Abstract: The objective of this study was to assess the oral health status, treatment needs, and barriers to dental care of noninstitutionalized children in The Netherlands who have severe disabilities. The oral health status of 61 children (38% female; 4-12 years of age; M = 7.7, SD = 2.2), randomly selected from seven different daycare centers, was evaluated. Caretakers (n = 126) and dentists (n = 40) completed questionnaires concerning demographic information, oral hygiene, frequency of dental visits, and possible barriers to the daily oral care of the children. Of all the children, 57.4% had untreated caries (mean dmft/DMFT = 3.0; SD = 3.1). The proportion of caries-free children was 29.5%. In comparison to Dutch children, a significantly higher proportion of children with disabilities belonging to an ethnic minority did not receive any routine dental care (53.1% and 23.8%, respectively). Caretakers considered the noncooperation of their patients as the most troublesome aspect of their daily oral care (68%). Dentists considered communication problems as the most important barrier to treatment (75%). In conclusion, Dutch noninstitutionalized children with severe disabilities still receive a relatively low degree of quality dental care. This is particularly true for children from ethnic minority groups.
Abstract: BACKGROUND: It has been estimated that among patients presenting for cosmetic treatments up to 15% suffer from Body Dysmorphic Disorder (BDD), a psychiatric condition characterised by a preoccupation with an imagined defect in appearance. OBJECTIVES: The main purpose of the current study was to establish the relationship between presence of BDD characteristics and interest in aesthetically motivated dental treatments. METHODS: Data were obtained by means of a survey within a sample of 879 Dutch citizens of 16 years and older. Characteristics of BDD were assessed based on DSM-IV criteria. RESULTS: Only one of the BDD features (ie a preoccupation with a defect of appearance) emerged as a significant predictor of undergoing cosmetic dental treatments. Patients with such preoccupation were nine times more likely to consider tooth whitening, and six times more likely to consider orthodontic treatment. They were also five times more likely to be dissatisfied about their most recent treatment. CONCLUSIONS: The results suggest that preoccupation with one's physical appearance is a motivating factor for undergoing certain types of cosmetic dental procedures.
Abstract: In a study involving a group of 907 randomly selected Dutch individuals, satisfaction about one's physical appearance and satisfaction about the appearance of one's teeth were assessed. Furthermore, the relationship between body esteem and happiness was explored. Three quarters of the respondents were satisfied about their physical appearance, while 70% was satisfied about the appearance of their teeth. Women and people with a non-Dutch background were significantly less likely to be satisfied about their physical appearance than men and those with a Dutch background. Individuals 30 years old and younger were more likely to be satisfied about their teeth than those who were older. Almost two third of the respondents (64%) reported that the appearance of their teeth contributed positively to their happiness. Women and people with a non-Dutch background were most likely to indicate that the appearance of their teeth contributed to their happiness. Satisfaction about general physical appearance and appearance of the teeth were significantly associated with happiness. Prospective studies are needed to examine to what extent esthetically motivated dental treatments make people happy and enhance their general well-being.
Abstract: Relatively little is known about the anxiety-provoking capacity of the various objects and situations characteristic of the dental setting. The aims of the current study were to establish a hierarchy of anxiety-provoking capacities of a large set of dental stimuli and to determine the differences in relation to gender, age, ethnicity, and level of dental trait anxiety. An additional aim was to derive an estimate of the number of stimuli to be presented to anxious patients in order to obtain full coverage of their dental fears. A questionnaire describing 67 potentially anxiety-provoking stimuli was constructed and presented to 960 adults. The results indicated that invasive stimuli (e.g. surgical procedures) were rated as the most anxiety provoking and that non-invasive stimuli (e.g. the dentist as a person) were the least anxiety provoking. The fear-evoking capacity of the dental stimuli varied with gender, age, ethnicity, and level of dental trait anxiety, whereas the rank order of these stimuli appeared to be independent of these factors. Furthermore, it appeared that the top 25 most anxiety-provoking objects and situations found in the current study contained only eight (28%) stimuli, which had been taken into account in previous research. The present findings support the need for assessment procedures using a broad spectrum of potentially anxiety-provoking stimuli.
