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Objectives: This randomized clinical trial compared the effectiveness of music and informative videos as distraction tools to reduce the anxiety of patients during root canal treatment and retreatment. Method and materials: A total of 90 patients were enrolled in the study. The patients were randomly allocated to three groups: Group 1 listened to music during the treatment (n = 30), Group 2 watched an informative preoperative video (n = 30), and a control group underwent treatment without a distraction method (n = 30). Prior to treatment, the Corah Dental Anxiety Scale (CDAS) and a visual analog scale for pain were used to assess anxiety and preoperative pain. Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded before the intervention (T1), after the local anesthetic (T2), following pulp extirpation or removal of root fillings (T3), and immediately following rubber dam removal (T4). One-way ANOVA, followed by post-hoc Bonferroni tests for multiple comparisons, were used to compare mean values of systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation among the groups. A P value of 5% was considered as significant. Results: Listening to music reduced systolic blood pressure, heart rate (P < .001), and diastolic blood pressure (P = .003) in patients undergoing root canal treatment and retreatment at T4 compared to the baseline (T1). Music (P < .001) and informative video (P = .003) groups had significantly lower postoperative visual analog scale pain scores. Conclusion: Listening to music during root canal treatment and retreatment reduced anxiety levels in patients compared to informative preoperative videos and no distraction technique. [ABSTRACT FROM AUTHOR]

Objectives: Sedation is commonly utilized for individuals otherwise unable to receive dental treatment, such as those with disabilities, medically complex conditions, and dentophobics. The aim was to characterize the profiles of patients receiving various types of sedation and assess the corresponding success rates. Method and materials: This was a 5-year records-based retrospective study. Data regarding the indication for sedation, medical history, sedation type, and treatments performed were recorded. Results: In total, 103 patients underwent 389 treatment sessions under sedation; 42.7% of the patients were disabled. The most commonly administered sedation was moderate sedation, (49.4%), followed by deep (36.8%) and inhaled sedation (13.9%). Successful treatment results were achieved in 96.1% of sessions, with no adverse effects noted during recovery. The high success rates were independent of patient age, sex, and sedation type. There was a positive association between the indication for sedation and the type of sedation. The medically complex patients and the dentophobic patients received mainly moderate sedation (85.3% and 58.2%, respectively), whereas the disabled patients received deep sedation (51.2%). In total, 94% of patients were returning (revisiting) patients. A statistically significant association was found between the type of sedation administered and the success rate during the first and last sessions (P< .001). The success rate at the first session may be predictive of the success in subsequent sessions. Conclusion: A significant positive correlation was found between patient characteristics and the chosen sedation type leading to a high success rate across the various sedation modalities. [ABSTRACT FROM AUTHOR]

Purpose: Phenomenology is a branch of philosophy that focuses on human lived experience. Illness including dental diseases can affect this living experience. Within the dental literature, there is very little reported on the use of phenomenology compared to other healthcare sciences. Hence, the aim was to review the literature and provide an overview of various applications of phenomenology in dental research. Methods: This study was a narrative review using literature in the last 10 years identified by web-based search on PubMed and Scopus using keywords. A total of 33 articles that were closely related to the field and application in dentistry were included. The methodology, main results, and future research recommendations, if applicable, were extracted and reviewed. Results: The authors in this study had identified several areas such as orofacial pain and pain control research, dental anxiety, dental education, oral healthcare perceptions and access, living with dental diseases and dental treatment experience in which the phenomenological method was used to gain an in-depth understanding of the topic. Conclusions: There are several advantages of using the phenomenological research method, such as the small sample size needed, the diverse and unique perspective that can be obtained and the ability to improve current understanding, especially from the first-person perspective. [ABSTRACT FROM AUTHOR]

Aim: The pathways to post‐operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient‐related predictors of post‐operative pain following root canal treatment. Methodology: A total of 154 patients received a single‐visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post‐operative pain was assessed using the Numeric Rating Scale at multiple time‐points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient‐related predictors on a theoretical model of post‐operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). Results: Dental anxiety (coefficient 0.028; p <.01), dental fear (coefficient 0.007; p =.02) and irrigant solution (coefficient 0.004; p =.03) exerted a direct effect on post‐operative pain. SOC exerted an indirect effect on post‐operative (coefficient 0.006; p =.01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p =.04) exerted an indirect effect on post‐operative pain through dental anxiety. Conclusions: Dental anxiety, dental fear, previous negative experiences and SOC are patient‐related predictors of post‐operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post‐operative pain. [ABSTRACT FROM AUTHOR]

