Publications by authors named "Johan Hoogstraten"

52 Publications

Management recommendations for invasive dental treatment in patients using oral antithrombotic medication, including novel oral anticoagulants.

Oral Surg Oral Med Oral Pathol Oral Radiol 2013 Dec 11;116(6):709-16. Epub 2013 Oct 11.

Assistant Professor and Director of Medicine, Clinic for Medical-Dental Interaction, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands. Electronic address:

Objective: The aims were (1) to search the scientific literature from 2007 to 2012 for guidelines and new studies on the dental management of patients using oral antithrombotic medication; (2) to summarize the articles' evidence and recommendations; and (3) to propose an updated clinical practice guideline for general dentists.

Study Design: A systematic literature search in MEDLINE, Embase, and the Guideline websites, from October 2007 to October 2012, produced articles that were critically evaluated.

Results: The systematic literature search for guidelines yielded 74 citations (MEDLINE, 45; Embase, 22; and the Guideline websites, 7). Of these, only 2 guideline publications and 2 systematic reviews met the inclusion criteria. They yielded 32 recommendations.

Conclusions: The evidence and subsequent recommendations from published guidelines all point in the same direction: do not interrupt oral antithrombotic medication, not even dual antiplatelet therapy, in simple dental procedures.
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http://dx.doi.org/10.1016/j.oooo.2013.07.026DOI Listing
December 2013

Pain related to mandibular block injections and its relationship with anxiety and previous experiences with dental anesthetics.

Oral Surg Oral Med Oral Pathol Oral Radiol 2012 Nov 23;114(5 Suppl):S114-9. Epub 2012 Jan 23.

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.

Objective: Anesthetic injections should reassure patients with the prospect of painless treatment, but for some patients it is the main source of their fear. We investigated pain resulting from mandibular block injections in relation to anxiety and previous experience with receiving injections.

Study Design: Patients (n = 230) filled out questionnaires before oral surgery. They were then asked to raise their hand when they felt pain as a result of the injection. The injection was administered, and pain intensity (11-point numeric rating scale) and pain duration (in seconds) was measured.

Results: In general, patients expected (mean 4.2, SD 2.7) significantly more pain than they experienced (2.4 ± 2.2). About 8.3% of patients reported a score in the range of 7 to 10. On average, pain lasted for 6.2 seconds (range 1-24.5 s), ≈ 36% of patients raised their hand for ≤ 2 seconds, and 14.6% raised their hand for ≥ 10 seconds. Pain was significantly positively associated with anxiety and the way previous injections were experienced.

Conclusions: Mandibular block injections can be considered to be mildly painful, with pain lasting only a few seconds. The pain experience of a mandibular block seems only partly dependent on experienced anxiety and previous experiences with receiving injections.
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http://dx.doi.org/10.1016/j.oooo.2011.08.006DOI Listing
November 2012

Treating dental patients who use oral antithrombotic medication: a survey of dentists in the Netherlands.

J Am Dent Assoc 2011 Dec;142(12):1376-82

Department of Oral and Maxillofacial Surgery, Medical-Dental Interaction, Academic Center for Dentistry, Gustav Mahlerlaan 3004, room 12N41, 1081 LA Amsterdam, the Netherlands.

Background: For many years, international guidelines have advised health care professionals not to adjust oral antithrombotic medication (OAM) regimens before invasive dental procedures. The authors conducted a study to examine the opinions of Dutch general dentists regarding the dental care of patients receiving treatment with these medications.

Methods: The authors invited via e-mail 1,442 general dentists in the Netherlands to answer a 20-item Internet-based questionnaire that they developed. Survey items consisted of questions about medical history taking, number of patients in the dental practice receiving OAM therapy, frequency of consulting with medical and dental colleagues and suggested dental treatment of patients during various invasive dental procedures.

Results: A total of 487 questionnaires were returned (response rate of 34 percent). The mean age of respondents was 47 years, and 77 percent were male. The majority of dentists responded that they obtain medical histories, but that they did not know how many of their patients were receiving OAM treatment. Dentists reported that they consult with medical colleagues frequently about antithrombotic medication. Ninety-one percent of respondents stated that they obtained their medical knowledge primarily in dental school. More than 50 percent of the dentists reported that they were not familiar with the international normalized ratio. The majority of dentists responded that they felt a need for clinical practice guidelines.

Conclusions: According to the results of our survey, most dentists remain cautious when performing invasive dental procedures in patients who are treated with OAMs. Moreover, survey respondents tended to estimate that the risk of bleeding during dental procedures when OAM therapy is continued is higher than the risk of rethrombosis when use of antithrombotic medication is interrupted.

Clinical Implications: A growing proportion of elderly patients and those with medically complex conditions are being treated in dental practices in the Netherlands. Consequently, more needs to be done to ensure that dentists are offered evidence-based guidance when treating patients who receive OAMs.
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http://dx.doi.org/10.14219/jada.archive.2011.0139DOI Listing
December 2011

The structure of common fears: comparing three different models.