Abstract: What are the dental stimuli and situations that are experienced as more or less fear provoking by anxious dental patients?To investigate this question, 81 highly anxious patients, who were referred to a centre of special dental care were presented with a list of 76 potentially fear provoking objects and situations. The results showed that invasive dental procedures are considered as most terrifying by anxious patients, and that stimuli related to the dental office (dental chair), the dental team (dentist) and their equipment (protecting clothes) are considered as least fear provoking. Root canal treatments were rated as most fear provoking. The results emphasize the importance of assessing the whole range of potentially terrifying stimuli for each anxious patient. Only in this way an approach focused on the extinction of patients' dental fear can be successful.
Abstract: The aim of this study was to identify possible problem areas regarding preventive selfcare and dental care for severely mentally retarded children living at home. The sample test comprised parents (n = 126) and dentists (n = 40) of children between the ages of 4 and 12 from 7 randomly selected daycare centres in The Netherlands, who were asked to fill out a questionnaire. Of the children 32% were found to receive no dental care at all, while among the children from ethnic minority groups this number exceeded 50%. Of the parents two-thirds indicated that they had encountered problems with daily dental care and 70% reported that their child's oral hygiene was in need of improvement. Of the dentists 25% were dissatisfied with the dental care they provide, and 75% felt that dental care for mentally retarded children needs improving. The results suggest that there is room for improvement in the support of parents of mentally disabled children in maintaining an adequate level of oral hygiene, and that adequate training of dental professionals in serving the needs of people with severe disabilities is wanted.
Abstract: As a result of the recognized need for dentists with a special expertise in the field of managing and treating patients who are difficult to treat especially because they are fearful, a post-graduate programme was established, in 2001, in 'dealing with fear of dentists.' This 3-year programme of study makes it possible for dentists, both working within and outside of departments of special dental care, to develop knowledge and experience in this field. The intention behind this initiative is to contribute to the quality of care provided to patients who avoid treatment out of fear. A brief summary of the programme's target group and academic goals, as well as its organization and contents are provided.
Abstract: The dental treatment of people with a mental and/or physical disability often entails a variety of related problems and requires extra expertise and competencies on the part of the dentist. If treatment in an ordinary practice is not (or is no longer) possible, the patient can be referred to a centre for special care dentistry or to dental practices in institutions for the mentally disabled. In the Netherlands, a three year postgraduate programme in dentistry for the disabled was established in 2004, the purpose of which is to improve the availability and quality of dental care for the disabled.
Abstract: There are indications of a growing public interest in aesthetic dental treatments. For want of reliable data, a group of 907 randomly selected Dutch individuals was questioned in order to give this apparent tendency a foundation in figures. The results of this study show that about 25% of the respondents received aesthetic dental treatment at some time, about 8% was treated during the past year, and almost 8% intended to undergo aesthetic dental treatment in the coming year. In this respect, tooth whitening was found to be the most popular treatment. The results of this study suggest that there is a positive attitude towards aesthetic dentistry and that women take a greater interest in it than men. Whether this interest will lead to a rise in the number of actual aesthetic dental treatments is still unclear.
Abstract: This questionnaire-based study investigated the traumatic background and trauma-related symptomatology among 141 treatment-seeking individuals with high levels of dental anxiety and among a low-anxious reference group consisting of 99 regular dental patients. The highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%). Horrific experiences in the dental setting were the most common traumatic events reported. Of the highly anxious individuals, 46.1% indicated suffering from one or more of the post-traumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, loss of interest, and insomnia), while in the reference group this percentage was 6%. Severity of dental anxiety was significantly associated with number of screening criteria for specific phobia and the extent to which the anxious subjects displayed symptoms of post-traumatic stress. Two variables were uniquely predictive for positive diagnostic screens for dental phobia and PTSD: having experienced a horrific dental treatment and having been a victim of a violent crime. In conclusion, post-traumatic symptoms are common accompaniments of severe forms of dental anxiety and are experienced even when dental treatment is not imminent.