Background: Children with hearing impairment (HI) face communication challenges during dental procedures due to hearing loss. Studies suggest that distraction techniques, like virtual reality (VR), can effectively divert their focus from stressful stimuli, resulting in a more comfortable dental experience. The present study aims to assess the effectiveness of distracting children with moderate to severe (HI) with virtual reality glasses that show cartoons in sign language during pulpotomy treatment compared to conventional management techniques. Methods: Forty children aged five to seven participated in a randomized controlled parallel two-arm clinical trial—the type of behavioral management employed determined which two groups children were randomly placed into. Group I (Study group) used virtual reality glasses as a diversion, while Group II (Control group) used the conventional behavior management approach. Local anesthesia was administrated, and a pulpotomy procedure was performed on the selected tooth, followed by stainless steel crown restoration (SSC). There were three methods used to assess dental anxiety before and after the procedure: the physiological method, which used heart rate (HR); the objective measure, which used the Venham Clinical Anxiety Scale (VCAS); and the subjective measure, which used the modified Facial Affective Scale (FAS). An independent t-test was employed for HR analysis of the difference between the groups as a continuous variable. The Pearson Chi-square test assessed differences between groups for categorical variables, such as (VCAS) (FAS). Results: No significant differences were found in mean (HR) or (VCAS) between the two groups throughout the procedures: during local anesthesia (p = 0.659, 0.282), pulpotomy (p = 0.482, 0.451), and stainless steel crown preparation (p = 0.090, 0.284). Anxiety levels by (FAS) remained statistically comparable between the two groups before and after the procedures (p = 0.507, 0.749), respectively. Conclusions: The use of VR glasses revealed no significant advantages in managing children with HI during the dental visit compared to the conventional method of child behavior management. Trial registration: The trial was prospectively enrolled on 11/11/2023 under the identification number NCT06153823 on ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords "music" and "dental anxiety". The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, −0.50; 95% CI, −0.80 to −0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, −0.51; p = 0.0007) than in children (SMD, −0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, −1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, −0.24; p = 0.02). Regarding music styles, classical music (SMD, −0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children. Methods: A triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4–6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer's Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery. Results: A significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03). Conclusion: Dexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present investigation was to evaluate the possible anxiolytic effect of jasmine aromatherapy in pediatric dental procedures. Materials and Methods: A parallel randomized single-blinded placebo-controlled clinical trial was designed and conducted from February 19 until April 19, 2020, on children aged 7 to 12 years-old requiring class 1 restorative treatment of primary or permanent tooth with infiltration anesthesia. Interventions were defined as 15 minutes of aromatherapy using 2mL of jasmine extract for the intervention group, and with water for the control group. Outcomes were defined as child's anxiety and pain perception, measured by modified child dental anxiety scale (MCDAS), visual analogue scale (VAS) and changes of vital signs. After the patients received interventions based on their groups, their data was collected and analyzed. We used parametric tests and linear regression for outcome comparisons. Results: 56 patients were randomized and allocated in two groups, 28 to each. The groups did not differ significantly regarding age, sex, heart rate and O2 saturation before, during, and after procedures. Based on multivariable regression, the intervention group showed a significantly reduced MCDAS (B (95% CI) =-2.11 (-4.09, -0.13), P=0.04) and VAS (B (95% CI) =-2.30 (-3.50, -1.10), P<0.001) scores. Conclusion: Jasmine aromatherapy showed to be effective in reducing children's anxiety and pain perception during dental procedures and therefore, can be suggested as a cheap and practical complementary method in dental practice. [ABSTRACT FROM AUTHOR]

Dental fear and phobia are prevalent worldwide, with local anesthesia being the most feared procedure. This study aimed to determine whether photobiomodulation therapy (PBMT), used as a pre‐anesthetic, could modulate puncture pain and enhance the effectiveness of local anesthesia. In this controlled, randomized, double‐blind study, 49 participants were divided into an experimental group (n = 24), which received infrared laser therapy (100 mW, at 808 nm, 8 J, 80 s at a single point) immediately before standard anesthesia; and control group (n = 25), which received the standard anesthetic technique and sham laser. Pain levels were measured using the visual analog scale, and anesthetic efficacy was assessed through electrical tests (latency), percentage of failures, and cartridge usage. Anxiety levels were evaluated using the Beck Anxiety Inventory. Cardiovascular parameters were evaluated through blood pressure, oxygen levels, and heart rate. This randomized, double‐blind study found no difference between groups in these experimental conditions. The bias toward a positive PBMT result was sufficiently removed. Autonomic responses of the PBMT group were maintained stable during the procedure. [ABSTRACT FROM AUTHOR]

Introduction Aim Methods Results Conclusions Dental care avoidance affects individuals' oral health status. There is limited literature examining the context of dental avoidance behavior.The aim of the study is to examine attitudes toward dental care services among adults.Overall, 16 patients participated in semi‐structured interviews. The interviews were analyzed using inductive thematic analysis. Through independent reviews of the themes that comprise the patients' experience, a consensus was established among the researchers.Ten major themes were identified that encapsulate patients' attitudes toward dental care attendance: Effect of environment and equipment, Fear and anesthesia, Procrastination, Dissatisfaction with the dental care system, Expectations of dentists, Quality of dental care, Edentulousness and social status, Financial involvement, Aesthetics, and Dentists' behavior. Compliance with oral health maintenance can be enhanced by specific training for professionals and dentistry students and by fine tuning the dental care system.This is the first comprehensive study in Hungary investigating attitudes among dentist patients toward dental care. The results suggest that there are many factors that may affect dental care attendance. Thus, these findings make a potentially fundamental contribution to the improvement of dental care and support practitioners in enriching their understanding of dental avoidance behavior. [ABSTRACT FROM AUTHOR]

Introduction: Children often experience anxiety and behavioural issues when exposed to dental stimuli such as the sight, sound, and sensation of the airotor. Behaviour modification techniques that involve familiarising children with dental equipment and procedures can help reduce this anxiety. Aim: To evaluate the effectiveness of three behaviour management techniques: Tell-Show-Do (TSD), Tell-show-play-do (TSPD), and a smartphone dental game application in managing Dental Fear and Anxiety (DFA) in children aged 4-8 years. Materials and Methods: This randomised clinical study included 60 children aged 4-8 years who required Class-I restorations (ICDAS Code 2 and Code 3) in maxillary or mandibular molars. Participants were randomly assigned to one of three groups: TSD (n=20), TSPD (n=20), or the smartphone dental game app (n=20). Preoperative anxiety levels were assessed using the Children's Fear Survey Schedule Scale-Dental Subscale (CFSSDS). Anxiety levels were evaluated pre- and postoperatively using the Modified Child Dental Anxiety Scale (MCDAS-f) and the Visual Analogue Scale (VAS). Physiological parameters, including pulse rate and SpO2 levels, were measured before and after treatment. Statistical analyses included paired t-tests for pulse rate, Wilcoxon signed-rank tests for VAS and MCDAS-f scores, Kruskal-Wallis tests for intergroup comparisons, and one-way ANOVA with Bonferroni post-hoc tests. Data were analysed using SPSS version 27.00. Results: The TSPD group exhibited a significantly greater reduction in dental anxiety compared to the TSD (p=0.01) and smartphone dental game groups (p=0.05), as evidenced by MCDAS-f (p<0.001) and VAS scores (16.7%). Physiological parameters indicated significant changes in the TSPD group, with a notable decrease in pulse rate post-treatment (p=0.014) and the lowest mean SpO2 level (96.55). One-way ANOVA with Bonferroni post-hoc tests confirmed significant anxiety reduction in the TSPD group both before (p=0.048) and after treatment (p=0.009). The Wilcoxon signed-rank test demonstrated a substantial decrease in DFA, with 16.7% of children in the TSPD group no longer experiencing anxiety post-intervention (p<0.001). These findings underscore the superior efficacy of the TSPD technique in managing DFA. Conclusion: Among the three techniques, the TSPD technique was the most effective overall, while the TSD technique was the least effective. It is crucial for paediatric dentists to employ child-friendly and pain-free methods to improve children's behaviour during dental treatments. [ABSTRACT FROM AUTHOR]

