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Healthcare (Basel, Switzerland) Apr 2021The objective of this paper was to evaluate the studies that have reported on psychological issues among dental students in Saudi Arabia and to develop coping strategies... (Review)
Review
The objective of this paper was to evaluate the studies that have reported on psychological issues among dental students in Saudi Arabia and to develop coping strategies to overcome these mental health-related issues. The present systematic review is in accordance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for the articles was carried out in the electronic databases by four independent researchers. The data search was performed in the electronic search engines like PubMed, Google Scholar, Web of Science, Scopus, Medline, Embase, Cochrane and Saudi Digital Library for scientific research articles published from January 2000 until December 2020. STROBE guidelines were adopted for qualitative analysis of six articles which met the eligibility criteria. The analysis of the literature revealed that most of the studies included were conducted in the past 8 years in different regions of Saudi Arabia. Findings of this systematic review clearly state that dental students in Saudi Arabia experience higher levels of depression, stress and anxiety and stress during their education period, with a higher stress for female students compared to male students. There is an urgent need to introduce interventional programs and preventive strategies to overcome the long-term effects.
PubMed: 33917191
DOI: 10.3390/healthcare9040429 -
Dentistry Journal Dec 2023Understanding predictors of pain associated with paediatric dental procedures could play an important role in preventing loss of cooperation, which often leads to the... (Review)
Review
Understanding predictors of pain associated with paediatric dental procedures could play an important role in preventing loss of cooperation, which often leads to the procedure having to be performed under general anaesthesia. We aimed to identify predictors of intra-operative and post-operative pain associated with routine dental procedures in children. A systematic review of observational studies was performed using electronic searches on MEDLINE, EMBASE, PsycINFO, Global Health via OVID, PubMed, Scopus, and SciELO. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate the quality of the included studies, which were meta-analysed to estimate the impact of dental procedures and anxiety on children's pain perception. A meta-regression analysis was also performed to determine the relative effect of predictors on children's pain perception measured as mean differences on a visual analogue scale (VAS). The search identified 532 articles; 53 were retrieved for full-text screening; 6 studies were included in the review; and 4 were eligible for the meta-analysis. The meta-analysis showed the types of procedures that predicted intra-operative pain, with dental extractions being the most painful (Mean VAS Difference [MD] 46.51 mm, 95% confidence interval [CI] 40.40 to 52.62 mm). The meta-regression showed that pain scores for dental extractions were significantly higher than polishing (the least painful procedure (reference category)) by VAS MD = 23.80 mm (95% CI 5.13-42.46 mm, -value = 0.012). It also showed that highly anxious children reported significantly higher pain scores during dental procedures by a 12.31 mm MD VAS score (95% CI 5.23-19.40 mm, -value = 0.001) compared to those with low anxiety levels. This systematic review demonstrates that the strongest predictors of intra-operative pain associated with paediatric dental procedures are dental extractions followed by drilling. Children with high anxiety also reported more pain for similar procedures. Tailoring interventions to reduce pain associated with paediatric dental procedures should be a priority for future research, as reducing pain can impact compliance and could reduce the need for general anaesthesia in dental treatment.
