Dental Anxiety and the Use of Oral Health Services among People Attending Two HIV Primary Care Clinics in Miami

Abstract

A sizable number of patients living with HIV have anxiety associated with obtaining needed dental care. Routine screening for dental anxiety and counseling to reduce dental anxiety are supported by this study as a means of addressing the impact of dental anxiety on the use of oral health services among HIV-positive individuals.

Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART

“…It should be noted that the poor periodontal health and low median nadir CD4 + T cell count of our cohort may both reflect poor access to care. Further, while HAART and/or immune reconstitution may help ameliorate PD, other factors, such as smoking status[23], access to ongoing dental care[30,31,32], dental anxiety[33], psychosocial stress, concomitant medical conditions, oral health literacy[34], oral hygiene skills[35]—and, as per this study, nadir CD4+ T-cell count, may influence the long-term risk for ongoing chronic periodontal disease in this population. …”

Barriers and facilitators to dental care among HIV‐Infected adults

“…Similarly, a 2012 study of HIV primary care patients (n = 444) assessing factors associated with dental anxiety and dental care utilization found that moderate to severe anxiety associated with securing needed dental services was prevalent in this population and resulted in lower odds of utilizing dental services in the prior year, compared to those with moderate or no dental anxiety. 25 Interventions that address dental-related fears and avoidance behaviors while also empowering HIV-positive patients to prioritize their oral health may have a beneficial impact on dental care utilization. 25 Additional psychological issues were also alluded to as barriers to obtaining oral care.…”

“…25 Interventions that address dental-related fears and avoidance behaviors while also empowering HIV-positive patients to prioritize their oral health may have a beneficial impact on dental care utilization. 25 Additional psychological issues were also alluded to as barriers to obtaining oral care. Some expressed hopelessness about living very long with HIV disease and therefore were not particularly motivated to preserve their teeth.…”

“…Longitudinal analysis of the HCSUS data showed that having physical and mental health problems also interfered with the use of dental services 18 In addition, a prospective observational study of HIV‐infected medical clinic attendees found that those of African‐American ethnicity were 1.6 times as likely as Caucasians to have unmet dental care needs; specifically, they were more likely to have loose teeth, need extractions, and be episodic dental care utilizers . Other identified barriers to dental care among HIV‐infected individuals have included having less than a high school education, lack of dental insurance, unstable housing, poorer perceived health status, and severe dental anxiety , …”

Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review

“…1 It is estimated that 10-40% of the population in western countries suffer from dental anxiety. [2][3][4][5][6][7] Much higher rates are seen in some non-western countries (up until 77%). 8 When apprehension towards dental situations is a transitory affective response that follows confrontation with specific dental situations, it is referred to as 'state anxiety'.…”