Torture victims struggling with post‐traumatic stress often experience elements in the dental treatment situation that may trigger trauma‐related reactions. The aim of the study was to explore intervention strategies that will enable dental health workers to adapt dental treatment to the needs of torture survivors. Exploratory interviews were conducted with 10 torture‐exposed resettled refugees with dental treatment experience in Norway. The data was analyzed using qualitative content analysis, which suggested that to minimize trauma‐reactions, dental personnel should focus on creating a safe therapeutic space and strengthening the patient's sense of control. Four main categories of clinical advice were proposed: (i) Acquire knowledge about psychology, consequences of torture, cultural differences, trauma‐informed care, and the patients' individual needs; (ii) Recognize the trigger‐potential of busyness or delays; (iii) Avoid surprises, such as sudden moves or actions and explore triggers individually, but make sure not to evoke images of interrogation, and; (iv) Provide overview both with respect to visibility in the clinical room, and to predictability regarding the dental treatment. Although undergoing dental treatment may be challenging for torture‐exposed individuals, it is possible to reduce the predicaments considerably by making feasible adaptions to the treatment and adopting a trauma‐informed approach. [ABSTRACT FROM AUTHOR]

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Purpose: Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures. Patients and Methods: This randomized clinical trial, 42 children between the ages of 5–6 years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale – Anxiety (VAS-A) score. Results: In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group. Conclusion: Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures. [ABSTRACT FROM AUTHOR]

Purpose: To assess levels of dental fear and anxiety (DFA) in children with and without Molar-Incisor Hypomineralisation (MIH) and dental caries lesions. Methods: In this cross-sectional observational study, 159 children between 8 and 12 years of age were included. For the evaluation of DFA, children responded to the validated version of the Children's Fear Survey Schedule-Dental Subscale. MIH was assessed using the MIH Index. To evaluate the activity of dental caries lesions and dental caries experience, the Nyvad criterion and the dmft/DMFT index were used, respectively. Dental hypersensitivity was evaluated using air stimulation and a Visual Analogue Scale. The association between MIH and dental caries with DFA was assessed using the generalised linear model with Poisson family, identity link function and robust variance estimation. The significance level was set at 5%. Results: The mean DFA score was 28.3 (SD = 13.4) with scores ranging from 15 to 64. Amongst children presenting both MIH and dental caries, the perception of DFA was notably higher compared to those with either MIH or dental caries alone. The activity of caries lesion in patients with MIH also influenced DFA levels (diff: 18.6; 95% CI: 12.0–25.2; p < 0.001). Dental caries experience in the primary dentition also demonstrated statistical significance concerning DFA (95% CI: 0.8–13.3; p value = 0.027). Conclusion: Children with MIH exhibit higher levels of DFA than children without MIH. The experience of dental caries and the activity of caries lesions significantly influence the perception of DFA in children with MIH. [ABSTRACT FROM AUTHOR]

Background: During dental school, students may encounter stressful events that contribute to stress, anxiety, and depression; in response to these factors, some students use vaping or electronic cigarettes. Objective: To evaluate the relationship between electronic cigarettes use and stress, anxiety, and depression among dental students. Methods: A cross-sectional study included 142 dental students in their preclinical, clinical, or internship year was conducted. The 142 participants were split evenly between two groups: smokers and nonsmokers. The average age of the study's male and female participants was 21.6 years. Using the DASS 21 scale, participants were instructed to complete an electronic questionnaire assessing the association between electronic cigarettes use and stress, anxiety, and depression in smokers and nonsmokers. Results: According to the findings of this study, stress, anxiety, and depression were significantly associated with electronic cigarette use. Compared to non-smokers, electronic cigarette smokers reported higher levels of severe/extremely severe depression (OR: 10.34, 95% CI: [4.23–24.1]), anxiety (OR: 13.8, 95% CI: [5.4–30.1]) and stress (OR: 27.6, 95% CI: [8.9–85.8]). Compared to males, females were 2.5 times (95% CI: [1.02–6.1]) more likely to report severe/extremely severe anxiety (P < 0.05). Conclusion: This study demonstrates a significant correlation between the use of electronic cigarettes and elevated levels of stress, anxiety, and depression among dental students in the UAE. [ABSTRACT FROM AUTHOR]

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques. [ABSTRACT FROM AUTHOR]

Background: Child dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators. Methods: A thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration's bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610. Results: The study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate. Conclusion: In this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future. [ABSTRACT FROM AUTHOR]

Introduction: Many patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems. Methods: The sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant's permission, no note-taking was done during the interviews, which allowed for greater focus on the participants' conversation. The obtained data was analyzed using the content analysis. Results: A total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient's perceptions of general practitioner(GP) and dental practitioner's scope of work [21], flawed dental system (34), dental anxiety [28], financial considerations [25], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs. Conclusion: Most participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient's consult behaviors regarding dental problems. [ABSTRACT FROM AUTHOR]

Dental fear still causes health risks and high costs for health insurances due to the common avoidance of dental visits by dentally fearful patients. Selective attention may be a potential trigger of dental fear. The aim of the present studies was to investigate the influence of threatening dental stimuli in image combinations on the performance in a visual search task. In three studies, we compared the influence of dental stimuli with pictures of weapons or accidents and different distractors, i.e., cutlery, animals, landscapes. In the first two studies, participants had to decide if a target is available in a 3 × 3 matrix or not. In the third experiment, participants had to decide if a threatening or a neutral stimulus was the target. In all three studies we could replicate the finding that there is a threat-superiority-effect as well as a disengagement-effect for dental stimuli in visual search tasks. Dental stimuli were not only detected faster than deciding that no dental stimulus is available with different distractors, but dental stimuli also decreased search performance within the 3 × 3 matrices when presented as distractors. This is the first paper that demonstrates that dental stimuli that are associated with a negative threatening valence attract attention very quickly in the context of non-threatening stimuli. Future studies should investigate if a distraction from these threatening stimuli or a habituation to these threatening stimuli could reduce dental fear. [ABSTRACT FROM AUTHOR]

