Dentist Empathic Accuracy Is Associated With Patient-Reported Reassurance.

OBJECTIVES: The aim of this work was to determine dentists' ability to accurately estimate patients' anxiety level during dental treatment (ie, "empathic accuracy") and to determine the strength of the association between empathic accuracy and patient-reported reassurance. METHODS: A cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients' anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS). RESULTS: Agreement between dentists' assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177) = 0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177) = 0.15; 95% CI, 0.00-0.29, was found between dentists' empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients' anxiety scores, r (177) = -0.23; 95% CI, -0.38 to -0.09. CONCLUSIONS: Given that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in anoptimal manner.

Tooth Agenesis Patterns in Orofacial Clefting Using Tooth Agenesis Code: A Meta-Analysis.

Individuals with orofacial clefting (OFC) have a higher prevalence of tooth agenesis (TA) overall. Neither the precise etiology of TA, nor whether TA occurs in patterns that differ by gender or cleft type is yet known. This meta-analysis aims to identify the spectrum of tooth agenesis patterns in subjects with non-syndromic OFC and controls using the Tooth Agenesis Code (TAC) program. An indexed search of databases (PubMed, EMBASE, and CINAHL) along with cross-referencing and hand searches were completed from May to June 2019 and re-run in February 2022. Additionally, unpublished TAC data from 914 individuals with OFC and 932 controls were included. TAC pattern frequencies per study were analyzed using a random effects meta-analysis model. A thorough review of 45 records retrieved resulted in 4 articles meeting eligibility criteria, comprising 2182 subjects with OFC and 3171 controls. No TA (0.0.0.0) was seen in 51% of OFC cases and 97% of controls. TAC patterns 0.2.0.0, 2.0.0.0, and 2.2.0.0 indicating uni- or bi-lateral missing upper laterals, and 16.0.0.0 indicating missing upper right second premolar, were more common in subjects with OFC. Subjects with OFC have unique TA patterns and defining these patterns will help increase our understanding of the complex etiology underlying TA.

Perioperative Propranolol Against Dental Anxiety: A Randomized Controlled Trial.

Background: Promising results from a trauma reactivation study on post-traumatic stress disorder suggest that propranolol is capable of attenuating symptoms of traumatically induced mental disorders by blocking memory reconsolidation. Methods: A randomized, parallel, placebo-controlled, quadruple-blind trial was designed to determine the effectiveness of perioperative propranolol during exposure to dental extractions in reducing dental anxiety in patients with dental anxiety or dental phobia. Between November 2014 and December 2018, 52 patients with high levels of fear in anticipation of dental extractions who were referred to a department of oral and maxillofacial surgery for at least two tooth and/or molar removals with 1 month in between were included. On the first visit participants received either 120 mg of perioperative oral propranolol (n = 19) or placebo (n = 17), and a core fear memory was reactivated 1 h preoperatively. The primary outcome was change in severity of dental anxiety from baseline to 1-month follow-up, as indexed by the short version of the dental anxiety inventory (S-DAI). Secondary outcome measures were change in intra-operative state anxiety and specific phobia diagnoses. Results: Linear mixed model (LMM) yielded no statistically significant difference in change of dental trait anxiety from baseline to 1-month follow-up between propranolol and placebo groups (Cohen's d = 0.23). S-DAI scores decreased in both study arms from baseline to follow-up (propranolol arm: from 32.1 [SD = 7.3] to 29.1 [SD = 8.8]; placebo arm: from 31.6 [SD = 7.5] to 27.1 [SD = 6.5]). Also, administering propranolol was not associated with a significant difference in change of intra-operative state anxiety or phobia diagnoses between groups over time. Conclusions: The results do not concur with earlier findings regarding post-traumatic stress disorder, and suggest that individuals with traumatically induced fears or phobias do not benefit from the application of perioperative propranolol.

Translation and Validation of the Short Form of the Fear of Dental Pain Questionnaire in China.