Abstract: This paper aims to provide an overview of the current knowledge regarding the management of adult dentally anxious patients. Furthermore, an attempt is made to formulate a number of preliminary clinical guidelines, based on the available literature. The findings are discussed in the light of the following four problem areas or types of patients, those with: 1) a mild form of fear or anxiety, 2) a phobia of specific dental procedures or situations, 3) interfering psychiatric symptoms and/or 4) a high treatment need. The literature suggests that particularly the implementation of a high level of predictability during treatment, the training of patients in the use of coping skills, and the application of in vivo exposure to anxiety provoking stimuli are the most appropriate options for the management of anxious dental patients and the reduction of their anxiety level.
Abstract: Treatment of extreme or pathological forms of dental anxiety requires specific skills. This paper is an attempt to formulate a number of treatment strategies, based on the available literature and effectiveness studies. It is suggested that based upon the assessment information three types of problem areas can be identified, namely, 1. a phobia of specific dental procedures or situations; 2. long overdue requiring acute dental treatment; and 3. intrusive or interfering psychiatric symptoms. In this article these problem situations are reviewed and several appropriate treatment options are discussed.
Abstract: Given the high prevalence of mental disorders in Western societies, dentists may be confronted with behaviors that may interfere with the safe and efficient delivery of dental care. This paper addresses the need for dentists to be aware of patient vulnerability factors and psychological problems due, for example, to the possible negative effects of psychological distress and critical incidents, and their consequences for both symptom presentation and dental treatment planning. This need for awareness is illustrated by a case report of a patient who developed body dysmorphic disorder (BDD)--a preoccupation with some imagined defect in physical appearance--following dental treatment.
Abstract: In this article an attempt is made to formulate a number of general clinical guidelines, based on the currently available knowledge and clinical experience within the area of dental anxiety. It is concluded that, in case of mild forms of anxiety, a careful treatment approach of the dental practitioner--which is focused on a style of establishing trust, specific pharmacological support and the teaching of coping strategies--can reduce patients' anxiety level, thereby preventing avoidance behaviour and deterioration of the oral health.
Abstract: In order to make a reliable diagnosis and offer appropriate treatment, it is important that the dentist is aware of the role played by psychosocial factors in the origin and persistence of dental problems and has the ability to recognise their importance in the patient's overall presentation. This paper is an attempt to improve dentist's awareness of psychosocial issues and recognition of possible psychological problems in general dental practice. It focuses on directions for the gathering of information on patients through careful assessment prior to dental examination, covering patients biological or physical history and present symptoms, their social background, their psychological history and mental functioning, and the observation of their behaviour and mood. It is argued that interpreting these types of information will enable the dentist to be better prepared for any pitfalls that may arise in the course of treatment.
Abstract: OBJECTIVES: This study was a first attempt to derive an estimate of the likely incidence of somatization-specific behaviour in a dental setting and its relationship with both somatic symptoms and symptoms of depression. METHODS: Somatization-specific behaviour was operationalized as reporting of inexplicable dental symptoms (eg pain), remarkable frequent attendance at a dental surgery, inexplicably high treatment use or unreasonable requests with regard to treatment. RESULTS: Of the 309 patients surveyed, 8.7%o fulfilled one or more of the criteria for somatization-specific behaviour. This was particularly manifested by a high attendance rate (6.8%). Women exhibited somatization-specific behaviour significantly more often (73%) than men (27%9). Support was found for the hypothesis that individuals exhibiting characteristics of somatization-specific behaviour would present themselves to dentists more often with dental complaints and would suffer more from symptoms of depression than patients that did not display these characteristics. CONCLUSIONS: The results suggest that somatization is a factor in dental practice.
