Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study.

The stress of dental treatment often elicits negative emotions in children, expressed as dental fear or anxiety. Highly anxious children obstruct treatment and avoid therapy, further amplifying oral health problems. The aim of this study was to examine the neuroendocrine and autonomic nervous system responses to dental treatment and their possible interactions and associations with psychometric indices of anxiety, caries, previous dental experience, anesthesia, age and gender in school children. Upon informed consent, saliva was obtained from 97 children (59% males, mean age ±  SD: 89.73 ± 15 months) in the Clinic of pediatric dentistry before treatment, immediately post-treatment and at the recall visit to determine cortisol and salivary alpha-amylase (sAA) levels. Dental and general anxiety was assessed through specific questionnaires completed by the children. Compared to pre-treatment, cortisol levels were increased following treatment, while sAA levels were higher at the recall. Pre- and post-treatment cortisol and sAA responses were positively correlated. Dental and general anxiety questionnaire scores were also significantly correlated with each other. The integrated autonomic and neuroendocrine responses prior to treatment were correlated with state anxiety and those following treatment with dental anxiety. However, univariable and multivariable linear regression analysis associated post-treatment cortisol, but not sAA, levels with dental anxiety. No associations of cortisol or sAA responses with caries, age, gender, previous dental experience or anesthesia were detected. These data provide some evidence that both sAA and cortisol levels are altered in children in anticipation or during dental treatment, but only cortisol levels are associated to dental anxiety.

An assessment of differences in pediatric dental services provided for a Medicaid population when compared to a federally subsidized (military) clinic

Reimbursement for dental services performed for children receiving Medicaid is reimbursed per service while dental treatment for military dependents provided at a military installation is neither directly reimbursable to those providing the care nor billed to those receiving the care. The purpose of this study was to compare pediatric dental services provided for a Medicaid population to a federally subsidized military facility to compare treatment choices and subsequent costs of care. It was hypothesized that differences in dental procedures for Medicaid and military dependent children would exist based upon treatment philosophy and payment method. A total of 240 records were reviewed for this study, consisting of 120 Medicaid patients at the University of Texas Health Science Center at San Antonio (UTHSCSA) and 120 military dependents at Wilford Hall Medical Center (WHMC), Lackland Air Force Base, San Antonio. Demographic data and treatment information were abstracted for children receiving dental treatment under general anesthesia between 2002 and 2006. Data was analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, and Fisher's exact test. The Medicaid recipients treated at UTHSCSA were younger than patients at WHMC (40.2 vs. 49.8 months, p<.001). The university also treated significantly more Hispanic children than WHMC (78.3% vs. 30.0%, p<.001). Children at UTHSCSA had a mean of 9.5 decayed teeth and were treated with 2.3 composite fillings, 0 amalgam fillings, 5.6 stainless steel crowns, 1.1 pulp therapies, 1.6 extractions, and 1.0 sealant. Children at WHMC had a mean of 8.7 decayed teeth and were treated with 1.4 composite fillings, 0.9 amalgam fillings, 5.6 stainless steel crowns, 1.7 pulp therapies, 0.9 extractions, and 2.1 sealants. The means of decayed teeth, total fillings, and stainless steel crowns were not statistically different. UTHSCSA provided more composite fillings (p<.001), fewer amalgam fillings (p<.001), fewer pulp therapies (p <.001), more extractions (p=.01), and fewer sealants (p<.001) when compared to WHMC. Age and gender did not effect decay rates, but those of Hispanic ethnicity did experience more decay than non-Hispanics (9.5 vs. 8.6, p=.02). Based upon Texas Medicaid reimbursement rates from 2006, the cost for dental treatment at both sites was approximately $650 per child. The results of this study do not support the hypothesis that Medicaid providers provide less conservative therapies, which would be more costly, care when compared to a military treatment center. ^

THE ALCOHOL TREATMENT PROFILE SYSTEM: ITS DEVELOPMENT AND AN EVALUATION OF ITS CAPABILITIES

The development of the Alcohol Treatment Profile System (ATPS) was described and an evaluation of its perceived value by various States was undertaken, The ATPS is a treatment needs assessment tool based on the unification of several large national epidemiologic and treatment data sets. It was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and responsibility for its creation was given to the NIAAA's Alcohol Epidemiologic Data System (AEDS). The ATPS merges county-level measures of alcohol problem prevalence (the specially constructed AEDS Alcohol Problem Indicators), indicating "need" for treatment, and treatment utilization measures (the National Drug and Alcohol Treatment Utilization Survey), indicating treatment "demand." The capabilities of the ATPS in the unique planning and policy-making settings of several States were evaluated.^

Estudio de distribución y frecuencia de caries en preescolares de alto riesgo social

