Dental malpractice experience: a closed claim study.
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Adult↗
Biomedical subjects
P Milgrom
Publications and source records attributed to P Milgrom.
The Dental Fear Survey Schedule: a study with Finnish children.
The reliability and validity of the Dental Fear Survey Schedule for Children (DFSS-C) was examined in a sample of 828 school children in Finland. The DFSS-C mean was 22.1. Choking, injections and drilling were the most common fears. Internal consistency indicated a high level of reliability. Factor analysis (principal components, varimax rotation) found three factors accounting for 54% of the scale variance. Factors were defined as (1) fear of highly invasive procedures, such as injections and drilling; (2) fear of potential victimization, including fear of strangers, choking and hospitals; and (3) fear of less invasive procedures, such as opening the mouth and being examined by the dentist. The factor pattern was similar to results obtained with a sample of children in the United States. There were significant differences in fear score for children whose parents reported them fearful and/or reported them to have had a previous bad experience at the dentist. Boys (but not girls) who had a DMFT score of at least 1 had a significantly higher mean DFSS-C score (21.1) than those who were caries free (20.0). These data suggest the DFSS-C operates in Finland as it does in the United States, but that culture-specific minimal scores for determining high dental fear are needed.
Analysis of Variance↗
Cross validation of a Brazilian version of the Dental Fear Survey.
The Dental Fear Survey (DFS), a paper and pencil instrument for assessing dental fear and avoidance, has been widely used and validated in fear studies in the US. However, before such instruments are used in countries and cultures dissimilar to the one in which it was developed, they should be cross-validated in that culture. The present study is an examination of the DFS response characteristics in a group of 374 Brazilian university students. Factor analysis of the DFS revealed three factors essentially identical to those found among university students in the US and in Singapore, as well as among US adult dental patients. Higher DFS scores were significantly associated longer intervals since last dental visit. These results are taken as evidence that the DFS performs in this Brazilian sample very much as it does in other samples; and is thus, a valid indicator of dental fear at least among Brazilian university students.
Adult↗
Fluoridation effects on periodontal disease among adults.
Numerous studies report that water fluoridation reduces caries in children, but little current evidence exists about fluoridation's effects on the periodontal health of adults. To address this issue, we estimated fluoridation effects on periodontal disease among 1066 Washington state employees and their spouses, aged 20 to 34, with current residences divided evenly between fluoridated and nonfluoridated communities. Subjects were interviewed by telephone to collect residence histories, personal characteristics and other data. Each subject's lifetime years of fluoridation exposure (YFE) was calculated from the person's residence history and the U.S. Centers for Disease Control's Fluoridation Census. Oral assessments were conducted to measure the extent of periodontal disease. Relative to adults with no exposure, continuous lifetime exposure reduced the probability of attachment loss from 0.87 to 0.72. Similar benefits were obtained for bleeding gingiva and calculus. The estimates of fluoridation's benefits were not influenced by selection bias due to subjects' nonparticipation in the oral assessments.
Adult↗
The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl.
This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. Fentanyl had a significant depressant effect on respiration. Fifty of 79 (63%) subjects who received a midazolam-fentanyl combination became apneic, while only two of 78 (3%) who received midazolam alone were apneic (Fisher's Exact Test, P < 0.001). Two subjects (2.5%) in the combination group and none in the midazolam alone group had oxygen saturations drop below 90%. About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated.
Adolescent↗
The effect of instruction on dentists' motivation to manage fearful patients.
This study assesses the effect of the pre-doctoral and continuing behavioral education on dentists' efforts to treat fearful patients. A mail survey consisting of a booklet of 27 questions was sent to the 1988 and 1989 graduates of the Universities of Washington (UW), Kentucky (UK), and British Columbia (UBC). Graduates from UW and UK who received predoctoral instruction and some UBC graduates who received continuing education on the behavioral approach to caring for fearful patients were compared with UBC graduates who received only a primarily pharmacological oriented education. The overall response rate was 80.4 percent (164/204). Results indicate the average proportion of fearful patients seen was greater for those receiving behavioral instruction. Dentists who received behavioral instruction also reported greater effort addressing fear during patient's initial contact with the practice; however, they perceived the costs of the behavioral approach to be greater. No differences were found between groups for the remaining effort measures.
Adaptation, Psychological↗
Dental fears in general practice: new guidelines for assessment and treatment.
Dental fear is a world-wide problem and universal barrier to oral health care services. Fears acquired in childhood through direct experience with painful treatment or vicariously through parents, friends or siblings, may persist into adulthood. Symptomatic treatment and lack of trust and control exacerbate fears. Coexisting psychiatric conditions further complicate treatment. Treatment steps recommended in this paper include careful assessment of fears, application of dental and psychological management techniques to enhance trust, feelings of control, and the development of coping skills, and appropriate and targeted use of pharmacological agents. Prevention of fear development through the use of effective behavioural child management techniques combined with preventive dentistry should be a fundamental part of general dental practice throughout the world.
Adaptation, Psychological↗
Adolescent dental fear and control: prevalence and theoretical implications.
This study examined the prevalence and etiology of dental fear in a large, representative sample of Singapore adolescents. Participants completed a questionnaire regarding fear of the dentist, dental beliefs and their most recent dental visit. The population prevalence of high dental fear was 115 fearful children per 1000 population (SE = 0.02). Children who reported painful treatment and perceived lack of control at the dentist were 13.7 times more likely to report high fear and 15.9 times less likely to be willing to return to the dentist or dental nurse. The etiology of severe clinical fear appears strongly related to direct conditioning in the presence of pain and vulnerability.
