Managing Fear and Anxiety in Patients Undergoing Dental Hygiene Visits with Guided Biofilm Therapy: A Conceptual Model
<p>Hygiene in the GBT protocol and the AirFlow Prophylaxis Master device.</p> "> Figure 2
<p>The 8 steps of GBT (source: <a href="https://www.ems-dental.com/en" target="_blank">https://www.ems-dental.com/en</a> (accessed on 15 August 2024)).</p> "> Figure 3
<p>Bacterial biofilm disclosed in the Guided Biofilm Therapy protocol.</p> "> Figure 4
<p>Flowchart depicting the number of patients qualified for the study.</p> "> Figure 5
<p>The Diagnocat program.</p> "> Figure 6
<p>(<b>A</b>) The AirFlow nozzle of the AirFlow Prophylaxis Master device. (<b>B</b>) The Piezon handpiece of the AirFlow Prophylaxis Master.</p> "> Figure 7
<p>Author-developed question about the experience of fear before the hygiene visit.</p> "> Figure 8
<p>Characteristics of the study sample.</p> "> Figure 9
<p>Level of dental anxiety in men and women (red line—trend line).</p> "> Figure 10
<p>Factors influencing dental anxiety (MDAS) and strategies for its reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 11
<p>Change in state anxiety levels (STAI X1) before and after the hygiene procedure (red line—trend line).</p> "> Figure 12
<p>Factors influencing state anxiety and trait anxiety (black and green arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 13
<p>Change in the level of dental fear (Gatchel’s scale) before and after the hygiene procedure (red line—trend line).</p> "> Figure 14
<p>Factors influencing dental fear (Gatchel’s scale) before the hygiene procedure and strategies for its reduction (black arrows: positive correlation).</p> "> Figure 15
<p>Factors influencing dental fear (Gatchel’s scale) after the hygiene procedure and strategies for its reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 16
<p>Change in the level of fear related to hygiene before and after the procedure (red line—trend line).</p> "> Figure 17
<p>Factors influencing fear related to hygiene assessed before the procedure and strategies for its reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 18
<p>Factors influencing fear related to hygiene assessed after the procedure and strategies for its reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 19
<p>Change in heart rate before, during, and after the hygiene procedure (red line—trend line).</p> "> Figure 20
<p>Factors influencing heart rate before, during, and after hygiene procedures and strategies for its reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 21
<p>Change in dental fear levels (Gatchel’s scale) before and after the procedure depending on the first-time hygiene visit (red line—trend line for first-time hygiene visits; blue line—trend line for subsequent hygiene visits).</p> "> Figure 22
<p>Change in the level of fear related to hygiene procedures before and after the treatment depending on the first-time hygiene visit (red line—trend line for first-time hygiene visits; blue line—trend line for subsequent hygiene visits).</p> "> Figure 23
<p>A conceptual model of the impact of sociodemographic factors, clinical factors, and patient experiences on the levels of fear and anxiety during a hygiene visit, along with strategies for their reduction (black arrows: positive correlation; red arrows: negative correlation).</p> "> Figure 24
<p>Factors influencing dental anxiety.</p> ">
Abstract
:Featured Application
Abstract
1. Introduction
1.1. Background and Significance of the Problem
1.2. The Objectives of the Study Were
- To analyze the levels of fear and anxiety among patients attending dental hygiene visits,
- To analyze the relationships between anxiety and the factors studied,
- To attempt to identify key prognostic factors and develop a conceptual model.
2. Materials and Methods
2.1. Inclusion Criteria
- Aged 18 years and above,
- Ability to respond,
- Consent to participate in the study,
- Scheduled for an oral hygiene visit (hygiene treatment),
- Recent radiographs are available (as shown in Figure 4).
2.2. Exclusion Criteria
- Under 18 years of age,
- Inability to respond,
- Legally incapacitated individuals,
- Lack of consent to participate in the study.
- The study also considered differences between returning and new patients, as the literature suggests that returning patients may experience greater levels of anxiety. Although the study was cross-sectional and prospective in nature, a quasi-randomization process was implemented to minimize bias in patient selection. Patients were invited to participate in the study based on the order in which they scheduled their oral hygiene procedures, in accordance with the Guided Biofilm Therapy protocol. This order was determined based on the registration list, which prevented any preferential selection of patients by the clinic staff.
- In the study, steps were taken to minimize bias, including the standardization of procedures to ensure consistent treatment of patients and the analysis of results by independent researchers without access to personal data. Additionally, statistical analysis included adjustments for potential confounding factors, such as age, gender, and oral health status.
