成人牙科焦虑症流行现状调查及成因分析
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摘要
目的：本研究通过应用Corah's牙科焦虑量表以及对引起牙科焦虑状态事件的害怕程度问卷,结合成人就诊患者的人口学资料,分析成人牙科焦虑症的流行病学特征及其影响因素,并进一步探寻汉族与回族成人牙科焦虑症的发病情况及其相关影响因素,指导口腔临床医生对患者进行治疗前的心理干预,使得患者的焦虑情绪得以缓解,最大程度地保证诊疗效果。
方法：(1)选取229例在口腔科门诊接受牙科治疗的成人患者,采用Corah's牙科焦虑量表和对引起牙科焦虑状态事件的害怕程度问卷,由患者按问卷要求并根据自身感受填写完成,统计分析成人牙科焦虑症的流行情况及相关影响因素。
(2)选取216例汉族和203例回族在口腔科门诊接受牙科治疗的成人患者,采用Corah's牙科焦虑量表和对引起牙科焦虑状态事件的害怕程度问卷,由患者按问卷要求并根据自身感受填写完成。对两组数据进行统计学分析,比较汉族与回族成人牙科焦虑症的患病情况及相关的影响因素。
结果：(1)成人牙科焦虑症患病率为26.6%,DAS平均分值为10.45+3.33。性别、直接牙科经历、间接牙科经历、对疼痛的耐受程度以及心情的紧张程度各组的DA患病率差异有显著统计学意义(P<0.05)；间接牙科经历痛苦、对疼痛的耐受程度低和最恐惧的治疗环节为拔牙的患者更易患牙科焦虑。在引起牙科焦虑状态的事件中,躺上牙椅、麻醉后仍觉疼痛以及需要更多的治疗为牙科焦虑症的危险因素。
(2)汉族与回族牙科焦虑症患病率分别为34.2%和45.0%,但两者差异没有统计学意义(P>0.05)。然而,两民族在牙科焦虑症的相关影响因素方面明显不同,汉族成人患者牙科焦虑水平与文化程度、亲友经历、最恐惧诊疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多治疗呈正相关；而回族成人患者牙科焦虑水平与轮到自己看牙、听到牙钻的声音、需要更多的治疗呈正相关,但二者均与患者对疼痛的耐受程度呈负相关。
结论：成人牙科焦虑症是一种由多因素综合作用引起的疾病,多见于直接和间接牙科经历痛苦、对疼痛的耐受程度较差以及心情很紧张的成年女性。间接牙科经历、对疼痛的耐受程度、最恐惧的治疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多的治疗为牙科焦虑症的危险因素。汉族成人患者牙科焦虑水平与文化程度、亲友经历、最恐惧诊疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多治疗呈正相关；而回族成人患者牙科焦虑水平与轮到自己看牙、听到牙钻的声音、需要更多的治疗呈正相关,但二者均与患者对疼痛的耐受程度呈负相关。
Objective:Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied with combination of demographic data. This study aimed to assess the epidemic features of dental anxiety (DA) in adult patients and analyse the relevant factors contributing to adult DA, futher dowse epidemic characteristics and influence factors of DA in adult patients of Han nationality and Hui nationality, thus the results can be used to direct dentists'psychological intervention for DA patients before treatment in order to relieve patients'anxiety and best guarantee the prognosis.
Methods:(1) 229 adult outpatients were selected for the questionnaire survey, Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied. All participants completed the questionnaire according to the requirments and subjective perceptions.Epidemic characteristics and influence factors of DA were statistically analyzed.
(2) 216 adult outpatients of Han nationality and 203 adult outpatients of Hui nationality were selected for the questionaire survey, Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied. All participants completed the questionaire according to the requirments and subjective perceptions.Both groups were statistically analyzed in order to assess the differences in epidemic characteristics and influencing factors of DA.
Results:(1)The prevalence rate of DA in adult patients is 26.6%.The mean DAS score is 10.45±3.33.Different prevalence rates of DA in groups of sex,direct trauma dental experience, indirect trauma dental experience, pain tolerance level and emotional tension level demonstrate notable statistical significance (P<0.05).Patients with indirect trauma dental experience, low pain tolerance level and who considers tooth extraction is most fearful therapy are prone to DA. At the same time, lying in the chair, painful feeling after anaesthesia and more treatment needed are risk factors of DA among the cases resulting in dental anxiety.
