart beats faster” and “the breathing rate increases.“ were the top two physiological responses.

Abstract Background Dental treatments often cause anxiety, fear, and stress in patients. Intravenous sedation is widely used to alleviate these concerns, and various agents are employed for sedation. However, it is important to find safer and more effective sedation agents, considering the adverse effects associated with current agents. This study aimed to investigate the efficacy and safety of remimazolam besilate (hereinafter called “remimazolam”) and to determine the optimal dosages for sedation in outpatients undergoing dental procedures. Methods Thirty-one outpatients aged 18–65 years scheduled for impacted third molar extraction were included in the study. Remimazolam was administered as a single dose of 0.05 mg/kg followed by a continuous infusion at a rate of 0.35 mg/kg/h, with the infusion rate adjusted to maintain a sedation level at a Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score of 2–4. The primary endpoint was the sedation success rate with remimazolam monotherapy, and the secondary endpoints included induction time, recovery time, time until discharge, remimazolam dose, respiratory and circulatory dynamics, and frequency of adverse events. Results The sedation success rate with remimazolam monotherapy was 100%. The remimazolam induction dose was 0.08 (0.07–0.09) mg/kg, and the anesthesia induction time was 3.2 (2.6–3.9) min. The mean infusion rate of remimazolam during the procedure was 0.40 (0.38–0.42) mg/kg/h. The time from the end of remimazolam administration to awakening was 8.0 (6.7–9.3) min, and the time from the end of remimazolam administration to discharge was 14.0 (12.5–15.5) min. There were no significant respiratory or circulatory effects requiring intervention during sedation. Conclusions Continuous intravenous administration of remimazolam can achieve optimal sedation levels without significantly affecting respiratory or circulatory dynamics. The study also provided guidance on the appropriate dosage of remimazolam for achieving moderate sedation during dental procedures. Additionally, the study findings suggest that electroencephalogram monitoring can be a reliable indicator of the level of sedation during dental procedural sedation with remimazolam. Trial registration The study was registered in the Japan Registry of Clinical Trials (No. jRCTs061220052) on 30/08/2022.

Introduction: Anxiety related to dental treatments is a phenomenon known to all dentists. Recognizing and alleviating this emotional response is the dentists’ duty. When dental fear progresses into phobia, and the patient reacts to every dental procedures related situation with such intense fear that it already affects her entire behavior and general condition, external help may be necessary. Material and methods: Dental fear and anxiety. It is important to be able to separate a panic attack from other lifethreatening conditions (e.g. heart attack, anaphylactic shock). The symptoms of a panic attack are quite common and can be extremely sever, such as shortness of breath, feeling of suffocation, tachycardia, chest pain, trembling of the limbs, feeling of fainting, fear of death. Measurement of dental anxiety: Several questionnaires are available to measure dental fear, the two most significant of which (Dental Anxiety Scale and Dental Fear Survey) are also available in Hungarian. Treatment of dental fear: The most important and fundamental method is a detailed communication with the patient. The “tell-show-do” technique: we describe in simple words what will happen during the treatment, then we show the patient what tools we are going to use. Results, Case report: In our case report, we present the oral rehabilitation of a patient with severe dental fear. During the treatment of the lady, her dental fear could be significantly reduced, her willingness to cooperate steadily improved, and consequently a demanding dental prosthesis, including an implant prosthetic solution could be made. Discussion: Recognition of dental anxiety from the initial steps and the use of anxiety-relieving methods (that can be easily applied “chair side”) facilitating a significant improvement in the quality of life of a young lady. The long-term follow- up confirm that the patient’s oral health related quality of life significantly improved.

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

Aim:This study aimed to compare the dental fear and anxiety of dental patients aged 6-12 years before and during the coronavirus disease-2019 (COVID-19) pandemic.Materials and Methods:The first phase of the study was conducted on Group 1 (n=350) before the pandemic and the second phase was conducted on Group 2 (n=350) during the COVID-19 pandemic. Dental anxiety and fear were assessed using 4 scales: the modified dental anxiety scale (MDAS), the modified child dental anxiety scale, the dental subscale of the children’s fear survey schedule (CFSS-DS), and the dental fear scale (DFS). In the second phase, participants also filled out a questionnaire related to the COVID-19 pandemic. The data were analyzed using SPSS Statistics 25 (IBM, Armonk, New York).Results:There were no significant differences between the two groups based on their socio-demographic variables (p>0.05). Scores during the pandemic decreased significantly for the MDAS, CFFS-DS and DFS (p=0.002, p=0.002, p=0.010, respectively). In Group 2, 2% of participants reported that their anxiety increased because of the changes in the dentists’ personal protective equipment and 30.9% reported that they were anxious about COVID-19 transmission.Conclusion:In this study, pediatric dental patients' dental fear and anxiety decreased during the COVID-19 pandemic. Personal protective equipment did not affect pediatric dental patients' dental fear and anxiety.