Am J Psychol 2011 ;124(2):141-9

Department of Behavioural Sciences, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, The Netherlands.

Previous studies showed discrepant findings regarding the factor structure of common fears. The purpose of the present study was to expand on these findings and contribute to the development of a descriptive framework for a fear classification. Using data from the Dutch general population (n = 961; 50.9% women), an exploratory factor analysis was performed to delineate the multidimensional structure of 11 common fears previously used in a factor analytic study by Fredrikson, Annas, Fischer, and Wik (1996). An independent sample (n = 998; 48.3% women) was used to confirm the newly derived model by means of confirmatory factor analysis. In addition, the model was tested against the DSM-IV-TR model and a model found earlier by Fredrikson et al. (1996). Although support was found for a 3-factor solution consisting of a blood-injection-injury factor, a situational-animal factor, and a height-related factor, confirmatory factor analysis showed that this 3-factor model and the DSM-IV-TR 4-factor model fitted the data equally well. The findings suggest that the structure of subclinical fears can be inferred from the DSM classification of phobia subtypes and that fears and phobias are two observable manifestations of a fear response along a continuum.
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http://dx.doi.org/10.5406/amerjpsyc.124.2.0141DOI Listing
September 2011

Instrument-order effects: using the Oral Health Impact Profile 49 and the Short Form 12.

Eur J Oral Sci 2011 Feb;119(1):69-72

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

Whereas it is well known that the ordering of items can influence research outcomes considerably, very little literature addresses instrument-order effects. Therefore, the aim of this study was to evaluate the effect of changing the administrative order of the Short-Form-12 (SF-12) and the Oral Health Impact Profile-49 (OHIP-49). It was hypothesized that if the SF-12 was administered first, the results would show poorer scores on the SF-12 subscales, as responses would not be restrained to only the oral impacts described by the OHIP-49. Using the Mann-Whitney U-test no significant instrument-order effects were found, except for the Psychological discomfort scale of the OHIP-49, where subjects scored higher when receiving the OHIP-49 first. However, the effect size was negligible (-0.08). These results suggest that no instrument-order effects occurred. Nonetheless, more research dealing with different instruments is needed. This study was performed within a dental setting and we recommend that instrument-order effects should be studied outside this domain.
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http://dx.doi.org/10.1111/j.1600-0722.2010.00796.xDOI Listing
February 2011

Value of bitewing radiographs for detecting approximal caries in 6-year-old children in the Netherlands.

Int J Paediatr Dent 2010 Sep 2;20(5):336-40. Epub 2010 Jun 2.

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry, Amsterdam, The Netherlands.

Background: When diagnosing caries using clinical judgment only, the prevalence of approximal caries is highly underestimated. Yet, surveys on this topic predominantly included adolescents and young adults.

Aim: To determine the additional diagnostic value of bitewing radiographs in 6-year-old children and to detect approximal dentin caries in the primary dentition.

Design: A total of 50 children were assessed both clinically (dmfs, oral hygiene) and radiographically by two experienced dentists. The relation between dmfs-scores and amount of plaque was established using Pearson's correlation coefficients at a significance level of 0.05.

Results: In nine patients (18%) it was impossible to make radiographs. Bitewing radiography appeared to have an additional effect of 97% when only caries in dentin is considered. The additional value for detecting inadequate restorations was 600%. Furthermore, the dmfs was highly correlated to the amount of plaque found.

Conclusion: Although not possible to achieve in all 6-year-old children, bitewing radiographs can reveal a considerable amount of carious surfaces and inadequate restorations, which appear clinically sound or adequate.
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http://dx.doi.org/10.1111/j.1365-263X.2010.01058.xDOI Listing
September 2010

Patients' and parents' expectations of orthodontic treatment.

J Orthod 2009 Dec;36(4):219-28

ACTA, Amsterdam, The Netherlands.

Objective: To investigate the expectations of children and their primary care-givers towards orthodontic treatment and to compare the results with those of a UK sample.

Design: A questionnaire survey of children and their primary care-givers attending for their first consultation.

Setting: The Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands.

Subjects And Methods: A total of 168 subjects (84 patients and 84 parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and parents and differences between boys and girls were examined using parametric statistical methods. The data from the Dutch sample were compared with a similar UK sample.

Results: Patients and parents shared similar expectations of orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with orthodontic treatment.

Conclusions: Since the expectations of patients and their parents differ on several aspects, effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis that Dutch patients' and parents' expectations of orthodontic treatment differ from the expectations of English patients and parents was supported.
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http://dx.doi.org/10.1179/14653120723247DOI Listing
December 2009

Model specification in oral health-related quality of life research.

