Kevin Buscemi ENC 1102 Professor Wolcott October 19, 2013 The Issue of Dental Anxiety and the

Approaches Being Taken The majority of people dont enjoy going to the dentist but go anyways for the sake of their health, however, some people have an extreme fear of the dentist, known as dental phobia. Patients with dental phobia or dental anxiety, which both go hand in hand, suffer from it so severely that in many cases it actually prevents them from making the much required trip to the dentist. It has been estimated that 9% to 15% of Americans avoid seeing the dentist because of anxiety and fear (Columbia University College of Dental Medicine). This is a serious problem because it is resulting in unhealthy oral health for patients dealing with dental anxiety. For example, people with dental anxiety have reported dealing with gum disease, pain, cavities, broken teeth and other serious dental health problems. Studies show that children dealing with dental anxiety, seem to suffer from it as adults as well, and as a result this often causes dental avoidance. For this reason, concerned dentists, researchers, and professors from universities all over are performing studies regarding many different aspects of dental anxiety. In this bibliography I will annotate numerous research studies in an attempt to analyze the causes of dental anxiety, the severity of it upon certain people, and the numerous approaches and strategies that dentists are taking to account for their patients dental anxiety.

Some well known approaches to this issue would be having children friendly movies, video games, and treasure chests but there are many more strategies to take. However, there are many more approaches being taken, using medical techniques and even approaches as simple as distracting the patient. Dentists all over are excited to see the success that they are getting from these different techniques. It is essential to reduce the anxiety levels in an effort to prevent future adults of having dental anxiety and avoiding dental care. The majority of the studies and articles being examined are scholarly journals and academic journals, written by either doctors or professors from multiple universities.

Stenebrand A, Wide Boman U, Hakeberg M. Dental anxiety and temperament in 15-year olds. Acta Odontologica Scandinavica [serial online]. January 2013;71(1):15-21. The authors of this academic article are researchers from the Centre of Oral Health, School of Health Sciences at Jnkping University, Sweden. They conducted a study with the purpose of analyzing the prevalence of dental anxiety and its association with temperance, sociodemographical factors, and previous unpleasant dental care experiences. They used a sample of 263 randomly selected 15-year olds living in the the city of at Jnkping, Sweden. The participants were given three self-reported questionnaires, each one pertaining to one of the three specific factors being studied. Once completed, the results showed that roughly 7% of the adolescents were suffering from dental anxiety, with girls tending to be more fearful. The results also show that the most common cause of dental anxiety amongst these individuals was a negative past dental experience resulting with pain. It is also worth noting that participants who reported being typically shy, nervous, and anxious were more likely to suffer from dental

anxiety. This research study is relevant to my topic as it analyzes the likelihood of one suffering from dental anxiety, as well as the factors contributing to the fear. Peretz, B., & Kharouba, J. (2013). Dental Anxiety among Israeli Children and Adolescents in a Dental Clinic Waiting Room. Pediatric Dentistry, 35(3), 252-256. The author of this article is focused on a specific pediatric dental clinic waiting room in Israel. The study being performed is attempting to evaluate the dental anxiety of numerous patients in a waiting room using self-reported questionnaires. One hundred and thirty patients (7-18 years old) were asked to complete a Dental Anxiety Scale as well as a Dental Fear Survey while waiting for their appointment. The results seemed to show some correlation to the previous study, as females reported having higher dental anxiety levels than males. Higher anxiety levels were also reported from those who last visited a dental office more than a year prior to their current one, as well as patients who feared possible pain. There was also an extreme correlation between the two questionnaires, where the responses on each seemed to be similar for patients reporting high anxiety. This study relates to my topic as it is dealing with analyzing what type of people dental anxiety is more common with as well as the causes of the anxiety. This is coming from a reliable source, as the study was conducted by reliable researchers analyzing a legitimate pediatric dental office.

