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Australian Dental Journal Mar 2022Anxiety is an adaptive emotional response to potentially threatening or dangerous situations; moderated by the sympathetic nervous system. Dental anxiety is common and... (Review)
Review
Anxiety is an adaptive emotional response to potentially threatening or dangerous situations; moderated by the sympathetic nervous system. Dental anxiety is common and presents before, during or after dental treatment. The physiological response includes an increase in heart rate, blood pressure, respiratory rate, and cardiac output. Consequently, extensive distress leads to avoidance of dental treatment and multiple failed appointments, impacting both oral and general health. Dental anxiety can generate a variety of negative consequences for both the dentist and the patient. Evidence-based strategies are essential for mitigating and relieving anxiety in the dental clinic. Psychotherapeutic behavioural strategies can modify the patient's experience through a minimally invasive approach with nil or negligible side effects, depending on patient characteristics, anxiety level and clinical situations. These therapies involve muscle relaxation, guided imagery, physiological monitoring, utilizing biofeedback, hypnosis, acupuncture, distraction and desensitization. Pharmacological intervention utilizes either relative analgesia (nitrous oxide), conscious intravenous sedation or oral sedation, which can have undesirable side effects, risks and contraindications. These modalities increase the cost and availability of dental treatment.
Topics: Adult; Humans; Dental Anxiety; Dental Clinics; Conscious Sedation; Anesthesia; Anesthesia, Dental
PubMed: 35735746
DOI: 10.1111/adj.12926 -
Journal of Dentistry Nov 2022To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients.
DATA SOURCES
Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity.
STUDY SELECTION
A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on pediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using Facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p = 0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p = 0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p = 0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p = 0.007).
CONCLUSIONS
Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21st century.
CLINICAL SIGNIFICANCE
Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.
Topics: Child; Humans; Pediatric Dentistry; Anxiety; Anxiety Disorders
PubMed: 36152953
DOI: 10.1016/j.jdent.2022.104303 -
Medicina (Kaunas, Lithuania) Dec 2019Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with...
Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.
Topics: Administration, Oral; Adult; Ambulatory Care; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Inhalation; Anti-Anxiety Agents; Benzodiazepines; Central Nervous System; Child; Conscious Sedation; Dental Anxiety; Dental Care; Dentistry; Humans; Nitrous Oxide; Operative Time; Postoperative Period; Safety
PubMed: 31817931
DOI: 10.3390/medicina55120778 -
Medicina (Kaunas, Lithuania) Oct 2019Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due...
Dentistry and oral health are at the heart of the systemic health of humans. Often this branch of medicine is underestimated either due to socioeconomic reasons or due to fear. In fact, in dentistry, there is often a widespread condition of odontophobia among patients. A clinician's knowledge of this condition, and an accompanying understanding of how to successfully manage it, is surely one of the first steps to gaining a patient's trust and maintaining his or her patronage. Being able to manage a dental phobic patient in the best way is the key to successful therapy. Psychological techniques often have to work alongside dentistry in managing these patients. A future perspective concerns precisely the implementation of non-invasive practices such as hypnosis in the management of the latter.
Topics: Dental Anxiety; Dental Care; Fear; Humans; Psychology
PubMed: 31597328
DOI: 10.3390/medicina55100678 -
Brain Sciences Apr 2022Hypnosis is a commonly used therapy option in dentistry and medicine for fear and pain reduction. Nevertheless, it is viewed very critically, as there is still... (Review)
Review
Hypnosis is a commonly used therapy option in dentistry and medicine for fear and pain reduction. Nevertheless, it is viewed very critically, as there is still insufficient evidence for a treatment effect. Specific phobia of dental treatment and dental anxiety are prevalent conditions that can cause an oral health impairment. This paper critically reviews 19 clinical trials aimed at reducing dental anxiety and fear avoidance in adults, published in peer-reviewed journals between 1979 and 2021. The search identified 257 papers; 223 were selected after removing duplicates. A total of 188 articles were excluded after title and abstract evaluation; 35 full text articles were assessed for eligibility. Another 10 papers were discharged after full text evaluation, as these were case reports and questionnaires. Six papers were discharged due to the lack of a comparable scale to measure dental anxiety. The following treatment techniques were reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, self-hypnosis by audio therapy, hypnotherapy, hypnosis, and nitrous oxide sedation. CBT delivered in a variety of formats, including one-session treatment, showed the most evidence for the efficacy of reducing anxiety. A wide heterogeneity of methods allowed only the inclusion of five studies to the performed meta-analysis, showing contrasting results for the application of hypnosis. The main reason for this issue is the great variety in methods used, making a distinct assessment of hypnotic interventions difficult. However, the results of the systematic review are promising in that hypnosis can also be regarded as powerful and successful method for anxiety reduction, while there are also studies with a small or even slightly negative effect. Therefore, further research is needed. Within the limitations of the current study, a more consistent use of methods to examine anxiety for hypnosis research is recommended.
PubMed: 35624907
DOI: 10.3390/brainsci12050521 -
Journal of Oral Rehabilitation Mar 2021Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions... (Review)
Review
BACKGROUND
Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions Oral Function, Orofacial Pain and Orofacial Appearance, has been proposed to cover the different areas of OHRQoL.
OBJECTIVE
The objective of the study was to collect further scientific support for the new four-dimensional structure of OHRQoL. This study is one out of a series of four and focuses on the PI in patients with dental anxiety, oral cancer and periodontitis (PROSPERO registration number: CRD42017064033).