Eur J Oral Sci 2009 Oct;117(5):481-4

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

The aim of this study was to analyze conventional wisdom regarding the construction and analysis of oral health-related quality of life (OHRQoL) questionnaires and to outline statistical complications. Most methods used for developing and analyzing questionnaires, such as factor analysis and Cronbach's alpha, presume psychological constructs to be latent, inferring a reflective measurement model with the underlying assumption of local independence. Local independence implies that the latent variable explains why the variables observed are related. Many OHRQoL questionnaires are analyzed as if they were based on a reflective measurement model; local independence is thus assumed. This assumption requires these questionnaires to consist solely of items that reflect, instead of determine, OHRQoL. The tenability of this assumption is the main topic of the present study. It is argued that OHRQoL questionnaires are a mix of both a formative measurement model and a reflective measurement model, thus violating the assumption of local independence. The implications are discussed.
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http://dx.doi.org/10.1111/j.1600-0722.2009.00650.xDOI Listing
October 2009

Preparatory information for third molar extraction: does preference for information and behavioral involvement matter?

Patient Educ Couns 2010 Apr 18;79(1):94-9. Epub 2009 Aug 18.

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, The Netherlands.

Objective: The objectives of the present study were to: (1) evaluate the impact of high versus low information provision in terms of anxiety towards third molar extraction (TME) as well as satisfaction with information provision. (2) Investigate how preference for information and behavioral involvement, interacted with the provision of information in terms of satisfaction with information and anxiety related to TME.

Methods: Psychology freshmen completed the Krantz Health Opinion Survey and questions concerning anxiety about TME (pretest). They were randomly allocated into 2 conditions and asked to read either high or low information concerning TME. A posttest questionnaire (anxiety items and evaluation of the information) was then completed.

Results: Data for 320 subjects were analysed (mean age=20.3, S.D.=4.0, range 16-51 years). Individual differences in preference for information did not affect outcome variables. There was a clear effect for information condition. The high information text was rated as more informative, requiring less additional information, and led to higher satisfaction by all participants.

Conclusion: Results suggest that more information is preferred, even when taking into account differences in preference for information and behavioral involvement.

Practice Implications: Although more work is needed within samples of actual TME patients, these preliminary findings may have important implications for information provision for this common procedure.
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http://dx.doi.org/10.1016/j.pec.2009.07.013DOI Listing
April 2010

Young children's Oral Health-Related Quality of Life and dental fear after treatment under general anaesthesia: a randomized controlled trial.

Eur J Oral Sci 2009 Jun;117(3):273-8

Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

During the past decade the research interest in Oral Health-Related Quality of Life (OHRQoL) has been prospering. This study was performed to test (using a randomized controlled trial design) the hypothesis that young children's OHRQoL improves after oral rehabilitation under general anaesthesia (GA). A further aim of this study was to explore whether dental fear also changes. One-hundred and four children (54 boys; mean age 4.08 yr, standard deviation = 1.09), who had been referred to a specialized clinic in paediatric dentistry, were randomly assigned, based on a Solomon four-group design, to two treatment (GA) and two control conditions. The Early Childhood Oral Health Impact Scale (ECOHIS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) were used to assess OHRQoL and dental fear, respectively, before and after the rehabilitation procedures. A 2 x 2 analysis of variance revealed that the total ECOHIS score after GA was more positive in the GA group than in the control group. There was no effect found of the pre-test and there was also no interaction between the pre-test and treatment. In the total CFSS-DS scores no effects were found. The results of this study showed that the child's OHRQoL improved after treatment under GA. Furthermore, children need guidance in reducing dental fear after treatment under GA.
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http://dx.doi.org/10.1111/j.1600-0722.2009.00627.xDOI Listing
June 2009

Anxiety and pain during dental injections.

J Dent 2009 Sep 27;37(9):700-4. Epub 2009 May 27.

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.

Objectives: The aim of this study was to study the relationship between anxiety and pain felt during a dental injection in a sample of 'normal' patients about to undergo 'invasive' dental treatment.

Methods: Duration and intensity of pain during a dental injection were measured within a sample of 247 patients. In addition, data on dental anxiety, fear of dental pain, type of treatment, amount of anesthetic fluid, injection location and the use of surface anesthesia were also collected.

Results: Anxious patients felt more pain and of longer duration than less anxious patients. 28% of variance on the duration of pain felt could be accounted for by fear of dental pain, the use of surface anesthesia and gender. For the intensity of pain felt, 22% of variance could be accounted for by anxiety felt for the injection and dental anxiety.

Conclusions: Pain felt during dental injections is dependent on dental anxiety, fear of dental pain, fear for the injection, gender and amount of injection fluid (rather than the use of surface anesthesia). In other words, some patients are expected to feel elevated levels of pain during dental injection and would benefit from extra attention and care from the dentist.
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http://dx.doi.org/10.1016/j.jdent.2009.05.023DOI Listing
September 2009

Dental management of patients using antithrombotic drugs: critical appraisal of existing guidelines.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 May;107(5):616-24

Clinic for Medical-Dental Interaction, Academic Center for Dentistry (ACTA), Amsterdam, The Netherlands.

