| BackgroundDental anxiety is a significant public and oral health issue and highly prevalent (about 4-30%) worldwide, leading a major public health problem in many countries. In previous studies, dental fear was related to low frequent dental visiting, poor oral health and functional impairment. Individuals with high dental fear would delay treatment, then leading to disease development, which ultimately require more invasive and potentially painful treatment. Then, these experiences may contribute to the increase of dental fear:this is the idea of a’vicious cycle’. The occurrence of dental anxiety worsens dental attendance, dental treatment quality, efficiency, oral health of periodontal patients and even doctor-patient relationship.Dental anxiety was regarded as a complex process with simultaneous interaction of both exogenous and endogenous factors. Exogenous components were involved in direct or indirect learning from adverse experience, and endogenous components were more likely to be genetically determined and physiological in nature. It was widely accepted that most of patients with dental anxiety had painful treatment experience. The level of dental anxiety was relative to the pain experiences from dental treatment, nervous and pretreatment anxiety.According to 3rd National oral health epidemiological research in 2008, caries and periodontitis were the most important factors affecting oral health, and the incidence of periodontal diease in our country was 80%-90%. In this case, periodontitis was the major cause of tooth loss. Several previous studies found that periodontal therapy was associated with high level of dental anxiety. Continuous high level of dental anxiety caused by experiencing discomfort or pain in treatment process might have negative effects on clinical outcome. About 71% patients had dental anxiety related to periodontal therapy, and patients had extreme anticipatory anxiety during treatment. Anxious emotion was relative to intra- and post- operative pain experience in periodontal treatment. Because of the long duration of periodontal therapy and high frequency of dental visit, the fear or anxiety of patient would lead to delay and absent treatment, affect patient compliance and result in deterioration of the periodontal health.To date, only a handful of studies have reported dental anxiety of patients with periodontal disease. Nevertheless, there was lack of assessment of dental anxiety in Chinese adult population with and without periodontal disease, and the correlative between dental anxiety and pain level in periodontal therapy.ObjectivesThe aim of the present study was use valid dental anxiety scale to assess the prevalence of dental anxiety in Chinese adult patients, and to evaluate the potential factors; Use valid dental anxiety scale to assess the prevalence of dental anxiety in patients with periodontal disease, and to evaluate the potential effect of periodontal status on dental anxiety; Analysis the correlation between dental anxiety and pain level in periodontal treatment to provide clinical assessment for acesodyne measure in periodontal non-surgical treatment.MethodsThe patients, who presented from July 2013 to November 2013 at the Outpatient Clinics of Guangdong Provincial Stomatological Hospital, University of Southern Medical, were randomly recruited as subjects to perform the dental questionnaires. The dental questionnaire included Corach’s Dental Anxiety Scales (DAS), Dental Fear Survey (DFS), and the short-form Dental Anxiety Inventory (S-DAI). General information besides questionnaire contained dental attendances (regular or irregular), peridontal status, past dental visit and socio-demographic features including gender, age, education, marital status, smoking and alcohol use. Oral health behaviors were investigated by three questions:"Do you have bleeding on brushing?"; "Do you feel your teeth sensitive?"; "Do you have regular scaling?".Patients with periodontal disease were accessed by the self-reported methods, which include three items:"Do you have a loose tooth? (Yes/No)"; "Have you had periodontal disease with bone loss? (Yes/No)"; "Has your dentist/hygienist told you that you have deep pocket? (Yes/No)". Patients who had any affirmative responses for the three questions were considered as patients with periodontal disease. The periodontal disease patients completed the dental questionnaires, which contained DAS, DFS and S-DAI to evaluate the dental anxiety level.30 chronic periodontitis patients performed periodontal non-surgical treatment including scaling and root planning (SRP). The patients completed the dental questionnaires to access the level of dental anxiety prior to the periodontal treatment. Examiner determined each patient’s probing of depth (PD), attachment level (AL)and bleeding on probing (BOP), and