Background: The present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients. Methods: This study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used. Results: The questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p < 0,000). Germans were more susceptible to signs of Anxiety (p < 0,000), Depression and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index (p < 0,000) than Albanian patients. Additionally Albanian patients scored significantly lower on the preventive care index (p < 0,000). Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients. Conclusion: The results showed that between both populations differences in dental anxiety, psychological distress and oral health exists. Patients from Germany report more psychological distress and described more dental anxiety compared to Albanian patients. Albanian patients reported not utilization on oral health care.The implementation of educational programs and preventive measures, would contribute to raising awareness about the importance of oral health and increased use of dental services. [ABSTRACT FROM AUTHOR]

Featured Application: This research can be directly applied in the development of more efficient dental biofilm management techniques, enhancing the effectiveness of preventive dental care. Specifically, the insights from our study could be used to improve the protocols of Guided Biofilm Therapy, potentially reducing the anxiety associated with dental hygiene visits and improving patient outcomes. Fear and anxiety during dental visits are common issues that can lead to avoidance of appointments and deterioration of oral health. Effectively managing patients' emotions during dental treatments is crucial to improving their experiences, increasing adherence to regular visits, and achieving better treatment outcomes. This study aimed to assess the levels of fear and anxiety in patients undergoing hygiene treatments utilizing Guided Biofilm Therapy (GBT) and identify factors that could reduce these negative emotions. A total of 247 patients were evaluated using standardized questionnaires (MDAS, STAI X1, STAI X2, and Gatchel), custom questions, and heart rate monitoring as a physiological stress indicator. Clinical factors, including dental status confirmed by AI-based radiographic analysis (Diagnocat system), as well as sociodemographic influences, were analyzed. Results indicated significant reductions in fear and anxiety after the procedure, as shown by both heart rate and questionnaire scores. Factors such as pain, the presence of caries, and implants were linked to higher anxiety, while strategies like avoiding visible needles and postprocedure interaction with staff were associated with lower stress levels. The findings underscore the importance of personalized care and emotional support to enhance patient experiences. [ABSTRACT FROM AUTHOR]

Background: While cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample's oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach. Methods: The study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study. Results: All patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2). Conclusions: TADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes. Trial registration: The study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority. [ABSTRACT FROM AUTHOR]

Background: Dental anxiety is marked by intense and irrational fear of dental procedures affecting millions of individuals worldwide. The purpose of this study was to investigate the relationship between dental anxiety, its influencing factors, and the preferred management techniques among adults seeking dental care in Riyadh. Methods: A cross-sectional questionnaire study was carried out among 1734 patients who visited dental clinics in Riyadh. A self-administered questionnaire was developed and validated, comprising 28 closed-ended questions; it demonstrated good reliability and internal consistency (Cohen's kappa coefficient = 0.90, Cronbach's alpha coefficient = 0.86), it contained pre-validated Modified Dental Anxiety Scale to quantitatively assess the level of dental anxiety. Data analysis involved descriptive analysis, Chi-square test, Pearson correlation coefficient and multiple linear regression. Results: Majority (59.2%) of participants reported moderate anxiety, while 10.9% experienced high anxiety which was significantly linked to factors such as fear of pain (37.8%) and anaesthetic needles (25.8%). Topical anaesthetic gel (64.5%), pre-treatment explanations (78.9%), and conducive clinic environment (79.4%) were perceived as effective anxiety alleviators. A negative correlation existed between dental anxiety and preferred management techniques. Dental anxiety had significant association between gender (β = 0.910) and age (β = 0.263). Conclusion: This study revealed that majority of participants had moderate dental anxiety, linked significantly to influencing factors like frequency and purpose of dental visits and past dental experiences. The study also found the preferred anxiety management methods among participants which included topical anaesthetic gel, pre-treatment explanations, and a comfortable clinic environment. [ABSTRACT FROM AUTHOR]

Introduction: Dental local anaesthesia serves several purposes, the most common of which is to minimise pain during dental procedures, thereby improving patient comfort and facilitating treatment. It can also have therapeutic effects, such as temporarily relieving pulpitis pain. Patients often experience anxiety before and after receiving local anaesthesia. Aim: To evaluate the perceptions and attitudes of patients receiving local anaesthesia through a self-administered questionnaire. Materials and Methods: This cross-sectional study was conducted among 398 patients, including 218 males and 180 females, between August 2022 and October 2022, who underwent dental extractions at a dental hospital in Chengalpattu district, Tamil Nadu, India. A 15-item questionnaire was administered to the patients. The questionnaire comprised three domains: the first domain included questions before the administration of local anaesthesia, the second domain included questions during the administration of local anaesthesia, and the third domain included questions after the administration of local anaesthesia. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Results: Of the participants, 126 (40.20%) were between 46 and 60 years of age. Males constituted 218 (54.8%) and females constituted 180 (45.2%) of the sample. Additionally, 76.38% of the patients were unaware of the preinjection topical anaesthesia. Moreover, 70.35% of patients experienced anxiety before the administration of local anaesthesia. During the administration of local anaesthesia, 300 (75.4%) of patients reported experiencing moderate pain. Many patients exhibited physical manifestations of fear, including sweating in 92 (23.12%), light-headedness in 102 (25.63%), and palpitations after the administration of local anaesthesia in 190 (47.74%). Conclusion: Anxiety was more prevalent among patients prior to the administration of local anaesthesia. Patients were more anxious about the fear of the injection rather than the fear of the extraction itself. The outcomes of anaesthesia may be significantly improved by educating patients about dental treatment processes. [ABSTRACT FROM AUTHOR]

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self‐control, randomized, and double‐blind clinical trial evaluated 30 children aged 6–12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong–Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong–Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p = 0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection. [ABSTRACT FROM AUTHOR]

