Dental anxiety and dental attendance among 25-year-olds in Norway: time trends from 1997 to 2007

<p>Abstract</p> <p>Background</p> <p>So far, there are few studies considering the development of dental anxiety and dental attendance patterns across time in the general population of Norwegian adults. This study aimed to 1) determine the frequency of dental anxiety and regular dental attendance among 25-year-olds in Norway in 1997 and 2007, 2) to study the development (time trend) of dental anxiety and the socio-behavioral distribution of dental anxiety from 1997 to 2007.</p> <p>Method</p> <p>Random samples of 1,190 and 8,000 25-yr-olds were drawn from the populations of three counties in Western Norway in 1997 and 2007, respectively. The eligible participants received questionnaires by mail including questions on socio-demographics, dental anxiety (DAS) and dental attendance.</p> <p>Results</p> <p>In 1997, 11.5% males versus 23% females reported high dental anxiety (DAS ≥ 13). Corresponding figures in 2007 were 11.3% and 19.8%. The proportions who had attended yearly for a dental check-up during the past 5 years fell from 62% in 1997 (men 56.9% and women 66.4%) to 44.6% (men 38.1% and women 48.6%) in 2007. After controlling for potential confounding factors, the 25-year-olds were 1.4 times more likely to report dental anxiety in 1997 compared to 2007. The decrease was largely attributable to a lower mean DAS score among higher educated females in 2007 than in 1997. The discrepancy in dental anxiety between regular and non-regular dental attendees had decreased, largely attributable to a decline in dental anxiety among irregular dental attendees.</p> <p>Conclusion</p> <p>The study showed reduced dental anxiety and dental attendance among 25 year-olds in Norway from 1997 to 2007. This study points to the importance of controlling for possible changes in socio-demographic distributions when different cohorts are compared.</p

The contribution of embarrassment to phobic dental anxiety: a qualitative research study

BACKGROUND: Embarrassment is emphasized, yet scantily described as a factor in extreme dental anxiety or phobia. Present study aimed to describe details of social aspects of anxiety in dental situations, especially focusing on embarrassment phenomena. METHODS: Subjects (Ss) were consecutive specialist clinic patients, 16 men, 14 women, 20–65 yr, who avoided treatment mean 12.7 yr due to anxiety. Electronic patient records and transcribed initial assessment and exit interviews were analyzed using QSR"N4" software to aid in exploring contexts related to social aspects of dental anxiety and embarrassment phenomena. Qualitative findings were co-validated with tests of association between embarrassment intensity ratings, years of treatment avoidance, and mouth-hiding behavioral ratings. RESULTS: Embarrassment was a complaint in all but three cases. Chief complaints in the sample: 30% had fear of pain; 47% cited powerlessness in relation to dental social situations, some specific to embarrassment and 23% named co-morbid psychosocial dysfunction due to effects of sexual abuse, general anxiety, gagging, fainting or panic attacks. Intense embarrassment was manifested in both clinical and non-clinical situations due to poor dental status or perceived neglect, often (n = 9) with fear of negative social evaluation as chief complaint. These nine cases were qualitatively different from other cases with chief complaints of social powerlessness associated with conditioned distrust of dentists and their negative behaviors. The majority of embarrassed Ss to some degree inhibited smiling/laughing by hiding with lips, hands or changed head position. Secrecy, taboo-thinking, and mouth-hiding were associated with intense embarrassment. Especially after many years of avoidance, embarrassment phenomena lead to feelings of self-punishment, poor self-image/esteem and in some cases personality changes in a vicious circle of anxiety and avoidance. Embarrassment intensity ratings were positively correlated with years of avoidance and degree of mouth-hiding behaviors. CONCLUSIONS: Embarrassment is a complex dental anxiety manifestation with qualitative differences by complaint characteristics and perceived intensity. Some cases exhibited manifestations similar to psychiatric criteria for social anxiety disorder as chief complaint, while most manifested embarrassment as a side effect

Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist

<p>Abstract</p> <p>Background</p> <p>The Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior.</p> <p>Methods</p> <p>An existing Contemplation Ladder for assessing stage of change in smoking cessation was modified to assess readiness to go to a dentist. The resulting Ladder was administered to samples of English-speaking adolescents (USA), Spanish-speaking adults (USA), and Norwegian military recruits (Norway) in order to assess construct validity. The Ladder was also administered to a sample of English-speaking avoidant adolescents and young adults who were enrolled in an intervention study (USA) in order to assess criterion validity. All participants also had dental examinations, and completed other questionnaires. Correlations, chi square, t tests and one-way ANOVAs were used to assess relationships between variables.</p> <p>Results</p> <p>In two samples, participants who do not go to the dentist had significantly more teeth with caries; in a third sample, participants who do not go to the dentist had significantly worse caries. Ladder scores were not significantly related to age, gender, caries, or dental fear. However, Ladder scores were significantly related to statements of intention to visit a dentist in the future and the importance of oral health. In a preliminary finding, Ladder scores at baseline also predicted whether or not the participants decided to go to a dentist in the intervention sample.</p> <p>Conclusions</p> <p>The data provide support for the convergent and divergent construct validity of the Ladder, and preliminary support for its criterion validity. The lack of relationship between dental fear and Ladder scores suggests that avoidant individuals may be helped to decide to go to a dentist using interventions which do not explicitly target their fear.</p

Comorbid mental disorders in substance users from a single catchment area - a clinical study

<p>Abstract</p> <p>Background</p> <p>The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described.</p> <p>Methods</p> <p>First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms.</p> <p>Discussion</p> <p>This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.</p

Measuring euthymia within the Neuroticism Scale from the NEO Personality Inventory: A Mokken analysis of the Norwegian general population study for scalability

Background Whereas the Eysenck Neuroticism Scale only contains items covering negative mental health to measure dysthymia, the NEO Personality Inventory (NEO-PI) contains neuroticism items covering both negative mental health and positive mental health (or euthymia). The consequence of wording items both positively and negatively within the NEO-PI has never been psychometrically investigated. The aim of this study was to perform a validation analysis of the NEO-PI neuroticism scale. Methods Using a Norwegian general population study we examined the structure of the negatively and positively formulated items by principal component analysis (PCA). The scalability of the identified two groups of euthymia versus dysthymia items was examined by Mokken analysis. Results With a response rate of 90%, 1082 individuals with a completed NEO-PI were available. The PCA identified the neuroticism scale as the most distinct where 14 items had acceptable loadings for the euthymia subscale, another 14 items for the dysthymia subscale. However, the Mokken analysis coefficient of homogeneity only found acceptable scalability for the euthymia subscale. Limitations A comparison with the Eysenck Neuroticism Scale was not performed. Conclusion The NEO-PI neuroticism scale contains two subscales consisting of items worded in an opposite direction where only the positive euthymia items have an acceptable scalability