Erik Skaret

Attentional and physiological characteristics of patients with dental anxiety

Twenty patients with dental anxiety were investigated while seated in a dental chair in a dental clinic. Heart rate (HR), heart rate variability (HRV), and skin conductance level (SCL) were recorded while the patients were exposed to scenes of dental treatment as well as a Stroop attentional task. Results showed an attentional bias with longer manual reaction times (RTs) to the incongruent compared to the congruent color words as well as the threat compared to the neutral words. Longer RTs to the incongruent and the threat words were found in the low HRV patients compared to the high HRV patients. Furthermore, all patients showed an increase in HR during exposure and the Stroop task compared to baseline. The HRV showed a decrease during the exposure and the Stroop task compared to baseline. HR and HRV did not differ between exposure and the Stroop task. Moreover, HR and HRV did not return to baseline levels during the recovery period. The SCL showed an increase from baseline to exposure, from exposure to the Stroop task and a decrease in the recovery phase. Results showed the importance of vagal cardiac control in attentional, emotional, and physiological processes in patients suffering from dental fear.

Socio-economic inequality in the self-reported number of natural teeth among Norwegian adults--an analytical study.

OBJECTIVE To assess inequality in dental status associated with educational level, gross personal and family income among Norwegian adults. METHODS Data were collected by Norways Central Bureau of Statistics in November-December 2003. A two-stage, proportional random sample comprising 2000 persons aged 16-79 years was drawn from the national population register. Information became available for 1309 subjects by interview. The present analyses pertain to 1092 subjects aged 25-79 years (response rate 66%, mean age 47.9 years). RESULTS Of the respondents, 3% were edentulous and 9% had fewer than 20 teeth. The mean number of teeth was 27.1 (SD 7.0). In multiple logistic regression analysis, low gross personal and adjusted family income were associated with increased likelihood of having fewer than 20 natural teeth (OR = 2.84, 95% CI 1.58, 5.10; OR = 3.63, 95% CI 1.99, 6.62, respectively). Educational level was significantly associated with dental status in bivariate but not in multivariate analyses, except once among males. The predictors of socio-economic inequality in dental status accounted for a limited proportion of explained variance (Nagelkerkes R(2)) when controlling for age, place of residence, perceived oral health compared with others, perceived importance of oral health, dental attendance and smoking. CONCLUSION Socio-economic inequality in dental status persists among Norwegians aged 25-79 years but absolute differences have decreased during the last 30 years. The findings are encouraging but challenging as far as choice of strategy for further reduction of differences in tooth loss.

Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18‐year‐olds in Norway

BACKGROUND More knowledge about the relationship between blood-injury-injection phobia (BIIP) and dental anxiety (DA) may give new clinically relevant information in the assessment and management of children with DA. OBJECTIVE The aims of this study were to explore the relationships between BIIP and DA, and to explore to what extent the two subtypes of BIIP in combination with DA are related to self-reported probability of avoiding dental treatment if a dental injection is needed. METHODS The subjects were a random sample of 1385 18-year-olds attending high schools in a county of Norway, and the data were collected by use of questionnaires completed in classrooms. The survey instruments applied were Dental Fear Survey, Injection Phobia Scale-Anxiety, and Mutilation Questionnaire. RESULTS About 11% of the subjects with DA and subtypes of BIIP, respectively, reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed. In multiple regression analysis, only DA contributed to self-reports of high probability of avoiding dental treatment. CONCLUSION The results indicate that among adolescents, BIIP is relatively often connected with DA. Clinical implications are discussed.

