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AIM: The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment. METHODOLOGY: A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). RESULTS: Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety. CONCLUSIONS: Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

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BACKGROUND: Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment. OBJECTIVES: The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery. MATERIAL AND METHODS: This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure. RESULTS: General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain. CONCLUSIONS: Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.

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Objetivo: A escala Children's Experiences of Dental Anxiety Measure (CEDAM) foi originalmente desenvolvida em Inglês para avaliar importantes aspectos da ansiedade odontológica em crianças. Os objetivos do estudo foram traduzir e realizar a adaptação cultural da CEDAM para o Português Brasileiro. Material e Métodos: A CEDAM consiste de 14 itens, medidos por escala Likert de 3 pontos, que indica a intensidade da ansiedade odontológica. O questionário foi traduzido para o Português Brasileiro, retraduzido para o Inglês, revisado por um Comitê de Especialistas e pré-testado em 10 escolares de oito a doze anos. Resultados: O Comitê Revisor de Especialistas comparou as versões original, traduzida (T1, T2) e retraduzida (BT1, BT2) e recomendou algumas mudanças a fim de obter uma boa compreensão dos itens. No pré-teste, somente a questão 8 não foi compreendida por uma criança, isto é, a versão traduzida foi bem compreendida por mais de 85% dos participantes. Conclusão: A versão brasileira da CEDAM foi culturalmente adaptada para a população avaliada de crianças.(AU)

Objective: The Children's Experiences of Dental Anxiety Measure (CEDAM) was originally developed in English to assess important aspects of dental anxiety for children. The aims of the study were to translate and perform the cultural adaptation of the CEDAM to Brazilian Portuguese. Material and Methods: The CEDAM consists of 14 items, measured by a Likert scale of 3 points, that indicates the intensity of dental anxiety. The questionnaire was translated to Brazilian Portuguese, back-translated to English, reviewed by an Expert Committee and pretested in 10 eight- to twelve-year-old schoolchildren. Results: The Expert Committee Review compared the original, translated (T1, T2) and back-translated (BT1, BT2) versions and recommended some changes in order to achieve good understanding of the items. In the pretest, only question 8 was misunderstood by one child, i.e., the translated version was well-understood by more than 85% of the participants. Conclusion: The Brazilian CEDAM was culturally adapted for the evaluated population of children(AU)

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Abstract This prospective study aims to evaluate dental pain, anxiety, and catastrophizing levels in pregnant women undergoing root canal treatment. Sixty pregnant and non-pregnant women presenting dental pain and an indication for root canal treatment were included in the study. Dental anxiety and catastrophizing were investigated using validated questionnaires. The endodontic intervention was performed, and a numerical scale measured preoperative and postoperative dental pain. The results were analyzed using STATA software 12.0. Unadjusted analyses assessed the association between pregnancy and pain, anxiety, and catastrophizing levels. Multiple linear regression models using 'forward stepwise' entry procedures were used to assess the independent effects of variables on pain scores. The significance level was set at 0.05. Initially, most patients experienced intense dental pain. The levels of dental pain, dental anxiety, and catastrophizing did not differ between pregnant and non-pregnant women. Logistic regression showed that postoperative pain was associated with irreversible pulpitis diagnosis (OR = 4.78; 95%CI 1.55-13.55) and high catastrophizing levels (OR = 1.96; 95%CI 1.01-3.84). Preoperative and postoperative pain rates and anxiety and catastrophizing were similar between pregnant and non-pregnant patients. Postoperative pain was associated with irreversible pulpitis diagnosis and high catastrophizing levels. The similarity between pregnant and non-pregnant women regarding preoperative and postoperative dental pain and catastrophizing and anxiety levels supports the indication of root canal treatment during the gestational period whenever necessary.

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ABSTRACT Objective: To assess children's self-reported distress during dental procedures and investigate risk factors. Material and Methods: A total of 163 children (3-10 years old) were included from a clinical trial on diagnostic strategies for evaluating restorations in primary teeth. Treatment plans were elaborated based on the clinical examination performed at the baseline of the study. Dentists performed 742 dental procedures, and an external evaluator collected children's self-reported distress through the Wong Backer Facial Scale (WBFS) and dentists' opinions about children's behavior during the treatment. Kruskal-Wallis Test was performed to compare the distress and the dentists' perception of the different dental procedures, and multilevel ordered logistic regression analysis was conducted to the evaluate association between explanatory variables and the outcomes. Results: More complex procedures caused more distress in children (p=0.017), with a 5.5 times higher risk than simple operative treatments. Similarly, dentists reported children's worse behavior (p<0.001). Older children (older than 7 years) reported less distress than younger children (OR 0.52; CI 0.30-0.87; p=0.014). Patients reported greater distress in the first consultations, reducing the chance of higher scores by 16% in the next interventions. Conclusion: Children experience higher levels of distress during their first treatment appointments. More complex operative procedures and the child's age below 7 years were risk factors associated with greater distress during dental treatment.