Halonen, H., Salo, T., Hakko, H., & Rsnen, P. (2012). Association of dental anxiety to personality traits in a general population sample of Finnish university students. Acta Odontologica Scandinavica, 70(2), 96-100. doi:10.3109/00016357.2011.598182 The authors of this academic journal are members of the Institute of Dentistry at the

University of Oulu as well as the Department of Oral Surgery. The purpose of the study performed is to analyze the association between ones personality and their dental anxiety. The researchers collected a sample of 880 Finnish University students and had them fill out the Modified Dental Anxiety Scale (MDAS) questionnaire. The questionnaire listed five specific personalities; neuroticism, agreeableness, extraversion, conscientiousness, and lastly openness to experience. They were also asked to respond with either mild, high, or none for the levels of the personality traits. To no ones surprise, the results showed that only one personality trait has a correlation with high dental anxiety; that being neuroticism. This relates to my article as it analyzes the personality factors of dental anxiety, and it comes from credible sources in two well recognized establishments.

Colares, V., Franca, C., Ferreira, A., Amorim Filho, H., & Oliveira, M. (2013). Dental anxiety and dental pain in 5- to 12-year-old children in Recife, Brazil. European Archives Of Paediatric Dentistry: Official Journal Of The European Academy Of Paediatric Dentistry, 14(1), 15-19. doi:10.1007/s40368-012-0001-8 The authors of this article are members of the Department of Pediatric Dentistry at the University of Pernambuco. The purpose of the study being performed is to examine the correlation between pain and dental anxiety amongst children. The study used a sample of nine hundred and seventy children (5-12 years old) and had the parents or guardians of the children fill out a questionnaire regarding dental pain and dental anxiety information. Results showed that nearly 35% of children had some sort of dental anxiety, ranging from severe to moderate. The study also showed that roughly half of the children dealing with

dental anxiety suffered from some sort of painful incident during a previous dentist visit. This article relates to my topic as it presents information providing the argument that dental anxiety is quite common amongst children and that past negative experiences, typically dealing with pain, contribute greatly to ones anxiety.

Carrillo-Diaz, M., Crego, A., & Romero-Maroto, M. (2013). The influence of gender on the relationship between dental anxiety and oral health-related emotional well-being. International Journal Of Pediatric Dentistry, 23(3), 180-187. doi:10.1111/j.1365263X.2012.01242.x The authors of this academic journal are members of a research group at Rey Juan Carlos University. They conducted a study focused on analyzing the relationship between dental anxiety and its negative impact on oral health and quality of life. The researchers decided to use the decayed, missing and filled permanent teeth (DMFT) index in order to evaluate this relationship. The DMFT index was then obtained from a random sample of one hundred and sixty-one children (7-14 years old). Information pertaining to the childrens oral health, emotional well-being, and dental anxiety were then collected by having the children fill out questionnaires. A correlation was found between low emotional wellbeing and poor oral health along with high levels of dental anxiety. Females typically reported having lower emotional well-being, poorer oral health, and higher anxiety levels than males. The study clearly portrays that dental anxiety has a huge influence on poor oral health and as a result, poor well-being. For this reason it definitely relates to my topic as it concerns many dentists, and motivates them to work towards reducing dental anxiety.

Vermaire, J., de Jongh, A., & Aartman, I. (2008). Dental anxiety and quality of life: the effect of dental treatment. Community Dentistry & Oral Epidemiology, 36(5), 409-416. The authors of this academic journal are members of the Academic Centre for Dentistry in Amsterdam. The study being performed is focused on analyzing the relationship between dental anxiety and quality of life. Thirty five patients dealing with high dental anxiety at a Dutch dental fear clinic were selected and they were then assessed on their dental anxiety as well as their oral health. This was done both before and after treatment, with an average session being anywhere between fourty five and sixty minutes. Once again, the results showed that those with poor oral health had much higher dental anxiety levels than the patients with good oral health. This relates to my topic as it emphasizes how much oral health and quality of life is negatively affected by the common issue of dental anxiety.