The short form of the Fear of Dental Pain Questionnaire (s-FDPQ) is a validated measure developed to screen patients for their fear of pain associated with dental procedures. As there is a high prevalence of dental fear/anxiety in Chinese adults, the primary aim of our study was to translate the s-FDPQ into standard Mandarin and explore its reliability and validity with Chinese adults. The second aim of our study was to explore fear of dental pain (FDP) scores in relation to dental attendance, anxiety and gender. We translated the s-FDPQ using the forward-backward method. It was completed by 480 Chinese adults alongside the Modified Dental Anxiety Scale (MDAS; Chinese version) to test convergent validity. 109 participants completed the s-FDPQ again 14 days later to evaluate test-retest reliability. The Chinese s-FDPQ (s-CFDPQ) was internally consistent (alpha = 0.87) and demonstrated convergent validity (r = 0.73 when correlated with the MDAS). Test-retest reliability was good (ICC = 0.86). Individuals who had never attended the dentist (22%) had higher FDP scores than those that had, even if they were not dentally anxious. Also, females reported higher FDP scores (p < 0.001). These findings suggest that the s-CFDPQ is a reliable and valid measure for assessing fear of dental pain in Chinese adults. The s-CFDPQ could allow quick identification of individuals who are fearful of dental pain who may require specialist attention.

Effect of periapical surgery on oral health-related quality of life in the first postoperative week using the Dutch version of Oral Health Impact Profile-14.

OBJECTIVE: To evaluate whether periapical surgery affects oral health-related quality of life (OHRQoL) within the first postoperative week. STUDY DESIGN: The primary outcomes in 133 patients (54 men, 79 women; mean age 50.8 years) undergoing periapical surgery were the Oral Health Impact Profile-14 (OHIP-14) score and postoperative sequelae, including pain, analgesic intake, swelling, limited mouth opening, chewing difficulties, and postoperative infection. RESULTS: We found a significant effect on OHIP-14, pain, and analgesics, which decreased throughout the week. We found no significant differences in mean OHIP-14, pain scores, or analgesic use for gender, medical history, surgical flaps, operation time, or location of the operated teeth. Younger patients had a higher OHIP-14 score in the first 2 days after surgery and more pain on the first postoperative day. Women experienced more pain during the first 3 days. Smokers had a higher OHIP-14 score on the first postoperative day and greater pain during the first 3 days compared to non-smokers. CONCLUSION: We identified a low incidence of pain and reduced OHRQoL following periapical surgery. The postoperative reduction in OHRQoL and pain were of short duration, with maximum intensity in the early postoperative period and rapidly decreasing with time.

Alveolar iodine tampon packing after impacted third molar surgery improves oral health-related quality of life and postoperative sequela: a randomized study.

OBJECTIVE: The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar. MATERIAL AND METHODS: Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort. RESULTS: This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort. CONCLUSIONS: Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.

Psychosocial oral health-related quality of life impact: A systematic review.

BACKGROUND: Psychosocial wellbeing is an important determinant for patients' oral health-related quality of life (OHRQoL). Psychosocial impact (PI), together with the dimensions Oral Function, Orofacial Pain and Orofacial Appearance, has been proposed to cover the different areas of OHRQoL. OBJECTIVE: The objective of the study was to collect further scientific support for the new four-dimensional structure of OHRQoL. This study is one out of a series of four and focuses on the PI in patients with dental anxiety, oral cancer and periodontitis (PROSPERO registration number: CRD42017064033). METHODS: Five databases (Pubmed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO) were electronically searched on 8 June 2017 and updated on 14 January 2019, to identify the studies that measure OHRQoL using the Oral Health Impact Profile (OHIP) for oral health conditions. In this review, studies were included if the mean/median domain scores from OHIP-14 or OHIP-49 were available for patients with dental anxiety, oral cancer or periodontitis. The score of the handicap domain from the OHIP was used to assess patients` PI. The handicap domain includes 6 items for OHIP-49 with a domain score ranging from 0 to 24 and 2 items for OHIP-14 with a domain score ranging from 0 to 8. For comparison between the 2 versions of the OHIP, the domain score of OHIP-49 was conversed into a 0 to 8 metric. The domain scores of the included studies were then pooled, separately for each of the included dental disorders. RESULTS: A total of 2104 records were identified based on the search strategy. After screening of titles and abstracts, 1607 articles were reviewed in full text. Twenty-three articles met the inclusion criteria for this review and were included in the study. The 23 articles contained 3884 patients, grouped in 30 patient populations and 42 patient samples. The pooled mean scores of PI for dental anxiety, oral cancer and periodontitis were 3.2, 1.9 and 0.8, respectively, on the 0 to 8 metric. CONCLUSION: This review provides standardised information about the OHRQoL impact for three dental disorders as a model for the PI dimension. Dental anxiety tends to show the strongest effect on the PI dimension, while periodontitis tends to show the weakest effect on the PI dimension. Future studies need to confirm whether the reported differences in PI scores between the three dental disorders are statistically significant.