(2) The prevalence rate of DA is 34.2% in adult patients of Han nationality and 45.0% in Hui nationality, and the difference of prevalence rate between two nationalities has no statistical significance (P>0.05).However, there are significant differences laid in impact factors related to DA. On one hand, the level of dental anxiety is positively correlated to education,indirect trauma dental experience, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed in adult patients of Han nationality, on the other hand, dental anxiety level of Hui nationality adult patients has positive correlation to'my turn', hearing the sound of dental drill and more treatment needed. Interestingly, both of them are negatively correlated to pain tolerance level.
Conclusions:Adult DA is a multifactor associated disease.The results of this study show that patients with DA are more likely to be adult female who have painful direct or indirect trauma dental experience, lower pain tolerance level and higher emotional tension level.Indirect trauma dental experience, pain tolerance level, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed are risk factors of adult DA. The level of dental anxiety is positively correlated to education,indirect trauma dental experience, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed in adult patients of Han nationality, However, dental anxiety level of Hui nationality adult patients has positive correlation to'my turn',hearing the sound of dental drill and more treatment needed. And both of them are negatively correlated to pain tolerance level.
方法：(1)选取229例在口腔科门诊接受牙科治疗的成人患者,采用Corah's牙科焦虑量表和对引起牙科焦虑状态事件的害怕程度问卷,由患者按问卷要求并根据自身感受填写完成,统计分析成人牙科焦虑症的流行情况及相关影响因素。
(2)选取216例汉族和203例回族在口腔科门诊接受牙科治疗的成人患者,采用Corah's牙科焦虑量表和对引起牙科焦虑状态事件的害怕程度问卷,由患者按问卷要求并根据自身感受填写完成。对两组数据进行统计学分析,比较汉族与回族成人牙科焦虑症的患病情况及相关的影响因素。
结果：(1)成人牙科焦虑症患病率为26.6%,DAS平均分值为10.45+3.33。性别、直接牙科经历、间接牙科经历、对疼痛的耐受程度以及心情的紧张程度各组的DA患病率差异有显著统计学意义(P<0.05)；间接牙科经历痛苦、对疼痛的耐受程度低和最恐惧的治疗环节为拔牙的患者更易患牙科焦虑。在引起牙科焦虑状态的事件中,躺上牙椅、麻醉后仍觉疼痛以及需要更多的治疗为牙科焦虑症的危险因素。
(2)汉族与回族牙科焦虑症患病率分别为34.2%和45.0%,但两者差异没有统计学意义(P>0.05)。然而,两民族在牙科焦虑症的相关影响因素方面明显不同,汉族成人患者牙科焦虑水平与文化程度、亲友经历、最恐惧诊疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多治疗呈正相关；而回族成人患者牙科焦虑水平与轮到自己看牙、听到牙钻的声音、需要更多的治疗呈正相关,但二者均与患者对疼痛的耐受程度呈负相关。
结论：成人牙科焦虑症是一种由多因素综合作用引起的疾病,多见于直接和间接牙科经历痛苦、对疼痛的耐受程度较差以及心情很紧张的成年女性。间接牙科经历、对疼痛的耐受程度、最恐惧的治疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多的治疗为牙科焦虑症的危险因素。汉族成人患者牙科焦虑水平与文化程度、亲友经历、最恐惧诊疗环节、躺上牙椅、麻醉后仍觉疼痛以及需要更多治疗呈正相关；而回族成人患者牙科焦虑水平与轮到自己看牙、听到牙钻的声音、需要更多的治疗呈正相关,但二者均与患者对疼痛的耐受程度呈负相关。
Objective:Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied with combination of demographic data. This study aimed to assess the epidemic features of dental anxiety (DA) in adult patients and analyse the relevant factors contributing to adult DA, futher dowse epidemic characteristics and influence factors of DA in adult patients of Han nationality and Hui nationality, thus the results can be used to direct dentists'psychological intervention for DA patients before treatment in order to relieve patients'anxiety and best guarantee the prognosis.
Methods:(1) 229 adult outpatients were selected for the questionnaire survey, Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied. All participants completed the questionnaire according to the requirments and subjective perceptions.Epidemic characteristics and influence factors of DA were statistically analyzed.
