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- Stenebrand, Agneta
(författare)
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Dental anxiety among 15-year-olds : Psychosocial factors and oral health
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- AIM: The overall aim of this thesis was to examine the associations between dental anxiety, experiences of dental care, psychosocial factors and oral health among 15-year-olds, and to analyse changes in the prevalence of dental anxiety over time.MATERIALS AND METHODS: The thesis was based on two cross-sectional epidemiological studies in Jönköping, Sweden. Papers I, II, and III were based on a random sample of 15-year-old individuals. The total sample consisted of 221 individuals. Six questionnaires were used, one included items of background data, while the others were psychometric instruments measuring dental anxiety, temperament, general anxiety and depression, general fearfulness and attitudes to dental care. Paper IV was based on the Jönköping studies, a series of epidemiological studies from 1973, 1983, 1993, and 2003 in which random samples of 15-year-old individuals were included. The total sample consisted of 405 individuals. Questionnaires including background data and dental anxiety were used and clinical data were collected.RESULTS: Of the 15-year-old individuals 6.5% were classified as dentally anxious with girls proportionally more fearful than boys (Papers I-III). Dental anxiety correlated significantly with three of the temperament dimensions; emotionality, activity and impulsivity. Reported pain or unpleasant experiences during dental care treatment were clear predictors concerning dental anxiety (Paper I). Both symptoms of general anxiety and depression were significantly correlated with dental anxiety after controlling for other potential risk factors (Paper II). Dental anxiety was associated with both general fearfulness and with attitudes to dental care, where the strongest predictor of dental anxiety was general fearfulness (Paper III). A trend analysis over the 30-year period showed a gradient of statistically significantly decreasing dental anxiety prevalence, from 38.1% in 1973 to 12.8% in 2003. Over the period the 15-year-old individuals with dental anxiety had significantly higher number of filled tooth-surfaces than those with no dental anxiety, and also more caries in 1973. There were no such differences concerning plaque and gingivitis (Paper IV).CONCLUSIONS: Dental anxiety in 15-year-olds correlated with experiences of dental care, psychosocial factors as well as to oral health. Specifically, pain experiences related to dental care, attitudes to dental care and general fearfulness seem to have the strongest impact on dental anxiety. Dental anxiety showed a clear declining change over time. More girls than boys reported dental anxiety. The thesis shows that dental care providers need paying attention on providing a supportive dental care situation, in which the patients should not experience pain. One part may be adequate local anaesthesia during operative dentistry or similar dental treatments. Another part may be a good oral health to prevent negative experiences of dental care. There is a need for the understanding of psychological factors associated with dental care procedures.
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| 2. |
- Fägerstad, Anida, 1978-
(författare)
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No-shows in dental care : perspectives on adolescents' attendance pattern
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- All children and adolescents living in Sweden have free dental care with regular check-ups. Yet, missed and cancelled dental appointments are not unusual. The overall aim was to explore potential explanatory factors associated with non-regular dental care and to seek a deeper understanding of why some adolescents fail to attend their dental appointments.An integrative review (Paper I) identified and summarized different sets of environmental, individual and situational factors that could be associated with dental avoidance or non-attendance. Paper II found similar levels of dental fear between children and adolescents (8-19 yrs) with a Swedish or a non-Swedish background. The occurrence and patterns of missed dental appointments among 16–19-year-olds were investigated in Paper III, where we report that 13.1% of 23 522 booked dental appointments were missed in 2012. Boys had more missed appointments than girls, while no age differences were found. In a case-control design, adolescents with missed appointments more often had sociodemographic load, dental fear or dental behaviour management problems, poor oral health, emergency visits, tooth extractions, operative treatments, and over the past years, more missed and cancelled appointments. A history of missed and cancelled dental appointments predicted future missed and cancelled appointments. Twelve adolescent girls with missed appointments were interviewed in Paper IV and described several potential barriers or facilitators to accessing dental care. They highlighted that knowing what will happen during the dental visit was decisive to whether or not they would attend their appointments.In conclusion, factors specifically associated with dental avoidance still need to be investigated. Dental fear should still be seen as potential causal factor for dental avoidance. Missed and cancelled dental appointments should never be ignored since they could predict future missed and cancelled appointments. The results indicate that missed dental appointments among adolescents remain a challenge for Swedish dental care.
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