Mapping Oral Disease Impact with a Common Metric (MOM)-Project summary and recommendations.

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-the dimensions of oral health-related quality of life-capture dental patients' oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM's findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM's systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.

Changes in Adolescents' Oral Health Status: Responsiveness of the Child Perception Questionnaire11-14.

Changes in oral health status following treatment should be assessed clinically as well as by patients' reported outcomes. This study investigated changes on oral-health-related quality of life (OHRQoL) of adolescents enrolled in a comprehensive oral health care program for caries and gingival conditions. The sensitivity of the Child Perception Questionnaire11-14 (CPQ11-14) to detect clinical changes, that is, its responsiveness, was assessed. A total of 618 10-15-year adolescents answered the questionnaire before treatment and 560 at follow-up after 1 year. In the follow-up, 2 additional global transition judgment questions were asked. The adolescents were clinically and radiographically examined. At the baseline, 374 adolescents needed only nonoperative treatment, whereas 274 needed non- and operative treatments. After 1 year, the adolescents were regrouped according to the fulfillment of their treatment needs in Group 1 (n = 363) needing/receiving nonoperative treatment only; Group 2 (n = 98) needing/receiving both non- and operative treatments; Group 3 (n = 99) receiving nonoperative treatment only, while needing also operative treatment. The CPQ11-14 total mean change scores by the global transition judgment on self-perceived oral health status indicated significant differences (p < 0.001, ANOVA; internal responsiveness). The effect of the program for the treatment groups was significant (p = 0.014, ANCOVA; external responsiveness). The effect size for the change scores was of moderate magnitude. In conclusion, an overall improvement of adolescents' OHRQoL was observed following 1-year oral health care program for caries and gingival conditions. The CPQ11-14 was internally and externally sensitive to detect substantial clinical changes. The CPQ11-14 seems appropriate for measuring long-term changes on adolescents' OHRQoL.

Maximum impact heights of currently used mouthguards in field hockey.

BACKGROUND/AIM: The effectiveness of mouthguards used in field hockey is unknown. The aim of this study was to compare the maximum impact heights between currently used mouthguards in field hockey to prevent dental injury. METHODS: Four boil-and-bite mouthguards (Dita, Shock Doctor, SISU, and Stag) and one custom-made mouthguard (Elysee) were tested for maximum impact height. A hockey ball was released in a tube from increasing heights onto plaster and polymethylmethacrylate (PMMA) dental models. Models were tested without mouthguard as a control. The experiment was repeated 10 times per mouthguard and for the control on each dental model. The maximum impact height for when the dental model broke was used to calculate the speed. The mouthguards and controls were compared. RESULTS: The maximum impact heights (median [25%-75%] in meters) onto plaster dental models were as follows: control 0.23 (0.15-0.25), Dita 0.35 (0.30-0.35), Elysee 0.45 (0.34-0.50), Shock Doctor 0.68 (0.60-0.74), SISU 0.23 (0.20-0.26), and Stag 0.35 (0.35-0.46). The maximum impact height for Shock Doctor was significantly higher than all other mouthguards and the control (all P < .05). The maximum impact heights onto PMMA dental models were as follows: control 2.00 (1.30-2.50), Dita 3.80 (2.65-6.95), Elysee 3.30 (2.30-4.20), Shock Doctor 6.20 (2.80-8.10), SISU 2.60 (1.90-3.15), and Stag 3.90 (1.25-5.15). The maximum impact height for Shock Doctor was significantly higher than for SISU, Stag, and the control (all P < .05), but did not differ significantly from Dita (P = .43) and Elysee (P = .12). CONCLUSION: Shock Doctor had the highest maximum impact height compared to the other mouthguards and appears to be the most effective mouthguard tested in this study.

