Cognitive vulnerability and dental fear

Background: The Cognitive Vulnerability Model proposes that perceptions of certain characteristics of a situation are critical determinants of fear. Although the model is applicable to all animal, natural environment and situational fears, it has not yet been applied specifically to dental fear. This study therefore aimed to examine the association between dental fear and perceptions of dental visits as uncontrollable, unpredictable and dangerous. Methods: The study used a clustered, stratified national sample of Australians aged 15 years and over. All participants were asked in a telephone interview survey to indicate their level of dental fear. Participants who received an oral examination were subsequently provided with a selfcomplete questionnaire in which they rated their perceptions of uncontrollability, unpredictability and dangerousness associated with dental visiting. Results: 3937 participants were recruited. Each of the three vulnerability-related perceptions was strongly associated with the prevalence of high dental fear. In a logistic regression analysis, uncontrollability and dangerousness perceptions were significantly associated with high dental fear after controlling for age and sex. However, unpredictability perceptions did not have a statistically significant independent association with dental fear after controlling for all other variables. Conclusion: Results are mostly consistent with the Cognitive Vulnerability Model of the etiology of fear, with perceptions of uncontrollability, unpredictability and dangerousness each showing a strong bivariate relationship with high dental fear prevalence. However, more extensive measures of vulnerability perceptions would be valuable in future investigations.Jason M. Armfield, Gary D. Slade and A. John Spence

Understanding animal fears: a comparison of the cognitive vulnerability and harm-looming models

Background: The Cognitive Vulnerability Model holds that both clinical and sub-clinical manifestations of animal fears are a result of how an animal is perceived, and can be used to explain both individual differences in fear acquisition and the uneven distribution of fears in the population. This study looked at the association between fear of a number of animals and perceptions of the animals as uncontrollable, unpredictable, dangerous and disgusting. Also assessed were the perceived loomingness, prior familiarity, and negative evaluation of the animals as well as possible conditioning experiences. Methods: 162 first-year University students rated their fear and perceptions of four high-fear and four low-fear animals. Results: Perceptions of the animals as dangerous, disgusting and uncontrollable were significantly associated with fear of both high- and low-fear animals while perceptions of unpredictability were significantly associated with fear of high-fear animals. Conditioning experiences were unrelated to fear of any animals. In multiple regression analyses, loomingness did not account for a significant amount of the variance in fear beyond that accounted for by the cognitive vulnerability variables. However, the vulnerability variables accounted for between 20% and 51% of the variance in all animals fears beyond that accounted for by perceptions of the animals as looming. Perceptions of dangerousness, uncontrollability and unpredictability were highly predictive of the uneven distribution of animal fears. Conclusion: This study provides support for the Cognitive Vulnerability Model of the etiology of specific fears and phobias and brings into question the utility of the harm-looming model in explaining animal fearJason M Armfiel

The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear

BACKGROUND: Based on the hypothesis that a vicious cycle of dental fear exists, whereby the consequences of fear tend to maintain that fear, the relationship between dental fear, self-reported oral health status and the use of dental services was explored. METHODS: The study used a telephone interview survey with interviews predominantly conducted in 2002. A random sample of 6,112 Australian residents aged 16 years and over was selected from 13 strata across all States and Territories. Data were weighted across strata and by age and sex to obtain unbiased population estimates. RESULTS: People with higher dental fear visited the dentist less often and indicated a longer expected time before visiting a dentist in the future. Higher dental fear was associated with greater perceived need for dental treatment, increased social impact of oral ill-health and worse self-rated oral health. Visiting patterns associated with higher dental fear were more likely to be symptom driven with dental visits more likely to be for a problem or for the relief of pain. All the relationships assumed by a vicious cycle of dental fear were significant. In all, 29.2% of people who were very afraid of going to the dentist had delayed dental visiting, poor oral health and symptom-driven treatment seeking compared to 11.6% of people with no dental fear. CONCLUSION: Results are consistent with a hypothesised vicious cycle of dental fear whereby people with high dental fear are more likely to delay treatment, leading to more extensive dental problems and symptomatic visiting patterns which feed back into the maintenance or exacerbation of existing dental fear

Australia\u27s health 2002 : the eighth biennial report of the Australian Institute of Health and Welfare

Australia\u27s Health 2002 is the eighth biennial health report of the Australian Institute of Health and Welfare. It is the nation\u27s authoritative source of information on patterns of health and illness, determinants of health, the supply and use of health services, and health service costs and performance. Australia\u27s Health 2002 is an essential reference and information resource for all Australians with an interest in health

When public action undermines public health: A critical examination of antifluoridationist literature