(2) 216 adult outpatients of Han nationality and 203 adult outpatients of Hui nationality were selected for the questionaire survey, Corah's Dental Anxiety Scale and fear level questionnaire of situations resulting in dental anxiety were applied. All participants completed the questionaire according to the requirments and subjective perceptions.Both groups were statistically analyzed in order to assess the differences in epidemic characteristics and influencing factors of DA.
Results:(1)The prevalence rate of DA in adult patients is 26.6%.The mean DAS score is 10.45±3.33.Different prevalence rates of DA in groups of sex,direct trauma dental experience, indirect trauma dental experience, pain tolerance level and emotional tension level demonstrate notable statistical significance (P<0.05).Patients with indirect trauma dental experience, low pain tolerance level and who considers tooth extraction is most fearful therapy are prone to DA. At the same time, lying in the chair, painful feeling after anaesthesia and more treatment needed are risk factors of DA among the cases resulting in dental anxiety.
(2) The prevalence rate of DA is 34.2% in adult patients of Han nationality and 45.0% in Hui nationality, and the difference of prevalence rate between two nationalities has no statistical significance (P>0.05).However, there are significant differences laid in impact factors related to DA. On one hand, the level of dental anxiety is positively correlated to education,indirect trauma dental experience, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed in adult patients of Han nationality, on the other hand, dental anxiety level of Hui nationality adult patients has positive correlation to'my turn', hearing the sound of dental drill and more treatment needed. Interestingly, both of them are negatively correlated to pain tolerance level.
Conclusions:Adult DA is a multifactor associated disease.The results of this study show that patients with DA are more likely to be adult female who have painful direct or indirect trauma dental experience, lower pain tolerance level and higher emotional tension level.Indirect trauma dental experience, pain tolerance level, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed are risk factors of adult DA. The level of dental anxiety is positively correlated to education,indirect trauma dental experience, most fearful therapy, lying in the chair, painful feeling after anaesthesia and more treatment needed in adult patients of Han nationality, However, dental anxiety level of Hui nationality adult patients has positive correlation to'my turn',hearing the sound of dental drill and more treatment needed. And both of them are negatively correlated to pain tolerance level.
引文
[1]Akbay Oba A, Dulgergil CT, Sonmez IS.Prevalence of dental anxiety in 7-to 11-year-old children and its relationship to dental caries [J].Med Princ Pract, 2009,18(6):453-457.
[2]Taani DQ, El-Qaderi SS,Abu Alhaija ES.Dental anxiety in children and its relationship to dental caries and gingival condition[J].Int J Dent Hyg, 2005,3(2):83-87.
[3]Weerheijm KL, Veerkamp JS,Groen HJ,et al.Evaluation of the experiences of fearful children at a Special Dental Care Centre[J].ASDC J Dent Child,1999, 66(4):253-257,228.
[4]Corah NL. Development of a dental anxiety scale[J].J Dent Res,1969,48(4):596.
[5]Loggia ML, Schweinhardt P, Villemure C, et al.Effects of psychological state on pain perception in the dental environment[J]. J Can Dent Assoc, 2008,74(7):651-656.
[6]Erten H,Akarslan ZZ, Borumlu E.Dental fear and anxiety levels of patients attending a dentalclinic[J].Quintessence Int,2006,37(4):304-310.
[7]辛伦忠.成人牙科焦虑症及其相关因素的临床研究[J].广东医学,2006,27(12)：1895-1897.
[8]Bissar AR, Oikonomou C, Koch MJ, et al. Dental health, received care, and treatment needs in 11-to 13-year-old children with immigrant background in Heidelberg, Germany[J].Int J Paediatr Dent,2007,17(5):364-370.
[9]Berggren U, Meynert G.Dental fear and avoidance:causes, symptoms, and consequences[J].Am Dent Assoc,1984,109 (2):247-251.
[1]史俊南.现代口腔内科学[M].北京：高等教育出版社,2000：359.
[2]Gatchel RJ, Ingersoll BD, Bowman L,et al.The prevalence of dental fear and avoidance:a recent survey study[J].J Am Dent Assoc.1983,107(4):609-610.
[3]Nicolas E, Collado V, Faulks D, et al.A national cross-sectional survey of dental anxiety in the French adult population[J].BMC Oral Health,2007,7(10):12-18.