Alveolar Iodine Tampon Packing Reduces Postoperative Morbidity After Third Molar Surgery.

PURPOSE: The aim of this study was to assess the efficacy of an iodine tampon after mandibular third molar surgery on oral health-related quality of life (OHRQoL), use of painkillers, postoperative sequelae, and self-care behaviors in the first postoperative week. MATERIALS AND METHODS: This prospective, crossover, randomized controlled study included patients undergoing surgical removal of bilateral symmetrically, horizontally impacted mandibular third molars. The surgical site was randomly allocated to receive an iodine tampon after surgery or wound closure and rinsing with a Monoject syringe (Tyco/Healthcare-Kendall, Mansfield, MA). The primary outcomes measured each day during the first postoperative week were the Oral Health Impact Profile 14 score and postoperative sequelae, including pain, swelling, limited mouth opening, postoperative infection, and alveolar osteitis. The secondary outcome measures were several self-care behaviors. Data were analyzed using repeated-measures analysis of variance and paired-samples t tests. RESULTS: A total of 54 patients (25 men and 29 women; mean age, 25.1 years) were enrolled, with a total of 108 surgically removed impacted mandibular third molars. The use of an iodine tampon resulted in a significantly lower impact on OHRQoL (mean of 21.5 [standard deviation (SD), 9.6] vs 26.5 [SD, 10.6]) on the first postoperative day, which was observable until the seventh postoperative day. In addition, after removal of the impacted third molar, patients with the iodine tampon condition reported less pain (mean of 5.2 [SD, 1.9] vs 6.1 [SD, 2.1] on day 1, lasting throughout the week), less use of painkillers, less limited mouth opening, fewer problems chewing, less swelling, and earlier recovery. CONCLUSIONS: The use of postoperative iodine packing after the removal of impacted mandibular third molars significantly reduces OHRQoL and postoperative sequelae.

Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. DATA SOURCES: A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. INCLUSION CRITERIA: Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. RESULTS: A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. CONCLUSIONS: A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. CLINICAL SIGNIFICANCE: The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. PROSPERO REGISTRATION NUMBER: CRD42017064810.

Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial.

BACKGROUND: Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia. METHOD: A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up. RESULTS: Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015. CONCLUSIONS: VRET was found to be efficacious in the treatment of dental phobia.

Prediction Models for Oral Health-Related Quality of Life in Patients with Temporomandibular Joint Osteoarthritis 1 and 6 Months After Arthrocentesis with Hyaluronic Acid Injections.

AIMS: To develop models for prognostic prediction of oral health-related quality of life (OHRQoL) for patients with temporomandibular joint osteoarthritis (TMJ OA) at 1- and 6-month follow-ups after arthrocentesis treatment with hyaluronic acid (HA) injections once a week for 4 weeks. METHODS: From a cohort of 522 adult patients with TMJ OA treated with arthrocentesis with HA injections, 510 and 463 adult patients were included in the 1- and 6-month follow-ups, respectively. Patient characteristics and history, clinical examinations, and questionnaires were recorded as potential predictors at start of treatment, and all patients underwent an identical treatment protocol. Patients' OHRQoL values at 1 and 6 months after completing the treatment were used as outcome measures. Logistic regression methods were used to develop prediction models, and the performance and validity of these models were evaluated according to state-of-the-art methods, including receiver-operating characteristics curve for the discrimination of the models and calibration plots for the calibration of the models. RESULTS: History of mental disease, maximal protrusion of the jaw, muscular pain with palpation, joint pain with palpation, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 1-month follow-up, while age, pain in other joints, history of mental disease, joint pain with palpation, sleep bruxism, awake bruxism, chewing-side preference, and low OHRQoL at baseline were significantly associated with OHRQoL at the 6-month follow-up. While the performance of both models was found to be good in terms of calibration, discrimination, and internal validity, the added predictive values of the 1-month and 6-month models for ruling in the risk of low OHRQoL were 19% and 31%, respectively, while those for ruling it out were 28% and 15%, respectively. CONCLUSION: Several predictors were found to be significantly associated with patients' OHRQoL after treatment. Both prediction models may be reliable and valid for clinicians to predict a patient's risk of low OHRQoL at follow-up, so the models may be useful for clinicians in decision-making for patient management and for informing the patient.