Objetivos: El presente trabajo establece en el escenario local, un patrón de distribución y severidad de caries en una población de riesgo social de niños preescolares, datos necesarios para la programación de recursos en programas de salud bucal Método: estudio descriptivo, correlacional y transversal sobre muestra intencionada de 150 niños preescolares de 4 y 5 años de edad, de ambos sexos, con actividad de caries, pertenecientes a escuelas públicas, del ámbito urbano-marginal-Distrito Pedro Molina-Mendoza. Rep. Argentina, cuyos padres hubieron firmado el consentimiento informado. Se registraron las lesiones de caries según diente y sitio, y la severidad según ICDAS II (Pitts, 2004). Se establecieron distribución de frecuencias para las variables diente, sitio y categoría de ICDAS II. Para establecer asociaciones entre variables se aplicó prueba de chi cuadrado, con un nivel de significación de 0.05. Resultados: 1º y 2º molares temporarios son los más afectados, principalmente 75 y 85. El valor 6 de ICDAS II es el más frecuente, seguido por valores 3 y 5. El 84 presenta mayor frecuencia de valores grado 6. La superficie oclusal es la más afectada (42.6%). Existe asociación entre diente y categoría de ICDAS II y entre diente y sitio de la lesión para 55, 52, 51, 61, 62, 63 y 64, 84 y 75. Conclusiones: la distribución y severidad de caries en denticióntemporaria de los niños estudiados evidencia una alta frecuencia de lesiones de caries en molares, y una necesidad de tratamiento complejo involucrando para su resolución niveles de atención sanitaria II y III que deberá encontrar como contraparte un sistema sanitario preparado para su resolución.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

Situación periodontal de la población trabajadora en España: estudio epidemiológico

Las enfermedades periodontales son un problema de salud pública a nivel mundial. Recientemente, se ha comunicado que la periodontitis severa era la sexta condición más prevalente en el mundo, con una prevalencia global estandarizada del 11,2%. Otras revisiones a nivel mundial han concluido que las formas moderadas de periodontitis afectan a un porcentaje de adultos todavía mayor. Dado que las tendencias de estas enfermedades cambian con el tiempo, las encuestas epidemiológicas son necesarias para estudiar su prevalencia, severidad y extensión periódicamente, así como las posibles repercusiones que puedan tener sobre la salud sistémica. En Europa, se han llevado a cabo varios estudios epidemiológicos nacionales en países con diferentes condiciones socioeconómicas y organización de los servicios de atención dental. La mayoría de los estudios en Europa han utilizado el índice CPITN (Community Periodontal Index and Treatment Needs), modificado posteriormente a Community Periodontal Index [en español, Índice Periodontal Comunitario (IPC)], auspiciados por la Organización mundial de la Salud (OMS), con el fin de evaluar el estado periodontal de las poblaciones estudiadas. En España se han realizado estudios nacionales los años 2000, 2005 y 2010, utilizando la metodología previamente reseñada. Sin embargo, hasta la fecha no se han realizado encuestas dirigidas específicamente a la salud bucodental de la población ocupada...

Uptake of dental services

Previous research has indicated that the majority of the UK dentate population suffers from dental disease. This problem was examined in terms of the supply of, and demand for, dental treatment: how might the uptake of dental services be increased and dental health improved? The target population for the main survey was adolescents among whom demand for dental treatment has decreased. In 524 adolescents surveyed, fear of pain was the major deterrent to regular dental visits. The theoretical literature was explored for illuminating and practical approaches to the problem. The theory of reasoned action developed by Fishbein seemed the most promising. This theory was tested and validated on the adolescent sample identifying clear differences between regular and irregular dental attenders which could be usefully exploited by dental health education. A repertory grid analysis study further illuminated perceptions of dental treatment. A survey of a random sample of 716 dentists revealed that most dentists were in favour of delegating work to auxiliary help but few could do so. Auxiliary help would increase supply of services: data revealed an encouraging trend for younger dentists to be more in favour of delegation than older dentists. A survey was carried out of computer systems available for dentists suggesting that this might reduce the need for clerical assistance but would not ususally affect the supply of treatment. However in some dental practices computerisation might increase demand. For example a personalised reminder was developed and evaluated in a controlled study of 938 appointments demonstrating an uptake in dental services. Conclusions are that demand for treatment can be increased in various ways especially by teaching dentists' behavioural strategies to deal with fear and pain. Various recommendations on this are made. If demand were to outstrip supply increased delegation to auxiliary help could provide a viable way of increasing supply.

A joint approach to treating dental phobia:a re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on

Objective To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia.Aim To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia.Method Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years.Results Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period.Conclusion This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research. © 2011 Macmillan Publishers Limited. All rights reserved.