Objectives: This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics. Methods: Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services. Results: In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non‐White respondents (OR = 1.76; 95% CI = 1.06–2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37–1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider. Conclusions: The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: Children with autism exhibit a higher general and dental anxiety, due to altered sensory sensibilities. Aim: This current systematic review aims to evaluate the effectiveness of Sensory adapted dental environment (SADE) over regular dental environment (RDE) on behavioral, physiological stress and overt anxiety in children with autism spectrum disorders (ASDs). Materials and methods: Prospero registered (CRD42024508336). PubMed, Cochrane, Scopus databases are searched from years January 1, 1980–January 1, 2024 using pre‐defined search strategy. Results: A total of 269 titles, were obtained from the included databases after application of filters, exclusion of duplicates and reviews and irrelevant articles led to the final inclusion of 12 articles for full text screening from which, three studies sustained the targeted PICO search. Conclusion: Skin conductance level (parameter indicating physiological stress) is lower in SADE environment in children with ASD, other behavior stress related parameters there is no significant difference between SADE and RDE environments. [ABSTRACT FROM AUTHOR]

The article explores the effectiveness and potential of aromatherapy for managing anxiety. It discusses the impact of anxiety in social, occupational and other areas of life. It examines the impact of essential oils and aromatherapy on various anxiety disorders including anxiety in academic and work environment, reproductive anxiety, pregnancy and labor/maternity anxiety, preoperative and surgery anxiety, dental anxiety, procedural anxiety and anxiety in cancer and palliative care.

Aim: No comprehensive synthesis of dental anxiety (DA), dental utilization (DU), oral health-related quality of life (OHRQoL), and their relationships have been examined despite various systematic investigations being done on their prevalence and interventions individually. Therefore, this review aims to systematically review the status and relationship between DA, DU, and OHRQoL among adult groups. Materials and Methods: Data collection spanned 6 months, from 1 July to 31 December 2023, involving eight databases. Only cross-sectional (CS) studies with adult participants aged 15-64 years, conducted globally, published in English, and available as full-text articles by December 31, 2023, were included. Two reviewers screened the titles and abstracts and assessed the full-text articles. All studies were CS. The risk of bias was evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist for Analytical CS studies. The quality of evidence for each measured factor was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: The initial search yielded 3333 studies. The 22 final studies included 13 highquality studies with over 80% and nine fair studies with 50% and 79% scored. None of the studies scored below 50%. A negative link between DA and DU was identified in 15 of 16 studies with 35,846 participants aged 22.19-50.21 years. Six studies on DA, DU, and OHRQoL included 22,845 participants aged 15-55 years, mostly in their late and mid-fifties. Four of six verified Berggren and Meynert's (1984) vicious cycle theory's high association between DA, DU, and OHRQoL. Conclusions: A 22-study review reveals a strong association between DA, DU, and OHRQoL. Most moderate to high-quality studies emphasized a negative correlation between DA and DU, which affected OHRQoL.PROSPERO registration number CRD42023455219. [ABSTRACT FROM AUTHOR]

Background: A Special Health Care Need (SHCN) is characterized by any type of physical, mental, sensorial, cognitive, emotional, or developmental condition that requires medical treatment, specialized services, or healthcare interventions. These conditions can negatively impact oral health as SHCN children can hardly cooperate or communicate and experience higher levels of dental fear/anxiety, which interfere with regular appointments. The present narrative review aims to analyze the use of audiovisual (AV) tools in dental setting for the management of SHCN children during dental treatment and to evaluate their effectiveness in anxiety/behavior control from the child, dentist, and care-giver perspectives. This analysis leads to the proposal of a new multi-session model for the behavioral management of SHCN pediatric subjects. Methods: An electronic search on the MEDLINE/Pubmed, Scopus, and Web of Science databases was carried out and through this analysis, a new model was proposed, the "UNISA-Virtual Stepwise Distraction model", a multi-session workflow combining traditional behavior management and the progressive introduction of AV media to familiarize the SHCN child with dental setting and manage behavior. Results: AV tools helped in most cases to manage SHCN behavior and decreased stress in both the dentist and child during dental treatments. Care-givers also welcomed AV distractors, reporting positive feedback in using them during future treatments. Conclusions: The present narrative review found increasing evidence of the use of AV media for SHCN pediatric subjects as distraction tools during dental treatment. In the majority of the studies, AV tools proved to be effective for the management of anxiety, dental fear, and behavior in dental setting. [ABSTRACT FROM AUTHOR]

People living with mental illness experience poorer oral health outcomes compared to the general population, yet little is known about their oral health knowledge, attitudes, and practices. The aim of this mixed-methods systematic review was to synthesise evidence regarding oral health knowledge, attitudes, and practices of people living with mental illness to inform preventative strategies and interventions. Database searches were conducted in PubMed, MEDLINE, PsycINFO, CINAHL, ProQuest, and Scopus with no limitations placed on the year of study. All studies available in the English language, that explored the oral health knowledge, attitudes, and/or practices of people with a mental illness were included. Articles were excluded if they primarily pertained to intellectual disability, behavioural and psychological symptoms of dementia, drug and alcohol or substance use, or eating disorders. A thematic synthesis was undertaken of 36 studies (26 high-moderate quality), resulting in 3 themes and 9 sub-themes. Study participants ranged from n = 7 to n = 1095 and aged between 15–83 years with most having a diagnosis of schizophrenia, schizoaffective, or bipolar affective disorder. People diagnosed with a mental illness were found to have limited oral health knowledge, particularly regarding the effects of psychotropic medication. Various barriers to oral health care were identified, including high dental costs, the negative impact of mental illness, dental fears, lack of priority, and poor communication with dental and health care providers. Study participants often displayed a reduced frequency of tooth brushing and dental visits. The findings highlight the potential for mental health care providers, oral health and dental professionals, mental health consumers, and carers to work together more closely to improve oral health outcomes for people with mental illness. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), (registration ID CRD42022352122). [ABSTRACT FROM AUTHOR]

Introduction: Oral hygiene is paramount for maintaining optimal oral and physical health, especially among children who are particularly susceptible to dental caries and issues due to dietary habits and inadequate hygiene practices. This study aimed to evaluate the awareness and knowledge of oral health among public school children, analyse their oral hygiene habits, educate parents on the importance of oral health for their children, and implement an oral hygiene educational program in Al-Kharj City, Saudi Arabia. Methods: Four public elementary schools were selected for the study, with a sample size of 200 school-going children participating. A structured questionnaire was used to assess awareness and knowledge of oral health among the participants. SPSS software version 26 was used for data analysis. Multiple regression analysis and correlation tests was employed to explore the relationships between the different variables measured in the study. Results: The findings revealed a significant lack of awareness regarding oral health among school children. Oral hygiene habits were found to be inadequate in many participants. Overall, the findings highlight the need for targeted interventions aimed at promoting regular dental visits, addressing dental fear, and fostering positive oral hygiene practices among school-going children to improve oral health outcomes in the studied population. Conclusion: The study highlighted a critical gap in oral health awareness among school children, underscoring the need for targeted interventions. While the oral hygiene educational program has been implemented and future data will shed light on its effectiveness, preliminary observations suggest that such programs could potentially improve oral health outcomes and overall engagement among students. [ABSTRACT FROM AUTHOR]

