Tracy Getz

CARL: A LabVIEW 3 computer program for conducting exposure therapy for the treatment of dental injection fear

This paper describes CARL (Computer Assisted Relaxation Learning), a computerized, exposure-based therapy program for the treatment of dental injection fear. The CARL program operates primarily in two different modes; in vitro, which presents a video-taped exposure hierarchy, and in vivo, which presents scripts for a dentist or hygienist to use while working with a subject. Two additional modes are used to train subjects to use the program and to administer behavioral assessment tests. The program contains five different modules, which function to register a subject, train subjects to use physical and cognitive relaxation techniques, deliver an exposure hierarchy, question subjects about the helpfulness of each of the therapy components, and test for memory effects of anxiolytic medication. Nine subjects have completed the CARL therapy program and 1-yr follow-up as participants in a placebo-controlled clinical trial examining the effects of alprazolam on exposure therapy for dental injection phobia. All nine subjects were able to receive two dental injections, and all reduced their general fear of dental injections. Initial results therefore indicate that the CARL program successfully reduces dental injection fear.

Psychiatric Diagnoses Among Self-Referred Dental Injection Phobics

In order to determine the psychiatric characteristics of people with dental injection phobia. 118 dental injection phobics were systematically assessed using a structured clinical interview and a written questionnaire. Fifty-four percent of subjects had a current Axis I diagnosis other than dental injection phobia, mainly anxiety, mood or adjustment disorder, and 68.6% of subjects had an additional lifetime Axis I diagnosis. Subjects with additional current Axis I diagnoses reported higher dental anxiety, greater severity of injection fear cognitions, and poorer relationships with dental professionals, than did subjects without any or with past Axis I diagnoses. Further investigation is needed to explore the treatment possibilities for patients with and without additional current diagnoses.

Beliefs about professional ethics, dentist-patient communication, control and trust among fearful dental patients: the factor structure of the revised Dental Beliefs Survey.

The revised version of the Dental Beliefs Survey (DBS‐R), intended to measure three dimensions of the patient–dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5‐factor solution, basically including the 3 assumed dimensions as well as the re‐introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS‐R, i.e. items 3, 11, 18, and 28. The reduced DBS‐R is recommended for clinical use when assessing the patients perception of the relationship to the dentist, including both trust and ethical behavior.

Amnestic and anxiolytic effects of alprazolam in oral surgery patients

PURPOSE This study was designed to identify a dose of alprazolam that would reduce anxiety associated with oral surgery without causing accompanying memory impairment. PATIENTS AND METHODS Thirty-six subjects in experiment 1 and 48 subjects in experiment 2 were pretested on a computerized memory battery to establish baseline performance. Subjects were then randomly assigned to receive placebo, 0.25 mg, or 0.75 mg oral alprazolam (experiment 1) or placebo, 0.25 mg, 0.50 mg, or 0.75 mg oral alprazolam (experiment 2). Forty-five minutes after the double-blind administration of alprazolam, subjects were given a second memory battery. The memory batteries tested story recall and recognition and word recall and recognition. Subjects in experiment 2 subsequently underwent oral surgery for the removal of one to four molars. The subjects completed anxiety questionnaires both before and after surgery. RESULTS The 0.75-mg and 0.50-mg doses, but not the 0.25-mg dose, impaired word recall. The 0.75-mg dose also impaired story recall and recognition. The proportion of subjects reporting moderate to high anxiety during oral surgery decreased with increasing doses of alprazolam. Multiple regression indicated that the 0.75-mg alprazolam dose significantly decreased anxiety during oral surgery. The 0.25-mg and 0.50-mg doses also tended to reduce anxiety, but beta values for these doses did not reach significance. CONCLUSIONS These findings indicate that alprazolam produces memory impairment at the dosages necessary to produce clinically significant anxiolysis during oral surgery.

Dental malpractice experience: a closed claim study.

This study is part of a larger study of closed dental malpractice claims recently funded by the Agency for Health Care Policy and Research, US Public Health Service. This paper focuses on the outcome of malpractice claims against dentists in a major state. Limiting the analysis of dentist closed claims to one state experience allows us to avoid confounding because of differences in legal, market, and sociodemographic characteristics across states and to concentrate