Magne Raadal

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.

The Prevalence of Dental Anxiety in Children from Low-income Families and its Relationship to Personality Traits

The prevalence of dental anxiety and the association between dental anxiety and personality traits were examined in a population-based sample of 895 US urban children, from 5 to 11 years of age, from low-income families. Dental anxiety was reported by the child using the Dental Subscale (DS) of the Childrens Fear Survey Schedule, and behavioral problems and personality traits were evaluated by parent report on the Child Behavior Checklist (CBCL). Mean DS scores were 31.1 (SD = 10.3) for boys and 34.3 (SD = 11.0) for girls. CBCL score means were 33.3 (SD = 23.2) for boys and 28.5 (SD = 19.1) for girls. The hypothesized relationship between DS and CBCL scores in this population was not demonstrated.

The ability of Corah's Dental Anxiety Scale and Spielberger's State Anxiety Inventory to distinguish between fearful and regular Norwegian dental patients

The purpose of this study was to test the ability of Corahs Dental Anxiety Scale (DAS) and Spielbergers State Anxiety Inventory (STAI-S) to distinguish between fearful (n = 145) and regularly attending (n = 156) Norwegian dental patients. The reliability of both instruments was high (Cronbachs alpha indices > 0.95). With DAS, 90% of the fearful patients and 85% of the reference patients were correctly assigned to their appropriate group. Thus it may be concluded that, when used on a Norwegian population, DAS is a valid instrument for distinguishing fearful patients from those regularly attending dental treatment. The corresponding figures for STAI-S were 80% for the fearful patients and 79% for the reference patients. Although not developed specifically for this purpose, this instrument may therefore still validly be used to distinguish between the groups. The correlation between the instruments was 0.76, indicating that to some extent they measure the same phenomenon.

Behavior Problems in 5− to 11-Year-Old Children from Low-Income Families

OBJECTIVE The aims of the present study were to survey the Child Behavior Checklist (CBCL) scores (behavioral section) in a nonclinical population of US urban children from low-income families and to compare the distribution and pattern of scores with the normative data in the CBCL manual (1991). METHOD The sample consisted of 890 low-income children and a mother or female guardian selected randomly from among Seattle public school students aged 5 to 11 years. RESULTS In this sample the total CBCL score as well as all subscale scores were significantly higher than the norms. The proportion of children who scored in the clinical/borderline range was also higher than the norm. CONCLUSIONS These findings support previous work showing that poverty is a risk factor for mental distress in children. They also raise questions about the validity of the CBCL norms for screening or research purpose for low-income families.

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.

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.

The efficiency of cleaning fissures with an air-polishing instrument

It is important to remove organic material before sealing fissures. The aim of this study was to evaluate the cleansing effect of an air-polishing instrument (Prophy Unit, 2000 Satelec). Nine pairs of newly erupted premolars were treated. One of the teeth was randomly selected for air-polishing; the contralateral one was cleaned with a rubber cup and a standardized solution of pumice. The teeth were immediately extracted and later photographed in a scanning electron microscope. The photos were mounted together, forming one large picture of each fissure. These pictures were split into pairs of contralateral sections, 22 pairs altogether. Three independent observers gave a score to the cleanest section within each pair. This evaluation was repeated after 7 weeks. The air-polished sections obtained 126.5 of 132 possible scores, whereas pumice was given only 5.5 (P = 0.0039). It is concluded that air-polishing is an effective pretreatment for fissure sealing of newly erupted teeth.

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.

Caries increment and prediction from 12 to 18 years of age: A follow-up study

Aim: This was to determine the increment of caries from 12 to 18 years of age and to explore the possibility of predicting caries increment in this period based on the caries experience at age12 years. Study design: Prospective longitudinal survey. Methods: A sample of 12-year-old children (n =159) were examined in 1993 and 70% of them re-examined at 18 years of age. Bitewing radiographs were taken and a diagnostic system using five caries grades (D1−D5) was used at both ages. Children at risk were defined as those who developed manifest caries lesions (D3−5FS) on approximal surfaces during the follow-up period. Possible predictors were analysed by calculation of sensitivity, specificity, and actual proportion of the population at risk. Results: The mean caries increment (D1−5MFS) from 12 to 18 years of age was 4.2 (SD±9.1). The percentage of caries-free adolescents at 12 and 18 years of age was 10% and 1% respectively; 25% had either a reversal or no increment in caries experience while the D1−5MFS increased in 65% of the adolescents. Of the increment of manifest lesions (D3−5FS), 18% were located in incisors/canines, 40% in premolars, 26% in first molars and 16% in second molars. Premolars had the largest proportion of the approximal surfaces with manifest caries increment. The best predictors of children at risk of approximal caries increment (D3−5FS) were caries experience (D1−5FS) on the approximal surfaces of premolars and second molars at the age of 12 years. The individuals that developed four or more manifest lesions on approximal surfaces between 12 and 18 years were the easiest to predict (sensitivity + specificity = 175%). Conclusions: There was a considerable increment of manifest caries lesions from 12 to 18 years of age in all tooth groups. The best predictors for increment of manifest caries on approximal surfaces during the age period were approximal caries in premolars and second molars at the age of 12 years.