Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults.
Background: Pain anticipation has been identified as a predictor of pain and avoidance with respect to endodontic therapy. Self-efficacy is also key to the development and maintenance of health behaviors and achieve patient adherence to treatment. However, the role of self-efficacy has not been studied yet in endodontic treatment. Methods: This study was conducted on 101 patients who needed root canal therapy. They had to fill a questionnaire before treatment registered pain anticipation and self-efficacy; during and after treatment were registered pain intensity and avoidance. Results: Pain anticipation explained pain during (Beta = 0.51, t = 5.82, p ≤ 0.001, [0.34, 0.69]) and after treatment (Beta = 0.38, t = 4.35, p ≤ 0.001, [0.21, 0.55]). Self-efficacy did not have an influence in pain values. Pain anticipation explained avoidance during (Beta = 0.51, t = 3.60, p ≤ 0.001, [0.23, 0.80]) and after treatment (Beta = 0.62, t = 4.29, p ≤ 0.001, [0.33, 0.91]). Self-efficacy had a significant role in avoidance during treatment (Beta = 0.12, t = 2.19, p ≤ 0.03, [0.01, 0.23]) with a strong moderation relationship between pain anticipation and avoidance when self-efficacy was medium (Beta = 0.44, t = 3.24, p = 0.002, [0.17, 0.72]) or high (Beta = 0.84, t = 3.5, p ≤ 0.001, [0.37, 1.33]). Self-efficacy was not significant respect to avoidance after treatment. Conclusions: Self-efficacy is an important variable in endodontic therapy due to their moderating effect between pain anticipation and avoidance behavior during the procedure. It is necessary to improve the results of root canal therapy and reduce patient’s avoidance in order to take into account this variable.
Patients with a high level of anxiety anticipate extremely intense pain during dental treatment and frequently avoid visiting dentists, showing a tendency to become caught in a vicious circle of pain–anxiety–avoidance. This research aimed to examine whether dental anxiety mediates the impact of pain anticipation before endodontic treatment in the subjective avoidance of future treatments as a function of positive affect (moderating variable). One hundred consecutive patients that required endodontic therapy were enrolled in this study. In this prospective observational study, patients had to fill out a questionnaire twice: (a) first, prior to treatment (a baseline measurement including pain anticipation, MDAS (dental anxiety), PANAS (positive affect), ASA-PS (physical health), previous medication, an assessment form, and pulpal/periapical status); (b) second, once treatment had ended, the patients were registered for subjective avoidance and their number of canals of treated teeth. The results showed a significant correlation between pain anticipation, dental anxiety, and subjective avoidance; furthermore, the index of the association between pain anticipation and dental anxiety was diminished at higher levels of positive affect. In conclusion, there does not seem to be a direct and deterministic association between pain anticipation, dental anxiety, and subjective avoidance, but rather this relationship would depend on the possible influence of the personality variables of the patients.
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