Abstract: OBJECTIVES: The main purpose of this descriptive study was to investigate whether dental anxiety is associated with the occurrence of trauma-related symptoms (i.e. recurrent memories and a tendency to avoid these memories) associated with earlier traumatic dental experiences. METHODS: A sample of 37 consecutive anxious patients attending a dental fear clinic was assessed prior to dental treatment. The results were compared with those of a sample of 32 consecutive patients of a general dental practice, who served as a reference group. RESULTS: The proportion of patients who indicated they had had a horrific dental experience at least once in their life did not significantly differ between the anxious group and the reference group. Conversely, significantly more patients (76%) in the anxious group reported suffering from memories of these events. They also showed a higher level of trauma-related symptomatology as indexed by the Impact of Event Scale (IES). About half of the anxious patients suffered from symptoms typically reported by patients with posttraumatic stress disorder (PTSD). Severity of dental anxiety showed a high correlation with both frequency of intrusions (r = 0.64, P < 0.001) and avoidance of the memories (r = 0.62, P < 0.001). CONCLUSIONS: The results suggest that in anticipation of treatment dentally anxious individuals suffer from a high level of intrusive recollections of earlier dental experiences.
Abstract: A series of single-case experiments was used to evaluate the application of Eye Movement Desensitization and Reprocessing (EMDR) to traumatically induced dental phobia. Following two to three sessions of EMDR treatment, three of the four patients demonstrated substantially reduced self-reported and observer-rated anxiety, reduced credibility of dysfunctional beliefs concerning dental treatment, and significant behavior changes. These gains were maintained at six weeks follow-up. In all four cases, the clinical diagnosis present at pretreatment was not present at posttreatment at a clinical level. All patients actually underwent the dental treatment they feared most within three weeks following EMDR treatment. The findings support the notion that EMDR can be an effective treatment alternative for phobic conditions with a trauma-related etiology.
Abstract: This study assessed trauma-related sequelae of 56 highly anxious patients attending a dental fear clinic. It was also examined whether such symptomatology interferes with anxiety reduction in response to a cognitive-behavioral treatment approach. About 34 patients (59%) indicated that they had experienced one or more aversive dental events that could explain the onset of their dental anxiety. There was no difference between the dental anxiety scores of patients who reported such a background and those who did not. Severity of trauma-related symptomatology was indexed by the Impact of Event Scale (IES). The mean IES score of patients with a traumatically induced dental fear was remarkably high (33.0; SD=19.7). Furthermore, there was a strong direct relationship between severity of trauma-related symptomatology and severity of dental anxiety (shared variance was 38%). Two patients (10%) met all DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) on the basis of the Self-Rating Scale for PTSD. However, no evidence was found to suggest that either a traumatic background, or level of trauma-related symptomatology, has a negative effect on treatment outcome.
Abstract: The aim of the present study was to determine the outcome of treatment of several treatment modalities utilized at the Centre for Special Dental Care in Amsterdam, the Netherlands. Outcome was assessed in 341 patients in terms of dental anxiety after treatment (response 65%) and dental attendance one year later (response 74%). After treatment, patients treated with a behavioral management approach had lower dental anxiety scores than patients treated with intravenous sedation. Furthermore, one year after treatment 66.7% of the treated patients indicated to visit a general dental practitioner regularly. It is concluded that treatment was effective. However, it was felt that dental attendance level could be increased by a change in the referral procedure to general dental practitioners. It is recommended that a psychologist is involved in diagnosis and treatment planning in dental fear clinics.
Abstract: OBJECTIVES: This study aimed to determine the methods suggested by general dental practitioners for management of patients with dental anxiety whom they refer to a dental hospital setting, the treatment modalities eventually used with such patients and the relationship between patients previous sedation experience and the current referral. METHODS: Consecutive referral letters (n = 125) for management of patients with dental anxiety over a 16 month period were analysed for content, including reason for referral and suggested treatment modalities. Patient records were also examined for previous sedation experience. RESULTS: From 115 referrals eligible for analysis, the dentists requested management of anxiety using pharmacological methods in 113 referrals with only two referrals mentioning psychologically-based treatments. In secondary care, 29% of the adult referrals opted for dental treatment using psychological techniques alone. CONCLUSIONS: In spite of the efficacy of psychological treatments for dental anxiety, primary and secondary care dentists appear not to be suggesting or promoting their use for patients with dental anxiety. Further research into the availablility of, and barriers to accessing the full range of services for those with dental anxiety, including patient perspectives, needs to be undertaken.