Background and purpose: Self-care is recognized as a fundamental approach in the field of providing, maintaining, and promoting health in individuals, families, and society. Providing essential training in the field of self-care is one of the important tasks of primary health service systems to the community, including household health ambassadors. On the other hand, determining the educational needs of self-care in each society should be based on the educational needs assessment in the same society. Therefore, the present study was conducted to determine the educational priorities of self-care using the educational needs assessment of health ambassadors. Materials and methods: The current study is a cross-sectional study (descriptive-analytical). The research community included household health ambassadors living in the Golestan and Mazandaran provinces. Entry criteria included being family health ambassadors, being between the ages of 20 and 60, and volunteering to enter the program. Also, the exclusion criteria included the health ambassador's unwillingness to participate in the evaluation. The study tools included a demographic questionnaire and a researcher-made questionnaire on "self-care educational needs" for health ambassadors. The health ambassadors' needs assessment questionnaire was the result of self-care educational priorities based on a general survey of the community, which was scored by the health ambassadors. Data analysis was done using SPSS version 20 software. U-Mann-Whitney and Kruskal-Wallis tests were used to analyze the data. Results: Results showed that the average age of health ambassadors participating in the study was 38.11±9.64 years. 987 people (57.8 percent) of them were health ambassadors of Golestan province and 721 people (42.2 percent) of them were health ambassadors of Mazandaran province. Also, concerning the participants' gender, 1439 people (84.3%) were women and 269(15.7%) were men. The educational needs assessment showed the top 10 priorities among self-care education topics determined by household health ambassadors, including stress and anxiety, healthy eating, life skills, parenting skills, water hygiene, inactivity, depression, skeletal problems, and lack of vitamins., and oral and dental health. It was also shown that there is a statistically significant difference between different subgroups of participants such as gender, place of residence, education level, occupation, and ethnicity with self-care educational priorities in household health ambassadors (P<0.05). Conclusion: The findings of the study showed that mental health issues such as stress, anxiety, and depression, as well as issues related to people's lifestyles, such as healthy eating, inactivity, and skeletal problems, were determined among the needs-based priorities for community education. Due to the limitation in financial and human resources, it is necessary to conduct self-care training based on the needs assessment of the society, because, on the one hand, an important part of the health needs of the society will be answered. On the other hand, the educational subjects that have priority will be the target of educational programs. [ABSTRACT FROM AUTHOR]

Background: Dentists, who frequently encounter potentially infected patients, have experienced significant changes worldwide due to the COVID-19 pandemic. The aim of this study was to evaluate the impact of the fear of COVID-19, depression, anxiety and stress on the presence of temporomandibular disorders (TMD), taking into account possible confounding variables, in Peruvian dental students during the post-pandemic period. Methods: This analytical cross-sectional study assessed 607 Peruvian dental students from two regions of Peru. The study utilized the Depression Anxiety Stress Scales-21 (DASS-21), the Fear of COVID-19 Scale (FCV-19S) and the Short Form of the Fonseca Anamnestic Index (SFAI). Possible confounding variables were sex, age, year of study, marital status, place of origin, area of residence, history of mental illness and living with people vulnerable to COVID-19. For the multivariable analysis, we utilized a Poisson regression model with an adjusted robust variance. The significance level was set at p < 0.05. Results: The rates of depression, anxiety, stress, fear of COVID-19 and temporomandibular disorders were 47.0%, 50.4%, 35.9%, 30.6% and 54.2%, respectively. Moreover, the study revealed that students with depression and anxiety were 38% and 75% more likely to have temporomandibular disorders compared to those without depression (APR = 1.38, 95% CI: 1.15–1.66) and anxiety (APR = 1.75, 95% CI: 1.44–2.13), respectively. Similarly, the likelihood of presenting temporomandibular disorders was 55% higher in women than in men (APR = 1.55, 95% CI: 1.28–1.87). Furthermore, we found that stress and fear of COVID-19 did not determine the development of temporomandibular disorders (p > 0.05). Conclusions: Almost half of the dental students experienced depression, anxiety and TMD in the post-pandemic period. In addition, depression and anxiety were influential factors in the occurrence of TMDs, with the female gender being a risk factor. However, factors such as fear of COVID-19, stress, age, year of study, marital status, place of origin, area of residence, history of mental illness or living with people vulnerable to COVID-19 were not significant. [ABSTRACT FROM AUTHOR]

Traumatic experiences can impact individuals' oral health and how they experience dental treatment in ways patients and their dental providers may or may not initially anticipate. As approximately half of children and two-thirds of adults in the United States have experienced some type of traumatic event, it is critically important for providers to be aware of patients' trauma histories and to appropriately provide trauma-informed care to their patients when needed. Individuals with a trauma history may experience significant anxiety and distress in the dental setting, even for treatment many providers and patients consider to be "simple," such as a brief intraoral examination, radiographs, or prophylaxis. Such aspects of the dental setting may trigger memories and emotions related to the original trauma and may re-traumatize patients. This short report introduces links between traumatic history, poor oral health, and dental care-related fear and anxiety. Additionally, this paper briefly describes how dental hygienists can provide compassionate trauma-informed care to their patients with the goal of providing whole-person care that considers patients' comfort, health goals, and prior experiences. Specific recommendations for providing trauma-informed care to children and adults within the scope of dental hygiene practice are provided, as is suggested wording for acknowledging a patient's prior trauma and tailoring dental care to accommodate patient experiences and concerns. As dental hygienists are often the oral health providers spending the most time with patients, they are uniquely positioned to provide compassionate effective trauma-informed care to patients with past traumatic experiences. [ABSTRACT FROM AUTHOR]

