A RELATIONSHIP OF DENTAL FEAR TO OTHER SPECIFIC FEARS LIKE GENERAL FEARFULLNESS , DISGUST SENSITIVITY AND THEIR ASSOCIATION WITH DENTAL CARIES AMONG COLLEGE STUDENTS AGED 18 -25 YEARS OF BANGALORE CITY .
6.BRIEF RESUME OF THE INTENDED WORK: 6.1 NEED FOR THE STUDY
Normal fear is an adaptive response to a real or imagined threat. Fear is adaptive because it warns a person of danger and motivates either escape or avoidance of what is feared.1 Fear is powerful and considerably aversive human emotion2.
Many fears and phobia, particularly those which are chronic, cause distress and impairment over long periods of time, may interfere with growth and development; undermine personality functioning and increase vulnerability to other psychopathology3. Disgust sensitivity refers to the rejection of stimuli that are bodily products or have been contaminated by these products4. Disgust plays an important role in some anxiety disorders and increases the likelihood of individual developing avoidance reactions5.
Despite innovations in dental equipment, treatment procedures, and increased knowledge of dental fear and its consequences, the prevalence of dental fear has been relatively constant during the last 20 years. The most common reasons given by Moore were 1) traumatic dental experiences 2) feelings of powerlessness and lack of control, 3) social learning processes and 4) secondary problems related to other psychological problems. Since one of the superior aims of the dental profession is to help a patient to achieve a high number of functional teeth throughout life, consequently detecting and treating dental fear should therefore be an important aspect of dental professionals work6.. People with high dental fear have poorer oral health and often suffer significant social and psychological impacts associated with their oral state. People with high dental fear or dental phobia may also suffer from a variety of anxiety disorders, personality disorders and behavioral disorder as well as for multiple other specific fears7.
Individual with high dental fear engage in avoidance behavior more frequently than low dental fear group. Individual with high dental fear had significantly higher number of decayed surfaces (DS), decayed teeth (DT) and missing teeth (MT) but a stastically significantly lower number of filled surfaces (FS), filled teeth (FT), functional surfaces (FSS) and functional teeth6.
For this reason the study of anxiety disorders is important. It is hoped that by better understanding these psychopathologies, their causes and correlates, more effective treatment and preventative measures may be discovered2. Thus there is need to investigate further the negative psychological effects of dental fear and anxiety, and to elucidate the characteristics of those who experiences such outcomes3.
REVIEW OF LITERATURE
1) A study was conducted by Locker D. on one hundred and thirty five subjects who were anxious or fearful about dental treatment. At the baseline in 1993 -1994, a four wave mail survey was undertaken of a random sample of adults aged 18years of metropolitan Toronto .The aim of the study was to determine whether the psychological problems reported by these individuals were a function of dental anxiety, more general fearfulness or both. Subjects were divided into low and high general fear groups based on number of other severe fears reported. Anxiety and fear about dental treatment were measured using the Dental anxiety Scale (DAS), the single item used by Milgrom et al and the Gatchel single item dental fear scale. General fear was assessed using a short –form of Fear Survey Schedule (FSS II). Negative psychosocial impacts were assessed using a modified form of scale developed by Kent et al (1996). Statistical analysis was done by using t-test and chi- square test .Linear and logistic regression analysis were undertaken .Those in the high fear group had higher psychosocial impact scores than those in low fear group .The high-fear group had scores indicative of lower self –esteem and lower morale. The author concluded that dental fear and anxiety have pervasive psychological consequences, and that these are more marked among subjects with high levels of general fearfulness.
2) Annemarie A.Schuller , Tiril Willumsen and Dorthe Holst conducted a study in which total of 2051 individuals aged 35years and older were invited and total of 1365 persons participated in the study. Random samples from selected age groups were taken in 1994.Data from Trondelag -94 study were used. The aim of the study was a) To describe the prevalence of dental fear in three age groups (35-44,45-55,and 55-64)in a random sample of the Norwegian population .b)To explore the difference in caries and treatment experience and in number of functional teeth between individuals with high and
low dental fear in the different age groups .c)To explore differences in oral health , oral hygiene and visiting habits between individuals with high and low dental fear . The method comprised of clinical measurement and self administered questionnaire. Dental fear was measured using the Corah dental anxiety scale (DAS).Oral status was described by the number of decayed, filled, missing, and sound teeth and surfaces. Statistical analysis was done using Student’s t-test and Chi –square test. There was a tendency for individuals with high dental fear to engage in avoidance behavior more frequently than low dental fear group. There were no differences in DMFS and DMFT between the age groups of high and low dental fear. The author concluded as aim of dental profession is to help patient to achieve high number of functional teeth throughout life, consequently detecting and treating dental fear should therefore be an important aspect.