Objectives: The aims were: 1) to identify the guidelines available for management of dental invasive procedures in patients on antithrombotic drugs; 2) to assess their quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument; and 3) to summarize their conclusions and recommendations.

Study Design: Systematic literature search for guidelines in several electronic databases. Retrieved guidelines were evaluated with the AGREE instrument for quality assessment.

Results: The systematic search yielded 93 results, of which only 4 were evidence-based practice guidelines. Two of these guidelines could be recommended for clinical use on the basis of the AGREE instrument. These 2 guidelines drew 68 conclusions from the existing literature and provided 58 recommendations.

Conclusions: Two evidence-based clinical practice guidelines, satisfactorily fulfilling the criteria of the AGREE instrument and both published in 2007, advise to not routinely discontinue antiplatelet and anticoagulation medication before dental surgery. The majority of the recommendations, however, were not sufficiently linked to levels of evidence.
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http://dx.doi.org/10.1016/j.tripleo.2009.01.038DOI Listing
May 2009

Prevalence of dental fear and phobia relative to other fear and phobia subtypes.

Eur J Oral Sci 2009 Apr;117(2):135-43

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, Louwesweg 1, Amsterdam, the Netherlands.

The purpose of the present study was to estimate the point prevalence of dental fear and dental phobia relative to 10 other common fears and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR subtypes of specific phobia. Data were also analysed to examine differences with regard to severity, presence of distressing recollections of fear-related events, gender, and prevalence across age. Data were obtained by means of a survey of 1,959 Dutch adults, 18-93 yr of age. Phobias were assessed based on DSM-IV-TR criteria, whereas severity of present fears was assessed using visual analogue scales. The prevalence of dental fear was 24.3%, which is lower than for fear of snakes (34.8%), heights (30.8%), and physical injuries (27.2%). Among phobias, dental phobia was the most common (3.7%), followed by height phobia (3.1%) and spider phobia (2.7%). Fear of dental treatment was associated with female gender, rated as more severe than any other fear, and was most strongly associated with intrusive re-experiencing (49.4%). The findings suggest that dental fear is a remarkably severe and stable condition with a long duration. The high prevalence of dental phobia in the Netherlands is intriguing and warrants investigation in other countries.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00602.xDOI Listing
April 2009

Burnout development among dentists: a longitudinal study.

Eur J Oral Sci 2008 Dec;116(6):545-51

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam/Vrije Universiteit, Amsterdam, The Netherlands.

Knowledge on the development of burnout among dentists is important for purposes of prevention and intervention. Using a two-wave longitudinal design, this study examined the chronological sequence of the three dimensions of the Maslach Burnout Inventory: emotional exhaustion; depersonalization; and personal accomplishment. Structural Equation Modelling was employed among a representative sample of Dutch dentists to examine the fit of several models proposed in earlier research. The results indicated that a model in which emotional exhaustion precedes depersonalization, which in turn precedes personal accomplishment, shows an adequate fit among dentists. However, an alternative model, in which personal accomplishment precedes emotional exhaustion, had an even better fit. In addition to the test of these a priori models, an ad hoc model was constructed that best fitted the current data. This model indicated emotional exhaustion to precede the development of depersonalization and personal accomplishment independently. Although not univocal, the results showed that emotional exhaustion should not be discarded as an early sign of burnout. This is in line with the view that emotional exhaustion can be considered as the key dimension of burnout.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00584.xDOI Listing
December 2008

Dutch primary schoolchildren's attitudes toward their dental appearance.

Pediatr Dent 2008 Sep-Oct;30(5):439-42

Department of Orthodontics, Academic Centre of DentistryAmsterdam (ACTA), The Netherlands.

Purpose: This study's purpose was to examine children's attitudes toward dental appearance and compare these with attitudes toward general health, body shape, grades in school, friends, money, and sports. The study also explored whether subjects reporting that they have attractive teeth believed themselves to have higher grades in school, more friends, a slim body shape, and better health than subjects reporting that they have unattractive teeth.

Methods: A sample of 216 9- to 13-year-old Dutch children participated. The methods of paired comparisons and direct ranking were used to investigate children's judgments about the importance of dental appearance. The subjects were also asked to indicate how strongly they believed that they had high grades in school, a lot of friends, money, success in sports, attractive teeth, a slim body shape, and good health.

Results: High grades in school, a slim body shape, good health, a lot of friends, and more money were preferred to attractive teeth. Children reporting that they have attractive teeth believed themselves to have higher grades in school, a slimmer body shape, more friends, more money, and better health than children reporting that they have unattractive teeth.

Conclusions: Although attractive teeth are highly valued in general, children give priority to other issues in their lives.
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December 2008

Linking oral health, general health, and quality of life.

