下颌埋伏阻生第三磨牙患者牙科焦虑症调查分析

Survey and analysis of dental anxiety in patients with impacted mandibular third molars

目的 探讨口腔门诊下颌埋伏阻生第三磨牙(IMTM)拔除术前的牙科焦虑原因、牙科焦虑水平及影响因素,为其干预治疗提供基线资料。方法 采用牙科焦虑原因调查表、改良牙科焦虑量表(MDAS)及一般资料调查表对临床选取的504例进行IMTM拔除的患者在术前进行横断面调查。结果 焦虑的原因主要是诊疗过程中的不适感(45.8%)、惧怕疼痛(42.1%)、口腔内注射恐惧或针头恐惧(41.5%)。MDAS平均分为(10.26±3.11)分,明显患牙科焦虑症的比例为22.6%,其中女性为30.9%,男性为12.2%。多因素logistic回归分析显示,性别(OR=2.362,95%CI 1.314~4.245)、教育水平(高中及以下组:OR=2.180,95%CI 1.094~4.341)、治疗前的心理状态(OR=3.101,95%CI 1.823~5.274)、牙科治疗危险性认知(牙科治疗有危险性组:OR=9.974,95%CI 5.335~18.645;中性组:OR=3.863,95%CI 1.924~7.755)、避医行为(OR=2.180,95%CI 1.285~3.699)、就诊原因(OR=3.388,95%CI 1.972~5.822)、儿童期牙科负面经历(OR=2.650,95%CI 1.461~4.807)是IMTM拔除患者拔牙前牙科焦虑症发生的危险因素。结论 拔除IMTM患者常见术前焦虑,医护人员应通过针对性的干预措施来有效降低牙科焦虑症的发生,以提高牙科诊疗效果,提高IMTM拔除患者的生活质量。

Objective To survey the causes,levels and influencing factors of dental anxiety(DA)in patients with impacted mandibular third molars(IMTM)in dental clinic,in order to provide the baseline data for the intervention of DA.Methods A total of 504 clinically selected patients who underwent IMTM removal were cross-sectional surveyed by the DA causes questionnaire,the modified dental anxiety scale(MDAS)and self-designed general information questionnaire before surgery.Results The major causes of DA were as follows:considerable discomfort when going to the dentist(45.8%),fear of pain(42.1%),fear of intra-oral injections or fear of needles(41.5%).The mean MDAS score was(10.26±3.11)points.The prevalence percentage of DA was 22.6%,that of the females and males was 30.9%and 12.2%respectively.Multiple logistic regression analysis showed that many independent factors influenced the occurrence of DA,including sex(OR=2.362,95%CI 1.314-4.245),educational levels(high school education and below groups:OR=2.180,95%CI 1.094-4.341,psychologic status before the treatment(OR=3.101,95%CI 1.823-5.274),the cognitive vulnerability perceptions of dangerousness of dental treatment(dental treatment was dangerous:OR=9.974,95%CI 5.335-18.645);the neutral group:OR=3.863,95%CI 1.924-7.755),avoidance of dental care(OR=2.180,95%CI 1.285-3.699),reasons for encounter(OR=3.388,95%CI 1.972-5.822),negative dental experiences in childhood(OR=2.650,95%CI 1.461-4.807).Conclusion The preoperative DA in IMTM patients is common.Medical staff should effectively reduce the incidence of DA through targeted intervention measures to improve the effect of dental diagnosis and treatment and improve the life quality of IMTM patients.