Abstract: In order to improve the reliability of diagnostic judgements of complex or persisting dental complaints it is important to be aware of the role of emotional problems regarding the origin and the maintenance of dental complaints. In this paper the focus is on the collection of information about patients' history through an anamnesis, and the observation of patients behaviour and mood.
Abstract: This article focuses on the different forms of factitious diseases. Patients may mimic or produce the manifestations of a disease in order to attract attention of doctors. Sometimes patients inflict such serious injuries on their own bodies that they need to undergo long-term treatment in a hospital such as in the case of Munchausen syndrome. Recognition of alarm signals associated with this type of condition may help to avoid a long lasting process of illness, screening and unnecessary treatments.
Abstract: The aim of the present study was to investigate the occurrence of somatization-specific behaviour in the dental setting and its relationship with patients' report of both dental and psychological complaints. Somatization-specific behaviour was operationalized as an unexplained dental complaint, high dental attendance, a high treatment consumption or an unreasonable demand with regard to treatment. Of the 309 patients 8.7% fulfilled the criteria for somatization-specific behaviour, which was mainly expressed as a high frequency of attendance (6.8%). Women showed significantly more often (73%) somatization-specific behaviour than men (27%). Further, a relation between depression and somatization-specific behaviour was found. Particularly patients with a relatively high level of long-lasting dental complaints demonstrated somatization-specific behaviour.
Abstract: Epidemiological studies show that one out of four Dutch individuals suffers from a mental disorder. Consequently, dentists are confronted with noticeable deviant or problematic behaviour. In this paper an overview is presented of several of psychological problems and their relevance to dental treatment. This is illustrated by a case description. For a proper diagnosis and adequate treatment planning it is important that dentists have some general knowledge of psychological functioning of patients, and the possible psychological determinants of illness and well-being. This would prevent unnecessary damage of dental tissues and needless suffering but also frustration, both for the patient and the dentist.
Abstract: OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.
Abstract: Clinically significant forms of choking fear (i.e., choking phobia) are characterized by fear and avoidance of objects and situations that may lead to choking such as ingestion of food or pills. During dental treatment patients may also be confronted with situations that give rise to extreme fear of suffocating or being choked (mouth full of water, the making of dental radiographs and dental impressions). Choking phobia often develops following an episode of choking on food. The paper shortly reviews relevant literature, medical and psychiatric differential diagnosis, as well as possible treatment approaches to individuals suffering from choking fear.
Abstract: OBJECTIVE: To assess differences among highly anxious dental patients assigned to different treatment modes (i.e. behavioural management (BM), nitrous oxide sedation (NOS), intravenous sedation (IVS). Patients were compared with regard to psychological and dental variables before treatment (e.g. number of decayed teeth), and dental variables after treatment (e.g. number of fillings made). DESIGN: Dentists experienced in the treatment of highly anxious patients allocated patients to a treatment mode based upon their clinical judgement. SETTING: Centre for Special Dental Care, Amsterdam, The Netherlands. SUBJECTS: 211 patients from this dental fear clinic. MEASURES: General psychopathology, as measured by the Symptom Checklist 90 (SCL-90), and dental anxiety (DAS, S-DAI, 10-point scale) were measured prior to treatment. From the panoramic radiograph the following pre-treatment dental variables were assessed: number of teeth, number of decayed teeth, number of retained roots, and number of root-filled teeth. After treatment, number of fillings, extractions, endodontically treated elements, number of visits, and treatment duration, were determined from the patients' records. RESULTS: Of the 144 patients who received dental treatment at the clinic, 46.5% was treated using a BM approach, 27.8% with NOS, 22.9% with IVS, and 2.8% under GA. No differences among the treatment groups were found with regard to SCL-90 and dental anxiety. The results showed that patients in the IVS group had statistically significant more decayed teeth than patients in the BM group. Furthermore, more fillings were made in the IVS group than in the BM group. CONCLUSION: Since it appeared possible to treat a large proportion of patients by BM alone, training dentists in the application of psychological methods for the treatment of anxious patients should be stimulated. In addition, future research should seek for variables that, besides oral health, are better able to discriminate between groups of highly anxious patients than measures of dental anxiety and psychopathology.