2.3. Sample Characteristics
2.4. Methods
2.4.1. Measures of Fear and Anxiety
Dental Anxiety
- 5 points: no anxiety,
- 6–10 points: low level of anxiety,
- 11–18 points: high level of anxiety,
- Above 19 points: very high level of anxiety, indicating that the patient may suffer from dentophobia.
Trait and State Anxiety
- 20–30 points: no anxiety
- 31–42 points: mild anxiety
- 43–53 points: moderate level of anxiety
- 54–80 points: high level of anxiety [24].
Dental Fear
Fear Related to Hygiene Procedure
Heart Rate
2.4.2. Clinical Factors
- 0: no pain,
- 1 to 25: mild pain,
- 26 to 50: moderate pain,
- 51 to 75: severe pain,
- 76 to 100: maximum pain.
- Positive recommendations/information from others,
- Belief in the professional care of the dental team,
- Positive and empathetic attitude of the staff,
- Calm atmosphere in the waiting room,
- Punctual admission to the treatment room.
- Detailed information about what will be performed,
- Lack of detailed information about what will be performed,
- Pain-free procedures,
- No use of needles,
- Absence of tools in the field of view,
- Absence of sounds from working tools (e.g., wearing headphones during the procedure),
- Lack of characteristic dental office smells,
- Feeling of comfort in the dental chair,
- Possibility of using sedatives and painkillers.
- Possibility of contacting the clinic/dentist/hygienist,
- Ability to schedule a follow-up visit.
2.4.3. Data Analysis
3. Results
3.1. Sociodemographic and Clinical Characteristics of the Study Population
3.2. Dental Anxiety
3.3. Trait Anxiety and State Anxiety
3.4. Dental Fear
3.4.1. Key Factors Influencing the Level of Dental Fear (Gatchel’s Scale)
3.4.2. Change in Dental Fear over Time
3.5. Fear Related to the Hygiene Procedure
3.5.1. Key Factors Influencing the Level of Fear Related to the Hygiene Procedure
3.5.2. Change in Fear Related to the Hygiene Procedure over Time
3.6. Heart Rate
3.6.1. Key Factors Influencing Heart Rate before, during, and after the Hygiene Procedure
3.6.2. Heart Rate Changes over Time
3.7. Inter-Relations of Parameters Measuring Fear and Anxiety
3.8. First-Time Dental Hygiene Visit
3.8.1. First-Time Dental Hygiene Visit and Changes in the Level of Dental Fear
3.8.2. First-Time Hygiene Visit and Changes in Fear Related to Hygiene Procedures
4. Discussion
4.1. Correlations between Fear and Anxiety Measures
4.2. The Impact of Fear and Anxiety on Pain Perception
4.3. Factors Influencing Fear and Anxiety
4.3.1. Sociodemographic Factors
4.3.2. Clinical Factors
4.3.3. History of Dental Visits
4.3.4. Oral Hygiene
4.3.5. Personality
4.3.6. Patient Preferences for Reducing Negative Emotions (Fear and Anxiety)
4.4. Conceptual Model
4.5. Clinical Implications and Future Research Directions
- Personalization of dental care: Developing patient anxiety and fear management strategies based on their previous experiences and individual responses.
- Optimization of clinical processes: Implementing effective technologies that simultaneously minimize patient discomfort.
- Reduction in sensory stimuli during dental visits.
- Increasing trust in dentists and dental hygienists: By better managing patient emotions.
