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

Delay of Dental Care: An Exploratory Study of Procrastination, Dental Attendance, and Self-Reported Oral Health

Delay of dental care is a problem for dental public health. The present study explored the relationship between procrastination and dental attendance, focusing on delay in seeking dental care. This hypothetical relation was compared to other avoidance-related factors affecting dental attendance. In addition, an inquiry into the reasons for delaying dental care was conducted. Students (n = 164) answered an internet-based questionnaire on socio-demographic factors, dental health, dental attendance, delay of dental care, reasons for the delay, procrastination (IPS), dental anxiety (MDAS), perceived stress (PSS) and oral health self-efficacy (OHSES). The study found no significant relation between procrastination and delay in dental care. However, procrastination was related differently to past, present, and future dental attendance and seemed to relate to oral health behavior. Delay of dental care was associated with higher dental anxiety and lower oral health self-efficacy. The cost of dental care was the most frequently given reason for the delay of dental care. Further research on the delay of dental care and dental attendance is warranted in understanding the behavior, implementing interventions, and improving the utilization of public dental care

Dental anxiety: A comparison of students of dentistry, biology and psychology

Dental anxiety is an important challenge for many patients and clinicians. It is thus of importance to know more about dental students’ own experiences with dental anxiety and their understanding of dental anxiety. The aim was to investigate differences in dental anxiety levels between dental students, psychology students, and biology students at a Norwegian university

Language of motivation and emotion in an internet support group for smoking cessation: Explorative use of automated content analysis to measure regulatory focus

The present study describes a novel approach to the identification of the motivational processes in text data extracted from an Internet support group (ISG) for smoking cessation. Based on the previous findings that a “prevention” focus might be more relevant for maintaining behavior change, it was hypothesized that 1) language use (ie, the use of emotional words) signaling a “promotion” focus would be dominant in the initiating stages of the ISG, and 2) that the proportion of words signaling a prevention focus would increase over time. The data were collected from the ISG site, spanning 4 years of forum activity. The data were analyzed using the Linguistic Inquiry and Word Count application. The first hypothesis – of promotion focus dominance in the initiating stages – was not supported during year 1. However, for all the other years measured, the data showed that a prevention failure was more dominant compared with a promotion failure. The results indicate that content analysis could be used to investigate motivational and language-driven processes in ISGs. Understanding the interplay between self-regulation, lifestyle change, and modern communication channels could be of vital importance in providing the public with better health care services and interventions

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective

Background - Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour. Methods - Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function – Adult Version (BRIEF-A). Results - Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP. Conclusion - EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours

Quality of life, mentalization, and perception of challenging patient encounters in dentistry: A cross-sectional study

Objective: This study investigated how exposure to challenging patient encounters influenced participants’ self-reported quality of life, and how participants’ mentalization capabilities affected the perceptions of challenging patients encounters among Norwegian dentists and dental students. Materials and Methods: Data was collected with an online questionnaire, and a total of 165 dentists (n = 126) and dental students (n = 39) responded. Results: Participants who reported higher total exposure of challenging encounters reported lower quality of life (QoL). Mentalization tendencies affected the perception of challenging encounters with specific types of patients; critical and anxious; as well as the estimation of the total exposure to challenging patient encounters. Participants that were overconfident with regards to the mental states of others found these patient types less challenging and they reported less overall exposure to challenging patients than underconfident participants. Also, overconfident participants reported higher QoL than underconfident participants. Conclusions: Mentalization capabilities of dental practitioners interact with the perception of challenging encounters in dental practice, and how practitioners respond to these challenges. Measures should be undertaken to increase the awareness of metacognitive skills in dentistry with the dual goal of improving patient care as well as the quality of life of dental practitioners

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

Procedure time and filling quality for bulk-fill base and conventional incremental composite techniques—A randomised controlled in vitro trial