3)Peter Muris and Thomas H.Ollendick conducted a cross-sectional study in 551 adolescents aged 12 to 19 years from a regular secondary school in Lanken in 2001. The aim of the study was to assess contemporary fears using a modified version of the Fear Survey Schedule For Children –Revised. Adolescents were asked to complete the set of questionnaire .Half of children first received the Fear Survey Schedule For Children –Hawaii (FSSC –HI)then the State -Trait Anxiety Inventory For Children (STAIC) and finally the SPENCE Children’s Anxiety Scale (SCAS). In other half of children this order was reversed .Statistical analysis was done using SPSS, ANOVA, and exploratory factor analysis .Results showed that a five and seven factor model both provided satisfactory fits for structure of FSSC-HI. Internal consistency of the scale was good and this appeared to be true for the five factor as well as seven factor solution.
4) Haral Merckelbach et al conducted a study which evaluated whether high disgust sensitivity is associated with high levels of blood injection injury (BII) fear. In this study, Study I was conducted in 166 undergraduate volunteers (25 men) aged 19 to 40 years .Subjects completed a set of questionnaires which included the Disgust Sensitivity Questionnaire (DSQ) and two questionnaires measuring BII fear and BII fainting .The main purpose of this study was to examine whether disgust sensitivity and BII fear co-vary in a sample of normal subjects. Study II consisted of 44 undergraduate psychology students aged 18 to 21 years. The aim was whether disgust sensitivity is linked to BII fear in a heterogeneous sample of undergraduate psychology students and dental anxious patients. Undergraduates completed the DSQ, the BII-fear questionnaire, and the Spider Phobia Questionnaire (SPQ).Study III consisted of 36 patients referred to the Dental Fear Department of the Centre for Special Dental Care, University of Amsterdam. The aim of this study was to focus on connection between disgust sensitivity and BII faintness in a sample of dental phobic patient. One week before they received dental treatment, patients were sent a booklet containing questionnaires. Measures included were DSQ, DAS, BII-fear questionnaire, and a short questionnaire. Study I,II,III were subjected to an omnibus analysis of variance (ANOVA) and overall co relational analysis. The
first study found no evidence for a connection between disgust sensitivity and BII fear in a sample of undergraduate students In contrast, the second study did find a significant correlation between disgust sensitivity and BII fear in a mixed sample of dental anxious patients and undergraduate students . The third study relied on a sample of patients with clinical dental phobia .These patients displayed heightened disgust sensitivity scores , no significant association were found between disgust sensitivity and BII fear or fainting . The author concluded that disgust sensitivity plays only minor role in BII-related fears.
5)April Bryington Fischer conducted a crossectional study in 884 students from Republic Of Trinidad and Tobago aged 11-18years of Trinidadian Secondary Schools in the year 2005. The aim of the study was to provide initial evidence for the psychometric properties of the Fear Survey Schedule For Children –II (FSSC-II) of a Trinidadian sample of children and adolescents. The present analysis examined the factor structure of FSSC-II scores of 884 Trinidadian children and adolescents. Factor consistency across age, sex, and nationality was examined by calculating the coefficient of congruence for each pair of conceptually similar factors . Both principal component analysis and common factor analysis were conducted. Results indicated a five factor structure for the overall sample.
6) Armfield JM conducted a study in 2006 on 88 adult undergraduate psychology students in Adelaide ,South Australia of age group 18-53 years .The aim of the study was to determine the relationship between dental fear and personality predispositions of general fearfulness, pain sensitivity and disgust sensitivity .Participants were administered the fear survey schedule III (FSS-III) , the harm sensitivity index and Disgust sensitivity index .Fear of dentists was assessed using the single item from the FSS-III, which asked how much fear people have of dentists. The Harm Sensitivity Index (HSI) was created by combining items from the Pain Sensitivity Index and the Pain Anxiety Symptoms Scale which comprised 16 items measuring feelings about and reactions to pain and danger. The Disgust Sensitivity Scale (DSS) is a modiﬁed 28-item scale measuring 6 domains of disgust elicitors .Principal axis factor analysis with Promax rotation was used to examine how dental fear is related to other specific fears .Dental fear was significantly correlated with other specific fears .The author concluded that dental fear was more related to diverse range of fears relating to loss of control than to medical specific fears .
6.3 AIM AND OBJECTIVES OF THE STUDY:
1. To estimate the dental fear through subjective opinion among study subjects.
2. To assess the specific fears and disgust sensitivity among study subjects using the fear survey schedule and disgust sensitivity index.
3. To correlate estimated dental fear with general fearfulness and disgust sensitivity.
4.To find out association of dental fear to Decayed , Missing, Filled teeth components (DMF-S)
7. MATERIALS AND METHODS: 7.1 SOURCE OF DATA:
A total sample of 300 adults aged 18 -25 years of either gender will be considered for the study. The study subjects will be randomly selected in Bangalore city of Karnataka state, India after obtaining prior permission from the concerned Head of Institution and subjects who are to be examined for the study.
METHOD OF COLLECTION OF DATA / METHOD
A total of 300 college students of age 18 to 25 years will be examined orally at the clinical premises. The study subjects will be examined using a sterile mouth mirror and CPI probe. World Health Organization (WHO) criteria will be used for assessment of decayed (D), missing (M) and filled (F) surface of permanent teeth using WHO Oral Health Assessment Form (1997).
