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© Borgis - Nowa Stomatologia 2/2021, s. 31-39 | DOI: 10.25121/NS.2021.26.2.31
*Katarzyna Białoszewska1, Magdalena Łazarewicz2
Pain control beliefs and dental patients’ oral health and hygiene status. A pilot study
Przekonania na temat kontroli bólu a stan zdrowia i higiena jamy ustnej pacjentów stomatologicznych. Badanie pilotażowe
1Department of Pediatric Dentistry, University Dentistry Centre, Medical University of Warsaw
Head of Department: Professor Dorota Olczak-Kowalczyk, MD, PhD
2Department of Health Psychology, Medical University of Warsaw
Head of Department: Dorota Włodarczyk, PhD in Health Sciences
Streszczenie
Wstęp. Ból jest często wymienianym czynnikiem związanym z leczeniem stomatologicznym, na którego odczuwanie wpływ mają czynniki psychologiczne, np. poczucie umiejscowienia kontroli bólu.
Cel pracy. Celem pracy jest zbadanie związku między lokalizacją poczucia kontroli bólu a stanem zdrowia jamy ustnej.
Materiał i metody. W badaniu wzięło udział 78 pierwszorazowych pacjentów poradni stomatologicznych (40 kobiet, 38 mężczyzn, Mwiek = 40,7 roku, SD = 14,4). Przed wizytą badani zostali poproszeni o wypełnienie kwestionariusza składającego się z pytań na temat deklarowanego stanu zdrowia jamy ustnej, częstości wizyt u dentysty oraz kwestionariusza Przekonań na Temat Kontroli Bólu (BPCQ, który posiada trzy podskale umiejscowienia kontroli bólu: wpływ lekarza (BCPQ_L), czynnik wewnętrzny (BCPQ_W) oraz przypadkowe zdarzenia (BCPQ_P)). Na podstawie badania wewnątrzustnego wyliczono wskaźnik PUWZ oraz wskaźnik płytki nazębnej (API).
Wyniki. Analiza danych wykazała istotną zależność między czynnikami: BPCQ_W (tau = -0,24), BPCQ_L (tau = -0,18) oraz BPCQ_P (tau = –0,19) a poziomem wykształcenia badanych (p ≤ 0,05). Wykryto istotny związek między BPCQ_W a częstością wizyt (F = 6,013, p = 0,001) oraz BPCQ_W i liczbą ubytków próchnicowych (PZ) (r = 0,248; p = 0,028). BPCQ_L koreluje z liczbą usuniętych zębów (UZ) (r = 0,315; p = 0,005) i liczbą wypełnień (WZ) (r = -0,222; p = 0,051). Istotną statystycznie ujemną korelację zaobserwowano pomiędzy BPCQ_W i deklarowaną higieną jamy ustnej (tau = -0,195; p = 0,030).
Wnioski. BPCQ pozostaje w związku z obiektywnie ocenianym i deklarowanym stanem zdrowia jamy ustnej oraz może wpływać na częstość wizyt u dentysty i podejmowane działania profilaktyczne.
Summary
Introduction. Pain is a frequently cited factor associated with dental treatment, the perception of which is influenced by psychological factors, e.g. locus of pain control.
Aim. The purpose of this study is to investigate the relationship between the locus of pain control and oral health status.
Material and methods. A total of 78 first-time dental clinic patients (40 females, 38 males, Mage = 40.7, SD = 14.4) participated in the study. Before the visit, the subjects were asked to complete a questionnaire consisting of questions about their declared oral health status and frequency of dental visits, and the Beliefs about Pain Control Questionnaire (BPCQ), which has three subscales of locus of pain control: physician influence (BPCQ_L), internal factor (BPCQ_W) and random events (BPCQ_P). On the basis of intraoral examination, the PUWZ index and plaque index (API) were calculated.
Results. Data analysis showed a significant relationship between the following factors: BPCQ_W (tau = -0.24), BPCQ_L (tau = -0.18) and BPCQ_P (tau = -0.19) and educational level of the subjects (p ≤ 0.05). A significant association was detected between BPCQ_W and frequency of visits (F = 6.013, p = 0.001), and between BPCQ_W and number of carious cavities (PZ) (r = 0.248; p = 0.028). BPCQ_L correlates with the number of extracted teeth (UZ) (r = 0.315; p = 0.005) and number of fillings (WZ) (r = –0.222; p = 0.051). A statistically significant negative correlation was observed between BPCQ_W and declared oral hygiene (tau= –0.195; p = 0.030).
Conclusions. The BPCQ is related to objectively assessed and declared oral health status and may influence the frequency of dental visits and preventive measures taken.



