Anxiety and post-traumatic stress symptoms following wisdom tooth removal

The purpose of the present study was to determine the psychological impact of wisdom teeth removal and to identify the psychological risk factors for the development of dental anxiety and post-traumatic stress symptoms. Participants were 34 consecutive elective patients referred for surgical removal of a wisdom tooth under local anesthesia. Frequency of previous distressing dental events and general traumatic life events were assessed at baseline (t1), and emotional distress (pain, state anxiety and disturbance) immediately after treatment (t2). Post-traumatic stress responses were determined three days after treatment (t3), and at four weeks follow-up (t4), while severity of dental trait anxiety was assessed at t1 and at t4. Two patients (8%) met screening criteria for Post-Traumatic Stress Disorder (PTSD) at t4. Multivariate analysis revealed that previous exposure to distressing dental events and pre-operative anxiety level predicted anxiety level at t4, accounting for 71% of the variance. Severity of pain during treatment was a significant predictor variable of PTSD symptom severity at t4 (25% explained variance). The findings underline the importance of pain-free treatments and awareness of patients' individual predisposition to anxiety or trauma-related symptoms to reduce the risk of iatrogenic psychological harm.     

Appraisal of behavioral measurement techniques for assessing dental anxiety and fear in children: A review

The aim of this article is to review and evaluate behavioral and physiological measurement techniques frequently used to assess dental anxiety and fear in children. Attention is given to the data collected, the empirical findings obtained, and the availability of normative data. The main focus, however, is on the reliability and validity. Results show that all questionnaires are open to criticism. Of the behavioral measures, Melamed's Behavior Profile Rating Scale is to be preferred to Frankl's Rating Scale, Venham Rating Scales, and Visual Analogue Scales. The main reasons are that Melamed's BPRS measures the behavior of the child more precisely and that it has superior psychometric properties. Furthermore, because of their practical, conceptual, and psychometric problems, physiological measures at this stage are found to be less appropriate for assessing dental fear in children. It is concluded that a behavioral measure is not always the ideal, but often the only available technique for assessing dental fear in children.     

Trauma-related sequelae in individuals with a high level of dental anxiety. Does this interfere with treatment outcome?

This study assessed trauma-related sequelae of 56 highly anxious patients attending a dental fear clinic. It was also examined whether such symptomatology interferes with anxiety reduction in response to a cognitive-behavioral treatment approach. About 34 patients (59%) indicated that they had experienced one or more aversive dental events that could explain the onset of their dental anxiety. There was no difference between the dental anxiety scores of patients who reported such a background and those who did not. Severity of trauma-related symptomatology was indexed by the Impact of Event Scale (IES). The mean IES score of patients with a traumatically induced dental fear was remarkably high (33.0; SD=19.7). Furthermore, there was a strong direct relationship between severity of trauma-related symptomatology and severity of dental anxiety (shared variance was 38%). Two patients (10%) met all DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) on the basis of the Self-Rating Scale for PTSD. However, no evidence was found to suggest that either a traumatic background, or level of trauma-related symptomatology, has a negative effect on treatment outcome.