All the examinations will be conducted by a single calibrated examiner and the data will be recorded by a trained assistant accompanying the investigator. The details of oral hygiene practices will be collected in proforma.
INCLUSION CRITERIA 1. College students aged 18-25 years (both male and female) study at Bangalore city.
2. Subjects who fulfill the research criteria and ready to give the written consent to participate in the study will be considered.
1. Subjects not willing to participate in the study.
2. Subjects with any serious systemic diseases not fulfilling the inclusion criteria.
3. Subjects suffering from any acute oral condition limiting examination of teeth.
STUDY DESIGN It is a cross sectional study involving 300 college students, from Bangalore city. A specially designed proforma will be used to collect information on demographic details and variables related to oral hygiene practice.
The duration for the study is estimated to be six months from the date of commencement till the required sample is achieved.
SAMPLE TECHNIQUE: Simple random sampling.
Sample size determination:
n = (Zα/2)2 *P*(1-P)*D / E2
n = number of participants
P = prevalence / proportion
D =design effect. This is taken as 1.
E = error
Zα/2 = confidence interval= 1.96
If, P = .23
E = .05
According to the above given formula, the values are:
In the present study eligible subjects will be considered for inclusion in the investigation.
The present study is a cross-sectional study conducted on a sample of 300 College students (both male and female) aged 18-25 years in Bangalore City , Karnataka State, India. The data will be collected from different colleges until the desired sample is attained. Before the oral examination, written informed consent will be obtained. It will be followed by oral assessment, which includes assessment of dental caries status will be recorded based on the standardized criteria of DMFS index.
Initial calibration: A single examiner will be calibrated to apply the required indices for the present study by the research guide at the department of Public Health Dentistry till the required kappa values obtained for the diagnostic summary.
A pilot study will be conducted on atleast 50 eligible subjects to find out the feasibility and application of methods used in the present study protocol.
The clinical examination will be carried out using WHO Type III method of oral examination using a sterile mouth mirror and CPI Probe under adequate natural day light and when required a battery operated torch will be used (artificial illumination), with the patient seated upright on the ordinary chair.
All the data collected will be subjected to statistical analysis using appropriate statistical application as described above.
The data collected will be analyzed statistically using ratios, means and standard deviations. Presentation of analyzed data is made using tables, graphs and other required figures.
Any other suitable statistical methods if needed, at the time of data analysis will be considered.
7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so please describe briefly.
No, only WHO type III examination, using a mouth mirror and a CPI probe under adequate light will be done.
7.4 Has the ethical clearance obtained from your institution in case of 7.3
Yes Ethical clearance has been obtained from the ethical committee of AECS Maaruti College of Dental Sciences and Research Centre, Bangalore.(Ref.No.AECS/MDC/162/2013-2014)
8. LIST OF REFERENCES:
1. Fisher AB, Schaefer BA, Watkins MW, Worrell FC, Hall TE. The factor structure of The Fear Survey Schedule for Children-II in Trinidadian children and adolescents. J Anxiety Disord 2006,20: 740–59.
2. Armﬁeld JM. Cognitive vulnerability: a model of the etiology of fear. Clin Psychol Rev 2006, 26:746–768.
3. Locker D. Psychosocial consequences of dental fear and anxiety. Community Dent Oral Epidemiol 2003, 31:144–51.
4. Merckelbach H, Muris P, de Jong PJ, de Jongh A. Disgust sensitivity, blood-injection-injury fear, and dental anxiety.1999,6:275–85.
5. Bunmi Olatunji. Intoduction to the special series:Disgust Sensitivity in anxiety disorders. Journal ofbehavior therapy and experimental psychiatry 2006, 37:1-3.
6)Schuller AA, Willumsen T, Holst D. Are there differences in oral health and oral health behavior between individuals with high and low dental fear? Community Dent Oral Epidemiol 2003,31:116–217
7) Jason M.Armfield .A preliminary investigation of the relationship of dental fear to other specific fears , general fearfulness , disgust sensitivity and harm sensitivity. Community dent oral epidemiol 2008,36:128-136.
9.SIGNATURE OF THE
10. REMARKS OF THE GUIDE
The present research topic is clinically relevant and results of the study would help to understand relationship of dental fear to general fearfulness and disgust sensitivity and its association with dental caries among college students aged 18-25years.
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
Dr. H. L. JAYAKUMAR.
PROFESSOR & HEAD OF THE DEPARTMENT,
DEPARTMENT OF PUBLIC HEALTH DENTISTRY,
A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES AND RESEARCH CENTRE, BANGALORE-76.
11.5 HEAD OF THE DEPARTMENT
Dr. H. L. JAYAKUMAR,
PROFESSOR & HEAD OF THE DEPARTMENT,
DEPARTMENT OF PUBLIC HEALTH DENTISTRY,
A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES AND RESEARCH CENTRE, BANGALORE-76.