Eitner, S., Wichmann, M., Paulsen, A., & Holst, S. (2006). Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health. Journal Of Oral Rehabilitation, 33(8), 588-593. The authors of this article are members of the Department of Prosthodontics at Friedrich-Alexander-University. The study performed focuses on analyzing the correlation between oral disease and dental anxiety. The researchers selected three hundred and seventy-four soldiers who had a dental check-up to be part of the study. They collected data from them using the Dental Anxiety Scale as well as the Gatchell Fear Scale. The results showed that nearly nine percent of individuals reported being anxious while almost five percent reported being highly anxious or what would be considered having dental phobia. It was also discovered that highly anxious patients had

more severe lesions and oral disease than the others with lower levels. This serves to show that dental anxiety is common even in older people as well as the oral health effects.

Sarnat, H., Arad, P., Hanauer, D., & Shohami, E. (2001). Communication strategies used during pediatric dental treatment: a pilot study. Pediatric Dentistry, 23(4), 337-342. The authors of this academic journal are members of the Department of Pediatric Dentistry at The Maurice and Gabriela Goldschleger School of Dental Medicine in Tel Aviv, Israel. The purpose of their study was to examine the effect on dental anxiety of communication techniques used by pediatric postdoctoral students. They approached this using three specific types of communication; permissive, empathic, and personal. They studied twenty four children (14 boys and 10 girls), ranging from three to twelve years of age. They videotaped the conversations and then analyzed the childs anxiety, cooperation, success of treatment, and mood at the end of the session. The results of the study showed that the permissive approach, which supplies information of the procedure, was most frequently used. This technique seemed to relax the patients a bit and was definitely the best at reducing dental anxiety. This relates to my topic as it shows one of the many techniques that dentists take in order to relieve dental anxiety.

de Jongh, A., Makkes, P., & Broers, D. (2004). [Treatment strategies for anxious adults in general dental practice: guidelines for mild forms of anxiety]. Nederlands Tijdschrift Voor Tandheelkunde, 111(2), 44-47.

The author of this article is a member of a Pediatric Dental Association in the Netherlands. The purpose of the study is to analyze the relationship between trust and dental anxiety. A pediatric dental office uses specific techniques with children patients and surveys the clients on their anxiety after the procedures. The dentists purposely converse with the children, discussing child friendly topics, in hope to gain their trust. The results of this study show that in cases of mild anxiety, conversations tend to relieve the anxiety of the patients. However, patients with high levels of dental anxiety were not relaxed by this strategy.

Lahmann, Claas, et al. "Brief relaxation versus music distraction in the treatment of dental anxiety." J Am Dent Assoc 139.3 (2008): 317-324. The authors in this scholarly article are all doctors of some sort, even having an MD, PHD, or DMD. The purpose of the study being done compares multiple techniques and their effectiveness of reducing the dental anxiety of patients. They randomly select 90 patients with dental anxiety to three groups; one receiving the brief relaxation method, the other music distraction, and the last one serving as a control group. They then examine the outcomes of their anxiety using the anxiety subscale of the State-Trait Anxiety Inventory to determine which method was best. The results of the study showed that the brief relaxation and music distraction methods reduced anxiety significantly. Roughly 80% of patients receiving these methods reported having less dental anxiety than in previous dental visits. Meanwhile, patients in the control group did not have their anxiety levels lowered what so ever. This relates to the last article, discussing how simply distracting and relaxing the patients can greatly reduce anxiety levels.

Kritsidima, Metaxia, Tim Newton, and Koula Asimakopoulou. "The effects of lavender scent on dental patient anxiety levels: a cluster randomizedcontrolled trial." Community dentistry and oral epidemiology 38.1 (2010): 83-87. The authors of this scholarly article are members of a group known as the Community Dentistry and Oral Epidemiology. The study being done has the goal of analyzing the influence that lavender scent has on lowering dental anxiety levels. 340 patients were randomly selected for this study and then they were asked to fill out questionnaires based on their dental anxiety; the State Trait Anxiety Indicator as well as the Modified Dental Anxiety Scale. Half of the participants were in a dental waiting room with a lavender scent while the other half were not. The results of the study showed that although quite similar, the group with the lavender scent reported having slight less anxiety than the other group. To be exact, the average score for the lavender group on the MDAS was less than five percent while the other group had roughly fifteen percent reporting high anxiety. This is a much different approach than other studies involve but it relates to my topic as it shows the many different ways in which dentists are working around the issue of dental anxiety.

