Minimizing the Vicious Circle of Pain–Anxiety–Avoidance: The Role of Positive Affect in Endodontic Therapy

Abstract

Featured Application: Increasing positive affect in patients (atmosphere at the clinic, personalized treatment, relaxation, communication, among others) could contribute towards a reduction in the pain–anxiety–avoidance vicious circle, reducing treatment avoidance, and increasing patients’ oral health. Patients with a high level of anxiety anticipate extremely intense pain during dental treatment and frequently avoid visiting dentists, showing a tendency to become caught in a vicious circle of pain–anxiety–avoidance. This research aimed to examine whether dental anxiety mediates the impact of pain anticipation before endodontic treatment in the subjective avoidance of future treatments as a function of positive affect (moderating variable). One hundred consecutive patients that required endodontic therapy were enrolled in this study. In this prospective observational study, patients had to fill out a questionnaire twice: (a) first, prior to treatment (a baseline measurement including pain anticipation, MDAS (dental anxiety), PANAS (positive affect), ASA-PS (physical health), previous medication, an assessment form, and pulpal/periapical status); (b) second, once treatment had ended, the patients were registered for subjective avoidance and their number of canals of treated teeth. The results showed a significant correlation between pain anticipation, dental anxiety, and subjective avoidance; furthermore, the index of the association between pain anticipation and dental anxiety was diminished at higher levels of positive affect. In conclusion, there does not seem to be a direct and deterministic association between pain anticipation, dental anxiety, and subjective avoidance, but rather this relationship would depend on the possible influence of the personality variables of the patients.