The atraumatic restorative treatment approach: an "atraumatic" alternative

INTRODUCTION Fear and anxiety are part of all human experiences and they may contribute directly to a patient's behavior. The Atraumatic Restorative Treatment (ART) is a technique that may be an alternative approach in treating special care patients or those who suffer fear or anxiety. OBJECTIVE the aim of this paper is to review the ART technique as an alternative to reduce pain and fear during dental treatment. MATERIAL AND METHODS A search for the term "atraumatic restorative treatment" was carried out in the MEDLINE search engine. References, from the last 10 years, containing at least one of the terms: "psychological aspects", "discomfort", "fear", "anxiety" or "pain", were selected. RESULTS A total of 120 references were found, from which only 17 fit the criteria. Discussion: All authors agreed that the ART promotes less discomfort for patients, contributing to a reduction of anxiety and fear during the dental treatment. Results also indicated that ART minimizes pain reported by patients. CONCLUSIONS The ART approach can be considered as having favorable characteristics for the patient, promoting an "atraumatic" treatment. This technique may be indicated for patients who suffer from fear or anxiety towards dental treatments and whose behavior may cause the treatment to become unfeasible or even impossible altogether.

Abordagem de pacientes autistas em Odontopediatria

O autismo é uma condição que faz parte de um grupo de perturbações do desenvolvimento global das funções cerebrais e que, por regra, é diagnosticada no início da infância. A dificuldade na linguagem e comunicação, o défice na interação social, as esteriotipias e os interesses específicos e comportamentos repetitivos caracterizam os indivíduos portadores desta patologia. A saúde oral das crianças autistas é geralmente precária e as necessidades de tratamento dentário elevadas. No entanto, os problemas comportamentais destes doentes fazem com que os pais não recorram às consultas de medicina dentária, outras vezes quando recorrem à consulta as dificuldades de colaboração impedem a prestação de cuidados de saúde oral adequados a estas crianças. Pretendeu-se assim, com este trabalho, realizar uma revisão sistemática de literatura científica, publicada nos últimos 15 anos, acerca dos problemas orais que atingem os pacientes autistas, e simultaneamente, compilar diretrizes de atuação clínica para orientar o médico dentista no atendimento destes doentes. Para isto, durante os meses de Outubro de 2014 a Outubro de 2015, procedeu-se a uma pesquisa bibliográfica nas bases de dados PubMed e B-on, sendo consultados também outros bancos de dados como LILACS – BIREME, SciELO, utilizando as seguintes palavras-chave: “autism”, “pediatric dentistry”, “Asperger Syndrome”, “Rett Syndrome”, “Childhood Disintegrative Disorder”, “prevalence”, “neurobiology”, “etiology”, “diagnosis”, “diagnostic criteria”, “comorbidity”, “oral health”, “dental caries”, “periodontal disease”, “oral habits”, “bruxism”, “self-injury”, “dental trauma”, “dental injury”, “malocclusion”, “behavior management techniques” separadas ou associadas pelo operador de pesquisa booleano AND. Na pesquisa foram empregues os seguintes limites: artigos publicados nos últimos 15 anos, abstract disponível, estudos em humanos e artigos e língua inglesa, francesa, portuguesa e espanhola. Desta pesquisa resultou um total de 150 artigos que foram selecionados primeiramente pelos títulos, seguidamente pela leitura dos abstracts e, finalmente, do artigo por inteiro, obtendo-se assim 95 artigos, para revisão. Foram ainda considerados artigos de referência publicados em anos anteriores, livros de texto médicos e publicações portuguesas com dados epidemiológicos sobre as Perturbações do Espetro do Autismo em Portugal. As doenças orais encontradas nas crianças autistas são semelhantes às das crianças sem qualquer perturbação mental, contudo a preferência por alimentos cariogénicos, a diminuição do fluxo salivar induzida pelos fármacos, associadas a uma pobre higiene oral, justificam uma maior prevalência de cárie. As doenças periodontais, também muito prevalentes neste grupo, desenvolvem-se em virtude da combinação da falta de hábitos de higiene oral, com os efeitos secundários de fármacos administrados a estes doentes, como os anticonvulsivantes. No seu atendimento na consulta dentária recorre-se às mesmas estratégias de orientação de comportamento aplicadas nas crianças saudáveis, para contornar os sentimentos de medo, ansiedade, desconfiança e a incapacidade de interação social, e assim evitar comportamentos de recusa durante a consulta dentária. É no entanto de salientar que os distúrbios comportamentais, o défice da comunicação e a falta de capacidades de interação social, caraterísticas do autismo impossibilitam a eficácia das técnicas de controlo do comportamento comunicativas, obrigando, muitas vezes, ao uso de técnicas de controlo de comportamento avançadas para prestação de cuidados de saúde oral com eficácia e em segurança. É importante uma grande motivação de pais/responsáveis para a saúde e higiene oral das crianças com Perturbações do Espetro do Autismo, e que todos os profissionais de saúde envolvidos no cuidado destes doentes contribuam para a aprendizagem de comportamentos que promovam a saúde oral destes doentes.

