Predictors of use of dental care by children in north-central Appalachia in the USA.

Use of dental services in childhood, especially preventive care, is associated with many important oral health outcomes throughout life. The Andersen behavioral model of healthcare utilization posits that predisposing characteristics, enabling resources, and need factors predict utilization in oral and other healthcare domains. Inequities that produce lower utilization of dental services in north-central Appalachia have been documented in comparison to the USA generally. Additionally, within Appalachia, there are disparities, such as those across different states related to varying public policies and resources supporting healthcare. Predictors of dental utilization in Appalachia have been a focus in adults, but less so in children. The aim of the current study was to understand predictors of dental utilization in children in north-central Appalachia in order to inform future research about how to intervene to address these disparities. In this study, there were 1,178 children, ages 1 through 10 years, from selected representative counties in West Virginia and Pennsylvania, along with a parent/caregiver, who were part of the Center for Oral Health Research in Appalachia (COHRA1) cohort. Use of dental services by their child was indicated by parents/caregivers, who also reported on sociodemographic, dental care-related anxiety and fear, and values and attitudes associated with oral healthcare. Results indicated that use of professional dental services by children was related to child age, dental anxiety and fear, and parental oral health values and attitudes. Older children in this age group, those who evidenced more dental care-related anxiety and fear, and whose parent/caregiver placed higher value on oral health and healthcare for themselves, were more likely to have had a dental visit in the past year.

Depressive- and anxiety-like phenotypes in young adult APPSwe/PS1dE9 transgenic mice with insensitivity to chronic mild stress.

Early Alzheimer's disease (AD) and depression share many symptoms, but the underlying mechanisms are not clear. Therefore, characterizing the shared and different biological changes between the two disorders will be helpful in making an early diagnosis and planning treatment. In the present study, 8-week-old APPSwe/PS1dE9 transgenic mice received chronic mild stress (CMS) for 8 weeks followed by a series of behavioral, biochemical and pathological analyses. APPSwe/PS1dE9 mice showed depressive- and anxiety-like behaviors, and reduced sociability, accompanied by high levels of soluble beta-amyloid, glial activation, neuroinflammation and brain derived neurotrophic factor signaling disturbance in the hippocampus. Notably, APPSwe/PS1dE9 mice exposure to CMS partially aggravated anxiety-like states rather than depressive-like responses and sociability deficits, with further elevated hippocampal interleukin-6 and tumor necrosis factor-α levels. These results demonstrated that young adult APPSwe/PS1dE9 have depressive- and anxiety-like phenotypes that were resistant to CMS compared to wild-type mice. This finding may help to understand the pathogenic mechanism of psychiatric symptoms associated with early AD.

Sex-specific associations between grey matter volume and phobic symptoms in dental phobia.

The knowledge about brain structure and function in men and women suffering from dental phobia is still limited. We compared grey matter volume (GMV) data from 36 patients suffering from dental phobia and 36 non-phobic controls via voxel-based morphometry. Half of the subjects were male, the other half female. Scores on different dental anxiety and pain questionnaires were correlated with GMV. Relative to controls, the patients had a smaller volume of the dorsomedial and dorsolateral prefrontal cortex (DMPFC/DLPFC). Within the phobic group, personal pain experience during dental treatment was negatively correlated with DLPFC volume. Sex-specific correlations were found for the amygdala and the hippocampus. Whereas in female patients GMV of both structures was positively correlated with self-reported dental anxiety, for male patients experienced dental pain was negatively associated with hippocampus volume. Our findings show that memory as well as anticipation of dental pain is associated with amygdala-hippocampal structure in men and women afflicted by dental phobia.

Electrocortical effects of directing attention during visual exposure in dentophobia.

Fear of pain is a main motivator for avoidance or delay of dental treatment in patients afflicted with dentophobia. Studies employing passive viewing paradigms found motivated attention to the phobic object to be associated with enhanced amplitudes of the late positive potential (LPP). The aim of the current study was to investigate, if explicit attention-guiding instructions are able to modify the LPP. Twenty-three patients suffering from dentophobia and 23 controls were presented with pictures showing disorder-relevant or neutral contents, which were combined with different instructions: to distract the attention away from the picture, to classify the content, or to decide whether the scene elicited fear of pain. Relative to controls, dentophobics displayed enhanced late positivity (300-1000 ms after picture onset) in the fear of pain condition at frontal and central recording sites, whereas there was no group difference during classification and distraction. Within patients, fear of pain elicited greater positivity than classification and distraction. The findings are discussed within the framework of attentional direction. Future studies could investigate whether psychotherapy differentially affects neural correlates of attention regulation.

