Psychological predictors of pain during dental hygiene treatment

This study examined the role of catastrophizing (i.e. a tendency to exaggerate the threat value of potentially painful situations) in predicting pain experience during dental hygiene treatment. Participants in the research were 100 patients undergoing scaling and/or root planing procedures at Dalhousie University's Dental Clinic. Following treatment, participants completed the Pain Catastrophizing Scale, a measure of emotional distress, a pain scale, and the Dental Anxiety Scale-Revised. Participants who scored above the median on the Pain Catastrophizing Scale were classified as catastrophizers, participants who scored below the median were classified as noncatastrophizers. Results showed that catastrophizers reported significantly more dental anxiety, emotional distress and pain than noncatastrophizers; and that distress reactions were more pronounced in men that in women. Discussion focuses on the importance of addressing psychological factors in dental hygiene practice, particularly as they relate to reactions to dental hygiene procedures, and avoidance of dental care.     

Children pain during dental treatment

This research work was done on the set of 69 children and adolescents 6-14 years old at the children's department of the dental clinic, university hospital in Hradec Králové. We found their expectancy of dental pain inadequate to reality: 67% children overestimated expected pain, 12% underestimated it. It does not see that children feelings prior to very performance would signalize in advance how much unpleasant or painful the dental procedure is going to be. We have not found any significant difference in either understanding the instruction or sticking to them, or general cooperation of children. The average time interval of dental procedures fluctuated between 18 and 40 minutes, children were not given any anesthetics (with exception of two cases of extractions) which could be one of the causes of distress. From all the children 35% experienced pain in the dental chair and were able to assess it by VAS and verbally characterize its quality. According to the view of children assessing the subjectively experienced pain intensity there exist two types of dental procedures: the first type being represented by painless but demanding patience procedures, the second group of painful treatment (making fillings or extractions). There were no statistical difference between girls and boys in their experiencing pain but there was some difference between girls and boys as went for an approach of health workers: these much more often tried to support girls.     

Positioning for clinical dental hygiene care. Preventing back, neck and shoulder pain

Spasmodic dysphonia is a focal dystonia that effects the proximal muscles (adduction dystonia) or dilatory (abduction dystonia) of the larynx. Botulinum toxin (BTX), generally delivered by percutaneous injection, is the treatment of choice. Recently, use has been made of a transoral route of delivery, with BTX injected through a curved device with visual control. It remains to be determined which route is better. Percutaneous injection is simple and well-tolerated, but the transoral route is theoretically more effective. We assessed the efficacy of both techniques in 19 patients with adduction dystonia, conducting 55 treatment sessions by percutaneous injection and 20 by transoral injection. All the transoral treatments were effective (20/20, 100%), but only 81% (45-155) of the percutaneous treatments were (p < 0.05). Two patients who had doubtful responses after percutaneous delivery improved considerably when the transoral approach was used. In spite of its greater complexity, the transoral approach is probably more effective than the percutaneous route. We describe a curved device for transoral injection that is composed of simple elements available at any health center.     

Catastrophizing, acceptance, and interference: Laboratory findings, subjective report, and pain willingness as a moderator.

Objective: The present study investigated the effects of both catastrophizing and the pain willingness component of acceptance on interference in daily activities and task performance during experimentally induced ischemic pain. In addition, the potential moderating role of pain willingness on the relationship between catastrophizing and degree of pain interference was also examined. Design: Sixty-seven persons with chronic low back pain completed measures of catastrophizing, acceptance, and daily pain interference. Participants underwent an ischemic pain induction procedure during which a Stroop-like task was administered. Main Outcome Measures: Self-reported pain interference and observed performance on a Stroop-like task during induced pain. Results: The pain willingness component of acceptance and catastrophizing both contributed significantly to self-reports of pain interference. However, levels of pain willingness had an effect much stronger than the negative effects associated with catastrophizing with respect to observed pain interference during induced pain. Results also indicated that pain willingness serves as a moderator in the relationship between catastrophizing and task performance during induced pain. Conclusion: The pain willingness factor of acceptance and catastrophizing both appear to be strong predictors for self-reported pain interference. During an objective assessment of pain interference, however, pain willingness shows a stronger effect and attenuates the negative impact of catastrophizing on task functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with dental anxiety

This study assessed dental anxiety in adults living in the Detroit tricounty area and identified factors associated with it. The prevalence of dental anxiety was 10.0 percent. Regression analysis revealed six factors associated with dental anxiety: unfavorable attitudes toward dentists, infrequent checkups, dissatisfaction with one's month, small numbers of filled surfaces, being female and lower income. Dentists should be aware of these factors when assessing dental anxiety in their patient populations.     

