Professional Documents
Culture Documents
JOHAN HOOGSTRATEN
Department of
Social Dentistry
372
C. BENJAMINS, ETAL.
METHOD
Subjects
Patients originated from two clinics for dental care, namely, the clinic
for special dental care for extremely anxious patients and a university clinic
(UvATZ). Data were collected from 29 patients, just before dental treatment.
Three patients were excluded because they had an history of high blood
pressure and two because there was a technical failure or data were missing.
The data of 24 dental patients of mean age 32.5 yr. ( f 10.7) were used for
analysis. This group of patients included 10 men of mean age 30.5 yr.
( k 9 . 0 ) and 14 women of mean age 33.9 yr. ( + 11.8). Ten patients visited
the dentist for a checkup, 12 for restorative treatment, and three for extraction of a tooth. ALl patients were seen between 9 and 11 p.m. to adjust for
diurnal fluctuations in blood-pressure values.
Materials
~ i n a ~ r readings
es~
of systolic and diastolic blood pressure were taken for
10 min. from the left index finger according to instructions in the manual.
Before and after the Finapres readings systolic and diastolic blood pressure
were determined with a sphygmomanometer and cuff from the left upper
arm. The disappearance of the Korotkoff-sounds represented the diastolic
pressure. Next, all subjects completed three self-assessment inventories for
dental anxiety. First, the short version of the recently developed inventory
for fear of dental treatment, K-ATB (Stouthard, 1989), was administered.
'Ohmeda, Madison, WI, USA.
373
This scale, which scores range from 9 (no anxiety) to 45 (extreme dental anxiety) has been proven v&d and reliable in some large scale studies
(Stouthard, 1989). The next questionnaire was the Dental Anxiety Scale, on
which scores range from 4 (no anxiety) to 20 (extreme dental anxiety) and
which has also been proven valid and reliable in large scale studies in the
United States (Corah, 1969; Corah, et a/., 1978) and in the Netherlands
(Eijkman & Orlebeke, 1975; Stouthard, 1989). Thereafter the patients were
presented a question to assess the duration of psychophysiological reactions
prior to a dental appointment (Schuurs, Duivenvoorden, Thoden van Velzen,
& Verhage, 1981). The scores range from one (a few days or longer before
the dental appointment) to seven (none at all). The scores were recoded so
that score of one represents a low and score of seven a high anxiety level.
The two sphygmomanometer pressure readings were combined to a
mean value because many people tend to respond with an heightened blood
pressure to the measurement itself. This mean value was also used in the
calculation of mean arterial pressure [Pmean = Pdia + 1/3(Psys - Pdia)]. The
values for systolic and diastolic pressures of a period of 30 sec. from the
Finapres reading were combined to a mean value which was also used to calculate mean arterial pressure. The 30-sec. period was extracted from the
record between time 3 min., 30 sec. and 4 min., 30 sec. This extraction of a
30-sec. period out of a 60-sec. period was done because the calibration cycles
in the recorded signal necessary to compensate for the influence of smooth
muscle tone in the arterial wall were unevenly spaced.
Table 1 shows the mean scores on the questionnaires and the Pearson
product-moment correlations between their scores. The correlations among
TABLE 1
MEANSCORESO N DENTALA ~ m Snc m , K-ATB A N D DURATIONOF
PSYCHOPHYSIOLOGICAL
REACTIONS
A N D T a m PWU~SON
PRODUCT-MOMENT
INTERCORRELATIONS
Dental
Anxiety
K-ATB*
Reacuons
Scale
Range
4-20
M SD
11.1 3.8
Dental Anxiety Scale
K-ATB
*K-ATB =Inventory for Fear of Dental Treatment.
tp < ,001.
Duration
Psychophy~iologicd
9-45
25.9 9.7
.94t
1-7
3.1k2.1
.83t
.80t
scores on the three questionnaires are high and significant. The respective
standard errors of the scores on the K-ATB and the Dental Anxiety Scale are
2.3 and 0.9. The internal consistency (Cronbach alpha) and the split-half re-
374
C. BENJAMINS, ET AL.
liability corrected for test length are .92 and .93 for the K-ATB and .93 and
.88 for the Dental Anxiety Scale.
Pearson coefficients did not reach significance for the association between the questionnaire scores and age. Sex was coded one for men and two
for women. Pearson correlation coefficients (Nunnally, 1967) indicated significant relationships with sex for the scores on the Dental Anxiety Scale
(r = -.45, p = .03) and the duration of psychophysiological reactions (r = -.48,
p = .02), but not for the K-ATB ( r = -.35, p = .09). Men tended to be somewhat more afraid than women.
The mean values for both blood-pressure measurement methods are
shown in Table 2. These blood pressure values were not related to age, sex,
or time of the day. The Pearson product-moment coefficients ranged from
-.32 to .36 (p>.05).
TABLE 2
MEANVALUESFORSPHYGMOMANOMETER
AND FINAPRES
BLOODPRESSURE
Sphygmomanometer
Systolic blood pressure
Diastolic blood pressure
Mean arterial blood pressure
Finapres
Systolic blood pressure
Diastolic blood pressure
Mean arterial blood ~ressure
SD
Range
119.9
75.3
90.2
11.2
7.8
7.8
99.0-139.0
60.5- 92.0
76.0-106.7
131.9
72.4
92.2
21.6
12.1
14.9
85.2-165.3
48.3- 97.4
60.6-116.3
D~scussro~
The mean Dental Anxiety Scale score (11.2) is higher than the mean
scores 8.89 and 9.8 reported by other researchers in their studies with students (Corah, 1969; Corah, etal., 1978; Stouthard, 1989) and a score of 9.3
registered with inhabitants of a Dutch city (Schuurs, et al., 1985). Also, dental emergency patients scored 10.5 on the Dental Anxiety Scale (Weisenberg,
et a / . , 1974). The values for Cronbach alpha and the split-half reliability are
high. The internal consistency and reliability of both the K-ATB and the
Dental Anxiety Scale for this population are good. In this study we found a
mean score of 3.1 on the question concerning the duration of psychophysiological reactions, which is higher than the mean score of 2.3 found among
3 75
376
C. BENJAMINS, ETAL.
377'
WILDER,. (1962) Basimetric a proach (law of initial values) to biological rhythms. Annals of
t e New York Academy ofsciences, 98, 1211-1228.