FOUR DIMENSIONS OF FEAR OF DENTAL INJECTIONS

doi:10.14219/jada.archive.1997.0301

The Journal of the American Dental Association

Volume 128, Issue 6, June 1997, Pages 756-762

https://doi.org/10.14219/jada.archive.1997.0301 Get rights and content

ABSTRACT

In 1995, students and staff at the University of Washington were surveyed regarding avoidance of dental care and fear of dental injections. More than 25 percent of adults surveyed expressed at least one clinically significant fear of injections. Almost one in 20 respondents indicated avoiding, cancelling or not appearing for dental appointments because of fear of dental injections. Fear of dental injections consists of four dimensions. General fear of dental injections including pain of injection and of bodily injury from injection are the two most common dimensions of dental injection fear. Many people also express fears of acquired disease. Fear related to local anesthetic (such as side effects, inadequate anesthesia) is less frequent. Some respondents have fears that must be categorized using more than one of these dimensions. Understanding the nature of a patient's fear of injection may suggest strategies to address his or her concerns.

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Cited by (196)

An ethologically based view into human fear
2023, Neuroscience and Biobehavioral Reviews
Citation Excerpt :
Several studies aim to comprehend the role of fear of pain in the etiology of fears, such as fear of dogs, syringes, dentists, or other potentially painful objects and situations. For example, fear of pain is the strongest predictor of fear of dentists (Bradley et al., 2008; Shim et al., 2015), injections (Milgrom et al., 1997), and surgery (Laskin and Carrico, 2019). SIA seems more related to extreme and uncontrollable (Janssen and Arntz, 1997) life-threatening events.
The quality of the defensive response to a threat depends on the elements that trigger the fear response. The current classification system of phobias does not account for this. Here, we analyze the fear-eliciting elements and discern the different types of fears that originate from them. We propose Pain, Disgust, Vasovagal response, Visual-vestibular and postural interactions, Movement and Speed, Distance and Size, Low and mid-level visual features, Smell, and Territory and social status. We subdivide phobias according to the fear-eliciting elements most frequently triggered by them and their impact on behavior. We discuss the implications of a clinical conceptualization of phobias in humans by reconsidering the current nosology. This conceptualization will facilitate finding etiological factors in defensive behavior expression, fine-tuning exposure techniques, and challenging preconceived notions of preparedness. This approach to phobias leads to surprising discoveries and shows how specific responses bear little relation to the interpretation we might later give to them. Dividing fears into their potentially fear-eliciting elements can also help in applying the research principles formulated by the Research Domain Criteria initiative.
Jet injection needle-free dental anaesthesia: Initial findings
2022, Journal of Dentistry
We evaluated patient preference and reported levels of anxiety and discomfort of participants treated with a new needle-free electric motor-driven device vs. conventional local anaesthetic for dental extractions in a proof-of-principle study. Healing and response of gingival tissues to injection were also evaluated at 1, 3- and 7-days post-procedure.
After informed consent, eight participants who required bilateral maxillary extractions were included in the trial. The side and order of placement for the needle-free and conventional anaesthetic were randomized. The same operator delivered anaesthesia and ensured teeth were anaesthetized on both sides. Another operator, unaware of order and type of anaesthesia placed, performed the extractions.
Participant's average discomfort scores were low for both techniques, and lower for the needle-free injection at all timepoints. Needle-free local anaesthesia was the preferred technique by most participants at most timepoints. The average volume of anaesthetic dispensed was similar between techniques. Successful anaesthesia with the needle-free device was achieved in 6 out of 8 participants. Healing of the extraction sockets and adjacent oral mucosa progressed normally for all participants, with no evidence of infection, trauma or hematoma in the injection sites of the test and conventional sides.
The needle-free local anaesthetic technique investigated achieved sufficient anaesthesia for tooth extractions in the maxilla in 75% of the subjects. A larger clinical trial is needed to further validate the technique tested and to investigate whether needle-free local anaesthesia can be successfully applied to the provision of restorative therapy.
The results of this study can be used by clinicians treating patients who suffer from dental anxiety and needle-phobia.
Does the use of topical anesthetics reduce the perception of pain during needle puncture and anesthetic infiltration? Systematic review and meta-analysis of randomized controlled trials
2022, International Journal of Oral and Maxillofacial Surgery
The objective of this systematic review was to assess whether the use of topical anesthetics reduces the perception of pain during puncture and anesthetic infiltration. Twenty-two randomized controlled clinical trials, published in English on or before August 6, 2020, were found in the PubMed/MEDLINE, Scopus, and Cochrane Library databases. Risk of bias was determined for randomization and other issues. A total of 1029 patients were evaluated using parameters such as type of topical anesthetic, application site, and pain (measured on a scale). Some studies assessed more than one topical anesthetic. Seventeen of them showed a reduction in pain from needle puncture and four from infiltration. Meta-analyses for some results showed considerable statistical heterogeneity. Regarding pain during needle puncture of the maxilla, statistically significant differences were observed in the topical anesthetics group, in both the vestibular (P = 0.0002) and palatal (P = 0.005) region. This was different from the mandible, for which there was no statistically significant difference (P = 0.07). With regard to pain caused by anesthetic infiltration in the maxilla, there was no difference in the use of anesthetic in relation to the control group (P = 0.11). Given these findings, using topical anesthetics only relieves pain during needle puncture and in the maxilla. PROSPERO 2020: CRD42020206362.
Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study
2021, British Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The palatal injection causes some discomfort, pain, numbness, and gagging. Of these manifestations, the pain of the injection is known to be poorly tolerated by patients.2,1 Healthcare professionals are trying to master the means of reducing pain using a number of techniques such as the application of topical anaesthetic,5 topical cooling of the palate,6 computerised injection systems,7 pressure administration, and transcutaneous electronic nerve stimulation (TENS).8
In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.
The effectiveness of electronic pulsed soft tissue vibration compared with topical anaesthesia in reducing the pain of injection of local anaesthetics in adults: a randomized controlled split-mouth clinical trial
2021, International Journal of Oral and Maxillofacial Surgery
The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P < 0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P < 0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level.
Vibrotactile devices, DentalVibe, and local anesthesia
2021, Treatments, Mechanisms, and Adverse Reactions of Anesthetics and Analgesics
Distraction is a widely used method of diverting a child’s attention from painful stimuli such as those from local anesthesia. Melzack and Wall’s theory of portal pain control is a widely accepted concept of pain perception. In recent years, a group of innovative products for dental use has been developed based on this theory called vibrotactile devices. Their action is expressed in the principle of masking the pain of the needle penetration by applying pressure, vibration, microoscillations, or a combination of them. Applied physical stimuli alter or interfere with pain signals by closing the neural gate of the cerebral cortex, thus reducing the sensation of pain due to distraction. In this chapter, vibrotactile devices such as the DentalVibe, Accupal, Vibraject, and others are discussed.