Altered functional connectivity of basal ganglia circuitry in dental phobia.

Recent symptom provocation studies that compared patients suffering from dental phobia with healthy controls identified hyperactivation of basal ganglia structures, but none have assessed striatal functional connectivity. We reanalyzed data from a previous functional magnetic resonance imaging study on dental phobia. Patients (20 men, 25 women) and healthy controls (18 men, 23 women) had been exposed to pictures showing dental treatment, and neutral contents. We conducted connectivity analyses via psychophysiological interactions (PPIs). Relative to non-phobic controls, the patients showed decreased connectivity between prefrontal and basal ganglia regions. Moreover, the clinical group was characterized by increased internal basal ganglia connectivity, which was more pronounced in female compared with male patients. This study provides first evidence for an altered information flow within a fronto-striatal network in dentophobic individuals during visual symptom provocation, which can be considered a neuromarker of this disorder.

Sex differences in the functional and structural neuroanatomy of dental phobia.

Although dental phobia is a common mental disorder, which afflicts both men and women, little is known about sex differences at the neural level. Patients suffering from dental phobia (20 men, 25 women) and healthy controls (18 men, 23 women) participated in a functional magnetic resonance imaging (fMRI) experiment. They were shown pictures depicting dental treatment, generally fear-eliciting, disgust-eliciting and neutral contents. After the fMRI experiment, the participants rated the affective value of the pictures. Additionally, grey matter volume (GMV) was compared between patients and controls, as well as between the sexes. Male and female patients responded differently to the phobogenic pictures. Women showed greater activation of the caudate nucleus, whereas men exhibited enhanced dorsolateral prefrontal cortex (DLPFC) involvement. Their DLPFC activation was negatively correlated with experienced arousal. Dentophobic females were characterized by a greater caudate volume relative to phobic males. The GMV of this structure was positively correlated with experienced arousal during exposure and symptom severity, only in female patients. This study provides first evidence of sex-specific brain activation and structure in patients suffering from dental phobia. The neural pattern during symptom provocation as well as the brain structural specificity might mirror different attention and self-control strategies of both sexes. The consideration of such differences could contribute to greater effectiveness in treating dental phobia.

Auditory symptom provocation in dental phobia: a near-infrared spectroscopy study.

The act of drilling a tooth belongs to the most feared situations of patients suffering from dental phobia. We presented 25 female patients and 24 nonphobic women with the sound of a dental drill, pleasant and neutral sounds. Brain activation was recorded via near infrared spectroscopy in fronto-parietal and premotor areas. The groups differed in supplementary motor area (SMA) recruitment. Relative to controls, the phobics displayed increased oxy hemoglobin while presented with the phobia-relevant sound, but showed comparable activation in the other conditions. As the SMA is engaged in the preparation of motor actions, the increased response in patients might mirror the priming of flight behavior during exposure. We found no indication of an emotional modulation of parietal and dorsomedial prefrontal cortex activation.

Eficacia de las técnicas de percepción de control y relajación en la reducción de ansiedad dental / Effectiveness of the control sensing techniques and relaxation in reducing dental anxiety

La ansiedad dental (AD) es un problema frecuente en la atención dental y constituye una barrera para el éxito terapéutico. El objetivo del estudio es determinar la eficacia de dos estrategias psicológicas para la reducción de la AD. Se conformaron tres grupos de 20 pacientes adultos cada uno, que se incorporaban a atención dental. El primer grupo fue apoyado con técnicas de percepción de control (PC), el segundo con técnica de relajación (R) y un tercero recibió la atención habitual (control). Se midió la AD utilizando la escala de Corah. El grupo PC tuvo una disminución significativa del porcentaje de sujetos con AD. Al término de las sesiones, el 40% de los sujetos con PC se ubicaron en el rango de baja ansiedad. La técnica de Percepción de Control es una estrategia más eficaz que la relajación en la reducción de ansiedad dental, cuando es aplicada por el dentista

Dental anxiety is a frequent problem in dentistry. It is one of the main barriers for therapeutic success. The aim of the study is to determinate the efficacy between two anxiety reduction psychological techniques. Three groups of 20 patients each received clinical dental sessions. The Control Perception (PC) technique was applied to the first group, the Relaxation (R) technique to the second and the third received the usual dental care (control group). Anxiety degree was assessed using the Corah Scale. Data showed a significant reduction in dental anxiety only in the PC group after the sessions. At the end of interventions, forty percent (40%) of the PC group and only a 15% of the R and control group ranged in low anxiety degree. The PC technique is simply to apply and more effective to reduce levels of dental anxiety than the relaxation technique, when applied by the dentist