Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures

Objective: To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents. Materials and methods: We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15–18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah’s DAS as a dichotomous dependent variable. Results: Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, ‘external control belief’, avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12). Conclusions: Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.<p

Asociaciones entre eventos vitales estresantes en la niñez/adolescencia y en la edad adulta: resultados de la 7.ª encuesta de Troms

Background: Exposure to highly stressful life events (SLEs), such as accidents, violence, or serious illness, is common. With the accumulation of SLEs, the risk of detrimental somatic and mental health outcomes increases. To understand patterns of SLE exposure, research into the associations between SLEs is needed. Method: The sample comprised 21,069 participants of the population-based Tromsø7 (2015/ 2016) study (52.7% female, mean age = 57.3 years, SD = 11.4 years). Participants were asked whether they had experienced eleven SLEs in childhood/adolescence and adulthood. Correlations, network analysis, and logistic regression analysis were used to examine the associations between SLEs. Results: Medium-sized to large correlations between SLEs in childhood/adolescence and SLEs in adulthood were found. Two clusters of SLEs emerged in the network analysis in childhood/ adolescence and in adulthood, respectively, interpreted as interpersonal (e.g. violence and sexual abuse) and impersonal SLEs (e.g. a life-threatening illness or serious accident). SLEs in childhood/adolescence predicted the number of SLEs in adulthood as well as exposure to the specific SLE categories in adulthood. Childhood neglect was an important predictor of SLE exposure in adulthood. Conclusions: Public health policies should focus on the prevention of SLEs and the early intervention after SLE exposure, especially childhood neglect

Dental anxiety in adolescents and adults. Epidemiological studies based on the Tromsø Study 7 and Fit Futures 1 & 2

Background: High dental anxiety can hinder individuals from seeking necessary dental treatment and thereby an obstacle in ensuring equal access to health care in the population. The overall aim of this thesis was to advance the understanding of dental anxiety in adolescents and adults, with a focus on the relevance of mental health symptoms, oral health and potentially traumatic events. Methods: All the papers included in this thesis uses data from population studies in Tromsø municipality, organized through the Tromsø Study. Fit Future 1 and 2 are repeated health surveys of the adolescent population in Tromsø and Balsfjord municipalities, inviting all registered first year of upper secondary school students at first wave (92.9% participated) and follow-up after two years (69.5% follow up rate). The Tromsø Study 7 is a health survey of the adult population in Tromsø municipality, inviting all registered citizens ≥ 40 years old (65% attendance rate). Results: - The initial measures of dental anxiety, mental health symptoms and caries experience were crucial in predicting high dental anxiety over time. However, more caries experience also significantly predicted a reduction of dental anxiety scores. Anticipated pain at the dentist changed in both directions in correspondence with the dental anxiety scores. - When it comes to potentially traumatic events outside the dental setting, sexual abuse directly affects dental anxiety after controlling for covariates and current psychological symptoms. Conclusions: High dental anxiety over time is associated with a higher burden of mental health symptoms, avoiding dental health care and poor oral health. However, it seems like positive dental experiences can reduce dental anxiety among adolescents regardless of dental caries and mental health symptoms. There was a direct association between sexual abuse and dental anxiety in the adult population

Are dental visiting patterns and oral pain associated with dental disease among Norwegian adults? A cross‐sectional study based on the Tromsø study