METHODS
Five databases (Pubmed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO) were electronically searched on 8 June 2017 and updated on 14 January 2019, to identify the studies that measure OHRQoL using the Oral Health Impact Profile (OHIP) for oral health conditions. In this review, studies were included if the mean/median domain scores from OHIP-14 or OHIP-49 were available for patients with dental anxiety, oral cancer or periodontitis. The score of the handicap domain from the OHIP was used to assess patients` PI. The handicap domain includes 6 items for OHIP-49 with a domain score ranging from 0 to 24 and 2 items for OHIP-14 with a domain score ranging from 0 to 8. For comparison between the 2 versions of the OHIP, the domain score of OHIP-49 was conversed into a 0 to 8 metric. The domain scores of the included studies were then pooled, separately for each of the included dental disorders.
RESULTS
A total of 2104 records were identified based on the search strategy. After screening of titles and abstracts, 1607 articles were reviewed in full text. Twenty-three articles met the inclusion criteria for this review and were included in the study. The 23 articles contained 3884 patients, grouped in 30 patient populations and 42 patient samples. The pooled mean scores of PI for dental anxiety, oral cancer and periodontitis were 3.2, 1.9 and 0.8, respectively, on the 0 to 8 metric.
CONCLUSION
This review provides standardised information about the OHRQoL impact for three dental disorders as a model for the PI dimension. Dental anxiety tends to show the strongest effect on the PI dimension, while periodontitis tends to show the weakest effect on the PI dimension. Future studies need to confirm whether the reported differences in PI scores between the three dental disorders are statistically significant.
Topics: Facial Pain; Humans; Oral Health; Periodontitis; Quality of Life; Surveys and Questionnaires
PubMed: 32761938
DOI: 10.1111/joor.13064 -
Clinical and Experimental Dental... Oct 2021Dental anxiety distresses children and their families with consequent poor oral health and costly pediatric dental services. Children's behaviors could be modified using... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Dental anxiety distresses children and their families with consequent poor oral health and costly pediatric dental services. Children's behaviors could be modified using a distraction technique for improved dental treatment. The study evaluates the effects of an audio-visual distraction on children's behaviors and pain expressions during dental treatment.
MATERIAL AND METHODS
One hundred healthy children, between 4 and 6 years of age, were randomly assigned to one of two groups: audio visual distraction (AVD, N = 61) group and control (CTR, N = 39) group. The pre and post pain expression was collected using a faces pain rating scale from the participated children. Children's behavior was evaluated using the Frankl behavior rating scale by the assigned dentist. Data was analyzed using chi-squared tests and analysis of variance.
RESULTS
The AVD group demonstrated more "definitely positive" behavior (91.8%) compared to the CTR group (35.9%) based on the Frankl scale evaluation from pre- and post-treatment (p < 0.0001). The pain rating scale did not demonstrate a significant difference in post-treatment pain scales (p = 0.2073) or changes in pain (p = 0.1532) between the AVD group and CTR group.
CONCLUSIONS
The AVD is an effective distraction tool for young children during dental treatment regardless of child's subjective pain expression.
Topics: Child; Child Behavior; Child, Preschool; Humans; Pain; Pain Measurement
PubMed: 33622030
DOI: 10.1002/cre2.407 -
Journal of Oral Science Oct 2021The aim of this study was to assess the effectiveness of laser acupuncture and intravascular laser irradiation of blood (ILIB) for managing anxiety in pediatric... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to assess the effectiveness of laser acupuncture and intravascular laser irradiation of blood (ILIB) for managing anxiety in pediatric dentistry. Eighty-four children recruited at a university dental clinic were randomly assigned to three groups: the Sham group (n = 27) underwent sham laser irradiation of three acupuncture points, the ILIB group (n = 25) underwent 10 min of ILIB, and the laser acupuncture group (LAC, n = 32) underwent 40 s of laser acupuncture over points VG20 (Baihui), PC6 (Neiguan), and the Oppression Point. The results suggest that ILIB and laser acupuncture are feasible alternatives for managing dental anxiety in children.
Topics: Acupuncture Points; Acupuncture Therapy; Child; Dental Anxiety; Humans; Lasers
PubMed: 34408110
DOI: 10.2334/josnusd.21-0025 -
Anesthesia Progress Apr 2022This study aimed to determine the effect of music as an intervention on relieving preoperative anxiety in patients with dental fear in an outpatient operating room (OR)... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed to determine the effect of music as an intervention on relieving preoperative anxiety in patients with dental fear in an outpatient operating room (OR) before intravenous sedation (IVS).
METHODS
Sixty adult patients with dental fear undergoing dental surgery under IVS were divided into 2 groups (music and nonmusic). The music group listened to music in the waiting room until immediately before the initiation of IVS whereas the nonmusic group did not. Patient anxiety was objectively measured using heart rate variability (HRV) analysis to assess the low-frequency/high-frequency ratio as an indication of sympathetic or parasympathetic nervous system activity. Subjective preoperative anxiety was evaluated with a visual analog scale (VAS).
RESULTS
Heart rate variability analysis failed to demonstrate any significant difference between the 2 groups from baseline to start of IVS. There were also no significant differences between the 2 groups regarding changes in VAS scores.
CONCLUSION
Music intervention was not found to reduce preoperative anxiety in patients with dental fear before IVS in the dental outpatient OR as determined by HRV analysis or VAS scores.
Topics: Adult; Anxiety; Humans; Music; Music Therapy; Operating Rooms; Single-Blind Method
PubMed: 35377929
DOI: 10.2344/anpr-68-03-06