[4]于海洋,蔡炜,江帆,等.大学生中牙科恐惧症与人格焦虑症的相关性研究[J].华西口腔医学杂志,2005,23(1)：43-45.
[5]钱明波,袁正林,李曦慧,等.牙科畏惧症的现状调查及相关心理因素分析[J].广东牙病防治,2005,13(1)：30-32.
[6]Kumar S,Bhargav P, Patel A, et al.Does dental anxiety influence oral health-related quality of life? Observations from a cross-sectional study among adults in Udaipur district, India[J].J Oral Sci,2009,51(2):245-254.
[7]Udoye CI, Oginni AO, Oginni FO.Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital[J].J Contemp Dent Pract, 2005,6(2):91-98.
[8]Mehrstedt M, Tonnies S,Eisentraut I. Dental fears, health status, and quality of life[J].Anesth Prog,2004,51(3):90-94.
[9]Erten H, Akarslan ZZ, Bodrumlu E.Dental fear and anxiety levels of patients attending a dental clinic[J].Quintessence Int,2006,37(4):304-310.
[10]辛伦忠.成人牙科焦虑症及其相关因素的临床研究[J].广东医学,2006,27(12)：1895-1897.
[11]Stabholz A, Peretz B.Dental anxiety among patients prior to different dental treatments[J].Int Dent J,1999,49(2):90-94.
[12]Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety[J].Community Dent Health,1996,13(2):86-92.
[13]Hilton IV, Stephen S,Barker JC, Weintraub JA. Cultural factors and children's oral health care:a qualitative study of carers of young children[J].Community Dent Oral Epidemiol,2007,35 (6):429-438.
[14]Bernstein DA, Kleinknecht RA, Alexander LD.Antecedents of dental fear[J].J Public Health Dent,1979,39(2):113-124.
[15]Corah NL. Development of a dental anxiety scale[J].J Dent Res,1969,48(4):596.
[16]Schuurs AH, Hoogstraten J.Appraisal of dental anxiety and fear questionnaires:a review[J].Community Dent Oral Epidemiol,1993,21(6):329-339.
[17]Locker D, Liddell AM. Correlates of dental anxiety among older adults[J].J Dent Res,1991,70(3):198-203.
[18]Kleinknecht RA, Klepac RK, Alexander LD.Origins and characteristics of fear of dentistry[J].J Am Dent Assoc,1973,86(4):842-848.
[19]Moore R, Berggren U, Carlsson SG. Reliability and clinical usefulness of psychometric measures in a self-referred population of odontophobics[J]. Community Dent Oral Epidemiol,1991,19(6):347-351.
[20]Kvale G, Berg E, Nilsen CM, et al.Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample[J].Community Dent Oral Epidemiol, 1997,25(2):160-164.
[21]Gale EN.Fear of the dental situation[J].J Dent Res,1972,51:964-966.
[22]Scott DS,Hirschman R. Psychological aspects of dental anxiety in adults[J].J Am Dent Assoc,1982,104(1):27-31.
[23]Moore R, Br dsgaard I, Abrahamsen R. A 3-year comparison of dental anxiety treatment outcomes:hypnosis, group therapy and individual desensitization vs.no specialist treatment[J].Eur J Oral Sci,2002,110(4):287-295.
[2]Taani DQ, El-Qaderi SS,Abu Alhaija ES.Dental anxiety in children and its relationship to dental caries and gingival condition[J].Int J Dent Hyg, 2005,3(2):83-87.
[3]Weerheijm KL, Veerkamp JS,Groen HJ,et al.Evaluation of the experiences of fearful children at a Special Dental Care Centre[J].ASDC J Dent Child,1999, 66(4):253-257,228.
[4]Corah NL. Development of a dental anxiety scale[J].J Dent Res,1969,48(4):596.
[5]Loggia ML, Schweinhardt P, Villemure C, et al.Effects of psychological state on pain perception in the dental environment[J]. J Can Dent Assoc, 2008,74(7):651-656.
[6]Erten H,Akarslan ZZ, Borumlu E.Dental fear and anxiety levels of patients attending a dentalclinic[J].Quintessence Int,2006,37(4):304-310.