Abstract: This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.
Abstract: The present study was carried out to explore the relation between BII phobia and dental phobia. An additional aim was to determine the fainting tendency of dental phobics and BII phobics during an invasive treatment procedure. Participants were 63 patients undergoing treatment in a dental fear clinic, and 173 patients undergoing dental surgery in a university hospital. They completed measures on fears of particular medical and dental stimuli, fainting history, general trait anxiety, dental anxiety, BII anxiety, BII avoidance, and a questionnaire aimed to define a phobia based on DSM-IV criteria. Immediately after treatment information was obtained on exposures to blood or injections, state anxiety, and feelings of faintness during treatment. The results did not indicate any significant relationship between measures of dental anxiety and BII anxiety or BII avoidance. However, 57% of the dental phobic patients could also be classified as BII phobic. The proportion of dental phobics who reported fainting episodes in their past was similar to that of the BII phobics (37%), but none of the participants fainted during treatment. It is concluded that, albeit the level of co-occurrence for both types of phobias is high, dental phobia should be considered as a specific phobia, independent for the BII subtype within DSM-IV. Further, the findings are inconsistent with the notion that individuals with BII phobia have a remarkably high tendency to faint in the presence of their phobic stimuli.
Abstract: The aim of the present paper is to inform the reader about individuals who are suffering from severe mental disorders, such as obsessive-compulsive disorder (OCD). A case story enlightens the fact that anxiety disorders like OCD can have profound implications for the dental treatment plan.
Abstract: Somatization is a process that makes that psychological and social problems are experienced physically and presented as a physical complaint. This phenomenon should be considered as a potentially dangerous pitfall for the dentist. Not recognizing the underlying problems may lead of unnecessary and inadequate treatments. The purpose of this article is to provide the dentist with practical guidelines for proper assessment, treatment and referral of this patient category.
Abstract: The aim of the present study was to assess psychological characteristics of highly anxious dental patients. Subjects were 321 patients (203 women) applying for treatment at a dental fear clinic in The Netherlands. Patients filled out several questionnaires to assess the amount of psychological complaints (Dutch version of the Symptom Checklist 90-Revised; SCL-90) and dental anxiety (Dental Anxiety Scale, Short version of the Dental Anxiety Inventory) approximately 4 months prior to their first appointment. The total mean score on the SCL-90 for the highly anxious patients was 142.7 (SD=47.2) for men and 166.5 (SD=64.3) for women. The SCL-90 total score and the mean scores of all subscales were significantly higher, and above the 80th percentile for most of the subscales, than the mean scores of the Dutch general population. The results indicate that patients who apply for treatment at a dental fear clinic are not just dentally anxious; they show complaints on a wide range of other psychological dimensions.
Abstract: This article presents the results of a study among 332 extremely anxious persons who applied for treatment at SBT, a Dutch special dental care clinic, between July 1990 and December 1991. It was found that 85% of these persons actually started treatment. Two and a half years later it appeared that 39% of them still received regular treatment, whereas 34% had completed treatment. Twelve percent stopped visiting before treatment was completed. Furthermore, results showed that dental anxiety was reduced after treatment. However, 36% of the patients still avoided appointments with a dentist. It is concluded that for most of the dentally anxious patients specialized care and oral health are no guarantee for regular dental attendance in the long term.