PubMed: 38248212
DOI: 10.3390/dj12010004 -
Cureus Aug 2022Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the... (Review)
Review
Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the pre-operative phase could cause the dentist to have issues with behavior control. Additionally, it may make pediatric dental treatments less effective. In order to reduce anxiety and control behavior in children receiving dental care, sedation is a pharmacological management technique that supports the provision of effective and high-quality dental services. The aim is to compare and evaluate the efficacy of sedative agents like dexmedetomidine and midazolam in pediatric dental practice. A thorough review of the literature was conducted using electronic databases like "MEDLINE, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as the World Health Organization International Clinical Trials Registry Platform, www.clinicaltrials.gov, conference proceedings abstracts, a bibliography of pertinent references, and manual searches of journals, conferences, and books". There were no restrictions on the language or the date of publication when searching the electronic databases. Randomized controlled trials were included which compared dexmedetomidine and midazolam in children up to 16 years of age subjected to dental treatment. Information on procedures, participants, interventions, outcome measures, and results were independently extracted by three review writers (TS, SL, and RO). Trial authors were contacted for papers that were confusing or lacking information. The risk of bias was evaluated for each study. We adhered to the Cochrane statistical recommendations. Three trials totaling 229 participants were included. All three studies were rated as having a low risk of bias, with none of them having a high or unclear risk. Meta-analysis was done for the available data for the primary outcomes like sedation level and recovery time. We searched for randomized controlled trials up to Jan 31, 2020. Participants are randomly assigned to an intervention or control group in randomized controlled trial research. While patients in the control group often get a placebo therapy or procedure, those in the interventional group receive the treatment being studied. We found three studies eligible to include in the review. One study evaluated 73 individuals who received general anesthesia for dental treatment. There were 72 and 84 individuals in the second and third investigations, respectively. All the participants of the three studies were divided randomly into two groups and were subjected to dexmedetomidine and midazolam as sedative agents. We gave the evidence an "extremely low certainty" rating. Because there are just three short trials with unusual parameters for comparison, the results are questionable. Overall, the results do not allow us to draw any firm conclusions. Three randomized controlled trials included in this systematic review reported data with varying conclusions; hence we recommend more randomized controlled trials to be conducted on this subject matter.
PubMed: 36176880
DOI: 10.7759/cureus.28452 -
Brain Communications 2022The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery... (Review)
Review
The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with . Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (= 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high ( = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.
PubMed: 35169700
DOI: 10.1093/braincomms/fcab297 -
Brazilian Oral Research 2023This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and... (Meta-Analysis)
Meta-Analysis
This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.
Topics: Child; Humans; Dental Enamel Hypoplasia; Dental Anxiety; Molar; Molar Hypomineralization; Surveys and Questionnaires; Prevalence
PubMed: 37436292
DOI: 10.1590/1807-3107bor-2023.vol37.0069 -
The Cochrane Database of Systematic... Apr 2017Coronary heart disease (CHD) is the most common cause of death globally, although mortality rates are falling. Psychological symptoms are prevalent for people with CHD,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Coronary heart disease (CHD) is the most common cause of death globally, although mortality rates are falling. Psychological symptoms are prevalent for people with CHD, and many psychological treatments are offered following cardiac events or procedures with the aim of improving health and outcomes. This is an update of a Cochrane systematic review previously published in 2011.
OBJECTIVES
To assess the effectiveness of psychological interventions (alone or with cardiac rehabilitation) compared with usual care (including cardiac rehabilitation where available) for people with CHD on total mortality and cardiac mortality; cardiac morbidity; and participant-reported psychological outcomes of levels of depression, anxiety, and stress; and to explore potential study-level predictors of the effectiveness of psychological interventions in this population.
SEARCH METHODS
We updated the previous Cochrane Review searches by searching the following databases on 27 April 2016: CENTRAL in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and CINAHL (EBSCO).
SELECTION CRITERIA
We included randomised controlled trials (RCTs) of psychological interventions compared to usual care, administered by trained staff, and delivered to adults with a specific diagnosis of CHD. We selected only studies estimating the independent effect of the psychological component, and with a minimum follow-up of six months. The study population comprised of adults after: a myocardial infarction (MI), a revascularisation procedure (coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)), and adults with angina or angiographically defined coronary artery disease (CAD). RCTs had to report at least one of the following outcomes: mortality (total- or cardiac-related); cardiac morbidity (MI, revascularisation procedures); or participant-reported levels of depression, anxiety, or stress.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles and abstracts of all references for eligibility. A lead review author extracted study data, which a second review author checked. We contacted study authors to obtain missing information.