each tooth with six sites (mesiofacial, mesiolingual, distofacial, mesiolingual, midlingual and distolingual). Use Visual Analogue Scale (VAS) to evaluate the pain level during periodontal treatment.Linear regression was used to analyze the correlation between the patients’ general characteristics and dental anxiety in 1203 dental adult patients. T-test was used to analyze the differences of prevalence of dental anxiety between the patients with and without periodontal disease. Mann-Whitney U test was used to analyze the differences of the percentage of DAS evaluation between patients with and without periodontal disease. Linear regression was used to analyze the correlation between the patients’ general characteristics and dental fear in patients with periodontal disease. Spearman Bivariate Correlation was used to analyze the correlation between dental anxiety and pain level in periodontal treatment. Statistical analysis was performed by SPSS 13.0, P values were two-tailed and the level of significance was set at P= 0.05.Results1. A total of 1203 validated questionnaires were collected. There were 438 male (36.24%) and 765 female (63.76%), and the average age was 37.7±14.8 (range from 18 to 85). The average score of DAS was 10.38±3.04 with 23.4% high dental anxiety among 1203 patients. The average score of DAS and S-DAI were 47.81±15.84 and 22.85±8.57 respectively. The level of dental anxiety was significant higher in women than men (P<0.05). Age was negatively correlated to dental anxiety, and the age increase the level of dental anxiety decrease. The patients who had high school or above degree show higher level of dental anxiety (P<0.05).The patients who had irregular dental attendances showed higher level of dental anxiety (P<0.05). Dental anxiety of ’never scaling’ was significantly higher than ’regular scaling’(P<0.05) Patients who had ’always bleeding on brushing’ and ’always dentine hypersensitivity’ had significantly higher level of dental anxiety than ’never bleeding on brushing’ and ’never dentine hypersensitivity’(P<0.05).Combination with DAS, DFS and S-DAI, gender, age, periodontal status, dental attendances and oral health behaviors were correlated with dental anxiety in 1203 adult patients.2. The six highest items were ’tooth drilling’,’ overall anxiety in dental treatment’,’hearing drill’,’seeing drill’,’injecting the anesthetic’and’seeing anesthetic needle’according to DFS evaluation.3.366 subjects were self-reported periodontal disease. Among the periodontal cases, there were 131(35.8%) male and 232 female (63.4%), and the average age was 42.4±14.6 years (range from 18 to 85). The dental anxiety of patients with periodontal disease was significantly higher than those without periodontal disease. The prevalence of high dental anxiety (DAS>13) in patients with periodontal disease (27.3%) was significantly more than those without periodontal disease (21.7%) (P<0.05). Among patients with periodontal disease, the level of dental anxiety was significant higher in women than men (P<0.05).The patients who had irregular dental attendances showed higher level of dental anxiety (P<0.05).Dental anxiety of ’never scaling’ was significantly higher than’regular scaling’(P<0.05).Combination with DAS, DFS and S-DAI, gender, dental attendances and oral health behaviors were correlated with dental anxiety in patients with periodontal disease.4. The score of DAS, DFS and S-DAI was positively correlated with VAS (P<0.05). The level of dental anxiety was positively correlated with pain level in periodontal treatment. PD≥4mm was positively correlated with VAS and had statistical significance (P<0.05). BOP was positively correlated with VAS and had statistical significance (P<0.05)Conclusions1. There was high prevalence of dental anxiety in China. Gender, age, education, periodontal status, dental attendances and oral health behaviors could have an effect on dental anxiety.3.’Drilling with the handpiece’and’injecting the anesthetic’ were the most important concern of invoking dental anxiety. As a result, clinical doctors should try best to decrease the level of dental anxiety by using painless techniques and better communications or explanations.2. The level of dental anxiety was higher in patients with periodontal disease. Gender, dental attendances and oral health behaviors could have an effect on dental anxiety in patients with periodontal disease, and poor periodontal status may correlative with high level of dental anxiety.4. The level of dental anxiety was positively correlated with pain level periodontal treatment and periodontal status. Perform interventions on moderate-to-severe periodontitis to reduce the level of anxiety and pain, enhance patients’ compliance and improve the prognosis of periodontal disease. |
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