Corah, N. L., et al. "The dentist-patient relationship: perceived dentist behaviors that reduce patient anxiety and increase satisfaction." The Journal of the American Dental Association 116.1 (1988): 73-76. The authors of this academic journal are members of the American Dental Association. They are performing a study that is focused on how the behavior of dentists alters the

dental anxiety of their patients. They collected a sample of 250 patients, 140 women and 110 men, at two clinics. The patients were asked to give their response to the behavior of their dentist and report the levels of anxiety they were dealing with during the procedure. They offered possible choices such as friendly, working quickly, being calm, giving moral support, and being conversive. The results of the study revealed that the majority of satisfied patients reported having a dentist with a calm approach to their work, as well as being friendly and talkative. This emphasizes the argument that conversation and distracting the patient will serve to reduce the dental anxiety levels of patients.

Veerkamp JS, Gruythuysen RJ, Hoogstraten J, van Amerongen WE. Department of Social Dentistry and Dental Health Education, ACTA, Amsterdam, The Netherlands. ASDC Journal of Dentistry for Children [1995, 62(1):44-48] The authors of this academic journal are members of the Department of Social Dentistry and Dental Health Education. Their study focuses on the impact that nitrous oxide has on reducing the anxiety levels of dental patients. They randomly selected 80 children from a local elementary school. Half of the subjects were given the nitrous oxide treatment prior to treatment, while the other half served as the control group. After treatment, the participants were asked to report their anxiety levels and happiness with the procedure. The results of this study ended up showing that the treatment of nitrous oxide significantly lowers the anxiety levels of the patients. In fact, nearly half of the patients who reported having dental anxiety prior to the procedure stated that the treatment effectively reduced their anxiety almost completely. This relates to my topic of the

approaches being taken by doctors to treat dental anxiety, yet this is a much more medical approach rather than the previous music, distraction, and lavender scent techniques.

Kudo, Masaru. "Initial injection pressure for dental local anesthesia: effects on pain and anxiety." Anesthesia progress 52.3 (2005): 95-101. The authors of this article are a part of the School of Dentistry, Health Sciences at the University of Hokkaido in Japan. The study is designed to analyze the impact of local anesthesia on the dental anxiety of patients. Twentyight men were randomly selected to take part in the study, each receiving local antesthesia treatment before their procedure. Subjects were given different levels of anesthesia ranging from 30 to 160 mL to determine the influence of the medication on lowering anxiety. After the procedure, participants were given a questionaries asking questions pertaining to their dental anxiety and how they felt about the anesthesia. Results revealed that the subjects who received more than 80 mL of anesthesia reported having no anxiety and having a good experience. Meanwhile, several men who received under this amount admitted to suffering from dental anxiety. Once again an affective medical approach is being taken towards the problem of dental anxiety.

Lehrner, Johann, et al. "Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office." Physiology & Behavior 86.1 (2005): 92-95. The authors of this article are members of a group that analyzes the behavior of medical patients all over the world. Their study focuses on the impact of orange and lavender odors on reducing

dental anxiety, much similar to the previous lavender study. 350 randomly selected patients were selected to take part in this study. The study took place in three dental waiting rooms, one consisting of orange scent, lavender scent, and one with no scent. While waiting the subjects were asked to fill out paperwork regarding their dental anxiety, which was later examined by the researchers. Their study showed that the patients in rooms with either the orange or lavender scent had nearly 25% less patients reporting dental anxiety. Once again, this is showing how much simple factors such as scent can reduce dental anxiety, and the creative approaches that continue to be taken by dentists all over in an effort to eliminate dental anxiety.