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      The prevalence of dental anxiety and its association with pain and other variables among adult patients with irreversible pulpitis

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          Abstract

          Background

          The aim is to investigate the prevalence of dental anxiety and its association with pain and other related factors in adult patients with irreversible pulpitis.

          Methods

          One hundred and thirty patients with irreversible pulpitis were included in this cross-sectional study. Participants were asked to fill out an information table and a battery of questionnaires to assess their level of dental anxiety, pain at their first and most recent dental experience, and pain intensity before/during the present endodontic treatment. The level of anxiety that participants displayed during the present treatment was also evaluated by the dentists using an anxiety rating scale. Data were analyzed by t-test, ANOVA, and Spearman correlation tests.

          Results

          83.1% of participants suffered from moderate or high dental anxiety, and 16.2% met criteria for specific phobia. Subjects who had higher MDAS scores were more likely to postpone their dental visits ( P < 0.05). Subjects who had bad experiences at their most recent dental visit were more anxious ( P < 0.05). Pain at the most recent dental visit ( P < 0.01) or before the present dental visit ( P < 0.05) was important factor correlating with dental anxiety among participants. Notably, 36.2% of participants displayed moderate or severe anxiety during this present visit for endodontic treatment based on dentist’s judgement.

          Conclusions

          A high percentage of people with irreversible pulpitis suffer from dental anxiety. Pain at the most recent dental visit and during endodontic treatment have strongly positive association with dental anxiety. Effective pain control in endodontics is beneficial to manage the anxiety.

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          Most cited references18

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          The Modified Dental Anxiety Scale: validation and United Kingdom norms.

          The Corah Dental Anxiety Scale (CDAS) has been used extensively in epidemiology and clinical research. It is brief and is claimed to have good psychometric properties. However, it does not include any reference to local anaesthetic injections, a major focus of anxiety for many. Also, the multiple choice answers for three of the four questions are not clearly in order of severity of anxiety as the CDAS intends. The answers differ among the questions thus making them difficult to compare. They include descriptions of physiological reactions and anxiety, confusing two loosely related components of the experience. The Modified Dental Anxiety Scale (MDAS) described, added a question on anxiety about oral injections. New multiple choice answers, in clear order of anxiety and the same for each question, were provided. Twenty five dental personnel all confirmed independently the order of the multiple choice answers for the MDAS. They disagreed among themselves however, about the appropriate sequence for the answers denoting intermediate anxiety in the CDAS. Therefore the CDAS, unlike the MDAS, can provide meaningful measures only of extremely high or extremely low dental anxiety. Of 1392 subjects tested, 13 per cent expressed extreme anxiety about injections on the MDAS but were only 'fairly' or less anxious about drilling. Thus, the CDAS, unlike the MDAS, must overlook subjects very afraid of injections only. Data confirm the high reliability and validity of the MDAS and provide norms for phobic and nonphobic subjects.
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            Pathways of fear and anxiety in dentistry: A review.

            The aim of this article was to analyze the theories underpinning dental fear, anxiety and phobias. To be included, articles must have been published between the years of 1949 and 2013 concerning fears and phobias within dentistry and/or psychiatry. Of 200 articles originally under review, 140 were included and reviewed by the authors.Five specific pathways relating to dental fear and anxiety were identified; Cognitive Conditioning, Informative, Visual Vicarious, Verbal Threat, and Parental. Eight currently accepted management techniques across all dental disciplines for dental fear and anxiety were identified. Further research is required to identify clinical diagnosis and treatment for fears originating from different pathways.
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              UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results

              Background A recent UK population survey of oral health included questions to assess dental anxiety to provide mean and prevalence estimates of this important psychological construct. Methods A two-stage cluster sample was used for the survey across England, Wales, and Northern Ireland. The survey took place between October-December 2009, and January-April 2010. All interviewers were trained on survey procedures. Within the 7,233 households sampled there were 13,509 adults who were asked to participate in the survey and 11,382 participated (84%). Results The scale was reliable and showed some evidence of unidimensionality. Estimated proportion of participants with high dental anxiety (cut-off score = 19) was 11.6%. Percentiles and confidence intervals were presented and can be estimated for individual patients across various age ranges and gender using an on-line tool. Conclusions The largest reported data set on the MDAS from a representative UK sample was presented. The scale’s psychometrics is supportive for the routine assessment of patient dental anxiety to compare against a number of major demographic groups categorised by age and sex. Practitioners within the UK have a resource to estimate the rarity of a particular patient’s level of dental anxiety, with confidence intervals, when using the on-line percentile calculator.
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                Author and article information

                Contributors
                leidoug@hotmail.com
                mmvanschaayk@gmail.com
                500366@hospital.cqmu.edu.cn
                30099376@qq.com
                jiping-62@hotmail.com
                86-23-88860061 , yangdeqin@gmail.com , yangdeqin@hospital.cqmu.edu.cn
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                7 June 2018
                7 June 2018
                2018
                : 18
                : 101
                Affiliations
                [1 ]GRID grid.459985.c, Stomatological Hospital of Chongqing Medical University, ; 426 Song Shi Bei Road, Chongqing, 401147 China
                [2 ]Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, 426 Song Shi Bei Road, Chongqing, 401147 China
                [3 ]Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, 426 Song Shi Bei Road, Chongqing, 401147 China
                [4 ]ISNI 0000 0001 2185 3318, GRID grid.241167.7, Wake Forest Institute for Regenerative Medicine, ; 391 Technology Way NE, Winston-Salem, NC 27101 USA
                Author information
                http://orcid.org/0000-0002-7363-9724
                Article
                563
                10.1186/s12903-018-0563-x
                5992818
                29879974
                23ff85a7-6751-46d9-9b5d-a42fbbac98a2
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 September 2017
                : 23 May 2018
                Funding
                Funded by: Chongqing Health and Family Planning Commission (China)
                Award ID: 2015MSXM047
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 31571508
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Dentistry
                adult people,associated factors,dental anxiety,irreversible pulpitis,pain
                Dentistry
                adult people, associated factors, dental anxiety, irreversible pulpitis, pain

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