- Enhancing the quality of dental services: Positive patient experiences and improved overall oral health.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Measure | Variable | Before Hygiene Procedure | After Hygiene Procedure |
---|---|---|---|
State-Trait Anxiety Inventory by S. Spielberger part X1 | State anxiety | ✔ | ✔ |
State-Trait Anxiety Inventory by S. Spielberger part X2 | Trait anxiety | ✔ | |
MDAS—Modified Dental Anxiety Scale | Dental anxiety | ✔ | |
Gatchels’s 10-Point Dental Fear Scale | Dental fear | ✔ | ✔ |
Author-developed question about the experience of fear before the hygiene visit | Fear related to the hygiene procedure | ✔ | ✔ |
Medical documentation | Clinical factors | ✔ | |
Heart rate | ✔ | ✔ | |
Sociodemographic factors | ✔ | ||
Factors that may reduce the experience of anxiety in the patient’s assessment | ✔ | ||
Author-developed questionnaire | Attitude of the dental hygienist | ✔ | |
VAS (Visual Analogue Scale)—scale for pain | Clinical factors—pain during the hygiene procedure | ✔ |
Characteristic | Value |
---|---|
Mean ± SD | |
Age [years] | 43.52 ± 12.95 |
n (%) | |
Gender | |
male | 100 (59.5) |
female | 147 (40.5) |
Education | |
primary/middle school | 2 (0.8) |
secondary | 68 (27.5) |
higher | 177 (71.7) |
First-time hygiene visit | |
yes | 26 (10.5) |
no | 221 (89.5) |
Orthodontic treatment in the past | |
yes | 95 (38.5) |
no | 152 (51.5) |
Dental visits in childhood | |
yes | 223 (90.3) |
no | 24 (9.7) |
Physical health problems | |
yes | 68 (27.5) |
no | 179 (72.5) |
Mental health problems | |
yes | 18 (7.3) |
no | 229 (92.7) |
Diagnosis of dentophobia | |
yes | 0 (0%) |
no | 247 (100%) |
Variable | Before Procedure (Mean ± SD) | During Procedure (Mean ± SD) | After Procedure (Mean ± SD) | Test Result | p-Value |
---|---|---|---|---|---|
Dental anxiety (MDAS) | 8.5 ± 3.5 | - | - | - | - |
Trait anxiety (STAI X2) | 45 ± 4.1 | - | - | - | - |
State anxiety (STAI X1) | 45.8 ± 4.2 | - | 43.7 ± 4.1 | t = 4.31 | <0.001 |
Dental fear (Gatchel’s scale) | 3.7 ± 2.4 | - | 3.0 ± 2.2 | Z = 6.84 | <0.001 |
Fear related to the hygiene procedure (author-developed question) | 2.51 ± 2.0 | - | 2.04 ± 1.5 | Z = 5.65 | <0.001 |
Heart rate [bpm] | 75.6 ± 8.6 | 74.0 ± 8.8 | 7.37 ± 7.9 | ANOVA = 17.28 | <0.001 |
Variable | Test Result | p Value | |
---|---|---|---|
Gender—male | U = −2.43 | 0.0152 | |
Frequency of dental visits | rs = −0.13 | 0.0431 | |
Good oral hygiene self-assessment | rs = −0.21 | 0.0008 | |
Absence of mental health issues | rs = −0.15 | 0.0171 | |
Not taking medication | rs = −0.15 | 0.0179 | |
Absence of traumatic dental experiences in the past | rs = −0.32 | <0.0001 | |
Number of carious lesions | H = 8.88 | 0.031 | |
Factors that, in the patient’s opinion, could reduce negative emotions | Not using needles | H = 8.40 | 0.0384 |
Absence of tools in the field of view | H = 21.92 | 0.0001 | |
Absence of sounds from working tools | H = 13.08 | 0.0045 | |
Absence of characteristic dental office smells | H = 14.49 | 0.0023 | |
Possibility of using sedatives and painkillers | rs = 0.17 | <0.0001 | |
Pain experienced during hygiene procedures | H = 26.40 | <0.0001 |
Variable | State Anxiety (STAI X1) | |||
---|---|---|---|---|
Test Result before the Procedure | p-Value before the Procedure | Test Result after the Procedure | p-Value after the Procedure | |
Trait anxiety (STAI X2) | rs = 0.14 | 0.0236 | rs = 0.12 | 0.03 |
Education | Chi2 = 125.56 | <0.001 | Chi2 = 120.50 | <0.001 |
Variable | Trait Anxiety (STAI X2) | ||
---|---|---|---|
Test Result | p-Value | ||
State anxiety (STAI X1) | rs= 0.14 | 0.0236 | |
Gender—male | Chi2 = 8.41 | 0.0149 | |
Factors that, in the patient’s opinion, could reduce negative emotions | Not taking medication | Chi2 = 11.77 | 0.0028 |