Salivary cortisol level and uncooperative behavior in pediatric dental practice

Aim: To investigate the relation between uncooperative behavior and salivary cortisol level in children who underwent preventive dental care. Methods: The sample was composed by 10 children of both sexes aged 40 to 52 months, presenting uncooperative behavior during dental preventive treatments. The saliva collection was performed using a cotton wheel and an Eppendorf tube (Sarstedt Salivete®) in 3 different moments: a) at home, on a day without dental treatment and at the same time on the day of the sessions treatment; b) 30 min after the end of the session, when there was manifestation of uncooperative behavior; c) 30 min after the end of the session, when there was a cooperative behavior of the child. A sample of saliva was centrifuged for 5 minutes at 2400 rpm, 1 of mL of saliva was pipetted in an Eppendorf tube and stored in a freezer at -20 ° C. For the determination of the levels of salivary cortisol was used an Active® kit for cortisol enzyme immunoassay (EIA) DSL-10-67100, composed of specific rabbit antibody anti-cortisol. Data were analyzed statistically for the uncooperative behavior issued in the beginning and at the end of sessions, using the paired t test (p<0.05) and for cortisol levels in saliva samples at home, after the beginning and at the end of sessions, using repeated-measures ANOVA and Tukey’s test (p<0.05). Results: During expression of uncooperative behavior in preventive dental care sessions the salivary cortisol level was significantly higher (0.65 ± 0.25 μg/dL) compared with expression of collaborative behavior (0.24 ± 0.10 μg/dL). Conclusions: It is possible to conclude that, even under preventive intervention, the stress must be controlled in order to reduce dental anxiety and fear.

Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

Context:Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition: A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results: Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions: Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

[do Elderly Individuals With A Cognitive Handicap Have Worse Oral Health?].

A comparison of the oral health of elderly people with and without a cognitive handicap was assessed. The cognitive condition, the indices of decayed, missing, filled teeth (DMFT), decayed, filled roots (DFR), the need for dental treatment, the presence of plaque (P), calculus (C), the community periodontal index (CPI), the rate of periodontal attachment loss (PAL), edentulism, prosthetic use and the need for prosthetics were evaluated in a complex probabilistic sample by conglomerates of the elderly (65-74 years). PASW(r) 17.0 was used for the statistical analyses with correction for the design effect, applying the Mann Whitney and chi-square test with 95% reliability. A total of 736 elderly individuals were interviewed and examined. Those with cognitive impairment had higher average DMFT, DFR and lower average healthy sextant CPI, a lower prevalence of sextants without plaque/calculus, use of prosthetics and higher prevalence of edentulism and need for prosthetics. Elderly individuals with a cognitive handicap had poorer oral health.

O comportamento de crianças durante atendimento odontológico

This research intended to investigate the use of diazepam in conjunction with behavioral strategies to manage uncooperative behavior of child dental patients. The 6 participants received dental treatment during 9 sessions. Using a double-blind design, children received placebo or diazepam and at the same time were submitted to behavior management produces (distraction, explanation, reinforcement and set rule and limits). All sessions were recorded in video-tapes biped in 15 seconds intervals, in which observers recorded child's (crying, body and/or head movements, escape and avoidance) and dentist's behavior. The results indicated that diazepam, considering the used dose, was only effective with one subject. The other participants didn't permit the treatment and showed an increase in their resistance. The behavioral preparation strategies for dental treatment should have been more precisely planned in order to help the child to face the real dental treatment conditions mainly in the first sessions avoiding to reinforce inappropriate behaviors.

Prolongamento da amamentação após o primeiro ano de vida: argumentos das mães

This paper aims to identify and analyze the reasons pointed by mothers to prolong breastfeeding beyond the first year of the child s life. The study involved 40 mothers whose children were treated in the Preventive Program of Research and Dental Treatment Center for Special Patients - Dental School of Piracicaba - UNICAMP. The group consisted of mothers who prolonged the breastfeeding beyond the baby s first year of life. All mothers were surveyed by a researcher using a specific questionnaire. In order to avoid information loss, the interviews were taped, then transcripted. Results showed that the main cause of the extended breastfeeding was maternal pleasure. It was also observed that the mother and infant attachment favors prolonged breastfeeding occurrence. Further studies should be carried out for more accurate functional analyses of variable that lead to extend breastfeeding or to wean.