Parental beliefs and attitudes towards child caries prevention: assessing consistency and validity in a longitudinal design

BackgroundExploring the stability of self-reports over time in observational studies may give valuable information for the planning of future interventions. The aims of the present study were: 1) to explore the consistency of parental self-reports of oral health habits, beliefs and attitudes towards child oral health care over a two-year period; 2) to evaluate possible differences in item scores and consistency between parents with different immigrant status; and 3) to assess the construct validity of items measuring parental beliefs and attitudes towards child oral health care.MethodsThe sample (S1, n = 304) included parents of 3-year-old children in Oslo, Norway; 273 mothers of western origin (WN-group) and 31 of non-western origin (IM-group). They were surveyed in 2002 (child age 3 years) and in 2004 (child age 5 years). Two additional samples of parents were also included; one with 5-year old children in 2002 (S2, n = 382) and one with 3-year-old children in 2004 (S3, n = 427). The questionnaire included items measuring child oral health habits and parental beliefs and attitudes towards child oral health care.ResultsIn 2002, 76.8% of the parents reported that they started to brush their childs teeth before the age of 1 year. Eighty-five percent of them reported the same in 2004; 87.0% of the WN-group and 33.3% of the IM-group (P < 0.001). For 17 of 39 items measuring beliefs and attitudes the responses were more positive for the WN-compared to the IM-group. Parents of caries-free children in 2004 reported significantly more positive beliefs and attitudes towards child oral health care in 2002 compared to parents of children with caries in 2004 (P < 0.05, P < 0.01 and P < 0.001). No differences in mean item scores were found between the three samples S1, S2 and S3.ConclusionThe results showed a fair to good consistency of parental self-reports from 2002 to 2004. They also indicate that parents with different cultural backgrounds should be evaluated separately and in a cultural context.

General self-efficacy, dental anxiety and multiple fears among 20-year-olds in Norway.

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.

One‐ vs. five‐session treatment of intra‐oral injection phobia: a randomized clinical study

The present study aimed to evaluate the effect of one and five sessions of treatment for intra-oral injection phobia in 55 subjects fulfilling the DSM-IV criteria for specific phobia. The subjects were randomly assigned to one or five sessions of cognitive behavioural therapy (CBT) performed by dentists. Assessments included behavioural tests and self-report instruments used pretreatment, post-treatment, and at 1 yr of follow-up. The dental anxiety scale (DAS), the injection phobia scale-anxiety, and the mutilation questionnaires were applied. Mean avoidance duration of intra-oral injections before treatment was 7.0 yr. The results showed that 89% of the subjects had received intra-oral injections from a regular dentist during the 1-yr follow-up. The only significant difference between the one- and the five-session groups was that the five-session group reported less anxiety (as measured using the DAS) at 1 yr of follow-up. It was concluded that both treatments performed by dentists specially trained in CBT have a significant treatment effect on the intra-oral injection phobia.

Dental anxiety and dental attendance among 25-year-olds in Norway: time trends from 1997 to 2007

BackgroundSo far, there are few studies considering the development of dental anxiety and dental attendance patterns across time in the general population of Norwegian adults. This study aimed to 1) determine the frequency of dental anxiety and regular dental attendance among 25-year-olds in Norway in 1997 and 2007, 2) to study the development (time trend) of dental anxiety and the socio-behavioral distribution of dental anxiety from 1997 to 2007.MethodRandom samples of 1,190 and 8,000 25-yr-olds were drawn from the populations of three counties in Western Norway in 1997 and 2007, respectively. The eligible participants received questionnaires by mail including questions on socio-demographics, dental anxiety (DAS) and dental attendance.ResultsIn 1997, 11.5% males versus 23% females reported high dental anxiety (DAS ≥ 13). Corresponding figures in 2007 were 11.3% and 19.8%. The proportions who had attended yearly for a dental check-up during the past 5 years fell from 62% in 1997 (men 56.9% and women 66.4%) to 44.6% (men 38.1% and women 48.6%) in 2007. After controlling for potential confounding factors, the 25-year-olds were 1.4 times more likely to report dental anxiety in 1997 compared to 2007. The decrease was largely attributable to a lower mean DAS score among higher educated females in 2007 than in 1997. The discrepancy in dental anxiety between regular and non-regular dental attendees had decreased, largely attributable to a decline in dental anxiety among irregular dental attendees.ConclusionThe study showed reduced dental anxiety and dental attendance among 25 year-olds in Norway from 1997 to 2007. This study points to the importance of controlling for possible changes in socio-demographic distributions when different cohorts are compared.