rs = −0.19 | 0.0028 | ||
Absence of tools in the patient’s field of view | rs = 0.17 | <0.0500 | |
Feeling of comfort in the dental chair | rs = 0.13 | <0.0500 |
Variable | Dental Fear (Gatchel’s Scale) | ||||
---|---|---|---|---|---|
Before the Procedure | After the Procedure | ||||
Test Result | p-Value | Test Result | p-Value | ||
Pain during the hygiene procedure | rs = 0.41 | <0.0500 | rs = 0.42 | <0.0500 | |
Factors that, in the patient’s opinion, could reduce negative emotions | Positive recommendations/information from others | rs = −0.07 | NS | rs = −0.16 | <0.0500 |
Absence of tools in the field of view | rs = 0.22 | <0.0500 | rs = 0.13 | <0.0500 | |
Absence of sounds from working tools | rs = 0.16 | <0.0500 | rs = 0.13 | <0.0500 | |
Absence of characteristic dental office smells | rs = 0.19 | <0.0500 | rs = 0.16 | <0.0500 | |
Possibility of using sedatives and painkillers | rs = 0.26 | <0.0500 | rs = 0.16 | <0.0500 | |
Possibility of taking breaks according to the patient’s needs | rs = 0.15 | <0.0500 | rs = 0.05 | NS | |
Possibility of contacting the clinic/dentist/hygienist | rs = 0.14 | <0.0500 | rs = 0.08 | NS |
Variable | Test Result | p-Value |
---|---|---|
Dental Fear (Gatchel’s scale) before the procedure | Z = 6.84 | p < 0.0001 |
Dental Fear (Gatchel’s scale) after the procedure |
Variable | Fear Related to Hygiene | ||||
---|---|---|---|---|---|
Before the Procedure | After the Procedure | ||||
Test Result | p-Value | Test Result | p-Value | ||
Pain during the hygiene procedure | rs = 0.48 | <0.0500 | rs = 0.56 | <0.0500 | |
Number of missing teeth replaced with implants | rs = −0.14 | <0.0500 | rs = −0.16 | <0.0500 | |
Factors that, in the patient’s opinion, could reduce negative emotions | Positive recommendations/information from others | rs = −0.23 | <0.0500 | rs = −0.26 | <0.0500 |
Belief in professional care | rs = −0.15 | <0.0500 | rs = −0.17 | <0.0500 | |
Positive and empathetic attitude of the staff | rs = −0.08 | NS | rs = −0.16 | <0.0500 | |
Calm atmosphere in the waiting room | rs = −0.11 | NS | rs = −0.15 | <0.0500 | |
Punctual admission to the treatment room | rs = −0.06 | NS | rs = −0.13 | <0.0500 | |
Absence of in the patient’s field of view | rs = 0.24 | <0.0500 | rs = 0.18 | <0.0500 | |
Feeling of comfort in the dental chair | rs = −0.13 | <0.0500 | rs = −0.18 | <0.0500 | |
Possibility of using sedatives and painkillers | rs = 0.19 | <0.0500 | rs = 0.12 | NS |
Variable | Test Result | p-Value |
---|---|---|
Fear related to hygiene before the procedure | Z = 5.65 | p < 0.0001 |
Fear related to hygiene before the procedure |
Variable | Test Result: rs—Spearman’s Rank Correlation (p < 0.0500) | ||
---|---|---|---|
Heart Rate before the Procedure | Heart Rate during the Procedure | Heart Rate after the Procedure | |
Heart rate before the procedure | 1.00 | 0.54 | 0.46 |
Heart rate during the procedure | 0.54 | 1.00 | 0.61 |
Heart rate after the procedure | 0.46 | 0.61 | 1.00 |
Variable | Heart Rate | ||||||
---|---|---|---|---|---|---|---|
Before the Procedure | During the Procedure | After the Procedure | |||||
Test Result | p-Value | Test Result | p-Value | Test Result | p-Value | ||
Age [years] | rs = −0.11 | NS | rs = −0.14 | <0.0500 | rs = −0.25 | <0.0500 | |
Number of missing teeth (not replaced) | rs = −0.08 | NS | rs = −0.10 | NS | rs = −0.19 | <0.0500 | |
Total number of missing teeth (including those replaced with implants) | rs = −0.10 | NS | rs = −0.10 | NS | rs = −0.18 | <0.0500 | |
Factors that, in the patient’s opinion, could reduce negative emotions | Positive recommendations/information from others | rs = 0.13 | <0.0500 | rs = 0.08 | NS | rs = 0.11 | NS |