IntroductionStress and anxiety are emotional states that often accompany patients who have to receive dental treatments, leading them to postpone or avoid treatments with the consequent deterioration of their oral health and, hence, their general condition. Music therapy has been shown to be an alternative to other treatments that are invasive and not without danger, such as anxiolytics or sedation. This systematic review and meta-analysis evaluated the effect of music therapy on anxiety and stress prior to dental treatments.MethodsStudies published in PubMed (through Medline), Web of Science (WOS), Embase, and Cochrane Library databases were consulted up to October 2023. The inclusion criteria were established for intervention studies (randomized controlled trials, RCTs) according to the PICOS (population, intervention, comparison, outcomes, and study) strategy in subjects with dental stress and anxiety (participants) treated with music therapy (intervention) in comparison with patients without music therapy (control) and evaluating the response to treatment (outcomes).ResultsA total of 154 results were obtained, with 14 studies finally selected. The risk of bias and the methodological quality were assessed using the Cochrane Risk of Bias Tool and the Jadad scale, respectively. A random-effects meta-analysis was used to quantify the results of the pooled studies, while a fixed-effects meta-analysis was used for studies in the pediatric population. The meta-analysis of pooled studies found statistical significance in the subgroups of anxiety and anxiety–stress (p = 0.03 and p = 0.05, respectively), with an overall effect in favor of the intervention group (p = 0.005). Meta-analysis of the studies in the pediatric population showed considerable statistical significance for the experimental group (p < 0.00001).ConclusionMusic therapy as a treatment for stress and anxiety, prior to dental treatment, proved to be effective in both children and adults although more well-designed randomized clinical studies are needed to validate its efficacy.Systematic review registrationINPLASY, identifier 202312000.

Objective: The primary objective of this study was to validate an Urdu translation of Kleinknecht's Dental Fear Survey (DFS) for use in Pakistan and to explore which items contribute the most to the variance in dental fear scores based on patient perceptions and lived experiences during dental care. Methodology: This mixed-method study was conducted at Dow Dental Hospital from February 2022 to June 2022. For quantitative analysis, a total of 273 participants were enrolled through convenience sampling. After obtaining signed consent, participants were asked to self-report their dental fear. In-depth interviews with 25 patients displaying moderate to high dental fear were conducted to clarify the elements of dental fear scores through the lens of individual perceptions and experiences. Results: The prevalence of moderate dental fear was significantly higher among female participants than males. The mean dental fear score was higher among females (39.47 ± 14.23) as compared to males (30.83 ± 10.50). Most of the female participants reported an increase in breathing rate and heartbeat during dental treatment. The highest mean fear score was reported by participants who underwent oral surgical treatment (42.98 ± 14.21), followed by participants who received restorative care (36.20 ± 12.60). Approaching the dentist's office was the significant factor that contributed the most to the variance in dental fear scores. Four themes were generated through the content analysis of the interviews: physical reactions to dental procedures, perceptions and fears about surgical and restorative procedures, and gender and environmental factors in dental fear and interaction with dentists. Conclusion: The Urdu translation of DFS is a reliable and valid instrument for assessing dental fears in Pakistan based on the findings of this study. Patients perceive surgical and restorative procedures as unpleasant and threatening. It was noted that "the heart beats faster" and "the breathing rate increases." were the top two physiological responses. [ABSTRACT FROM AUTHOR]

The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms. Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named 'depression', 'anxiety' and 'distress'. Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively. Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis. [ABSTRACT FROM AUTHOR]

Background: Dental fear affects children's oral health; there is, however, no evidence regarding the pathways linking possible predictors for its occurrence. Aim: This study aimed at exploring the direct and indirect effects of sociodemographic, clinical, behavioural and psychosocial factors on the development of dental fear in schoolchildren over time. Design: This is a prospective cohort study, with 10 years of follow‐up. The first assessment started in 2010 (T1) with a sample of 639 children aged 1–5 years from Southern Brazil. For this study, the follow‐up (T2) of these individuals was performed in 2020. Dental fear was assessed at T2 using the Brazilian version of the Children's Fear Survey Schedule–Dental Subscale (CFSS–DS). Socio‐economic, demographic, psychosocial and oral health measures were collected in both assessments. A structural equation model was performed to assess the direct and indirect pathways among variables at T1 and T2 to predict the CFSS–DS scores at T2. Results: Of the 639 children, 429 were re‐evaluated at T2. Higher levels of untreated dental caries, younger individuals, dental visits for nonroutine reasons and low sense of coherence at T2 directly impacted dental fear at T2. Considering the indirect effects, the presence of dental caries and low household income at T1 indirectly impacted higher levels of dental fear over 10 years via dental caries at follow‐up. Conclusion: Our findings suggest that socio‐economic, demographic, clinical, psychosocial and behavioural conditions can influence dental fear from childhood to adolescence. [ABSTRACT FROM AUTHOR]

