Who requires dental treatment under general anesthesia due to pain and severe dental anxiety? Findings from panoramic X-ray images and anamnesis
DOI:
https://doi.org/10.2340/aos.v84.42895Keywords:
Dental anxiety, dental status, abuse, general anesthesia, patient profileAbstract
Objective: The aims were to describe the dental status and mental and somatic health profile of patients with severe dental anxiety requiring dental treatment under general anesthesia (GA) in Rogaland County, Norway (2018–2021), and to compare patients with and without reported abuse history.
Material and methods: Dental status was assessed by panoramic X-rays. General health variables were collected from patient records. Statistical comparisons of patients with and without abuse experience by tests of association (significance level p < 0.05).
Results: 38 women and 18 men (mean ± standard deviation [SD]: 37.9 ± 9.2 years) were included; 27 reported abuse experience. Dental assessment showed 4.6 ± 3.8 missing teeth, 4.8 ± 3.0 root remnants, 5.8 ± 3.7 teeth with caries and 2.6 ± 1.9 teeth with apical periodontitis, among patients with ≥1 of the respective findings. 57.1% used analgesics due to dental pain. 55.4% had comorbid psychiatric conditions; 35.7% used psychopharmaceuticals. There were no statistical differences in dental variables but the abuse experience group had higher frequencies of comorbid psychiatric disorders (p = 0.01) and mixed somatic conditions (p = 0.03).
Conclusions: Patients with severe dental anxiety requiring dental treatment under GA have complex health problems. They need access to treatment under GA, as treatment of serious odontogenic conditions is otherwise unmanageable.
Downloads
References
Silveira ER, Cademartori MG, Schuch HS, Armfield JA, Demarco FF. Estimated prevalence of dental fear in adults: a systematic review and meta-analysis. J Dent. 2021;108:103632. https://doi.org/10.1016/j.jdent.2021.103632 DOI: https://doi.org/10.1016/j.jdent.2021.103632
Berggren U, Meynert G. Dental fear and avoidance: causes, symptoms, and consequences. J Am Dent Assoc. 1984;109(2):247–51. https://doi.org/10.14219/jada.archive.1984.0328
Berggren U, Carlsson SG, Hagglin C, Hakeberg M, Samsonowitz V. Assessment of patients with direct conditioned and indirect cognitive reported origin of dental fear. Eur J Oral Sci. 1997;105(3):213–20. https://doi.org/10.1111/j.1600-0722.1997.tb00203.x DOI: https://doi.org/10.1111/j.1600-0722.1997.tb00203.x
Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295–301. https://doi.org/10.1159/000357223 DOI: https://doi.org/10.1159/000357223
Larijani HH, Guggisberg A. Improving clinical practice: what dentists need to know about the association between dental fear and a history of sexual violence victimisation. Int J Dent. 2015;2015:1. https://doi.org/10.1155/2015/452814 DOI: https://doi.org/10.1155/2015/452814
Fredriksen TV, Softestad S, Kranstad V, Willumsen T. Preparing for attack and recovering from battle: understanding child sexual abuse survivors’ experiences of dental treatment. Community Dent Oral Epidemiol. 2020;48(4):317–27. DOI: https://doi.org/10.1111/cdoe.12536
Willumsen T. Dental fear in sexually abused women. Eur J Oral Sci. 2001;109(5):291–6. https://doi.org/10.1034/j.1600-0722.2001.00069.x DOI: https://doi.org/10.1034/j.1600-0722.2001.00069.x
De Jongh A, Schutjes M, Aartman IH. A test of Berggren’s model of dental fear and anxiety. Eur J Oral Sci. 2011;119(5):361–5. DOI: https://doi.org/10.1111/j.1600-0722.2011.00843.x
Hakeberg M, Berggren U, Grondahl HG. A radiographic study of dental health in adult patients with dental anxiety. Community Dent Oral Epidemiol. 1993;21(1):27–30. https://doi.org/10.1111/j.1600-0528.1993.tb00714.x DOI: https://doi.org/10.1111/j.1600-0528.1993.tb00714.x
Moore R, Brodsgaard I, Rosenberg N. The contribution of embarrassment to phobic dental anxiety: a qualitative research study. BMC Psychiatry. 2004;4(1):10. https://doi.org/10.1186/1471-244X-4-10 DOI: https://doi.org/10.1186/1471-244X-4-10
Mehrstedt M, John MT, Tonnies S, Micheelis W. Oral health-related
quality of life in patients with dental anxiety. Community Dent Oral Epidemiol. 2007;35(5):357–63. https://doi.org/10.1111/j.1600-0528.2007.00376.x DOI: https://doi.org/10.1111/j.1600-0528.2007.00376.x
