Minimizing the Vicious Circle of Pain–Anxiety–Avoidance: The Role of Positive Affect in Endodontic Therapy

Abstract

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.

Psychometric Assessment of the Romanian Version of the Index of Dental Anxiety and Fear (IDAF-4C+)

“…The IDAF-4C score was 2.47 for participants with dentures and 1.71 for those without; the difference was statistically significant (p = 0.004). This finding is probably best explained by the fact that dental anxiety is a barrier to seeking dental care with a negative impact on oral health [21], and also that people with a high level of dental anxiety prefer to have their teeth extracted than restored [6,22]. Therefore, it is suggested that people with a high level of dental anxiety are at risk to become wearers of removable prostheses.…”