Background: The addition of the chemical fluorine to the water supply, called water fluoridation, reduces dental caries by making teeth more resistant to demineralisation and more likely to remineralise when initially decayed. This process has been implemented in more than 30 countries around the world, is cost-effective and has been shown to be efficacious in preventing decay across a person's lifespan. However, attempts to expand this major public health achievement in line with Australia's National Oral Health Plan 2004–2013 are almost universally met with considerable resistance from opponents of water fluoridation, who engage in coordinated campaigns to portray water fluoridation as ineffective and highly dangerous. Discussion: Water fluoridation opponents employ multiple techniques to try and undermine the scientifically established effectiveness of water fluoridation. The materials they use are often based on Internet resources or published books that present a highly misleading picture of water fluoridation. These materials are used to sway public and political opinion to the detriment of public health. Despite an extensive body of literature, both studies and results within studies are often selectively reported, giving a biased portrayal of water fluoridation effectiveness. Positive findings are downplayed or trivialised and the population implications of these findings misinterpreted. Ecological comparisons are sometimes used to support spurious conclusions. Opponents of water fluoridation frequently repeat that water fluoridation is associated with adverse health effects and studies are selectively picked from the extensive literature to convey only claimed adverse findings related to water fluoridation. Techniques such as "the big lie" and innuendo are used to associate water fluoridation with health and environmental disasters, without factual support. Half-truths are presented, fallacious statements reiterated, and attempts are made to bamboozle the public with a large list of claims and quotes often with little scientific basis. Ultimately, attempts are made to discredit and slander scientists and various health organisations that support water fluoridation. Summary: Water fluoridation is an important public health initiative that has been found to be safe and effective. Nonetheless, the implementation of water fluoridation is still regularly interrupted by a relatively small group of individuals who use misinformation and rhetoric to induce doubts in the minds of the public and government officials. It is important that public health officials are aware of these tactics so that they can better counter their negative effectJason M Armfiel

Community Effectiveness of Public Water Fluoridation in Reducing Children's Dental Disease

OBJECTIVES: Water fluoridation is one of the most effective public health programs of the past century. However, efforts to extend water fluoridation into currently non-fluoridated areas are often thwarted. Despite considerable evidence regarding the effectiveness of water fluoridation at an individual level, published national community-based studies are rare. This study compared children's decay experience and prevalence between areas with and without water fluoridation in Australia. METHODS: Oral health data were obtained from clinical examinations of 128, 990 5- to 15-year-old children attending for a regular visit with their respective Australian state or territory School Dental Service in 2002. Water fluoridation status, residence remoteness, and socioeconomic status (SES) were obtained for each child's recorded residential postcode area. RESULTS: Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water ( or = 0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively. CONCLUSIONS: This study demonstrates the continued community effectiveness of water fluoridation and provides support for the extension of this important oral health intervention to populations currently without access to fluoridated water.JM Armfieldhttp://www.ncbi.nlm.nih.gov/pubmed/2087328

A cognitive theory of the etiology of fear.

In an effort to address weaknesses in previous theories and to provide a stronger more inclusive theoretical account of the etiology of specific phobias and sub-clinical fears, a new cognitive model is proposed. It is argued that the development and expression of fear is cognitively determined, stemming directly from perceptions of any given stimulus or situation. In particular, perceptions of uncontrollability, unpredictability, dangerousness and disgustingness are proposed to form a vulnerability-related schema, which guides future perceptions and serves to channel emotional, behavioural, cognitive and physiological reactions upon encountering a fear-relevant stimulus or situation. The cognitive schema is based on both previous learning experiences and underlying personality traits which may predispose an individual to more readily perceive any given stimulus as uncontrollable, unpredictable, dangerous and disgusting, and to react with greater arousal given these perceptions. Other cognitive resources such as coping strategies may help to mitigate the fear response by impacting upon the general cognitive evaluation arising out of the fear-provoking encounter. The new model, termed the Cognitive Vulnerability Model, explains some of the more vexing aspects of specific phobias: (1) why some people do not acquire fears after traumatic experiences; (2) why some people with fears and phobias have never had a traumatic experience with their fear-relevant stimulus; (3) the uneven distribution of fears in the population; and (4) the apparent various modes of acquisition of fear. The model has implications for both understanding the origins of fear and for the treatment of fears and specific phobias. Ten studies are presented which investigate the Cognitive Vulnerability Model as it relates to fears and phobias. Each study takes the form of either a published scientific paper or a paper submitted for publication. The setting out of the studies forms two parts – the first deals with the model generally and uses primarily animal fears as the feared stimulus, whereas the second part focuses on dental fear as a special case. The first paper presents a literature review of the area and the theoretical development of the model. Subsequent papers explore the relationship between fear of eight different animals and perceptions of the animals as uncontrollable, unpredictable, dangerous and disgusting, experimental manipulations of perceptions of spiders and self-rated fear of an encounter with a spider, the extent to which vulnerability-related perceptions mediate the associations between personality trait-like dispositions and spider fear, and the recall and recognition bias for spider schema relevant words which suggests the active presence of a cognitive schema. The second part of the thesis moves to an examination of dental fear, including both those characteristics of dental fear which make it such an important social and health concern (such as the high population prevalence, the so-called ‘vicious cycle’ of dental fear, and the association of dental fear with numerous other fears) as well as the relationship between cognitive vulnerability perceptions and dental fear. Although there remain limitations to overcome and more studies are required to further test the model, the studies as a whole paint a consistent picture, providing strong support for the utility of the Cognitive Vulnerability Model in explaining specific fears. The model has important implications both for understanding the genesis of fear and for treating it.Thesis (Ph.D.) -- University of Adelaide, School of Dentistry, 200

Oral health impacts among children by dental visiting treatment needs

This report provides information on the oral health impacts experienced by Australian children during the period 2004-06. It investigates differences in parent-reported toothache, eating difficulties and poor oral health perception between children with different dental visiting patterns and treatment needs. Image: Monkeyc/ Flickr &nbsp