Objectives: The aims of this randomised controlled laboratory trial were to determine the procedure time and immediate quality (surface porosity and marginal gaps) of fillings placed using the bulk-fill base technique and the conventional incremental technique in simulated clinical settings. Methods: Forty-two dentists and dental students were randomly allocated to use either the bulk-fill base technique or the conventional incremental technique to fill an identical class II disto-occlusal cavity in a maxillary left first molar typodont tooth. We recorded the time the participants used to fill the cavity and evaluated the surface porosity and marginal gaps on the approximal surfaces of the fillings using a stereomicroscope and specific probes according to the FDI criteria for restoration evaluation. Data were analysed using the Mann–Whitney U, Kruskal–Wallis, and chi-square tests. Results: The median time ± interquartile range was 186 ± 80 s for the bulk-fill base technique and 463 ± 156 s for the conventional incremental technique (p < 0.001). The quality of the fillings was better for the bulk-fill base technique than for the conventional incremental technique (X2 = 9.5, p = 0.002). Neither operator experience nor the usual technique of choice were associated with the procedure time or the quality of the fillings. Conclusions: Compared to the conventional incremental technique, the use of the bulk-fill base technique shortened the time to fill a cavity by 59.8 % or 4 min and 36 s, and it improved the immediate surface and marginal quality of the fillings, regardless of the operator’s experience or technique preference. Clinical significance: The use of the bulk-fill base technique instead of the conventional incremental technique leads to significant time-savings when placing large class II composite fillings. Additionally, the use of the bulkfill base technique instead of the conventional incremental technique improves the immediate quality of large class II composite fillings

Electronically mediated health-communication : uses of text-based media

This project has focused on why and how people are using the Internet for healthissues. The studies involve collection of descriptive survey data aimed at determining the characteristics of the participants, what characterizes the use of online discussion forums for mental health, and the communication patterns of these forums. Based on these data the objective has been to establish an understanding of the needs this use fulfills for the participants, and the factors responsible for motivating and shaping behavior. Additionally, the impact of health-professionals’ involvement in these settings has been investigated, specifically how such involvement could affect the interaction patterns. Using theories from social psychology and social cognition, and evidence from laboratory research on text-based communication, a theoretical perspective is presented concerning people’s use of text-based, “poor” media in communicating about their health. Several methodological approaches are represented by the studies. The data presented in Paper I was collected by means of a web-based questionnaire that had participants enter the study by self-selection. The study was made possible by the cooperation of Doktor Online (DO; www.doktoronline.no) and Scandinavia Online (www.sol.no). Studies presented in Papers II and III were based on content analyses of log materials from the forums of DO. In Paper II content was condensed into categories to enable comparison of thematically different forums with regards to interaction patterns. Paper III investigated what effects health professionals would have on levels of social presence and interaction structure in an online health-forum. The two studies presented in Paper IV were laboratory experiments that challenge the view that text-based communication, as it is manifested on the Internet, are mainly different from face-to-face communication (speech) in terms of anonymity. This dissertation attempts to describe the relevance of these laboratory experiments in context of the health communication investigated in Papers I – III, and also outside of the online, selfhelp setting (i.e., traditional health-services). Electronically Mediated Health-Communication The results indicated that users of text-based communication for health-purposes were experiencing this as meaningful and rewarding. Participants exhibit high levels of selfdisclosure and share information with fellow participants that they would not share with others face-to-face. Furthermore, the communication patterns are believed to be potentially “health-promoting” by exemplifying social support, even in the absence of monitoring by health-professionals. It is argued that professional involvement might help facilitate discussions of special topics, for instance eating disorders. Participants view these forums as a supplement to traditional health-services, and they probably serve different functions. Also, it is argued that the characteristics of the communication medium (text-based) are likely to influence these behaviors and experiences markedly. These characteristics appear to influence people’s abilities to conduct strategic and controlled self-presentation, as measured by the accessibility of the “actual self” concept. This could help explain the health-related uses of text-based media and inform the design of future health services. Text-based health communication appears to fulfill important needs to those participating. These venues allow people to seek out information and find communion with their peers. In the process they disclosure highly personal information and provide and receive social support from others. Although these settings appear to be health promoting and serve a positive function in the lives of those participating, health professionals might have roles as moderators or role models in these settings. Clinical adaptations of these findings will extend these roles further. The experimental studies and the theoretical discussion provided by this thesis are advocating an approach to understanding individuals’ use of text-based communication technology for health-purposes along both interpersonal and intrapersonal dimensions based on theories of self-presentation and self-perception

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