Introduction
Pain is frequently mentioned in the literature as an aetiological factor for anxiety associated with dental treatment and the reason for its persistence (1). According to the International Association for the Study of Pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (2). There is an interrelationship between pain and anxiety. It can be explained by a vicious circle in which the higher the pain, the stronger the anxiety. As a result, patients experience a much stronger pain (3, 4). Kent (5) demonstrated that the memory of pain associated with dental treatment is reconstructed over time. Kent believes that individuals with high anxiety display a tendency towards overestimating the expected level of pain associated with a dental procedure (4, 5).
The pain itself and the very awareness of the possibility of it appearing during dental treatment for example, or the sight of a syringe or dental chair may influence the mood of an individual, affect their methods of coping with danger, modify health behaviour and even alter the treatment process (6-11). The way in which an individual experiences pain is affected by psychological factors that include cognitive processes (information processing, attention, memory) and a sense of control over pain.
The focus of the present study is the locus of pain control, which is associated with a sense of subjectivity and possibility to influence one’s experiences and environment (8, 12). People differ in terms of locus of pain control. Individuals with an external locus of control believe that pain is the result of external factors beyond their control, unlike people with an internal locus of control, who claim that they can influence their pain and reduce it through their own activity (10, 12).
Aim
There are few studies in the literature regarding beliefs on pain control in dentistry. The aim of the study is to gain knowledge on the beliefs about pain control associated with dental treatment and to investigate the relationship between the locus of pain control and oral health and hygiene status.
Material and methods
The study included first-time patients of dental clinics in the Warsaw metropolitan area who provided their informed consent to complete an anonymous questionnaire. The following exclusion criteria were applied: intellectual disability, lack of possibility for cooperation, mental disorders and complete lack of teeth. The questionnaire consisted of standardised research tools including the Beliefs about Pain Control Questionnaire (BPCQ) to determine the locus of pain control, an originally developed part that involved self-rating of oral health and hygiene status and knowledge about the oral cavity, and a survey of demographic data. After completing the questionnaire, the subjects underwent dental examination to determine the presence of decayed teeth (PZ), and the number of lost teeth (UZ) and filled teeth (WZ). The patient’s oral hygiene was also evaluated using the Approximal Plaque Index (API) (13). The PUWZ index (decayed, missing and filled teeth, DMFT) was also calculated for the study group (14).
In total, 150 individuals were examined. After exclusion criteria were considered, the results of 78 patients were included in the final statistical analysis: 40 women and 38 men aged 18-76 years (M = 40.65; SD = 14.4).
Statistical analysis was performed using the IBM SPSS package. In order to assess the associations between the different variables, Pearson’s r, Kendall’s tau, one-way analysis of variance and Duncan’s test were applied. Results with p ≤ 0.05 were considered statistically significant. The study was approved by the Bioethics Committee at the Medical University of Warsaw (approval no. KB/73/2013).
Research tools
The Beliefs about Pain Control Questionnaire (BPCQ), which was developed by Skevington and adapted to Polish patients by Juczyński (2012) (9), consists of 13 statements that correspond to three factors which measure the strength of individual beliefs regarding the locus of pain control: internal (BPCQ_W, e.g. example item), physician influence (BPCQ_L, e.g. example item) and random events (BPCQ_P, e.g. example item). The participants were asked to rate the statements on a six-point Likert scale (from 1: “I fully disagree” to 6: “I fully agree”). The subjects could score between 5 and 30 points on BPCQ_W and between 4 and 24 points on the other two measures. A higher score means a stronger belief that pain can be controlled by a given factor. The questionnaire’s reliability was evaluated using the Cronbach’s alpha, which was 0.75 for the whole scale.
Results
Characteristics of the study group
Most of the subjects had secondary education (42.3%). The majority were blue-collar workers (37.2%) and individuals employed by a business (21.8%).
The subjects declared that they attended dental appointments every six months (26.9%), once a year (19.2%) and once a quarter (15.4%). Among the subjects, 38.5% stated that they used dental services when they felt pain. During the study, 19.2% of patients reported this symptom. The mean caries severity index (PUWZ) was 14.87 for the study group (PZ = 3.53; UZ = 5.23; WZ = 5.96). The analysis of API demonstrated that 69.2% of the patients had an inadequate level of hygiene, 21.8% a sufficient level and only 5.1% had a relatively good level and 3.8% an optimal level of hygiene.
BPCQ vs sociodemographic data
Data analysis revealed a significant correlation between BPCQ_W (tau = -0.24, p = 0.007), BPCQ_L (tau = 00.18, p = 0.039) and BPCQ_P (tau = -0.19, p = 0.032) and the subjects’ education.
Frequency of dental appointments

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Piśmiennictwo
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2. International Association for the Study of Pain – IASP, https://www.iasp-pain.org, (data dostępu 10.01.2022).
3. Kazalska D, Jarosz J, Góraj E, Hilgier M: Czy go boli – czy się boi? Lęk jako istotny czynnik psychologiczny kształtujący percepcję bólu. Onkol Pol 2005; 8(3): 121-124.
4. Kent G: Cognitive process in dental anxiety. Br J Clin Psychol 1985; 24: 259-264.
5. Kent G: Anxiety, pain and type of dental procedure. Behav Res Ther 1984; 22: 465-469.
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8. Sztandera P, Szczepanowska-Wołowiec B: Evaluation of beliefs about pain control in patients after physical therapy treatment. Journal of Education, Health and Sport 2017; 7(6): 45-62.
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10. Juczyński Z: Narzędzia pomiaru w promocji i psychologii zdrowia. Pracownia Testów Psychologicznych PTP 2012, Warszawa: 149-155.
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otrzymano: 2021-04-20
zaakceptowano do druku: 2021-05-04

Adres do korespondencji:
*Katarzyna Białoszewska
Zakład Stomatologii Dziecięcej Uniwersyteckie Centrum Stomatologii Warszawski Uniwersytet Medyczny
ul. Binieckiego 6, 02-097 Warszawa
tel.: 696-466-525
katarzyna.bialoszewska@gmail.com

Nowa Stomatologia 2/2021
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