[7]辛伦忠.成人牙科焦虑症及其相关因素的临床研究[J].广东医学,2006,27(12)：1895-1897.
[8]Bissar AR, Oikonomou C, Koch MJ, et al. Dental health, received care, and treatment needs in 11-to 13-year-old children with immigrant background in Heidelberg, Germany[J].Int J Paediatr Dent,2007,17(5):364-370.
[9]Berggren U, Meynert G.Dental fear and avoidance:causes, symptoms, and consequences[J].Am Dent Assoc,1984,109 (2):247-251.
[1]史俊南.现代口腔内科学[M].北京：高等教育出版社,2000：359.
[2]Gatchel RJ, Ingersoll BD, Bowman L,et al.The prevalence of dental fear and avoidance:a recent survey study[J].J Am Dent Assoc.1983,107(4):609-610.
[3]Nicolas E, Collado V, Faulks D, et al.A national cross-sectional survey of dental anxiety in the French adult population[J].BMC Oral Health,2007,7(10):12-18.
[4]于海洋,蔡炜,江帆,等.大学生中牙科恐惧症与人格焦虑症的相关性研究[J].华西口腔医学杂志,2005,23(1)：43-45.
[5]钱明波,袁正林,李曦慧,等.牙科畏惧症的现状调查及相关心理因素分析[J].广东牙病防治,2005,13(1)：30-32.
[6]Kumar S,Bhargav P, Patel A, et al.Does dental anxiety influence oral health-related quality of life? Observations from a cross-sectional study among adults in Udaipur district, India[J].J Oral Sci,2009,51(2):245-254.
[7]Udoye CI, Oginni AO, Oginni FO.Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital[J].J Contemp Dent Pract, 2005,6(2):91-98.
[8]Mehrstedt M, Tonnies S,Eisentraut I. Dental fears, health status, and quality of life[J].Anesth Prog,2004,51(3):90-94.
[9]Erten H, Akarslan ZZ, Bodrumlu E.Dental fear and anxiety levels of patients attending a dental clinic[J].Quintessence Int,2006,37(4):304-310.
[10]辛伦忠.成人牙科焦虑症及其相关因素的临床研究[J].广东医学,2006,27(12)：1895-1897.
[11]Stabholz A, Peretz B.Dental anxiety among patients prior to different dental treatments[J].Int Dent J,1999,49(2):90-94.
[12]Locker D, Shapiro D, Liddell A. Negative dental experiences and their relationship to dental anxiety[J].Community Dent Health,1996,13(2):86-92.
[13]Hilton IV, Stephen S,Barker JC, Weintraub JA. Cultural factors and children's oral health care:a qualitative study of carers of young children[J].Community Dent Oral Epidemiol,2007,35 (6):429-438.
[14]Bernstein DA, Kleinknecht RA, Alexander LD.Antecedents of dental fear[J].J Public Health Dent,1979,39(2):113-124.
[15]Corah NL. Development of a dental anxiety scale[J].J Dent Res,1969,48(4):596.
[16]Schuurs AH, Hoogstraten J.Appraisal of dental anxiety and fear questionnaires:a review[J].Community Dent Oral Epidemiol,1993,21(6):329-339.
[17]Locker D, Liddell AM. Correlates of dental anxiety among older adults[J].J Dent Res,1991,70(3):198-203.
[18]Kleinknecht RA, Klepac RK, Alexander LD.Origins and characteristics of fear of dentistry[J].J Am Dent Assoc,1973,86(4):842-848.
[19]Moore R, Berggren U, Carlsson SG. Reliability and clinical usefulness of psychometric measures in a self-referred population of odontophobics[J]. Community Dent Oral Epidemiol,1991,19(6):347-351.
[20]Kvale G, Berg E, Nilsen CM, et al.Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample[J].Community Dent Oral Epidemiol, 1997,25(2):160-164.
[21]Gale EN.Fear of the dental situation[J].J Dent Res,1972,51:964-966.
[22]Scott DS,Hirschman R. Psychological aspects of dental anxiety in adults[J].J Am Dent Assoc,1982,104(1):27-31.
[23]Moore R, Br dsgaard I, Abrahamsen R. A 3-year comparison of dental anxiety treatment outcomes:hypnosis, group therapy and individual desensitization vs.no specialist treatment[J].Eur J Oral Sci,2002,110(4):287-295.