Adaptation, Psychological↗
Disinhibition of behaviors with midazolam: report of a case.
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Adult↗
Nonalcohol-based chlorhexidine dental rinse.
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Adult↗
Experience with triazolam in preschool children.
Triazolam (0.125 to 0.25 mg) was administered preoperatively to 17 unmanageable children aged 22 to 65 months. The children were monitored visually and by pulse oximeter. No child experienced any airway obstruction and none had oxygen saturation below 90%. Older children had lower SaO2 values than younger children. There was no relationship between the mg/kg dose and SaO2 values.
Anesthesia, Dental↗
Dental decisionmaking and variation in dentist service rates.
Previous medical and dental studies report wide variations in service rates across small areas, regions and providers. A major source of this variation appears to be the pattern of clinical decisionmaking of the provider. This argument was tested using dentist service rates (the average number of services provided per patient) calculated from 1984-1985 claims data for a population of well-educated, middle-class patients in Washington state, U.S.A. (N = 23,153). Service rates were calculated for each dental procedure in the following pairs of alternative treatments: crown vs amalgam or crown build-up; root canal therapy vs extraction; and fixed bridge vs removable partial denture. For each pair, dentists identified patient (e.g. cost, patient preference) and technical (e.g. periodontal status, tooth damage) factors which they considered to be important in choosing therapy. Regression analysis revealed that the technical factors explained little variation in the rates, while at least one patient factor was significant across services, except prosthetics. Environmental characteristics, structural features of the practice, and the dentists' practice beliefs also explained variation in the rates.
Crowns↗
Effect of a beta-adrenergic blocking agent on dental anxiety.
The effect of propranolol was studied on 23 dental phobics in a double-blind, placebo-controlled clinical trial involving actual dental treatment. The subjects were selected because they showed high physiological reactivity in the dental situation. Twelve subjects received the test drug and 11 subjects received the placebo at individualized doses of either 80 or 120 mg. A significant difference in self-reported anxiety at the injection phase of treatment and less overall pain intensity and aversiveness were observed for the propranolol as compared with the placebo group. No differences were detected for behavior ratings. Beta-adrenergic blocking agents may have utility for reducing anxiety in individuals fearful of dental treatment.
Adolescent↗
A cross-cultural cross validation of the Dental Fear Survey in South East Asia.
This study was designed as a cross-cultural replication and cross validation of the Dental Fear Survey (DFS) in two groups of Singapore adults: university students and military conscripts. Factor analysis of the DFS in each of these dissimilar samples revealed factor structures that were highly comparable to one another as well as to those obtained in the U.S.A. Behavioral and physiological fear assessment during exposure to simulated dental treatment also showed results comparable to those found in Western cultures. Self report measures were more likely to correlate with other self reports than with physiologic or behavioral measures. Among university students, those who had visited a dentist within the past year had significantly lower DFS scores than those who had avoided dentistry. The fear-avoidance relationship did not hold for military subjects who reported less dental fear overall. It was concluded that the DFS was factorially stable; and therefore, generalizable to this South East Asia culture.
Adolescent↗
Prevalence of dental anxiety and fear in children in Singapore.
505 primary school children in Singapore aged 10-14 were surveyed regarding fear of the dentist. Sixty-eight children were classified as having high fear, giving a sex and race adjusted population prevalence rate of 177 fearful children per 1000 population. Females were 2.64 times more fearful than males. There were no significant racial differences in the prevalence rate. Children with high state anxiety are almost three times as likely to report dental fear as those with low state anxiety. Children with trait anxiety scores above the population mean were just as likely as those reporting below the mean to be fearful. Access to dental care is an important intervening variable in dental fear.
Adolescent↗
Variation in dentist service rates in a homogeneous patient population.
Previous studies in medicine and dentistry document wide variations in service rates across small areas, large regions, and providers. The practice patterns of providers and underlying differences in patient need are thought to be important sources of this variation. To control for variation in patient needs, we calculated service rates of 200 general dentists in Washington state based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations were found in the rate for many dental services. Dentists' practice beliefs and characteristics of the practice were sources of variation in the rates. The evidence is insufficient to determine whether undertreatment of overtreatment occurred among dentists with the lowest and highest expenditures per patient, respectively. However, the perceived oral health status of adult patients was lower in practices with the lowest total expenditures per patient than in practices with the highest total expenditures per patient, suggesting the undertreatment of adult patients in the lowest-expenditure practices may have occurred.
Adult↗
Factors influencing variation in dentist service rates.
In the previous article, we calculated dentist service rates for 200 general dentists based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations in the rates were detected. In this analysis, factors influencing variation in the rates were identified. Variation in rates for categories of dental services was explained by practice characteristics, patient exposure to fluoridated water supplies, and non-price competition in the dental market. Rates were greatest in large, busy practices in markets with high fees. Older practices consistently had lower rates across services. As a whole, these variables explained between 5 and 30 percent of the variation in the rates.
Attitude of Health Personnel↗
Prevalence of dental fear in young adult Singaporeans.
One-hundred-and-fifteen male military recruits and 176 mostly female first- and second-year students in the National University of Singapore were surveyed regarding their fear of the dentist. Nine of 115 recruits and 36 of 176 university students were classified as having high fear, giving a population prevalence rate between 78 and 208 fearful young adults per 1000 population. Higher educational levels were associated with fear of the dentist. There were no significant racial differences in the prevalence rate in either sample. Higher fear scores were associated with longer intervals between dental visits for the university but not the military population. Efforts are needed to prevent and ameliorate the development of dental fears. Trust and control appear to be major factors associated with dental fears.
Adolescent↗