Background: Dental treatments often cause anxiety, fear, and stress in patients. Intravenous sedation is widely used to alleviate these concerns, and various agents are employed for sedation. However, it is important to find safer and more effective sedation agents, considering the adverse effects associated with current agents. This study aimed to investigate the efficacy and safety of remimazolam besilate (hereinafter called "remimazolam") and to determine the optimal dosages for sedation in outpatients undergoing dental procedures. Methods: Thirty-one outpatients aged 18–65 years scheduled for impacted third molar extraction were included in the study. Remimazolam was administered as a single dose of 0.05 mg/kg followed by a continuous infusion at a rate of 0.35 mg/kg/h, with the infusion rate adjusted to maintain a sedation level at a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 2–4. The primary endpoint was the sedation success rate with remimazolam monotherapy, and the secondary endpoints included induction time, recovery time, time until discharge, remimazolam dose, respiratory and circulatory dynamics, and frequency of adverse events. Results: The sedation success rate with remimazolam monotherapy was 100%. The remimazolam induction dose was 0.08 (0.07–0.09) mg/kg, and the anesthesia induction time was 3.2 (2.6–3.9) min. The mean infusion rate of remimazolam during the procedure was 0.40 (0.38–0.42) mg/kg/h. The time from the end of remimazolam administration to awakening was 8.0 (6.7–9.3) min, and the time from the end of remimazolam administration to discharge was 14.0 (12.5–15.5) min. There were no significant respiratory or circulatory effects requiring intervention during sedation. Conclusions: Continuous intravenous administration of remimazolam can achieve optimal sedation levels without significantly affecting respiratory or circulatory dynamics. The study also provided guidance on the appropriate dosage of remimazolam for achieving moderate sedation during dental procedures. Additionally, the study findings suggest that electroencephalogram monitoring can be a reliable indicator of the level of sedation during dental procedural sedation with remimazolam. Trial registration: The study was registered in the Japan Registry of Clinical Trials (No. jRCTs061220052) on 30/08/2022. [ABSTRACT FROM AUTHOR]

Background and Objectives: One of the professional goals of pediatric dentistry is to promote a positive attitude and improve the dental health of society. The percentage of unmet medical needs in primary and permanent teeth in children is high, and dental fear and anxiety are some of the factors involved in this. The present study aimed to assess the relationship between 4-11-year-old children's dental anxiety and their behavior during treatment. Materials and Methods: This cross-sectional study was conducted on 272 children referred to pediatric dental clinics. After obtaining their consent, the children's parents completed a questionnaire containing the children's demographic information. In the waiting room, the child's fear and anxiety were evaluated based on two standard scales: Facial Image Scale and the Children's Fear Survey Schedule-Dental Subscale. After the treatment, the Frankle index was recorded by the dentist to assess the child's behavior. The obtained data were analyzed in SPSS software (version 20) using the chi-square test. Results: The average score obtained in the CFSS-DS test for children was 28.08. Anxiety Levels showed a statistically significant relationship with age (P=0.008) and history of dental visit (P=0.006). Children in the very happy group in the FIS and those in the anxious group in the CFSS-DS test displayed more negative behavior with the FBRS index (P=0.000). Conclusion: As evidenced by the obtained results, dental anxiety is lower in children with older age and a history of dental visits. The fear of injection and the sound of dental instruments were, respectively, the most important causes of dental anxiety in children. [ABSTRACT FROM AUTHOR]

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Objectives: Dental fear is common and yet often remains unrecognised. COVID-19 has challenged health care since 2020. This study aimed to evaluate patients’ self-reported dental fear and detection of dental fear by the dentists. Another aim was to validate a colour code instrument for estimating dental fear. The influence of COVID-19 on fear and attendance was assessed. Methods: A cross-sectional survey was conducted in the primary urgent dental care of Oulu, Finland, in spring 2020 and 2021 after the first (T1) and third waves (T2) of the pandemic. Data were obtained for analyses using the Modified Dental Anxiety Scale (MDAS), Facial Image Scale (FIS), and a new “traffic light” colour code for dental fear (CCF). The influence of COVID-19 on dental fear and attendance was assessed with structured and open-ended questions. The questionnaires were completed by 273 anonymous participants. Results: Of the participants, 167 (61.2%) visited dental care during T1 and 106 (38.8%) during T2. Their mean age was 45.1 years. An MDAS score of 19 or above, indicating severe fear, was reported by 10.6% of the participants. Of those with severe dental fear, 87% chose the red colour in the CCF “traffic light” system. The association between dentists’ and participants’ estimation of dental fear was weak (P < .001) and agreement with the red code was nonexistent (Cohen's kappa value = −0.035). MDAS scores of the younger participants were higher than those of the older ones after the first wave (T1) (P = .021). COVID-19 had the strongest influence on dental attendance and dental fear of those having the most severe self-reported dental fear as measured by the MDAS. Conclusions: Colour-coded traffic lights seem valid for screening severe dental fear and are easy and quick to use. They could be useful tools especially since recognising dental fear seems difficult for dentists. The COVID-19 pandemic has complicated dental care for the most fearful individuals.

Background and Objectives: Research into the relationship between occupation and dental fear and anxiety (DFA) is scarce. This exploratory study aimed to compare the level of DFA and its association with its predictors amongst adults from different occupational groups. Materials and Methods: A cross-sectional study with 422 respondents from four occupational groups (physicians, teachers, industry workers, and artists) was carried out. A questionnaire on previous dental experience using the Dental Anxiety Scale (DAS), Dental Fear Survey (DFS), and Self-Esteem Scale was self-administered electronically. The data analysis involved descriptive statistics and structural equation modeling (SEM). Results: The DFA levels differed significantly across the occupational groups, with the lowest mean scores among physicians (DAS = 9.29 (SE 0.39); DFS-1 = 14.67 (0.63); DFS-2 = 33.94 (1.69)) and the highest mean scores among artists (DAS = 10.74 (0.38); DFS-1 = 17.19 (0.71); DFS-2 = 41.34 (1.92)). A significant impact of self-esteem on DFA was observed among physicians, teachers, and artists, but not among industry workers. Multi-group analysis with SEM revealed differences in the variable association (Chi-squared = 53.75; df = 21; p < 0.001), thus rejecting the hypothesis of the same mechanism underlying DFA across occupational groups. Conclusions: Individuals from various occupations experience DFA at different levels, and there are different mechanisms underlying their DFA. These findings can provide valuable insights for dental practitioners in developing tailored approaches to reduce the feeling of DFA of their patients.

This study aimed to determine the associations between acculturation, dental anxiety, and dental utilization among Hispanics/Latinos living in the US. A proxy measure of dental anxiety was available for 7539 adults who had not visited a dentist within the last year. All completed the Short Acculturation Scale for Hispanics (SASH). Bivariate logistic regression and adjusted multivariable logistic regression analysis were conducted. Approximately 22% of the sample was dentally anxious. Dental anxiety was significantly associated with SASH language scale score (OR 1.09, 95%CI 1.02, 1.18, p = 0.04), years in US (OR 1.53, 95%CI 1.23, 1.91, p < 0.0001), and preferred Spanish language (OR 1.30, 95%CI 1.05, 1.63, p = 0.0192); lower acculturation corresponded to higher dental anxiety. Adjusting for sex, age, education, income, insurance, and oral health status, level of acculturation was associated with dental anxiety (AOR 0.87, 95%CI 0.75, 0.91, p = 0.009), but neither were associated with utilization. Acculturation may be an important predictor of dental anxiety for Hispanics/Latinos living in the US. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the dental fear and anxiety of dental patients aged 6-12 years before and during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods: The first phase of the study was conducted on Group 1 (n=350) before the pandemic and the second phase was conducted on Group 2 (n=350) during the COVID-19 pandemic. Dental anxiety and fear were assessed using 4 scales: the modified dental anxiety scale (MDAS), the modified child dental anxiety scale, the dental subscale of the children's fear survey schedule (CFSS-DS), and the dental fear scale (DFS). In the second phase, participants also filled out a questionnaire related to the COVID-19 pandemic. The data were analyzed using SPSS Statistics 25 (IBM, Armonk, New York). Results: There were no significant differences between the two groups based on their socio-demographic variables (p>0.05). Scores during the pandemic decreased significantly for the MDAS, CFFS-DS and DFS (p=0.002, p=0.002, p=0.010, respectively). In Group 2, 2% of participants reported that their anxiety increased because of the changes in the dentists' personal protective equipment and 30.9% reported that they were anxious about COVID-19 transmission. Conclusion: In this study, pediatric dental patients' dental fear and anxiety decreased during the COVID-19 pandemic. Personal protective equipment did not affect pediatric dental patients' dental fear and anxiety. [ABSTRACT FROM AUTHOR]