Raw_Psychophysiological_Data_Dental_Anxiety_2020.xlsx

Participants:Twenty-five participants with dental anxiety and twenty-five HCs participated in this study. The participants were 18 to 63 years old (Mdental anxiety=44.40 (13.29); MHC=44.48 (13.07)), and all were Slovenian citizens. The sample was recruited from the community via the snowball method, beginning with dentally anxious acquaintances of the researchers, who in turn recruited more of their own dentally anxious acquaintances into the study. The participants were then screened for dental anxiety; the presence and level of their dental anxiety was evaluated through two different relevant questionnaires. Those meeting the inclusion criteria for dental anxiety were then age matched with HCs and the sampling was terminated after reaching 25 members in each group. The inclusion criterion for individuals with dental anxiety was set to reach a cut-off score in at least one of the two questionnaires, while the inclusion criterion for HCs was reaching the cut-off score in neither questionnaire. The exclusion criteria were the presence of cardiovascular diseases or pharmacotherapy affecting the cardiovascular system; having diseases affecting the SCL; and psychiatric conditions (except dental anxiety) or current treatment with medication for any psychiatric conditions. Materials:- Modified Dental Anxiety Scale The Modified Dental Anxiety Scale (MDAS) is a brief self-report questionnaire used for the assessment of dental anxiety. The participant must respond to each question with one of the given answers, which are scored from 1 to 5. The sum of all five items represents the total score. The total score ranges from 5 to 25. Anyone who gets a score of 19 or above (the cut-off score) is considered as an individual with high dental anxiety. In our study, the MDAS was back-translated from English into Slovene and demonstrated a high level of internal consistency, as determined by a Cronbach's α of 0.912 in our sample.- Dental Anxiety Scale – Revised The Dental Anxiety Scale – Revised (DAS-R) is composed of four questions concerning the dental setting. Each question offers five answers ranked on a five-point scale. The maximum possible score is 20; scores of 13-14 indicate high anxiety, and scores of 15-20 indicate severe anxiety (or dental phobia). In our study, the DAS-R was back-translated from English into Slovene and demonstrated a high level of internal consistency, as determined by a Cronbach's α, of 0.956 in our sample.The consistency between MDAS and DAS-R questionnaires was tested with Cohen's kappa. A moderate agreement between the two questionnaires was found, κ=0.520, 95% CI [0.312, 0.728], p<0.001.- Stimuli for Visual and Auditory ModalitiesTo examine the visual and auditory modalities, the stimuli were presented to the participants on a personal computer. In the visual modality trial, 10 neutral images were presented in the beginning, each for 6 seconds. After a 10 second break, 10 images related to dental treatment were presented, each for 6 seconds. All the images related to dental treatment were selected by the dentist as representing threatening stimuli, based on their experience in dealing with dentally anxious patients, but were not standardized. Neutral images were selected from the EmoMadrid affective picture database to ensure that images themselves do not induce elevated levels of arousal. In the auditory modality trial, the participants were exposed to two types of audio recordings. Firstly, a 60-second-long recording of neutral sounds (e.g. sounds of traffic and birds) was presented, followed by a 10 second break and then a 60-second-long continuous recording of sounds related to dental treatment (e.g. sounds of dental procedures). Both audio recordings were custom-made, so the auditory stimuli were thus not standardized. The presentation of neutral images and sounds was carried out in order to get the participants accustomed to the task. Psychophysiological reactions were measured during exposure to the visual and auditory dental-related stimuli and during the neutral stimuli of both modalities.- Psychophysiological MeasurementThe Vrije University Ambulatory Monitoring System (VU-AMS, Version 5, Vrije University, Amsterdam) was used to measure autonomic markers during the experimental conditions. The device combines an electrocardiogram (ECG) and measurement of the SCL. Skintact F-50 electrodes, Ø50mm with AquaGel and foam backing were used for the ECG recording, and Biopac Skin Resistance Trans TP-TSD203 electrodes in combination with Isotonic 4OZ-GEL101 electrode gel were used for the measurement of SCL. Two Ag-AgCl, non-polarizable Trans TP-TSD203 electrodes, mounted in individual, polyurethane housings that terminate in Touchproof connectors were used. The electrodes were attached to the fingers by Velcro straps and had a 6 mm (diameter) contact area with a 1.6 mm cavity to accommodate the electrode gel. The electrodes were attached according to the Data Analysis and Management Software (DAMS) manual for the VU-AMS. The obtained variables were HR in beats per minute [bpm], SCL in micro Siemens [μS], and HRV measured as a standard deviation of all normal RR intervals (SDNN) in milliseconds [msec].Procedure:The study was carried out at the Dental Clinic, University Medical Centre Ljubljana, Slovenia. The same procedure was followed for all participants: first of all, the nature of the study was explained and they signed an Informed Consent Form. The procedure consisted of two main parts – psychological and dental. The psychological part was carried out by a psychologist in a room which did not contain any dental-related stimuli. First, the MDAS and DAS-R questionnaires were administered, and then the electrodes of the VU-AMS were placed and the psychophysiological reactions were recorded from that point on. A baseline recording was made for 5 minutes with the subject in an armchair that had a similar incline to a dental chair. The participants were asked to close their eyes and relax. After the baseline measurements, the participants were exposed to the visual stimuli. They were instructed to sit on a chair and observe the sequence of images and be aware of the feelings triggered. Ear plugs were used to ensure that the participants were preferentially exposed to visual stimuli. Afterwards the participants were exposed to the auditory stimuli. The participants were asked to put on headphones and instructed to sit on the chair, close their eyes, listen to the sequence of audio recordings and be aware of the feelings triggered. In the dental part of the study, the participants were asked to complete a standard medical history questionnaire. The participants were then asked to move to the dental surgery, where a complete dental examination was carried out by a dentist. A thorough medical and dental history was taken, followed by a brief oral examination. The participants were then moved from the sitting to the lying position and a complete intraoral dental examination was made using a dental mirror, sharp dental explorer, periodontal probe, and air/water syringe. First, dental occlusion was determined and the dental soft tissues were examined. Next, dental status, dental caries, and dental plaque were assessed, and the periodontal tissues were examined for signs of gingivitis or marginal periodontitis, such as bleeding on probing and periodontal pockets. On selected teeth, tooth mobility, percussion, and palpation were checked, and a pulp vitality test was carried out. Pulp vitality was confirmed by a thermal pulp vitality test with cold spray (Plurasol Kältespray, Pluradent AG et Co KG, Offenbach, Germany) on a cotton pellet, followed by an electric pulp test with an electric pulp vitality tester (Parkell Pulp Vitality Tester, Farmingdale, USA). As a demonstration, one selected tooth was isolated by a rubber dam. Additionally, dental plaque and calculus were removed using an ultrasonic scaler. Finally, the participant walked back to the room where the experiment began, where the electrodes of the VU-AMS were removed.Data processing:The DAMS for the VU-AMS was used to process the raw data obtained by the VU-AMS device. All the ECG and SCL signals were averaged separately for each of the four experimental conditions, and automatically scored and calculated into HR, SCL and SDNN variables by the DAMS program. The data were prepared in line with the DAMS manual for the VU-AMS (VU-AMS, version 5, Vrije University, Amsterdam). For the ECG data automated artifact labelling was used to identify clipping and signal loss, while suspicious peaks and other possible artifacts were visually inspected and manually corrected if required. The SCL signal was pre-processed to remove noise and power line interference in the signal. A low pass filter with a cut-off frequency of 2 Hz was used to filter the signal. In order to avoid shifting of peaks, filtering was done in both the forward and reverse directions.