The combination of three dental fear scales
Dental fear should be studied with regard to the situation to which it pertains, the reactions it evokes, and its duration . Every single scale of dental fear can describe one aspect very well but relatively incomprehensive. This study used three scales, including DAS, DFS and S-DAI, to evaluate dental fear in different aspects. DFS reflects dental fear informatively to help clinicians understand a patient’s fear better, while DAS measures dental fear generally . S-DAI focuses on psychometric grounds , of which nearly half of its items reflect the emotional reactions [12, 31].
The levels of dental fear were significantly decreased at patients subsequent visit after 6 months in most scales except stage I and II of DAS and S-DAI, because of the different concentration of the three scales, particularly in S-DAI, which was focused on psychometric grounds. The response categories of DAS were not comprehensive to evaluate the anticipated fear of specific stimuli . Santuchi et al, reported significantly lower dental fear level at the first attendances on DAS, but no statistical significance on DFS . Researchers drew different conclusions for the same concerned problem from different scales. Although the statistical significance of each scale was diverse, the combination of three dental fear scales was consistently decreased at the time of 6 months subsequent visiting, while the trend from mean number of all scales also showed decrease. In this case, combination with three scales in the present study could enhance the accuracy of the results.
Periodontal status, dental fear and pain
Periodontal status was an important factor affecting dental fear, and poor periodontal status could contribute to high dental fear . The present study exhibited correlations between periodontitis stages and dental fear, reflecting worse periodontitis with higher dental fear. Many emerging evidences had indicated that periodontal status was associated with dental fear. Guentsch et al suggested that patients with higher dental fear value showed more sites of bleeding on probing (BoP), which had negative effects on periodontal health . Levin et al illustrated periodontal clinical parameters, including plaque index, radiographic bone loss and probing depth were correlated with DAS . Bell et al reported that dental fear was associated with bleeding gums as signs of gingivitis . These literatures were in agreement with the findings of the present study. However, there were also reports describing no association of dental fear and poor periodontal health. Delgado-Angulo et al concluded that dental fear was not related to the number of teeth with PD ≧ 4mm, while Eitner et al identified that anxious was not associated with periodontal status. Besides, these findings suggested that important to evaluate dental fear levels for successful treatment of a periodontitis patient.
Pain is an ‘unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage’ . As a major component of dental fear, fear of pain associated with dental treatment has been identified . SRP is often associated with pain and discomfort, although pain occurrence is variable and dramatically different among patients . The VAS of the pain perceived during periodontal procedures range from approximately 20–80 mm [37, 38]. VAS during SRP in this study was 24.79 ± 14.61, which was significant associated with dental fear. Our findings were corroborated by Tickle et al, who found that subjects with dental fear were 2.3 times more likely to experience pain after dental treatment than patients without dental fear . Fardal & McCulloch also demonstrated that patients with high dental fear scores reported greater pain after periodontal therapy . The negative reinforcement of aversive stimuli avoidance including pain, anticipation or memory of pain, and environmental factors, also identified the association between dental fear and postoperative pain . It suggested periodontal treatment should lead professionals to design health and comfort treatment strategies that will cope with the dental fear and reduced discomfort during treatment .
In the present study, dental fear, pain and periodontal status were significantly correlated with each other. Individuals, who had high dental fear, would delay treatment, and lead to more extensive development of disease, which ultimately required more invasive and potentially painful treatment, and these experience could contribute to the increase of dental fear: this is the idea of a ‘vicious cycle’. The level of dental fear in periodontitis patients was higher, and the poor periodontal status was related to dental fear in the present study. In this case, without intervention of SRP, the periodontal status would be exacerbated because of high level of dental fear, then resulting in periodontitis aggravation, and the vicious cycle established. Hence, periodontitis patients should be noticed by clinicians to the level of dental fear and break this cycle. The dental fear value were all reduced in every stage of periodontitis patients, especially in stage III and IV were significantly reduced, which suggested intervention treatment necessary. Santuchi et al reported that periodontal clinical were improved and experiences of fear were reduced during SRP, which was similar to our study .
The proportion of periodontitis stage III(35.48%) and IV(41.94%)in high dental fear group was significantly increased compare to low dental fear group(stage III21.34%, stage IV 19.10%). After 6 months return visit, although the dental fear level of patients were reduced compared to the first attendance, the dental fear value were still high, especially in stage III and IV periodontitis patients. According to the new periodontitis classification in 2018, stage I and II were considered to initial and moderate periodontitis, while stage III and IV were severe and advanced periodontitis . This was in line with other studies demonstrating that patients with severe periodontitis had poorer oral health, worse functional limitation, physical pain, and psychological incapacity domain scores, than those with mild and moderate periodontitis . To the best of our knowledge, this is the first study in the literature that measured periodontal status by periodontitis stages to evaluate relationship between dental fear and pain. Based on the above study, it should pay more attention to notice periodontitis patients dental fear level, especially stage III and IV periodontitis by clinicians.
The sample of current study was relatively small although statistically enough. Secondly, long term follow-up could advance questionnaire accuracy. Grading assessment in the further study can supply clinical evaluation of new periodontitis classification.