A Prediction Model for Types of Treatment Indicated for Patients with Temporomandibular Disorders.

AIMS: To identify potential predictors of types of treatment indicated for patients with temporomandibular disorders (TMD) and to develop, validate, and calibrate a prediction model for type of treatment. METHODS: The derivation cohort at baseline was comprised of 356 adult patients with TMD. Patient and disease characteristics were recorded at baseline as potential predictors. Types of treatment indicated for TMD patients were the end points of the model, classified into no treatment, physical treatment only (including splint and/or physiotherapy), and combined physical and psychological treatment. Multinomial logistic regression analysis was used to develop the prediction model. The internal validation, calibration, discrimination, and external validation of the model were determined. For practical use, the prediction model was converted into score charts and line charts. The score of each included predictor was produced based on the shrunken regression coefficients. RESULTS: Patient age, gender, anxiety, sleep bruxism, pain-related TMD, function-related TMD, stress, passive stretch of maximum mouth opening, and depression were significantly associated with the type of treatment indicated for TMD patients. The multinomial model showed reasonable calibration and good discrimination, with area under the curve values of 0.76 to 0.86. The internal validity of the model was good, with a shrinkage factor of 0.89. The external validity of the model was acceptable. CONCLUSION: Potential predictors in patient profiles for prediction of type of treatment indicated for TMD patients were identified. The internal validity, calibration, discrimination, and external validity of the model were acceptable.

Does Parental Anxiety, Coping, and Pain Catastrophizing Influence Child Behavior During Sedation?

Purpose: Little is known about psychological factors associated with children's behavior during dental sedation. The purpose of this study was to investigate the associations between parental dental anxiety, coping style, pain catastrophizing (an exaggerated negative response to pain), and children's behavior during dental treatment under moderate sedation. Methods: Participants included 110 pairs consisting of mothers, fathers, or grandmothers and healthy children (60 boys, 50 girls; mean age equals 47.0 months, range equals 20 to 81 months) with a history of disruptive behavior during dental treatment. All children required one dental restoration under moderate sedation, using local anesthesia and rubber dam isolation. Children, s behavior was assessed using the Ohio State University Behavioral Rating Scale, based on the video files of the procedure. Parents completed the Dental Anxiety Scale, the Coping Orientation to Problems Experienced Scale, and the Pain Catastrophizing Scale-Parents. Results: Parents of children with more positive behavior scored higher on planning (P=0.02) and acceptance (P=0.02) strategies than parents of children in the regular and negative behavior groups. No associations were found between parental dental anxiety or pain catastrophizing and children's behavior. Conclusions: Parental adaptive coping strategies can have a positive impact on children's behavior during dental treatment under moderate sedation.

Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis.

OBJECTIVES: The aim was to assess the added diagnostic value of ultrasonography (US) for establishing the presence or absence of disc displacements (DDs) in temporomandibular joints (TMJs). MATERIALS AND METHODS: Pubmed and EMBASE were searched electronically to identify diagnostic accuracy studies that assessed the diagnostic value of US for the diagnosis of DD, using Magnetic resonance imaging (MRI) as the reference standard. Meta-analyses were performed with Metadisc 1.4 and RevMan 5.3. RESULTS: A total of 16 studies qualified for meta-analyses. For the diagnosis of DD at closed mouth position (DD-CM) and DD at maximum mouth-opening position (DD-MMO), the added values of a positive result with US for ruling in DD-CM and DD-MMO were 22 and 41%, while those of a negative result with US for ruling out DD-CM and DD-MMO were 30 and 20%. For the diagnosis of DD with reduction (DDWR) and DD without reduction (DDWoR), the added values of a positive result in US for ruling in DDWR and DDWoR were 35 and 41%, while those of a negative result in US for ruling out DDWR and DDWoR were 21 and 27%. CONCLUSIONS: Using MRI as reference standard, the added values of both positive predictive values and negative predictive values of US for ruling in and ruling out DDs are sufficient in the decision-making in dental practice. CLINICAL RELEVANCE: US can be a good imaging tool to supplement clinical examination findings in patients with suspected DDs. Combined static and dynamic examinations using high-resolution US should be preferred.