Perceived environmental stressors for dental hygiene students

This study identifies stressors for dental hygiene students and examined significant differences in stress levels between first- and last-year dental hygiene students and between dental hygiene and dental students. A modified dental environmental stress (DES) questionnaire was utilized to determine the sources of stress. The questionnaire was completed by 153 (93 percent) first- and last-year dental hygiene students from four programs. Seven stressors were among the top ten stress items cited by both classes of dental hygiene students; seven other stressors exhibited significant differences (p = .01). The authors' hypothesis is that some of these stressors may be remediable. Seven of the top ten stressors for first-year dental hygiene and dental students were shared, while ten exhibited significant differences. Among last-year students, eighteen items were significant, and seven of the top ten stressors were the same.     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desire for control, felt control, and stress inoculation training during dental treatment.

Coping style research has typically assessed Ss' desire for a coping resource, but ignored whether Ss possess that resource. In this study 110 dental patients were categorized as to their desire for and feelings of control and were randomly assigned, just prior to dental treatment, to a 20 min Stress Inoculation Training (SIT) session or a Filler condition. SIT significantly reduced pain and increased control only for patients who initially reported a high desire for control coupled with low perceived control. This finding supports the view that the discrepancy between high desire for control and low perceived control plays a causal role in the elevated distress and pain initially reported by patients with such control perceptions. These data indicate that consideration of patients' perceived coping resources as well as their coping preferences adds to our ability to predict reactions to stress reduction manipulations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experiences with sedation and restraint during dental treatment in Romania

PURPOSE: The authors assess the stability of visual acuity outcomes after the surgical removal of subfoveal choroidal neovascularization in a large series of patients with presumed ocular histoplasmosis syndrome (POHS). METHODS: A retrospective study of 117 consecutive patients undergoing vitrectomy between February 1990 and December 1994 was performed. All patients underwent the surgical removal of subfoveal choroidal neovascularization due to POHS and had at least 3 months of follow-up. Postoperative Snellen visual acuity was the primary study endpoint. RESULTS: With a median follow-up of 13 months (range, 3-46 months), 35% of patients had postoperative visual acuity of 20/40 or better, and 40% had improvement of three or more Snellen lines after surgery. In a subset of 54 eyes followed for at least 1 year, 91% showed stable or improved vision between the 3- and 12-month time points, and 85% showed stable or improved vision between 3 months and final visit. CONCLUSION: Follow-up of a large number of patients appears to confirm initially encouraging results and to suggest stability of beneficial effect after the surgical removal of subfoveal choroidal neovascularization in POHS.     

Reduction of pain in childbirth by the alleviation of anxiety during pregnancy.

Used the Institute for Personality and Ability Testing (IPAT) Anxiety Scale and 3 anxiety-related scales from Schaefer and Manheimer's Pregnancy Research Questionnaire (PRQ) to measure fear and anxiety before and after courses in childbirth education and childcare for 42 primiparas (mean age = 26 yrs) in the 3rd trimester of pregnancy. A groups * trial analysis of variance indicated that both kinds of instruction significantly reduced 2 of 3 pregnancy-related anxieties, as determined by PRQ Fears for Baby and Irritability and Tension scores. Only the childbirth education course (Lamaze method) succeeded in reducing general anxiety level, as measured by the IPAT Anxiety Scale. Anxiety level was found to exert a significant effect on self-ratings of pain during the transition stage of labor. It is concluded that childbirth education can reduce fear and anxiety and that pain perception is enhanced by high anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is dental hygiene a profession? A literature review

From a literature review of theories of professionalism, the historical development of the attributes of a profession are discussed. This paper then discusses various theories of professionalism and specifically examines the extent to which the criteria developed by Greenwood are fulfilled by dental hygiene. Greenwood's model, which discusses certain attributes that a profession should possess, is selected to provide a broader model to analyze the current professional status of dental hygiene. Greenwood's model states that a profession has acquired: 1) systemic theory, 2) authority, 3) community sanction, 4) ethical codes, and 5) a culture. The author will conclude by suggesting possible steps the dental hygiene profession could continue to take to acquire these attributes and thereby recognition as a profession by other professions, governments and the public.     