Svensson L, Hakeberg M, Wide U. Dental pain and oral health-related quality of life in individuals with severe dental anxiety. Acta Odontol Scand. 2018;76(6):401–6. https://doi.org/10.1080/00016357.2018.1473892 DOI: https://doi.org/10.1080/00016357.2018.1473892
Ng SK, Leung WK. A community study on the relationship of dental anxiety with oral health status and oral health-related quality of life. Community Dent Oral Epidemiol. 2008;36(4):347–56. DOI: https://doi.org/10.1111/j.1600-0528.2007.00412.x
Grytten J, Hoist D, Dyrberg L, Fæhn O. Some characteristics of patients given dental treatment under general anesthesia. Acta Odontol Scand. 1989;47(1):1–5. https://doi.org/10.3109/00016358909004793 DOI: https://doi.org/10.3109/00016358909004793
Bertossi D, Barone A, Iurlaro A, Marconcini S, De Santis D, Finotti M, et al. Odontogenic orofacial infections. J Craniofac Surg. 2017;28(1):197–202. https://doi.org/10.1097/SCS.0000000000003250 DOI: https://doi.org/10.1097/SCS.0000000000003250
Matsumoto Y, Ikeda T, Yokoi H, Kohno N. Association between odontogenic infections and unilateral sinus opacification. Auris Nasus Larynx. 2015;42(4):288–93. https://doi.org/10.1016/j.anl.2014.12.006 DOI: https://doi.org/10.1016/j.anl.2014.12.006
Brook I. Sinusitis of odontogenic origin. Otolaryngol Head Neck Surg. 2006;135(3):349–55. DOI: https://doi.org/10.1016/j.otohns.2005.10.059
Koorbusch GF, Fotos P, Terhark Goll K. Retrospective assessment of osteomyelitis : etiology, demographics, risk factors, and management in 35 cases. Oral Surg Oral Med Oral Pathol. 1992;74(2):149–54. https://doi.org/10.1016/0030-4220(92)90373-X DOI: https://doi.org/10.1016/0030-4220(92)90373-X
Cohen S, Fiske J, Newton J. The impact of dental anxiety on daily living. Br Dent J. 2000;189(7):385–90. DOI: https://doi.org/10.1038/sj.bdj.4800777a
Berggren U. Long‐term management of the fearful adult patient using behavior modification and other modalities. J Dent Educ. 2001;65(12):1357–68. https://doi.org/10.1002/j.0022-0337.2001.65.12.tb03495.x DOI: https://doi.org/10.1002/j.0022-0337.2001.65.12.tb03495.x
Ridell K, Borgström M, Lager E, Magnusson G, Brogårdh-Roth S, Matsson L. Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia. Acta Odontol Scand. 2015;73(1):1–7. https://doi.org/10.3109/00016357.2014.919661 DOI: https://doi.org/10.3109/00016357.2014.919661
Angelsen M, Bjørheim K, Lundeby M, Wigen TI, Rønneberg A. Barn og deres omsorgspersoners erfaring med tannbehandling under generell anestesi. Nor Tannlegeforen Tid. 2024;134:196–202. DOI: https://doi.org/10.56373/2024-3-3
Søftestad S, Kranstad V, Fredriksen TV, Willumsen T. Invading deeply into self and everyday life: how oral health-related problems affect the lives of child sexual abuse survivors. J Child Sex Abus. 2020;29(1):62–78. https://doi.org/10.1080/10538712.2019.1682096 DOI: https://doi.org/10.1080/10538712.2019.1682096
Berggren U. Dental fear and avoidance : a study of etiology, consequences and treatment. Gøteborg: University of Gøteborg, Faculty of Odontology; 1984. DOI: https://doi.org/10.14219/jada.archive.1984.0328
Bohman W, Lundgren J, Berggren U, Carlsson S. Psychosocial and dental factors in the maintenance of severe dental fear. Swed Dent J. 2010;34(3):121.
Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health. 2007;7(1):1–15. https://doi.org/10.1186/1472-6831-7-1 DOI: https://doi.org/10.1186/1472-6831-7-1
Silveira ER, Cademartori MG, Schuch HS, Corrêa MB, Ardenghi TM, Armfield J, et al. The vicious cycle of dental fear at age 31 in a birth cohort in Southern Brazil. Community Dent Oral Epidemiol. 2021;49(4):354–61. https://doi.org/10.1111/cdoe.12609 DOI: https://doi.org/10.1111/cdoe.12609
Armfield JM. What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance. Community Dent Oral Epidemiol. 2013;41(3):279–87. DOI: https://doi.org/10.1111/cdoe.12005
Samei E, Rowberg A, Avraham E, Cornelius C. Toward clinically relevant standardization of image quality. J Digit Imaging. 2004;17(4):271–8. https://doi.org/10.1007/s10278-004-1031-5 DOI: https://doi.org/10.1007/s10278-004-1031-5
Norwegian Directorate of Health. Tilrettelagte tannhelsetilbud for mennesker som er blitt utsatt for tortur, overgrep eller har odontofobi [Facilitated dental health services for people who have been subjected to torture, abuse or odontophobia]. Oslo: Helsedirektoratet; 2010.