Abstract: This study presents a contribution to the understanding of the mechanisms that are involved in the development and maintenance of dental anxiety. Subjects were 224 undergraduate psychology students who completed questionnaires regarding dental anxiety, painful and traumatic experiences, negative cognitions, dental beliefs, and how their attitude to dental treatment had changed during their life. The results showed that both the extent to which earlier dental treatments were perceived as painful and the extent to which these incidents were reported as traumatic were significantly related to dental anxiety. Evidence was also found to support the latent inhibition hypothesis, which predicts that patients less easily acquire dental anxiety in case they received a number of relatively painless treatments prior to conditioning. Both findings confirmed those earlier obtained by Davey in a conceptually similar design (Behaviour Research and Therapy, 27, 51-58, 1989). In addition, frequency of negative cognitions about dental treatment and dental anxiety appeared to be positively related (r = 0.74; P < 0.001). Significant differences were found between highly anxious Ss and Ss showing low levels of anxiety on a variety of expectations and beliefs related to undergoing dental treatment. The results are discussed in terms of a cognitive-behavioural perspective of dental anxiety.
Abstract: The present study was intended to explore the relationship between individuals' level of dental anxiety and thoughts (both self-statements and mental images) related to dental treatment. Subjects were 210 psychology students (75 males, 135 females). The results showed that 98% of the subjects reported one or more negative or catastrophic thoughts. A significant positive relationship was found between reported severity of anxiety (S-DAI scores) and frequency of thoughts. The results indicate that dental anxiety is associated with the tendency to experience negative or threatening thoughts concerning treatment.
Abstract: This article presents a new development on the field of psychotherapy: Eye-Movement Desensitization and Reprocessing (EMDR). This recently developed procedure promises rapid and effective treatment of anxiety related complaints, including post-traumatic stress disorders (DSM-III-R). In essence the therapist induces a series of rapid and rhythmic eye-movements. EMDR facilitates cognitive changes and lasting decrease of anxiety. As indicated by research and illustrated by case histories, EMDR can be effective in one session. Until now there is no definitive explanation for the effectiveness of this method.
Abstract: The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.
Abstract: This study investigated the psychometric properties of the Dental Cognitions Questionnaire (DCQ). This measure contains 38 items and assesses both frequency and believability of negative cognitions related to dental treatment. The results indicated that the DCQ has good internal consistency, high test-retest reliability, and satisfactory concurrent validity, as indicated by positive associations with indices of anxiety and other cognitive measures (n = 180). Factor analysis revealed a one factor solution. Furthermore, the DCQ discriminated strongly between dental phobics (n = 85) and non-phobic Ss (n = 70). Moreover, it was found that combinations of DCQ items have substantially more explanatory power than did a measure of dental trait anxiety, explaining up to 70.7% of the variance in state anxiety ratings in the dental situation. Overall, it appears that dental phobics have many extremely negative beliefs and self-statements about themselves and about what might happen during treatment. Since certain cognitions seem to play a critical role in fear evocation, diminishing catastrophizing ideation may be an important determinant of adjustment to dental treatment and reduction of psychological distress.
Abstract: The aim of this article is to present a critical reflection on 'cures of patients' after the removal of dental amalgam fillings, reported in the popular press. It is concluded that, when the removal of dental amalgams in patients with a hypersensitivity to mercury is put aside, possible explanations for these questionable cures are not connected with the removal of amalgam but may involve the functioning of the immune system, the relation between environment and the opinions of patients and the influence of psychological factors on illness and health.
Abstract: This study examined cognitive correlates of dental anxiety among 24 highly anxious patients and 17 low-anxious patients. In both groups, anxiety expectations, dental trait anxiety, and state anxiety (in the waiting room and in the dental chair) were rated. Negative cognitions and cognitive control were also assessed. It was found that dentally high-anxious patients claimed to experience more negative thoughts than those with low anxiety (p < 0.001). None of the highly anxious patients reported relatively few negative cognitions, and none of the patients in the low-anxiety group reported relatively numerous negative cognitions. While patients from both groups reported that cognitive control declined with the imminence of treatment, highly anxious patients were found to have less control over their negative thoughts (p < 0.001). A series of stepwise regression analyses revealed that both the number of negative cognitions and perceived cognitive control accounted for 75% of the variance in dental trait anxiety. The results of the present study suggest that cognitive activities, such as negative thinking (catastrophizing) and cognitive control, are important moderators of dental anxiety.