Oral health and oral treatment needs in patients fulfilling the DSM-IV criteria for dental phobia: Possible influence on the outcome of cognitive behavioral therapy

Objective. To describe oral health and oral treatment needs in a group of dental phobic patients (DSM-IV) and to explore possible relationships between these factors and changes in self-reported dental anxiety before and after phobia treatment. Material and Methods. Forty patients (25 women) fulfilling the DSM-IV criteria for specific phobia were included in the study. Mean age of the group was 34.9 years (range 19–60) and mean dental avoidance was 11.2 years (range 3–30 years). They were treated with cognitive behavioral therapy (CBT) during either one session (3 h) or five sessions (1 h each). Oral health was evaluated by orthopantomogram and clinical examination. The outcome of the CBT was measured by the change in dental anxiety scores (DAS, DFS) and in positive and negative thoughts during a standardized dental behavior test from pretreatment to 1-year follow-up. Results. Mean (SD) DMFT was 16.5 (5.8), range 3–26; DT was 6.6 (4.2). Mean number of teeth with dental treatment need (restorative, periodontal, extractions, etc.) was 9.6 (6.9), range 1–28. There were statistically significant correlations between number of decayed teeth and decrease in negative thoughts (r=−0.39, p=0.048) and maximum anxiety (r=−0.65, p=0.001). The total number of teeth with treatment need correlated with an increase in positive thoughts (r=0.60, p=0.001) and decrease in maximum anxiety (r=0.50, p=0.015). Conclusions. There are large variations in oral health and treatment needs among patients fulfilling the DSM-IV criteria for dental phobia. Patients with the best dental health and lowest treatment needs experience the largest increase in positive cognitions during exposure to dental treatment at 1-year follow-up.

Oral health and its influence on cognitive behavioral therapy in patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for intra-oral injection phobia

Abstract Objective. To describe self-perceived and clinically assessed oral health and oral treatment needs among intra-oral injection-phobic patients (Diagnostic and Statistical Manual of Mental Disorders-IV) and to explore whether these factors have an impact on the outcome of cognitive behavioral therapy (CBT). Material and methods. Fifty-five patients (43 women, mean age 32.5 years, range 18–62 years) were treated with short-duration CBT. Dental anxiety (Dental Anxiety Scale and Dental Fear Survey) and self-perceived oral health were assessed by means of questionnaires. Three dentists assessed oral health by means of clinical examination and radiographs. Treatment outcome was measured by ability to receive an intra-oral injection by a general dentist within a 1-year follow-up (FU) period or ability to complete a behavioral avoidance test (BAT) at FU, and changes in dental anxiety and positive and negative thoughts from pretreatment to FU. Results. Forty percent of patients ranged their oral health as “good” or “very good”. Mean decayed teeth (DT) was 2.2 (range 0–15). The total number of teeth in need of treatment, periodontal treatment, endodontic treatment and extractions ranged from 0 to 15, 0 to 19, 0 to 4 and 0 to 5, respectively. Self-rated oral health correlated significantly with clinical oral health. The outcome of CBT in terms of being able to receive a dental injection during FU was not influenced by oral health status. However, correlation analyses indicated that patients with the poorest oral health had the greatest increase in positive thoughts and the greatest decrease in negative thoughts from pretreatment to FU. Conclusions. The oral health of intra-oral injection-phobic patients varies substantially, but is comparable to that of the normal population. Coping with a dental injection after CBT is not influenced by oral health and treatment needs.

Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia

Abstract Objective. To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. Materials and methods. Subjects were 55 patients (mean age 35.5 ± 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. Results. Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. Conclusions. Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.