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: This research was supported by grants Nos. DE10735, DE00379 and DE07132 from the National Institute of Dental Research, NIH. The authors thank Professors Ronald Kleinknecht and Timothy Smith for their participation in pretesting the survey instrument.

¹: Dr. Milgrom is professor, Department of Dental Public Health Sciences, and director, Dental Fears Research Clinic, University of Washington, Box 357475, Seattle, Wash. 98195-7475.

²: Dr. Coldwell is senior postdoctoral fellow, Department of Dental Public Health Sciences, University of Washington, Seattle.

³: Dr. Getz is senior lecturer, Department of Dental Public Health Sciences, University of Washington, Seattle.

⁴: Dr. Weinstein is professor, Department of Dental Public Health Sciences, University of Washington, Seattle.

⁵: Dr. Ramsay is associate professor, departments of Pediatric Dentistry and Orthodontics, University of Washington, Seattle.

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FOUR DIMENSIONS OF FEAR OF DENTAL INJECTIONS

ABSTRACT

JADA

Behav Res Ther

JADA

JADA

JADA

Sources of dentists&apos; stress

JADA

Age of onset in different phobias

J Abnorm Psychol

Cross validation of a factor analysis for a dental beliefs survey (Abstract)

J Dent Res

Origins and characteristics of fear of dentistry

JADA

Fears of the dental situation

J Dent Res

Sources of dentists' stress