MAIN RESULTS
This review included 35 studies which randomised 10,703 people with CHD (14 trials and 2577 participants added to this update). The population included mainly men (median 77.0%) and people post-MI (mean 65.7%) or after undergoing a revascularisation procedure (mean 27.4%). The mean age of participants within trials ranged from 53 to 67 years. Overall trial reporting was poor, with around a half omitting descriptions of randomisation sequence generation, allocation concealment procedures, or the blinding of outcome assessments. The length of follow-up ranged from six months to 10.7 years (median 12 months). Most studies (23/35) evaluated multifactorial interventions, which included therapies with multiple therapeutic components. Ten studies examined psychological interventions targeted at people with a confirmed psychopathology at baseline and two trials recruited people with a psychopathology or another selecting criterion (or both). Of the remaining 23 trials, nine studies recruited unselected participants from cardiac populations reporting some level of psychopathology (3.8% to 53% with depressive symptoms, 32% to 53% with anxiety), 10 studies did not report these characteristics, and only three studies excluded people with psychopathology.Moderate quality evidence showed no risk reduction for total mortality (risk ratio (RR) 0.90, 95% confidence interval (CI) 0.77 to 1.05; participants = 7776; studies = 23) or revascularisation procedures (RR 0.94, 95% CI 0.81 to 1.11) with psychological therapies compared to usual care. Low quality evidence found no risk reduction for non-fatal MI (RR 0.82, 95% CI 0.64 to 1.05), although there was a 21% reduction in cardiac mortality (RR 0.79, 95% CI 0.63 to 0.98). There was also low or very low quality evidence that psychological interventions improved participant-reported levels of depressive symptoms (standardised mean difference (SMD) -0.27, 95% CI -0.39 to -0.15; GRADE = low), anxiety (SMD -0.24, 95% CI -0.38 to -0.09; GRADE = low), and stress (SMD -0.56, 95% CI -0.88 to -0.24; GRADE = very low).There was substantial statistical heterogeneity for all psychological outcomes but not clinical outcomes, and there was evidence of small-study bias for one clinical outcome (cardiac mortality: Egger test P = 0.04) and one psychological outcome (anxiety: Egger test P = 0.012). Meta-regression exploring a limited number of intervention characteristics found no significant predictors of intervention effects for total mortality and cardiac mortality. For depression, psychological interventions combined with adjunct pharmacology (where deemed appropriate) for an underlying psychological disorder appeared to be more effective than interventions that did not (β = -0.51, P = 0.003). For anxiety, interventions recruiting participants with an underlying psychological disorder appeared more effective than those delivered to unselected populations (β = -0.28, P = 0.03).
AUTHORS' CONCLUSIONS
This updated Cochrane Review found that for people with CHD, there was no evidence that psychological treatments had an effect on total mortality, the risk of revascularisation procedures, or on the rate of non-fatal MI, although the rate of cardiac mortality was reduced and psychological symptoms (depression, anxiety, or stress) were alleviated; however, the GRADE assessments suggest considerable uncertainty surrounding these effects. Considerable uncertainty also remains regarding the people who would benefit most from treatment (i.e. people with or without psychological disorders at baseline) and the specific components of successful interventions. Future large-scale trials testing the effectiveness of psychological therapies are required due to the uncertainty within the evidence. Future trials would benefit from testing the impact of specific (rather than multifactorial) psychological interventions for participants with CHD, and testing the targeting of interventions on different populations (i.e. people with CHD, with or without psychopathologies).
Topics: Aged; Anxiety; Cause of Death; Coronary Disease; Depression; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Psychotherapy; Randomized Controlled Trials as Topic; Reoperation; Stress, Psychological
PubMed: 28452408
DOI: 10.1002/14651858.CD002902.pub4 -
Dental and Medical Problems 2022Demand for dental implants has increased in recent years and the use of conscious sedation for this type of surgery can be of great benefit. Therefore, the aim of this... (Meta-Analysis)
Meta-Analysis Review
Demand for dental implants has increased in recent years and the use of conscious sedation for this type of surgery can be of great benefit. Therefore, the aim of this systematic review was to evaluate the scientific literature related to the effect of conscious sedation on the reduction of anxiety, and patient and surgeon satisfaction. The Embase, PubMed, ProQuest, Scopus, Ovid, and Cochrane databases were searched without limitations. According to the inclusion and exclusion criteria determined for the study, 10 articles were selected for the final review during several screening stages. These studies were reviewed in their full-text form by the research team and the intended data was extracted. The risk of bias was assessed for each of the selected articles. Five studies were ultimately included. Two of the them compared local anesthesia and conscious sedation, while another 2 compared the consequences of different types of conscious sedation. The anxiety reduction and patient and surgeon satisfaction data was collated. Midazolam was the most frequently used agent. After a thorough review of the final articles extracted based on the study protocol, it was concluded that the use of conscious sedation during implant surgery reduces patient anxiety, and also increases the satisfaction of the patient and surgeon.