Purpose Many adults in the United States struggle with mild, moderate, or severe dental anxiety (DA). Understanding the perspectives of patients with DA may help oral health professionals gain greater insight into their needs and learn how to provide an improved experience for these patients. The purpose of this study was to identify patients' perspectives on factors that impact anxiety in a dental practice setting. Methods A qualitative, descriptive case study design was used to identify patients' perspectives on factors impacting anxiety in a dental practice setting. Potential participants were screened using the Modified Dental Anxiety Scale (MDAS) and needed a moderate DA score to qualify for the study. An interview guide focused on obtaining information about the etiology, contributing factors, management strategies, and participant experiences of DA was used for the semi-structured virtual interviews. Responses were coded using a qualitative research analytic platform (Dedoose; Los Angeles, CA, USA). The co-investigators systematically reviewed the codes using the classic qualitative analysis strategies and journal notes to identify themes and subthemes. Results Twenty-two individuals qualified for participation in this study. Most participants reported having DA beginning in early childhood and throughout their adult life. Seven themes, including Avoidance, Supportive Behaviors, Confidence in Provider, Diversion, Enduring, Adaptations, and Benevolence emerged. Participants reported their primary method for managing DA was to avoid attending their dental appointments. Conclusion Participants in this study expressed various coping mechanisms and management strategies to alleviate the symptoms of DA. Multiple opportunities exist for increasing patient-provider trust and patient comfort to reduce DA, and ultimately improve the oral health status of individuals with DA. Keywords dental anxiety, coping mechanisms, triggers, dental practice setting, communication, patient-provider relationship [ABSTRACT FROM AUTHOR]

Lidocaine hydrochloride (HCl) 2% with 1:100,000 epinephrine (LW/E) is widely used to prevent pain during dental procedures and has been associated with injection sting, jittering effects, slow onset, and a bitter aftertaste. Since LW/E's introduction in 1948, no significant modifications have been proposed. This study aims to design and characterize an improved dental lidocaine HCl injectable formulation without epinephrine (LW/O/E) via buffers, sweeteners, and amino acids. LW/O/E injections were prepared with pH and osmolality values of 6.5–7.0 and 590–610 mOsm/kg. Using the electronic tongue (ETongue), the LW/O/E injectable formulations were characterized for viscosity, injectability, and taste analysis. The results were compared with the LW/E control. In vivo efficacy and anesthetic duration of the samples were measured through radiant heat tail-flick latency (RHTFL) and hot plate (HP) tests and local toxicity was assessed after a single intra-oral injection in Sprague Dawley rats (SDR). The viscosity and injectability values of the LW/O/E samples were found to be comparable to the LW/E injection. ETongue taste analysis showed an improvement in bitterness reduction of the LW/O/E samples compared to the LW/E formulation. Toxicity studies of samples in SDR showed minor and transient signs of erythema/eschar and edema. Anesthetic duration via RHTFL and HP paw withdrawal latency time in SDR were found to be comparable for the LW/O/E Sample 3A and the LW/E injection (p < 0.05). In conclusion, the buffered, higher osmolality and reduced bitterness developed LW/O/E formulation (Sample 3A) could be considered a promising alternative to the LW/E formulation for dental use. [ABSTRACT FROM AUTHOR]

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety‐reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One‐way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety. [ABSTRACT FROM AUTHOR]

Background and Objective: Most evidence about difficult‐to‐treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult‐to‐treat'. Methods: We conducted a cross‐sectional survey of Australians aged ≥18 years with current asthma from large web‐based survey panels. Enrolment was stratified by gender, age‐group and state/territory based on national population data for people with asthma. Difficult‐to‐treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high‐dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID‐19)‐related behaviour. Weighted data were analysed using SAS version 9.4. Results: The survey was conducted in February–March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non‐DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2–5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3–4.4, p < 0.0001]) in the previous 12 months. Conclusion: Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under‐represented in registries or clinical trials. In this cross‐sectional study of a nationally‐representative population of 6048 adults with current asthma, 21.7% had difficult‐to‐treat asthma. Burden for patients and health system was seen in poor general health status, poor asthma symptom control, frequent urgent GP and emergency department (ED)/hospital visits and high prevalence of multimorbidity, particularly anxiety and/or depression. See relatededitorial [ABSTRACT FROM AUTHOR]

Purpose: The study aims to evaluate the effectiveness of brainwave entrainment on pre-operative fear and anxiety in pediatric dental patients. Methods: The study protocol received approval from the Institutional Ethical Committee under reference number 3010/IEC/2021. Pediatric patients (252) aged from 7 to 12 years, who reported to the dental department were randomized pre-operatively and presented either with brainwave entrainment (experimental), delivered using a "David delight plus device" or a standard behavior management protocol (control). Baseline and post-assessment of anxiety and fear levels were done using the Visual Facial Anxiety Scale and Frankl's behavior rating scale with Wright's modification. Vitals such as blood pressure and pulse rate were also measured. Results: The study sample (n = 252) comprised 118 females and 134 males. The non-significant differences for values of (VFAS1, FRS1, HR1, and BP1) indicated similar baseline characteristics. In the brainwave entrainment group, the p values of the Mann–Whitney U test and Wilcoxon Signed Ranks test (p < 0.01) between the two-timepoints indicated a statistical difference for the values of (VFAS1, FBRS1, HR1, BP1) and (VFAS2, FBRS2, HR2, BP2). Conclusions: Brainwave entrainment effectively reduces pre-operative fear and anxiety in pediatric dental patients. Therefore, they can be a non-pharmacological and non-invasive behavior management aid. Trial Registration: Clinical Trial Registry of India database CTRI/2023/03/051066. [ABSTRACT FROM AUTHOR]

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Objective: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Inferior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. Methods: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1:80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% lignocaine (with 1:80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated measures analysis of variance (ANOVA). Results: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The difference in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. Conclusion: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children. [ABSTRACT FROM AUTHOR]