Calm atmosphere in the waiting room | rs = 0.08 | NS | rs = 0.08 | NS | rs = 0.21 | <0.0500 | |
Not using needles | rs = 0.06 | NS | rs = 0.05 | NS | rs = 0.13 | <0.0500 | |
Absence of characteristic smells of the dental office | rs = 0.07 | NS | rs = 0.05 | NS | rs = 0.14 | <0.0500 | |
Possibility of contacting the clinic/dentist/hygienist | rs = 0.15 | <0.0500 | rs = 0.01 | NS | rs = 0.17 | <0.0500 |
Variable | Test Result | p Value | Degrees of Freedom |
---|---|---|---|
Heart rate before the hygiene procedure [bpm] | ANOVA = 17.28 | <0.001 | df = 2 |
Heart rate during the hygiene procedure [bpm] | |||
Heart rate after the hygiene procedure [bpm] |
Pairwise Comparison | Mean Rank Difference | p-Value |
---|---|---|
Heart rate before the hygiene procedure [bpm] vs. during the hygiene procedure [bpm] | 0.2 | NS |
Heart rate before the hygiene procedure [bpm] vs. after the hygiene procedure [bpm] | 0.4 | <0.0500 |
Heart rate during the hygiene procedure [bpm] vs. after the hygiene procedure [bpm] | 0.1 | NS |
Variable | Test Result: rs—Spearman’s Rank Correlation (p < 0.0500) | ||||
---|---|---|---|---|---|
Dental Anxiety (MDAS) | Dental Fear (Gatchel’s Scale) before Hygiene Procedure | Dental Fear (Gatchel’s Scale) after Hygiene Procedure | Fear Related to Hygiene before Procedure | Fear Related to Hygiene after Procedure | |
Dental anxiety (MDAS) | 1.00 | 0.79 | 0.67 | 0.65 | 0.59 |
Trait anxiety (STAI X2) | NS | NS | NS | 0.13 | NS |
Dental fear (Gatchel’s scale) before hygiene procedure | 0.79 | 1.00 | 0.79 | 0.72 | 0.66 |
Dental fear (Gatchel’s scale) after hygiene procedure | 0.67 | 0.79 | 1.00 | 0.57 | 0.73 |
Fear related to hygiene before procedure | 0.65 | 0.72 | 0.57 | 1.00 | 0.79 |
Fear related to hygiene after procedure | 0.59 | 0.66 | 0.73 | 0.79 | 1.00 |
Dental Fear (Gatchel’s Scale) | Mean | |
---|---|---|
First-Time Hygiene Visit | Subsequent Hygiene Visit | |
Before hygiene procedure | 4.58 | 3.54 |
After hygiene procedure | 3.19 | 3.01 |
Parameters | Test Result | p Value | Partial Eta-Squared | Observed Power (Alpha = 0.05) |
---|---|---|---|---|
First-time dental hygiene visit | F = 1.81 | 0.1802 | 0.007 | 0.268 |
Change in the level of dental fear (R1) | F = 48.88 | <0.0001 | 0.166 | 1.000 |
Interaction: First-time dental hygiene visit × Change in the level of dental fear (R1) | F = 9.76 | 0.0020 | 0.038 | 0.875 |
Fear Related to Hygiene | Mean | |
---|---|---|
First-Time Hygiene Visit | Subsequent Hygiene Visit | |
Before procedure | 3.77 | 2.36 |
After procedure | 2.12 | 2.03 |
Parameters | Test Result | p Value | Partial Eta-Squared | Observed Power (Alpha = 0.05) |
---|---|---|---|---|
First-time dental hygiene visit | F = 4.84 | 0.0288 | 0.019 | 0.591 |
Change in the level of fear related to hygiene procedure (R1) | F = 60.19 | <0.0001 | 0.197 | 1.000 |
Interaction: First-time dental hygiene visit × Change in the level of fear related to hygiene procedure (R1) | F = 26.78 | <0.0001 | 0.098 | 0.999 |
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Share and Cite
Leśna, M.; Górna, K.; Kwiatek, J. Managing Fear and Anxiety in Patients Undergoing Dental Hygiene Visits with Guided Biofilm Therapy: A Conceptual Model. Appl. Sci. 2024, 14, 8159. https://doi.org/10.3390/app14188159
Leśna M, Górna K, Kwiatek J. Managing Fear and Anxiety in Patients Undergoing Dental Hygiene Visits with Guided Biofilm Therapy: A Conceptual Model. Applied Sciences. 2024; 14(18):8159. https://doi.org/10.3390/app14188159
Chicago/Turabian StyleLeśna, Marta, Krystyna Górna, and Jakub Kwiatek. 2024. "Managing Fear and Anxiety in Patients Undergoing Dental Hygiene Visits with Guided Biofilm Therapy: A Conceptual Model" Applied Sciences 14, no. 18: 8159. https://doi.org/10.3390/app14188159