Efficacy of Various Subject Screening Measures: DISCUSSION

In: Dental treatment

3 Mar 2010

Dental anxiety

In an earlier report, we emphasized the importance of including fearful subjects in studies testing analgesic and anxiolytic agents. In that study, we concluded that university students are a good source of subjects representing a wide variety of populations, including anxious people. In order to select a study population including anxious patients, researchers should pay attention to recruitment measures. This research describes characteristics of subjects recruited for a study testing the effect of an experimental sedative agent during third molar extractions. Only subjects who were moderately or highly fearful of tooth extractions and oral surgery were accepted. Several different measures were used to assess the dental anxiety of the population.

The average DAS score among general dental patients has been reported to range from 7.3 to 8.7, and the average DFS score among the normative population varies from 38.0 to 44.6. The average dental anxiety scores (both DAS and DFS) were considerably higher for subjects in this study. More than one third of the subjects were highly fearful of dental treatment; this amount is much higher than the 20% rate found earlier in a representative community sample. However, scores on the self-efficacy measure (OSCQ) were about the same as those reported by oral surgery patients who received standard care. The level of trait anxiety was the same as that reported among general dental patients in private practice, about the same as that reported by patients before different types of minor surgeries, and similar to that found in another clinical study testing concepts that are related to pain experience following oral surgery. Nearly 40% of subjects ex­pressed being afraid before oral surgery; this was much higher than the 26% rate reported in a clinical sample of patients waiting for extractions. These subjects were also more anxious before oral surgery compared with subjects from a previous clinical study. However, subjects in that study were sedated before reporting pre-surgery anxiety, while subjects in the current study were not sedated for the initial anxiety assessment. The level of state anxiety (STAI-S, 46) reported in this population was much higher than the level reported for a general dental population (STAI-S, 32).

High correlations were found between dental anxiety (both DAS and DFS) and anxiety before oral surgery. Self-efficacy (OSCQ) and trait anxiety did not correlate well with anxiety before oral surgery. The failure to find a relationship between the OSCQ and presurgery anxiety was contrary to our hypothesis that the OSCQ would be the most predictive measure in this population. It is surprising that, although the OSCQ was developed to measure a subject’s ability to cope during oral surgery, it was not significantly related to anxiety immediately before oral surgery in this population. In an earlier clinical study, the OSCQ appeared to be related to anxiety before oral surgery. However, the previous study included subjects with all levels of anxiety and was not restricted to high-fear subjects as was the current study. The OSCQ may be predictive when a wide range of subjects is recruited. However, in the Coldwell study, OSCQ was not related to anxiety experienced during oral surgery and reported immediately postoperatively. Together, these findings suggest that self-efficacy may be only indirectly related to oral surgery anxiety.

Both dental anxiety measures, the DAS and the DFS, are well established and validated measures of dental anxiety. The DFS contains specific questions about procedures used during third molar extractions (eg, injections, drilling, and appointment-making). Unlike the DAS, the DFS significantly predicted presurgery anxiety in a regression analysis including all anxiety measures. Our findings indicate that these measures are predictive of anxiety before oral surgery, even in a population restricted to fearful subjects.
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One third of our subjects had had a previous experience with permanent tooth extraction. Those subjects who had a previous tooth extraction reported higher anxiety before oral surgery. This was true even though dental anxiety and self-efficacy did not differ between the experienced and nonexperienced groups. These findings are consistent with a conditioning account of fear acquisition. However, the findings are inconsistent with a previous study that suggested that inexperienced patients are more fearful than experienced patients. Age or sex differences between study populations may account for the difference. The previous study used a military base population that was mostly male and only 78% of which was under 30 yr of age. The current study was largely balanced by gender and included mainly younger subjects. Consistent with our findings, a clinical study among oral surgery patients found that a large percentage of patients reported postoperatively that they would be more afraid if the surgery was repeated.

George and colleagues (1980) found that high trait anxiety was related to high anxiety about recovery but not to expectation of a more traumatic surgery, expectation of a greater amount of suffering, or vigilant coping style. Therefore, our finding that trait anxiety is not related to anxiety before oral surgery is consistent with the George study. Because state anxiety data were collected the day of surgery, it is not surprising that it correlates with ISAR. The significant correlation further validates the use of ISAR as a measure of anxiety. Viagra Online Canadian Pharmacy

Locker and colleagues (1996) recommend the use of multiple measures to accurately describe dental anxiety within a study population. An ideal would be to describe the population very thoroughly and select the population on the basis of different measures to accurately represent all people. However, it is not always efficient or cost-effective to use a variety of measures. This research indicates that dental anxiety, as measured by the DFS, is a good predictor of anxiety experienced immediately before third molar extraction. In addition, the research suggests that previous experience with tooth extractions may result in increased anxiety.


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.