Effect of intended treatment on anxiety and on reaction to electric pulp stimulation in dental patients

Fear and anxiety are common emotional concomitants of acute pain that increase the perception of noxious events as painful. In the present study, 92 patients who were about to undergo various dental treatments (calculus removal, filling, root canal treatment, and extraction) were evaluated comparing the level of their dental anxiety and pain expectation from the intended treatment to their reaction to electric pulp stimulation. The data indicate that patients differ significantly in their dental anxiety levels and in their expectation to experience pain according to the following hierarchy (in descending order): extraction, root canal treatment, filling, and calculus removal. Anxiety and amount of pain expected from treatment correlated significantly with each other, but no simple correlations were found between anxiety and actual pain measures recorded after pulp stimulation.     

Physiological response to dental anxiety in children

Live attenuated varicella vaccine elicits protection against varicella-zoster virus (VZV), but adults require two doses to achieve optimal seroconversion rates. To assess the potential role of cell-mediated immunity (CMI), T cell proliferation to VZV antigen was compared in children and adults. Mean stimulation indices (SI) in two cohorts of 39 children tested 6 weeks after vaccination were 28.6 +/- 6.21 and 22.1 +/- 3.84, whereas 20 adult vaccines had a mean SI of 9.1 +/- 0.99 (P = .04). Vaccinees had significant increases in CMI after a second dose of vaccine. At 1 year, VZV CMI was significantly lower in adults after two doses (10.0 +/- 1.13 vs. 15.6 +/- 1.77; P = .02), even though 82% of children received one dose. Limitations in the adult helper T cell response to VZV antigens may explain the need for booster doses to elicit effective immunity and the more frequent occurrence of varicella when adult vaccines are exposed to wild type virus.     

A radiographic study of dental health in adult patients with dental anxiety

We used Northern blot hybridization to determine whether 9-amino-1,2,3,4-tetrahydroacridine (THA), a potential antidementia drug, selectively altered the levels of muscarinic acetylcholine receptor (mAChR) mRNA in differentiating cerebellar granule cells. Granule cells were cultured for 8 days in media containing 15 mM K+, 25 mM K+ or 15 mM K+ plus 30 microM THA. High K+ markedly increased the levels of m2- and m3-mAChR mRNA in the surviving cells. In contrast, THA increased the levels of m3-mAChR mRNA, but had little or no effect on m2-mAChR mRNA levels. These results suggest that THA selectively up-regulates the synthesis of m3-mAChR mRNA.     

Learned helplessness and its correlation to impairment, pain, anxiety and depression in rheumatoid arthritis

A Swedish version of the self-report instrument Arthritis Helplessness Index (AHI) is presented. Validity and reliability of the translation has been analyzed. 100 consecutive patients with rheumatoid arthritis (RA) were studied, 78 of which completed 2 self-administered questionnaires with AHI, impairment, pain, anxiety and depression. Furthermore 20 of the patients were interviewed with regard to AHI. Forty-two other patients with RA were analyzed for correlation between AHI and biochemical activity and Signals of Functional Impairment (SOFI). We conclude that the Swedish version of AHI has satisfactory validity and reliability. It correlates with age, physical impairment, pain, anxiety and depression but not with sex or disease activity. Five of the original 15 items could for various reasons be omitted, leaving a 10 statement instrument. AHI is promising as a variable in future outcome studies of RA.     

Dental and dental hygiene students'' attitudes in a joint local anesthesia course

The unfortunate exception to a general downturn in violent crime involves an upsurge in violence among youth. Violence often results when minor confrontations escalate. As school violence increasingly has become widespread, schools have become the location of many violence prevention efforts, few of which have been evaluated adequately. This paper focuses on enhancing decision-making skills as one approach to increase adolescents' ability to manage interpersonal violence. Adolescents can be considered fairly skilled decision-makers and their unique perspective must be considered in development of effective intervention programs. Data from a pilot study were examined for insights about adolescents' ability to make decisions in situations of interpersonal conflict.