World Health Organization. International Statistical Classification of Diseases and related health problems: alphabetical index. Geneva: World Health Organization; 2004.
Aardal V, Willumsen T, Evensen KB. Differences in anxiety, depression, and oral health‐related quality of life among dental anxiety patients with and without reported abuse experience. Eur J Oral Sci. 2024;132(2):e12976-n/a. https://doi.org/10.1111/eos.12976 DOI: https://doi.org/10.1111/eos.12976
Aardal V, Evensen KB, Willumsen T, Hervik Bull V. The complexity of dental anxiety and its association with oral health‐related quality of life: An exploratory study. Eur J Oral Sci. 2023;131(1):e12907-n/a. DOI: https://doi.org/10.1111/eos.12907
Sødal ATT, Hove LH, Diep MT, Skudutyte-Rysstad R, Koldsland OC. Periodontal conditions in a 65-year-old population and prevalence of periodontitis according to three different bone level thresholds. BMC Oral Health. 2022;22(1):246. https://doi.org/10.1186/s12903-022-02276-1 DOI: https://doi.org/10.1186/s12903-022-02276-1
Rødseth SC, Høvik H, Schuller AA, Bjertness E, Skudutyte-Rysstad R. Dental caries in a Norwegian adult population, the HUNT4 oral health study; prevalence, distribution and 45-year trends. Acta Odontol Scand. 2023;81(3):202–10. https://doi.org/10.1080/00016357.2022.2117735 DOI: https://doi.org/10.1080/00016357.2022.2117735
Hadler-Olsen E, Jönsson B. Oral health and use of dental services in different stages of adulthood in Norway: a cross sectional study. BMC Oral Health. 2021;21(1):257. https://doi.org/10.1186/s12903-021-01626-9 DOI: https://doi.org/10.1186/s12903-021-01626-9
Høvik H, Kolberg M, Gjøra L, Nymoen LC, Skudutyte-Rysstad R, Hove LH, et al. The validity of self-reported number of teeth and edentulousness among Norwegian older adults, the HUNT Study. BMC Oral Health. 2022;22(1):82. DOI: https://doi.org/10.1186/s12903-022-02116-2
Henriksen BM, Ambjørnsen E, Axéll T. Dental caries among the elderly in Norway. Acta Odontol Scand. 2004;62(2):75–81. DOI: https://doi.org/10.1080/00016350310008580
Kirkevang L-L, Hörsted-Bindslev P, Ørstavik D, Wenzel A. Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population. Int Endod J. 2001;34(3):198–205. https://doi.org/10.1046/j.1365-2591.2001.00370.x DOI: https://doi.org/10.1046/j.1365-2591.2001.00370.x
Tibúrcio‐Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta‐analysis. Int Endod J. 2021;54(5):712–35. https://doi.org/10.1111/iej.13467 DOI: https://doi.org/10.1111/iej.13467
Khalighinejad NDDS, Aminoshariae MRMD, Aminoshariae ADDSMS, Kulild JCDDSMS, Mickel ADDSMSD, Fouad AFDDSMS. Association between systemic diseases and apical periodontitis. J Endod. 2016;42(10):1427–34. https://doi.org/10.1016/j.joen.2016.07.007 DOI: https://doi.org/10.1016/j.joen.2016.07.007
Halonen H, Nissinen J, Lehtiniemi H, Salo T, Riipinen P, Miettunen J. The association between dental anxiety and psychiatric disorders and symptoms: a systematic review. CP & EMH. 2018;14:207. https://doi.org/10.2174/1745017901814010207 DOI: https://doi.org/10.2174/1745017901814010207
Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res. 1999;78(3):790–6. https://doi.org/10.1177/00220345990780031201 DOI: https://doi.org/10.1177/00220345990780031201
Estrela C, Bueno MR, Leles CR, Azevedo B, Azevedo JR. Accuracy of cone beam computed tomography and panoramic and periapical radiography for detection of apical periodontitis. J Endod. 2008;34(3):273–9. https://doi.org/10.1016/j.joen.2007.11.023 DOI: https://doi.org/10.1016/j.joen.2007.11.023
Published
Issue
Section
License
Copyright (c) 2025 Vilde Aardal , Caroline Hol , Anne Rønneberg , Sudan Prasad Neupane, Tiril Willumsen
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