Eur J Oral Sci 2008 Oct;116(5):445-50

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.

The aim of this work was to assess the association among oral health, general health, and quality of life (QoL). The Oral Health Impact Profile (OHIP-49) and the RAND-36 were distributed amongst 118 psychology freshmen. Additionally, two single items self-rated general health (SRGH) and self-rated oral health (SROH) - were administered. Kruskal-Wallis and Mann-Whitney U-tests were used to evaluate differences between SRGH and SROH categories, regarding OHIP subscale scores and RAND subscale scores. More than 75% of the subjects rated their oral and general health as good. Mean OHIP scores and RAND scores indicated a relatively good oral- and general health-related QoL respectively. The correlation between oral and general health was weak. Significant differences were found between SRGH categories regarding RAND subscale scores, except for the 'role emotional' and 'mental health' subscales. Significant differences were also found between SROH categories regarding OHIP subscale scores, except for the 'psychological disability' subscale. However, no significant differences were found between SRGH categories regarding OHIP subscale scores, or between SROH categories regarding RAND subscale scores. The findings suggest that oral health, general health, and QoL have different determinants. Furthermore, oral health and general health appear to be mostly unrelated in this seemingly healthy population. It is proposed that if no apparent disease is present, oral and general health must be regarded as separate constructs.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00564.xDOI Listing
October 2008

The Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ): a measure of severity of exposure to distressing dental events.

Eur J Oral Sci 2008 Aug;116(4):353-61

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Louwesweg, EA Amsterdam, the Netherlands.

To understand the development of dental anxiety better and to identify those at increased risk of developing dental anxiety, the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ) was developed. The aim of the current study was to determine the psychometric properties (i.e. factor structure, reliability, and validity) of the LOE-DEQ and to determine its suitability as an additional screening instrument for dentally anxious patients. Five different samples were used: (i) highly dentally anxious patients (n = 119); (ii) general dental patients (n = 480); (iii) students (n = 186); (iv) psychiatric outpatients (n = 17); and (v) oral surgery patients (n = 34). Results of the factor analysis revealed a four-factor solution. The LOE-DEQ has sufficient internal consistency (Cronbach's alpha values ranging from 0.69 to 0.85) and satisfactory test-retest reliability (intraclass correlation coefficient = 0.78). The results further suggest that this instrument has adequate discriminant, concurrent, and predictive validity. It is concluded that the LOE-DEQ is a useful tool for assessing patients' background in terms of previous exposure to distressing dental events, which is considered a vulnerability factor in the development of dental anxiety.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00542.xDOI Listing
August 2008

Item-order effects in the Oral Health Impact Profile (OHIP).

Eur J Oral Sci 2008 Jun;116(3):245-9

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.

Items and subscales in quality of life questionnaires generally have a part-whole combination, making the content of one item more general than another. Consequently, order effects can occur. The aim of this study was to evaluate the effect of changing the item order of the Oral Health Impact Profile (OHIP). Two versions of the OHIP were randomly distributed amongst psychology freshmen. Subjects who filled out the version in which more general items were presented first showed higher subscale scores. Using the Mann-Whitney U-test, small, but statistically significant, differences between the two versions of the OHIP were found on the Psychological disability scale, the Social disability scale, and the Handicap scale. Subscale intercorrelations of both versions of the OHIP were compared to investigate whether item order also influences the factor structure. Statistically significant differences between subscale intercorrelations were found, indicating a different factor structure for both versions. In conclusion, the OHIP seems to be susceptible to order effects, implying that the original item order of the OHIP should be upheld, especially when considering comparing research outcomes with other studies.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00532.xDOI Listing
June 2008

On the severity of impacts captured by the dimensions of the Oral Health Impact Profile.

Eur J Oral Sci 2008 Apr;116(2):153-6

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

The Oral Health Impact Profile (OHIP), containing seven dimensions, is based on a hierarchical model. Therefore, one could argue that events described by dimensions higher in the hierarchy are judged as having a more severe impact on quality of life than events described by dimensions lower in the hierarchy. The aim of this study was to test this assumption and to assess the relative severity of impact on daily life with which each dimension is judged relative to all other dimensions. The subjects were psychology freshmen. Subjects' judgments were assessed using the method of direct ranking and the method of paired comparison. The results showed differences between dimensions, with Handicap and Psychological disability being regarded as having the most severe impact on daily life. The results demonstrated the tenability of Locker's hierarchical model as the foundation of the OHIP, in that subjects rank the dimensions in a similar order of severity as intended by this model. It is suggested that the difference of the severity of impact should be compensated for, either by including subscale weights or by increasing the number of items of subscales where the impact on Quality of Life (QoL) is judged as being more severe.
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http://dx.doi.org/10.1111/j.1600-0722.2008.00523.xDOI Listing
April 2008

Confirmative factor analysis of the dimensions of the Child Oral Health Impact Profile (Dutch version).

Eur J Oral Sci 2008 Apr;116(2):148-52

Department of Orthodontics, Academic Centre for Dentistry Amsterdam ACTA, The Netherlands.

The aim of this study was to examine the subscales of the Child Oral Health Impact Profile (COHIP). The Dutch version of the COHIP consists of the subscales 'Oral Symptoms', 'Functional Well-being', 'Emotional Well-being', 'School', and 'Peer Interaction'. The questionnaire was administered to a sample of 510 children in Amsterdam. Missing data were replaced with the personal mean. Subsequently, questionnaire reliability was investigated by means of corrected item-total correlations and Cronbach's alpha if-item-deleted. Based on these results, six items were excluded from further analysis. Then, the questionnaire and its subscales were examined using confirmative factor analyses. One-factor models were fitted on each subscale and a five-factor model was applied to the entire questionnaire. In several cases, model fit was below an acceptable level. In conclusion, the structure of five subscales does not seem to be entirely supported in this study population.
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http://dx.doi.org/10.1111/j.1600-0722.2007.00515.xDOI Listing
April 2008

Positive engagement and job resources in dental practice.

Community Dent Oral Epidemiol 2008 Feb;36(1):47-54

Department of Social Dentistry & Behavioural Sciences, Academic Centre for Dentistry Amsterdam, Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.

Objectives: The aim of this study is to determine the level of engagement among dentists, and subsequently, to investigate which dental job resources are positively correlated with engagement.

Methods: By stratifying on gender, age, and region, a representative sample of 848 general dental practitioners was drawn at random, plus an extra group of 95 female dentists for gender comparison purposes. Engagement was assessed using the Utrecht Work Engagement Scale (UWES), consisting of three subscales: Vigor, Dedication; and Absorption. Job resources were measured using the Dentists' Experienced Job Resources Scale (DEJRS).

Results: Six hundred and thirty two dentists (67%) responded, 76% male and 25% female. Mean age: 44.6 years (SD = 9.0). Engagement: Dedication and Absorption mean scores were higher among dentists when compared with manual norm scores, based upon a variety of professions, whereas Vigor mean scores were comparable to manual norm scores. Job resources:'Immediate results / Aesthetics' and '(Long term) Patient results' showed highest mean scores among all dentists. Gender differences were found on '(Long term) Patient results' and 'Patient care'. Engagement and job resources: All DEJRS subscales and the full scale showed statistically significant positive correlations (pmcc) with the UWES subscales.

Conclusion: Dentists showed relatively high mean scores on an engagement measure when compared with manual norm scores. No gender differences in mean scores were found. Job resources most valued were 'Immediate results / Aesthetics'. The job resources, 'Idealism/Pride' and 'Patient care', showed most predictive value with regard to engagement among dentists. In order to prevent burnout, it is recommended to raise dentists' awareness of the importance to create sufficient time and space for stimulating aspects in their work.
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http://dx.doi.org/10.1111/j.1600-0528.2007.00350.xDOI Listing
February 2008

Comparing subjective and objective measures of headgear compliance.

Am J Orthod Dentofacial Orthop 2007 Dec;132(6):801-5

Department of Social Dentistry and Behaviorial Sciences and Department of Orthodontics, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Introduction: Many studies have used subjective measures to examine patient compliance during orthodontic treatment. Objective measurement of compliance has been confined to only a few studies that used electronic timing devices built into removable appliances. Our aim in this study was to compare subjective and objective methods of measuring compliance with headgear wear. It was hypothesized that orthodontists, patients, and patients' parents overestimate compliance and report more wearing hours than the headgear timers indicate. Also, relationships between sex, age, treatment time, and headgear compliance were explored.

Methods: A headgear timer device and 3 questionnaires were developed to assess compliance. The subjects were unaware that their headgear use was being measured.

Results: Significant differences between the estimates of orthodontists, patients, parents, and headgear timer scores were found. Also, there were differences regarding age and treatment time.

Conclusions: Subjective measures might result in overestimation of compliance. This suggests that the use of an objective instrument to measure headgear compliance should be continued in future studies.
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http://dx.doi.org/10.1016/j.ajodo.2006.01.041DOI Listing
December 2007

Children's self-reported pain at the dentist.

Pain 2008 Jul 26;137(2):389-394. Epub 2007 Nov 26.

University of British Columbia, Department of Psychology, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4 Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, The Netherlands University of Amsterdam, Department of Psychological Methods, The Netherlands.

The aim of the present study is to get an insight into the pain report of children over two sequential dental visits. Furthermore, it was studied whether age, previous dental experience, level of dental anxiety and injection site were of influence on the self-reported pain of children during the first and second treatment session. One hundred and forty-seven children (4-11 years old) were included in the study. After receiving a local anesthesia injection prior to their dental treatment, they were asked how much pain they had felt. The level of dental anxiety was measured once by the parental version of the Dental Subscale of the Children's Fear Survey Schedule. Young children with a low level of dental anxiety show a sensitized reaction trend for self-reported pain over two sequential dental visits. Young children with a high level of dental anxiety reported the most pain on the first treatment session. For the older children, the children having previous dental experience gave the highest pain ratings on the first treatment session. Furthermore, for both young and older children the amount of pain reported for the second injection was best predicted by the amount of pain reported for the first injection, whereby higher scores the first time predict higher scores the second time. In conclusion, the memory of previous experience with dentistry and earlier treatment sessions seems of great influence on the behaviour and the experience of children during subsequent treatment sessions.
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http://dx.doi.org/10.1016/j.pain.2007.09.025DOI Listing
July 2008

Dental fear, communication, and behavioural management problems in children referred for dental problems.

Int J Paediatr Dent 2007 Nov;17(6):469-77

Department of Cariology, Endodontology, and Pedodontology, Academic Centre of Dentistry Amsterdam, Amsterdam, The Netherlands.

Background: Knowledge about the influence of the interaction between child, parent, and dentist and the referral pattern is very limited.

Aim: This study intended to assess to what extent the pathways of Rachman could clarify why a child is being referred to a specialist in paediatric dentistry and if other aspects in the interaction between child, parent, and dentist play a role in the referral.

Design: The referral letters of 500 children referred to a Special Dental Care Centre in Amsterdam were examined. All parents filled out the Children's Fear Survey Schedule-Dental Subscale, on behalf of the child. Information about interaction and the referral was collected from the referral letter and a semistructured interview with the parent and dentist separately.

Results: Eighty pairs of parents and dentists of referred children participated in a semistructured interview. Child factors seem to contribute the most to the referral. For the cause of referral the pathways of Rachman and communication were often combined.

Conclusions: Apart from fear acquisition, as implied in Rachman's pathways, the interaction between child, dentist, and parent also contributes to the referral of a child to a specialist clinic in paediatric dentistry.
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http://dx.doi.org/10.1111/j.1365-263X.2007.00870.xDOI Listing
November 2007

Professional burnout and work engagement among dentists.

Eur J Oral Sci 2007 Jun;115(3):180-5

Department of Social Dentistry and Behavioral Sciences, Academic Center for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.

A recent development within burnout research is the shift to its conceptual opposite: work engagement. This study aimed to unravel the concepts of burnout and work engagement, and to determine their levels among dentists. A representative sample of 497 Dutch general dental practitioners was included (survey response rate of 59%), consisting of 372 men and 121 women (the gender of 4 dentists remained unknown). The hypothesized three-factor structure of work engagement (vigor, dedication, and absorption), as measured by the Utrecht Work Engagement Scale (UWES), was substantiated among dentists. It was also found that work engagement was related negatively to burnout, as measured by the Maslach Burnout Inventory (MBI). However, a model consisting of a reduced ('core') burnout factor and an 'enhanced' engagement factor (composed of the three original factors plus the burnout factor, personal accomplishment) showed the best fit. Overall burnout levels among dentists are low, and the levels of engagement indicate that dentists have a positive working attitude.
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http://dx.doi.org/10.1111/j.1600-0722.2007.00439.xDOI Listing
June 2007

A short English version of the Fear of Dental Pain questionnaire.

Eur J Oral Sci 2006 Jun;114(3):204-8

Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam, ACTA, Universiteit van Amsterdam and Vrije Universiteit, the Netherlands.

Fear of dental pain is a highly relevant covariate in dental pain research. The present study was designed to develop a short version of the Fear of Dental Pain questionnaire (FDPQ) in order to facilitate research in this area. The original 18-item FDPQ was translated from Dutch to English, and data from previously published and unpublished studies (all Dutch-speaking subjects) were used to examine psychometric properties (n = 960). A short version was constructed based on psychometric properties and face validity of the items. Five items were selected for a short FDPQ. A strong correlation was found between the original and the short version (r = 0.96). Factor analysis revealed a one-dimensional solution, explaining approximately 76% of the variance, with high internal consistency (alpha = 0.87). The short FDPQ allows rapid identification, by dentists, of patients who may require special attention, longer appointments, and specific dental pain management. In addition, it would assist in the development and evaluation of tailored interventions aimed at this group.
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http://dx.doi.org/10.1111/j.1600-0722.2006.00350.xDOI Listing
June 2006

Dental discomfort questionnaire for young children before and after treatment.

Acta Odontol Scand 2005 Nov;63(6):367-70

Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, The Netherlands.

Objective: To present a follow-up using the Dental Discomfort Questionnaire (DDQ) before and after the treatment of children, under the assumption that the number of toothache-related behaviors diminishes as a result of treatment, and to see whether this effect is related to the site of the carious teeth or to the treatment itself.

Methodology: Sixty-one parents completed the DDQ before and after the treatment of their child, aged between 30 and 59 months. The available dental records were used to assess the status of the caries and the consecutive treatment.

Results: Overall, there was a significant decrease in the average number of post-treatment behaviors displayed by children. However, children with extractions during treatment or children with caries in their front teeth did not change their behavior. These children continued to have difficulty with chewing and biting.

Conclusions: The dental treatment of children leads to reduced toothache-related behaviors. Our study showed the DDQ to be a useful instrument for acquiring insight into the behavioral aspects of young children as a consequence of toothache or dental treatment, thereby underlining the importance of a behavioral approach in young children.
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http://dx.doi.org/10.1080/00016350500264362DOI Listing
November 2005

Dental Discomfort Questionnaire: assessment of dental discomfort and/or pain in very young children.

Community Dent Oral Epidemiol 2006 Feb;34(1):47-52

Department of Cariology, Endodontology and Pedodontology, Academic Centre of Dentistry Amsterdam, the Netherlands.

Objective: To present and analyse the Dental Discomfort Questionnaire (DDQ) for very young children and to assess the possible differences in pain-related behaviours displayed by children with or without reported toothache, and by children with or without decayed teeth.

Methods: Based on parental interviews of toddlers referred to a dental care practice 12 pain-related behaviours were identified which formed the DDQ. The DDQ was filled out by parents on behalf of their children (n = 146; mean age 47 months). Two-third (n = 94) of the children were referred to a special dental care centre and one-third (n = 52) were controls from a day care centre.

Results: The results show that the 12 items of the DDQ seem to measure one dimension. However, four items do not correlate with the presence of reported toothache, when these items are removed the DDQ-8 has a satisfactory reliability. All eight behaviours from the DDQ-8 occur significantly more often in children with decayed teeth and toothache than in children without decayed teeth or toothache. Especially behaviours concerning eating or brushing teeth are found to be more often present in children with decayed teeth and toothache.

Conclusions: It seems useful to take the child behaviour into account in assessing toothache. The DDQ has shown to be a reliable instrument, which could be helpful in the future for both parents and dentists in identifying toothache in young children.
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http://dx.doi.org/10.1111/j.1600-0528.2006.00253.xDOI Listing
February 2006

Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children.

Eur J Oral Sci 2005 Dec;113(6):488-93

Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, Netherlands.

The aim of this study was to compare the behavioral reaction of children who receive local anesthesia with a traditional syringe with the behavioral reaction of children who receive local anesthesia with a computerized device (Wand) and to differentiate between the reactions of highly anxious children with those displaying low anxiety. One hundred and twenty-five children aged 4-11 yr were randomly allocated to receive local anesthesia with the Wand or a traditional injection. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Two independent observers scored videotapes of the anesthesia in 15-s intervals. The occurrence of muscle tension, crying, verbal protest, movement, and resistance was registered and a score was given on the Venham distress scale. The mean injection time with the Wand was four times as long as with the traditional syringe. During the first 15 s of the injection, low-anxious children receiving local anesthesia with the Wand displayed less muscle tension, less verbal protest and less movement than children receiving local anesthesia with the traditional syringe. Within the high-anxious group no differences were found. It was concluded that low-anxious children seem to benefit from the use of the Wand instead of the traditional syringe in receiving local anesthesia.
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http://dx.doi.org/10.1111/j.1600-0722.2005.00252.xDOI Listing
December 2005

The theory of reasoned action and patient compliance during orthodontic treatment.

Community Dent Oral Epidemiol 2005 Dec;33(6):419-26

Department of Orthodontics and Social Dentistry, Academic Centre of Dentistry Amsterdam, The Netherlands.

Objectives: The aim of the present study was to investigate the potential of the theory of reasoned action (TRA) for the prediction and understanding of patients' intention to comply during orthodontic treatment and to analyze the effect of two additional variables in the model, namely perceived behavioral control and anticipated regret. Moreover, (the determinants of) intentions of orthodontic patients to comply during treatment were compared with (the determinants of) intentions of parents to stimulate this cooperation.

Methods: A questionnaire was handed out to patients and parents visiting the Department of Orthodontics of the Academic Centre of Dentistry in Amsterdam. In both the patient and parent sample, independent-sample t-tests, correlation analyses and stepwise regression analyses were conducted. Variables in both samples were compared and tested.

Results: The extended version of the TRA explained 20% of the variance in the patients' intention to comply. The patients' anticipated regret, attitude and motivation to comply were significant determinants of the patients' intention to comply. In addition, the parents' attitude toward compliance was a significant predictor. The role of parents in enhancing patients' intentions to comply cannot be neglected.

Conclusion: Our findings suggest that patients' intentions to comply during orthodontic treatment are influenced by factors outside of the TRA. Therefore, it is recommended to develop a new model, in which factors of the TRA are included, which can be used specifically for the study of compliance in orthodontics.
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http://dx.doi.org/10.1111/j.1600-0528.2005.00241.xDOI Listing
December 2005
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