Abstract Objectives The present study aims to describe the dental visiting patterns in a Norwegian adult population and their associations with sociodemographic and oral health variables, including oral pain. We further explore if the utilization of dental health services and oral pain predicts caries and periodontitis, the most common oral diseases. Materials and Methods We use data from the seventh wave of the Tromsø study performed in 2015–2016. In this cross‐sectional survey, all residents 40 years or older in Tromsø municipality in Norway were invited, of whom 21,083 (65%) participated. All participants answered questionnaires assessing sociodemographic characteristics, use of health services, and self‐reported health measures, including pain. Almost 4000 participants underwent a dental examination with registration of caries and periodontitis. Associations of dental visiting patterns and utilization of dental services the past 12 months with sociodemographic‐, self‐reported‐, and clinical oral health measures were analyzed by cross‐tabulation and Pearson's χ2 tests, as well as with logistic regression analyses with caries and periodontitis as outcomes. Results A regular, annual dental visiting pattern was the most common, but among respondents with severe dental anxiety and poor dental health, visiting for acute problems only or never (symptomatic visiting) was the most common. Intervals of more than 24 months between visits and a symptomatic visiting pattern were associated with caries, whereas shorter than 12‐month intervals and a symptomatic visiting pattern were associated with periodontitis. Many characteristics were shared among respondents with the lowest and the highest utilization of dental services, including oral pain, a difficult financial situation and poorer self‐reported and clinical dental health. Conclusions Regular dental visits at 12–24 month intervals were associated with beneficial oral health parameters, compared with more frequent, rarer, and symptomatic dental visiting patterns. Oral pain was an unreliable predictor of caries and periodontitis

Changes in dental anxiety among 15‐ to 21‐year‐olds. A 2‐year longitudinal analysis based on the Tromsø study: Fit futures

Objective: Identify predictive variables related to the development and continuation of high dental anxiety among young people over 2 years and assess differences between youth experiencing increased, decreased or unchanged dental anxiety scores over time. Methods: An observational panel study of 15‐to 21‐year‐old people in Tromsø and Balsfjord region followed students from their first to their last year of upper secondary school (2010/11‐2012/13). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) of possible predictive variables assessed at baseline when using dental anxiety score from the second wave as a dichotomous dependent variable. Variables measured at baseline: Sex, Dental Caries Experiences (DMFS index), Dental Anxiety (Corah's Dental Anxiety Scale/DAS), Psychological Distress (Hopkins Symptom Checklist/HSCL‐10), Avoidance of dental treatment, Pain Estimation at the dentist and motivational questions related to tooth brushing and caries (Self and Social Motivation). Wilcoxon signed‐rank tests and Kruskal‐Wallis tests were used to test whether changes in DAS score between waves were associated with changes in Pain Estimation between waves and HSCL‐10 scores at baseline. Results: Hopkins Symptom Checklist, DMFS and DAS scores at baseline predicted high dental anxiety scores after 2 years. Sex, motivation related to oral hygiene and avoidance due to fear at baseline did not contribute significantly to our model. DMFS and HSCL‐10 were higher among young people who reported a substantial change in DAS score (2.0>Interquartile range/IQR), irrespective of the direction of change. Pain Estimation changed consistently with a change in DAS score. Conclusion: Mental health symptoms, pre‐existing dental anxiety and dental health status are important contributors to the development of dental anxiety in youth. Estimations of pain at the dentist are central when it comes to changes in dental anxiety over time in this study

Pain, discomfort, and functional impairment after extraction of primary teeth in children with palatally displaced canines–a randomized control trial comparing extraction of the primary canine versus extraction of the primary canine and the primary first molar

Objective - To assess pain, discomfort, and functional impairment in children experiencing extraction of primary canine or primary canine and primary first molar as an interceptive treatment for palatally displaced permanent canines. Material and methods - Twenty-eight children, aged 9.5–14 years with displaced permanent maxillary canines were randomly assigned for extraction of the primary canine only or the primary canine and the primary first molar. Pain and discomfort were rated on visual analogue scales, and influence on daily activities was assessed by a questionnaire that has been previously tested for reliability and validity. Differences between groups were assessed by independent samples t-tests, Mann–Whitney U-tests or the Fisher's exact test. Results - Tooth extraction was associated with low levels of pain and discomfort on a group level. Extraction of both the canine and the first molar was associated with significantly more pain and discomfort than was the extraction of the canine only. Extractions were associated with chewing problems among one-third to half of the children, otherwise, few children reported any jaw impairment after extraction. Conclusion - Primary canines and first molars can be extracted in a way that is associated with relatively low levels of pain and discomfort during and after the procedures. Double extractions induced more pain and discomfort than single extractions, which should be accounted for in the treatment planning

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study—Tromsø 7

Objective The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population. Method The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015–2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety. Results High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. Conclusions The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study—Tromsø 7

Objective The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population. Method The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015–2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety. Results High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. Conclusions The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression