Arjen J. van Wijk

The Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD)

&NA; For musculoskeletal disorders like low back pain and fibromyalgia, evidence is growing for fear of movement to play an important role in the development of chronic pain. In temporomandibular disorder (TMD) patients, however, this construct has not received any attention yet. Therefore, in this paper, (1) a generally used instrument to measure fear of movement, the Dutch version of the Tampa Scale for Kinesiophobia (TSK), was adapted for its use in TMD patients (and translated for equivalence to English), (2) the psychometric properties of the Dutch version of the TSK‐TMD were assessed, and (3) the association of various symptoms of TMD (i.e., pain, joint sounds, and limited jaw movements) with fear of movement was evaluated. In a sample of TMD patients (N = 301), confirmatory factor analysis indicated that a two‐factor model based on 12 items provides the best fit of the TSK‐TMD, with activity avoidance and somatic focus as its subscales. This two‐factor solution of the Dutch TSK‐TMD has generally good reliability and convergent validity. Multiple regression analysis showed that TMD functional problems (i.e., temporomandibular joint sounds or a stuck/locked feeling) were more strongly associated with fear of movement than with pain. This finding leads to new perspectives regarding the interplay between musculoskeletal complaints, cognition, and avoidance behavior. The results provide a basis for use of the 12‐item version for routine assessment of fear of movement in TMD patients, and for future clinical studies, for example, to the role of fear of movement in TMD‐treatment success.

Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis

The effects of propranolol in the treatment of anxiety disorders have not been systematically evaluated previously. The aim was to conduct a systematic review and meta-analysis of randomised controlled trials, addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders. Eight studies met the inclusion criteria. These studies concerned panic disorder with or without agoraphobia (four studies, total n = 130), specific phobia (two studies, total n = 37), social phobia (one study, n = 16), and posttraumatic stress disorder (PTSD) (one study, n = 19). Three out of four panic disorder trials qualified for pooled analyses. These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia. Also, no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation. In conclusion, the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders.

A comparison of two implant techniques on patient-based outcome measures: a report of flapless vs. conventional flapped implant placement

BACKGROUND Flapless implant surgery is considered to offer advantages over the traditional flap access approach. There may be minimized bleeding, decreased surgical times and minimal patient discomfort. Controlled studies comparing patient outcome variables to support these assumptions, however, are lacking. AIM The objective of this clinical study was to compare patient outcome variables using flapless and flapped implant surgical techniques. PATIENTS AND METHODS From January 2008 to October 2008, 16 consecutive patients with edentulous maxillas were included in the study. Patients were randomly allocated to either implant placement with a flapless procedure (eight patients, mean age 54.6 + or - 2.9 years) or surgery with a conventional flap procedure (eight patients, mean age 58.7 + or - 7.2 years). All implants were placed using a Nobel guide CT-guided surgical template. Outcome measures were the Dutch version of the Impact of Event Scale-Revised (IES-R), dental anxiety using the s-DAI and oral health-related quality of life (OHIP-14). RESULTS Ninety-six implants were successfully placed. All implants were placed as two-phase implants and the after-implant placement dentures were adapted. No differences could be shown between conditions on dental anxiety (s-DAI), emotional impact (IES-R), anxiety, procedure duration or technical difficulty, although the flapless group did score consistently higher. The flap procedure group reported less impact on quality of life and included more patients who reported feeling no pain at all during placement. CONCLUSIONS Differences found in the patient outcome variables do suggest that patients in the flapless implant group had to endure more than patients in the flap group.

Dutch translation of the Fear of Pain Questionnaire: Factor structure, reliability and validity

Background The Fear of Pain Questionnaire (FPQ‐III) is a 30‐item self‐report instrument measuring fear of a variety of pain‐related stimuli.

Anxiety sensitivity as a predictor of anxiety and pain related to third molar removal.

PURPOSE Anxiety sensitivity (AS) refers to the fear of anxiety-related symptoms resulting from beliefs that such sensations have negative somatic, social, or psychological consequences. The aim of the present study was to investigate whether AS can predict both anticipated and experienced pain and state and trait anxiety related to third molar removal. MATERIALS AND METHODS Data were collected from 160 patients who had completed measures of anxiety sensitivity, including the Anxiety Sensitivity Index, the short form of the Fear of Dental Pain questionnaire, the short form of the Dental Anxiety Inventory, and numeric rating scales to assess the anticipated anxiety and pain. Postoperatively, patients were asked to rate their experienced anxiety and pain during treatment, first immediately after surgery and again after 2 days and after 1 week. RESULTS AS was significantly associated with the severity of dental trait anxiety. However, multiple stepwise regression analysis revealed that AS did not significantly predict anticipated and experienced anxiety and pain beyond that of state anxiety and fear of dental pain. State anxiety was the single best predictor of trait anxiety and pain, followed by the fear of dental pain. CONCLUSIONS In the present study, AS did not predict anxiety and pain related to third molar removal. One possible explanation is that most measures were taken postoperatively, a period in which anticipatory anxiety is irrelevant.

Psychological Impact of Third Molar Surgery: A 1-Month Prospective Study

PURPOSE To prospectively examine the psychological impact of surgical third molar removal, and to identify possible psychological risk factors for the development of dental anxiety and symptoms of psychological trauma. MATERIALS AND METHODS Patients (N = 71) scheduled for surgical mandibular third molar removal were assessed regarding operative and psychological variables immediately postoperatively and at 1-week and 1-month follow-up. RESULTS The emotional impact of the surgical procedure appeared to be modest. Only a small proportion of respondents reported a significant increase in dental anxiety or posttraumatic stress (4.3%) at 1-month follow-up. CONCLUSIONS The results suggest that surgical removal of a third molar by use of local anesthesia, without sedation or general anesthesia, has minimal impact on the development of dental anxiety or symptoms of psychological trauma. Replication of the findings in samples with higher preoperative anxiety levels and with other types of surgical procedures is warranted.