Topics: Anxiety; Conscious Sedation; Dental Implants; Humans; Patient Satisfaction; Personal Satisfaction
PubMed: 35403382
DOI: 10.17219/dmp/141868 -
Journal of Clinical Medicine Apr 2020Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare... (Review)
Review
BACKGROUND
Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age.
METHODS
MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: "virtual reality", "distraction systems", "dental anxiety" and "pain". Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used, and in standard care situations.
RESULTS
31 studies were identified, of which 14 met the inclusion criteria. Pain levels were evaluated in four studies ( = 4), anxiety levels in three ( = 3) and anxiety and pain together in seven ( = 7). Our meta-analysis was based on ten studies ( = 10). The effect of VR was studied mainly in the pediatric population (for pain SMD = -0.82). In the adult population, only two studies (not significant) were considered.
CONCLUSIONS
The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area.
PubMed: 32260538
DOI: 10.3390/jcm9041025 -
International Journal of Environmental... Sep 2022This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under... (Meta-Analysis)
Meta-Analysis Review
This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. In November 2020, multiple electronic databases (Cochrane, EMBASE, MEDLINE, PsycInfo, PsycArticles, PubMed, and Web of Science) were searched for articles published in English. Inclusion criteria were randomized-controlled trials reporting the effectiveness of any non-pharmacological interventions in reducing fear or anxiety levels in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After screening, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. The anxiety levels after intervention in each study were pooled and meta-analyzed by the random-effect model. A significant reduction in anxiety level was observed in non-pharmacological intervention groups (SMD = -0.32; 95% CI -0.57 to -0.07; = 0.01). Subgroup analyses showed that a significant anxiety reduction by non-pharmacological interventions could be demonstrated by pooled data from studies using psychometric assessments, but not from studies using physiological assessments. Non-pharmacological interventions appear to reduce fear and anxiety levels in patients undergoing third molar extraction under local anesthesia.
Topics: Anesthesia, Local; Anxiety; Anxiety Disorders; Humans; Molar, Third; Randomized Controlled Trials as Topic
PubMed: 36141435
DOI: 10.3390/ijerph191811162 -
Journal of Dental Education Oct 2018The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught... (Review)
Review
The biopsychosocial model is advocated as part of a more comprehensive approach in both medicine and dentistry. However, dentists have not traditionally been taught psychosocial screening as part of their predoctoral education. The aim of this systematic review was to provide an overview of published studies on the implementation of screening for psychological comorbidity in dental and dental hygiene education. The term "psychological comorbidity" refers to the degree of coexisting anxiety, depression, or other mental health problems in a patient presenting with a physical condition. The review followed a protocol registered in PROSPERO (CRD42016054083) and was carried out in accordance with the PRISMA guidelines. The methodological quality of the included studies was assessed using a ten-item tool developed for medical education. The electronic search in PubMed, Scopus, and PsycINFO from the inception of each database until December 31, 2016, together with a hand search, identified 1,777 articles. After abstracts were screened, 52 articles were reviewed in full text applying inclusion and exclusion criteria; four articles remained for the qualitative synthesis. Generally, the reported data on specific methods or instruments used for psychological screening were limited. Only one of the included articles utilized a validated screening tool. The results of this systematic review show that published data on the implementation of psychological patient assessment in dental and dental hygiene education are limited. To address this gap, the authors recommend short screening tools such as the Graded Chronic Pain Scale and the Patient Health Questionnaire for Depression and Anxiety. Educating dental and dental hygiene students about easy-to-use, reliable, and validated screening tools for assessing psychological comorbidity warrants more research attention and greater implementation in educational curricula.
Topics: Anxiety; Comorbidity; Depression; Education, Dental; Humans; Mass Screening; Mental Disorders; Oral Hygiene
PubMed: 30275141
DOI: 10.21815/JDE.018.104