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OBJECTIVES: Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients' anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: "Can music therapy reduce patient's state anxiety during endodontic treatment?". METHODS: A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients' anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool. RESULTS: Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure. CONCLUSIONS: With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety. CLINICAL RELEVANCE: Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.

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OBJECTIVE: To evaluate the influence of dental anxiety on the perception of pain before and during endodontic treatments. MATERIALS AND METHODS: The PRISMA checklist was followed. A search was conducted in Scopus, Medline/PubMed, The Cochrane Library, and Web of Science databases. Based on PECOS criteria, the first outcome was a possible association between pre-operative pain and anxiety. The second outcome was a possible association between intraoperative pain and anxiety. The type of studies was observational. The JBI Critical Appraisal Checklist was used to evaluate the methodological quality of articles. The certainty of the evidence was analyzed using the GRADE approach. RESULTS: Four articles were included with a total of 471 patients. Two studies found a positive association between pain and pre-endodontic treatment anxiety. Three studies investigated the relationship between anxiety and intraoperative pain; two identified an extremely significant positive association. One article noted that anxiety influences pain expectancy. The studies were of good quality as assessed by the JBI Critical Appraisal Checklist for cross-sectional studies. However, the certainty of the evidence was considered low and very low. CONCLUSIONS: Dental anxiety can be directly associated with pre- and intraoperative pain during endodontic procedures. CLINICAL RELEVANCE: It is necessary to identify patients with dental anxiety to employ therapies to bring their anxiety under control, avoiding the increase of endodontic infections, and the postponement and evasion of endodontic treatments.

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AIM: The objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. METHODS: For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). RESULTS: MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. CONCLUSION: No association was found between dental fear and dental hypersensitivity in children with MIH.

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A fobia odontológica afeta considerável parcela da população, a ansiedade e medo frente ao tratamento dentário induzem pacientes ao cancelamento ou adiamento de tratamentos essenciais, agravando assim o seu quadro clínico. As abordagens restauradoras minimamente invasivas preconizam maior preservação dos tecidos dentários, diminuindo o desconforto e dor durante as intervenções. Sob esta ótica o Tratamento Restaurador Atraumático (ART) dispensa o uso das turbinas rotatórias, da anestesia local, do isolamento absoluto e utiliza o Cimento de Ionômero de Vidro de alta viscosidade nas restaurações. A relevância do ART no panorama odontológico e sua ampla utilização nos serviços públicos e privados de assistência bucal justificam a realização desta revisão narrativa de literatura, realizada a partir de artigos publicados nos últimos dois anos, acessados nas bases de dados online Scientific Eletronic Library On-line (SciELO), MEDLINE e LILACS. Esta pesquisa tem como objetivo reconhecer a fobia odontológica e associá-la à indicação do ART assim como definir a efetividade desta proposta de intervenção, colaborando para seu uso de forma criteriosa e adequada.

Dental phobia affects a considerable portion of the population, anxiety and fear regarding dental treatment induce patients to cancel or postpone essential treatments, thus aggravating their clinical condition. Minimally invasive restorative approaches advocate greater preservation of dental tissue, reducing discomfort and pain during interventions. From this perspective, the Atraumatic Restorative Treatment (ART) dispenses with the use of rotating turbines, local anesthesia, absolute isolation and uses high viscosity Glass Ionomer Cement in restorations. The relevance of ART in the dental panorama and its wide use in public and private oral care services justify this narrative literature review, based on articles published in the last two years, accessed in the online databases Scientific Electronic Library On- line (SciELO), MEDLINE and LILACS. This research aims to recognize dental phobia and associate it with the indication of ART, as well as to define the effectiveness of this intervention proposal, contributing to its judicious and appropriate use.

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BACKGROUND: Dental anxiety is a common issue among adolescents. Despite the use of smartphones being an important part of their daily lives, only a few digital-based interventions for dental anxiety have been tested in randomized controlled trials (RCT). AIM: The aim of this study was to evaluate a new smartphone application (App) named FALE, which was designed to demonstrate interest from the dentist to adolescent and to reduce dental anxiety. DESIGN: This is a RCT in which 184 adolescents aged 10-19 years were randomly allocated into the intervention group (IG) or the control group (CG). The intervention was applied in the waiting room before the consultation at a dental clinic. The IG answered the FALE, which contained 14 questions-of which the first and last questions addressed anxiety, whereas the CG answered the question about anxiety twice with an interval between them. RESULTS: There was a significant difference in the distribution of anxiety rating frequencies before and after the intervention period in both groups. For the IG, there was a reduction in anxiety after the intervention of 16.29%, and, in the CG, a reduction of 2.2% (p < .001). CONCLUSION: The FALE App effectively reduced dental anxiety before the appointment.

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