Abstract: The purpose of the present paper is to provide a summary of features of patients suffering from a wide range of anxiety disorders by means of case histories and clinical descriptions. Particularly, attention is being devoted to distinguishing between patients of which the predominant problem is specific fear for one or more aspects of dental treatment and patients with a non-specific or a general anxiety problem, including panic disorder and generalized anxiety disorder.
Abstract: The purpose of the present paper is to provide the dentist with a number of treatment steps that may reduce anxiety and may enhance trust, feelings of control and application of coping skills. A distinction should be made between patients with specific fear for one or more aspects of dental treatment and patients with non-specific, general anxiety. Practical implications for dental treatment of both groups are given. Dentists should be familiar with the signs and symptoms of the various anxiety disorders, in order to be able to properly refer or treat the patient.
Abstract: Although dental anxiety is a well investigated phenomenon in dental health care, remarkably little is known about anxiety reactions related to treatment carried out by the dental hygienist. In the present study anxiety reactions were measured among 101 patients attending the dental hygienist. General level of anxiety was assessed through the PAQ (Photo Anxiety Questionnaire; STOUTHARD, DE JONGH & HOOGSTRATEN, 1991), whereas an additional questionnaire was used to obtain information about specific stimuli and situations that might provoke anxiety in the dental hygienist situation. The results indicated that during dental hygienist treatment only 15% of the patients experienced no feelings of anxiety. Another 15% of the patients reported that a visit to the dental hygienist was more distressing than dental treatment. The level of anxiety appeared to be strongly related to a number of stimuli and situations, with actual pain (78%) and expected pain (67%) major anxiety provoking factors. The relation between pain and anxiety was highly significant, with highly anxious patients having more fear for pain than their low anxious counterparts. Also feelings and sounds of instruments, patient's helplessness and perceived lack of control over what happens were identified as important contributors to anxiety for the dental hygienist treatment. The results of this study suggests that treatment by the dental hygienist is a distressing event for many patients.
Abstract: According to BECK's cognitive model of emotional disorders (1976) anxiety is associated with negative and threatening thoughts concerning the likelihood of personal danger. In the present study the content of thoughts of 32 anxious dental patients was investigated. Patients' mean score for the Dental Anxiety Scale was 17.1 (SD = 2.0). The average time period patients had not visited a dentist was 9.1 yr (SD = 8.7). Using semi-structured interviews 132 thoughts were explored. The mean number of thoughts reported per patient was 4.1 (SD = 1.6). Almost all patients reported thoughts in some way related to their fear. All patients except one reported self-verbalizations of a negative or catastrophizing nature. Nine different categories of the content of the thoughts were identified. Nine percent of the thoughts consisted of visual images. The largest category (23%) consisted of catastrophic thoughts about the patient's own functioning during dental treatment, e.g., thoughts about losing control, panicking and dying. Fifty-nine percent of the patients reported thoughts of this type. The findings provide support for BECK's cognitive model of emotional disorders.
Abstract: Many people expect dental treatment to be painful. This kind of expectation has important negative consequences for the patients' well-being. Disappointing occurrences during the treatment itself can further influence the expectations about a next treatment. The fact that the treatment result happens to be more positive than expected is a necessary instead of a sufficient condition for changing existing expectations. A cognitive model for dental fear is proposed and some implications for the general practice are discussed.
Abstract: Dental anxiety was measured by administering a questionnaire with photographs to patients of two dental practices and a group of psychology students. In one group of patients behavior was also observed. Although in all samples females reported more anxiety than males, the difference was significant in only one of the samples. The difference did not correspond with the difference in actual behavior of the two sexes. In the discussion the question is raised whether the commonly found difference in dental anxiety between males and females is due to a structural difference or merely reflects a difference in verbal response.
Abstract: A questionnaire on dental anxiety using photographs, the FAV, was constructed. It measures the expected level of dental anxiety at ten different moments with regard to the dental treatment. Answers are given on a scale consisting of five photographs of facial expressions, ranging from 'relaxed' to 'extremely anxious'. The FAV has good psychometric qualities. The validation results are promising.
