Efficacy of Various Subject Screening Measures

In: Dental treatment

27 Feb 2010

Various Subject Screening Measures

People vary in their ability to cope with oral surgery. Although a large number of patients request sedation or anxiolytic medication, others are able to tolerate oral surgery without the aid of anxiolytic drugs. Unfortunately, it is the latter type of patient that tends to volunteer for research studies in which the possibility of receiving a placebo is present. Conducting studies of anxiolytic medication in a nonfearful population makes it difficult to evaluate the effects of this medication; researchers are therefore well advised to recruit fearful subjects. Several measures exist for assessing anxiety in patients; however, there is little literature to guide researchers in selecting from among these measures the most effective recruitment tools for studies involving anxiolytic medication.

Several factors can affect fear of oral surgery. People without oral surgery experience have higher anxiety levels than do people with such experience. Situation-specific trait anxiety has been found to be predictive of distress before oral surgery, and general trait anxiety has been associated with anxiety about recovery after oral surgery. Psychiatric morbidity, neuroticism, and trait anxiety are also related to increased pain intensity and duration following oral surgery. Increases in coping self-efficacy have been demonstrated to reduce preoperative distress and anxiety before oral surgery.
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Many different scales for measuring dental anxiety have been presented in the literature by researchers and clinicians. Kleinknecht’s Dental Fear Survey (DFS) and Corah’s Dental Anxiety Scale (DAS) have been widely used on a variety of different populations. The DFS was developed to identify specific dental fear stimuli and reactions to these stimuli; the purpose of the DAS is to estimate overall dental anxiety (situation-specific trait anxiety). Some researchers have used the DAS to describe pre-existing anxiety before oral surgery in studies testing anxiolytic agents. In a study by Coldwell and colleagues, DAS score (reported before sedative) was positively related to physical symptoms before oral surgery.

The Oral Surgery Confidence Questionnaire (OSCQ) was developed to determine subjects’ feelings of self-efficacy and confidence in their ability to cope with the stress of oral surgery. Litt and colleagues manipulated self-efficacy in order to evaluate its role in coping with dental stress. Their study indicated that dental stress can be lowered both by increases in self-efficacy and by relaxation training. In a follow-up study, Litt and colleagues found that self-efficacy, relaxation, and perceived control play equal roles in coping with oral surgery. They also found that perceived control is necessary for feelings of self-efficacy.

The State-Trait Anxiety Inventory (STAI) was developed to measure situational anxiety and general prone-ness to anxiety. It is considered a valid measure and has been extensively used in the literature. In the study of illness behavior and anxiety in dental patients, state and trait anxiety were found to be related to discomfort and greater worry about current dental visits. 

In this report, we describe a population recruited for a pharmacological study that was designed to test an anxiolytic agent using the third molar model, and we examine the usefulness of different measures as recruitment tools for similar studies. An effort was made to recruit an anxious population for this study in order to observe the maximum possible effect of the anxiolytic agent; several measures of dental anxiety were used in order to find a measure that best predicts anxiety before oral surgery. Because the OSCQ is the only measure developed specifically to predict the stress experienced during oral surgery, we hypothesized that the OSCQ would be more predictive of the anxiety experienced before oral surgery than would measures of dental anxiety or measures of general trait anxiety. We also hypothesized that subjects without previous experience with tooth extractions would express both higher anxiety and lower confidence in their ability to cope during oral surgery than would subjects with such experience and that subjects with higher trait anxiety scores would express more anxiety before oral surgery and would score lower on self-efficacy than would subjects with lower scores.

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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.