Periodontitis is an independent risk indicator for atherosclerotic cardiovascular diseases among 60 174 participants in a large dental school in the Netherlands

Background The association between periodontitis and atherosclerotic cardiovascular diseases (ACVD) has been established in some modestly sized studies (<10 000). Rarely, however, periodontitis has been studied directly; often tooth loss or self-reported periodontitis has been used as a proxy measure for periodontitis. Our aim is to investigate the adjusted association between periodontitis and ACVD among all individuals registered in a large dental school in the Netherlands (Academic Centre for Dentistry Amsterdam (ACTA)). Methods Anonymised data were extracted from the electronic health records for all registered patients aged >35 years (period 1998–2013). A participant was recorded as having periodontitis based on diagnostic and treatment codes. Any affirmative answer for cerebrovascular accidents, angina pectoris and/or myocardial infarction labelled a participant as having ACVD. Other risk factors for ACVD, notably age, sex, smoking, diabetes, hypertension, hypercholesterolaemia and social economic status, were also extracted. Logistic regression analyses were used to evaluate the adjusted associations between periodontitis and ACVD. Results 60 174 individuals were identified; 4.7% of the periodontitis participants (455/9730) and 1.9% of the non-periodontitis participants (962/50 444) reported ACVD; periodontitis showed a significant association with ACVD (OR 2.52; 95% CI 2.3 to 2.8). After adjustment for the confounders, periodontitis remained independently associated with ACVD (OR 1.59; 95% CI 1.39 to 1.81). With subsequent stratification for age and sex, periodontitis remained independently associated with ACVD. Conclusions This cross-sectional analysis of a large cohort in the Netherlands of 60 174 participants shows the independent association of periodontitis with ACVD.

Pain related to mandibular block injections and its relationship with anxiety and previous experiences with dental anesthetics.

OBJECTIVE Anesthetic injections should reassure patients with the prospect of painless treatment, but for some patients it is the main source of their fear. We investigated pain resulting from mandibular block injections in relation to anxiety and previous experience with receiving injections. STUDY DESIGN Patients (n = 230) filled out questionnaires before oral surgery. They were then asked to raise their hand when they felt pain as a result of the injection. The injection was administered, and pain intensity (11-point numeric rating scale) and pain duration (in seconds) was measured. RESULTS In general, patients expected (mean 4.2, SD 2.7) significantly more pain than they experienced (2.4 ± 2.2). About 8.3% of patients reported a score in the range of 7 to 10. On average, pain lasted for 6.2 seconds (range 1-24.5 s), ≈ 36% of patients raised their hand for ≤ 2 seconds, and 14.6% raised their hand for ≥ 10 seconds. Pain was significantly positively associated with anxiety and the way previous injections were experienced. CONCLUSIONS Mandibular block injections can be considered to be mildly painful, with pain lasting only a few seconds. The pain experience of a mandibular block seems only partly dependent on experienced anxiety and previous experiences with receiving injections.

Preparatory information for third molar extraction: does preference for information and behavioral involvement matter?

OBJECTIVE The objectives of the present study were to: (1) evaluate the impact of high versus low information provision in terms of anxiety towards third molar extraction (TME) as well as satisfaction with information provision. (2) Investigate how preference for information and behavioral involvement, interacted with the provision of information in terms of satisfaction with information and anxiety related to TME. METHODS Psychology freshmen completed the Krantz Health Opinion Survey and questions concerning anxiety about TME (pretest). They were randomly allocated into 2 conditions and asked to read either high or low information concerning TME. A posttest questionnaire (anxiety items and evaluation of the information) was then completed. RESULTS Data for 320 subjects were analysed (mean age=20.3, S.D.=4.0, range 16-51 years). Individual differences in preference for information did not affect outcome variables. There was a clear effect for information condition. The high information text was rated as more informative, requiring less additional information, and led to higher satisfaction by all participants. CONCLUSION Results suggest that more information is preferred, even when taking into account differences in preference for information and behavioral involvement. PRACTICE IMPLICATIONS Although more work is needed within samples of actual TME patients, these preliminary findings may have important implications for information provision for this common procedure.

Usefulness of a trauma-focused treatment approach for travel phobia

Despite its prevalence and potential impact on functioning, there are surprisingly little data regarding the treatment responsiveness of travel phobia. The purpose of this non-randomized study was to evaluate the usefulness of a trauma-focused treatment approach for travel phobia, or milder travel anxiety arising as a result of a road traffic accident. Trauma-focused Cognitive Behavioural Therapy (TF-CBT), and Eye Movement Desensitization and Reprocessing were used to treat a sample of 184 patients, who were referred to a psychological rehabilitation provider. Patients in both treatment groups were encouraged to encounter their feared objects and situations between sessions. Specific (i.e., travel) phobia was diagnosed in 57% of cases. Patients in both treatment conditions showed equally large, and clinically significant, decreases in symptoms as indexed by three validated measures (Impact of Event Scale, Hospital Anxiety and Depression Scale, and General Health Questionnaire), therapist ratings of treatment outcome, and a return to driving or travelling by car or motorbike. These improvements were obtained within an average course of 7.3 sessions of 1 hour each. Patients with travel phobia responded with a greater reduction of anxiety and post-traumatic stress disorder symptoms than those with milder travel anxiety. Passengers reported higher levels of trauma symptoms than drivers, but no difference in effectiveness of treatment was found between these groups. The results suggest that trauma-focused psychological interventions can be a treatment alternative for patients with travel anxiety. Given the seriousness of the clinical problems related to road traffic accidents more rigorous outcome research is warranted and needed.