Virtual Reality Exposure Therapy for the Treatment of Dental Phobia: A Controlled Feasibility Study.

BACKGROUND: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. AIM: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. METHOD: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants' heart rate response during VRET, and their experience post-VRET, were indexed. RESULTS: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-to-treat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.61, p = 0.019, and Dental Fear Scale, F (1,8) = 10.53, p = 0.012], and behavioural avoidance in the VRET compared with the IP group [d = 4.2 and -1.4, respectively). There was no increase in average heart rate during VRET. Of the nine treatment completers, six (four from the VRET group and two from the IP group) no longer had dental phobia at 6-month follow-up. Four of the five VRET participants, but none of the IP participants, scheduled a dental treatment appointment following the intervention. CONCLUSION: VRET is a feasible alternative for patients with dental phobia.

Anxiety and pain related to mandibular block injections: comparison of self-reported measures and physiological response.

OBJECTIVE: The aim of this study was to determine whether patients with a pain score ≥7 (high pain group) after a mandibular block injection had a higher physiologic response compared with patients with scores <7 (low pain group). STUDY DESIGN: Before oral surgery, patients (n = 66) filled out questionnaires to measure anxiety and expected pain. The questionnaires also assessed patients' experiences with dental injections and dental anxiety, as well as their emotional state and intensity of anxiety. Before, during, and after the injection, physiologic responses were measured by using Nexus-10. Patients were then asked about the pain and anxiety they had experienced. RESULTS: The mean score for pain experienced was 3.45 (standard deviation 2.17) on an 11-point rating scale. Eight patients (12.1%) experienced high injection pain. There was a significant increase in mean sweat secretion and a significant decrease in mean respiration between the relaxing phase and the injection phase. There was a significant positive relationship between experienced anxiety and mean heart rate during the injection phase. No significant difference in physiologic response was found between patients who experienced high pain and those who experienced low pain. CONCLUSIONS: Reported pain was not associated with the physiologic response of patients receiving mandibular block injections.

Natural variation of the zygomaticomaxillary complex symmetry in normal individuals.

OBJECTIVE: The study aim was to investigate variations in the symmetry of the zygomaticomaxillary complex (ZMC) in normal individuals. METHOD: Computed tomography datasets of 200 individuals without facial fractures were analyzed using a validated three-dimensional analysis technique. The absolute average distance (AD) and 90th percentile distance (NPD) were calculated, representing respectively the overall and maximum symmetry between bilateral ZMCs. RESULTS: The mean AD and NPD of the total study group was 0.9 ± 0.3 mm (95% CI 0.3-2.3) and 1.7 ± 0.5 mm (95% CI 0.5-3.9), respectively. The mean AD and NPD in males were 1.0 ± 0.3 mm (95% CI 0.28-2.34) and 1.9 ± 0.5 mm (95% CI 0.5-3.9) versus 0.8 ± 0.3 mm (95% CI 0.4-1.7) and 1.6 ± 0.5 mm (95% CI 0.8-2.9), respectively, for females. A statistically significant difference between male and female was found for both AD and NPD (p < 0.01). The male population <40 years had a mean AD and NPD of 1.0 ± 0.3 mm and 1.8 ± 0.5 mm, which was not statistically significant when compared with males >40 years. CONCLUSION: The naturally occurring anatomic variation in ZMC symmetry described in this study is proposed as a benchmark for evaluating the amount of preoperative displacement and postoperative reduction of ZMC in trauma cases.