Background: The study aimed to compare the self-perceived oral health status measured through a self-administered questionnaire with clinically determined oral health status measured by decayed-missing-filled teeth (DMFT) and community periodontal index of treatment need (CPITN) indices in university going females. In addition, access barriers to treatment related to oral healthcare were also determined. Methods: A 3-month analytical cross-sectional study was designed for consenting university going females (aged 18–22 years) in Islamabad, Pakistan. The self-perceived oral health was recorded through a questionnaire requesting information regarding socio-demographics, self-perception of oral health, frequency of dental visits and barriers to seeking oral health. Seven independent examiners performed intraoral clinical examination and assessed the oral health status using globally standardized oral health assessment indices (DMFT and CPITN). Results: A total of 400 students were included in the final sample. The study revealed a significant disparity between self-perceived oral health and clinical assessment. Although perceived oral health was considered "good" by 80.0% of the respondents, clinical examination revealed moderate DMFT scores (mean 2.95 ± 1.41) and periodontal disease requiring treatment in 89.5% of the individuals. The most common barriers in seeking dental care were lack of knowledge, dental phobia, affordability issue and false self-perception. Conclusion: The present study demonstrated a notable discrepancy between self-perception of oral health and clinically assessed oral health. These results emphasize the importance of focused educational programs and community outreach programs, especially directed towards this demographic. Prioritizing such initiatives will help individuals to recognize their actual oral health condition thus encouraging positive oral health behaviors and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the effect of virtual reality distraction (VRD) on dental anxiety during scaling and root planing (SRP) in periodontitis patients. Materials and Methods: This randomized controlled split‐mouth study included 60 patients who scored 9 or above on the dental anxiety scale (DAS) and required SRP in at least two quadrants with at least five teeth and two sites with a probing depth of ≥4 mm. Randomly chosen quadrants were treated using virtual reality glasses, and other quadrants were treated without glasses at the same visit. During VRD, a video of nature scenes was projected onto the screen in front of the patient's eyes. DAS and a visual analogue scale about patient feelings were applied at the end of the procedure. Results: With VRD, the scale value of pain and discomfort level (VASP) was significantly reduced (p = 0.01, d = 0.57). Starting treatment without glasses significantly decreased VASP in both control and test sides (p = 0.00, d = 0.85; p = 0.00, d = 0.80, respectively) and increased the sensation of immersion and realism (p = 0.03, d = 0.45; p = 0.02, d = 0.46, respectively). Intraoperative and postoperative DAS values were significantly lower in patients who started treatment without VRD (p = 0.04, d = 0.34; p = 0.02, d = 0.44, respectively). Of the patients, 63.3% preferred VRD in the subsequent treatment. While patient preference did not correlate with sex, it correlated with age (r = −0.48, p = 0.01). Conclusions: The VRD and initiating SRP procedure with VRD affected the pain and discomfort level in anxious periodontitis patients. In addition, the anxiety level was also affected by starting the procedure with glasses. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to investigate the prevalence of dental anxiety, its association with self-reported oral health, and sociodemographic factors in adults that are critical for improving oral health and well-being. Materials and Methods: An online survey was conducted via social media, with 1551 adults (76.5% women, 23.5% men) participating nationwide. Data collected included demographic data, Modified Dental Anxiety Scale (MDAS) scores, and associations between dental anxiety, negative experiences, and self-reported oral health. The analysis included psychophysiological, behavioural, and emotional responses and avoidance of dental visits, using descriptive and generalised linear regression models. Results: This study found that the mean score of the MDAS was 9.70 ± 5.11 out of 25, 19.1% of the participants reported no dental anxiety, and 7.8% suffered from dental phobia. Gender, age, and socioeconomic status had no significant effect on the prevalence of anxiety. Although more than half of the participants reported negative dental experiences, particularly in childhood, anxiety levels were unaffected. However, those who rated their oral health as excellent or very good had lower anxiety scores (p = 0.008, p = 0.024). Among the dental procedures, oral surgery (58.7%) and prosthetic (restorative) dental treatments (15.2%) caused the most anxiety. Avoidance behaviour correlated with increased anxiety (p ≤ 0.001), as did postponing dental visits until severe pain occurred (p = 0.011). Conclusions: These results emphasise the significant prevalence of dental anxiety in adults, particularly for surgical procedures and drilling, posing challenges in patient management. Tailored strategies are essential to reduce anxiety, improve patient well-being, and optimise dental service delivery and treatment efficacy. [ABSTRACT FROM AUTHOR]

PURPOSE. This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF). MATERIALS AND METHODS. Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day). RESULTS. The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days. CONCLUSION. The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care. [ABSTRACT FROM AUTHOR]

Background: Identifying the risk indicators of parental dental anxiety (PDA) and oral health literacy (OHL) can help oral healthcare professionals recognise challenges in this field. Armed with the appropriate information, they can effectively engage with parents to build trust and promote early and regular child dental visits. Objectives: This study aimed to investigate the association between PDA and OHL with the sociobehavioural characteristics of families, self-reported child oral health (presence of ≥ 1 untreated decayed teeth) and the dental visit patterns amongst children living in Al Jouf Province, Kingdom of Saudi Arabia. Subjects and methods: A total of 430 parents with children aged ≥ 14 years were invited using a systematic random sampling method. PDA was assessed using the Dental Anxiety Scale-Revised (DAS-R) scale, and parents' OHL was measured using the Rapid Estimate of Adult Literacy in Dentistry-30 (REALD-30). The relationships amongst participant characteristics, PDA and OHL were evaluated through the Chi-square and ANOVA. Additionally, binary regression analysis was conducted to identify predictor variables associated with PDA and OHL. A P value of < 0.05 was considered statistically significant. Results: Children with ≥ 1 untreated decayed tooth were 2.5 times more likely to have PDA (95% confidence interval [CI] = 1.37, 4.37). Children who visited the dentist in < 6 months had 93% lower likelihood to have PDA (adjusted odds ratio (AOR) = 0.07; 95% CI = 0.03, 0.18). Parents aged 20–25 years were 81% less likely to have OHL than those above 30 years (AOR = 0.19; P = 0.038). Similarly, parents with medium family income were 52% less likely to have OHL than the high-income group (AOR = 0.48; P = 0.013). Finally, parents of children who visited the dentist within < 6 months were 34 times more likely to have OHL than those whose children visited the dentist > 12 months ago (AOR = 34.94; P < 0.001). Conclusion: PDA and OHL were significantly affected by parental age, family income, the presence of ≥ 1 untreated decaying tooth and the child dental visit patterns. During a child's first dental visit, paediatric dentists should always assess the PDA, OHL and sociobehavioural characteristics of a family by using appropriate scales and semistructured interviews. [ABSTRACT FROM AUTHOR]

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