ABSTRACT Introduction In military training settings, stress can improve focus and motivation fostering effective learning. However, high perceived stress can be debilitating resulting in poor learning and clinical errors. Multiple studies have focused on medical residency stress; but there has been minimal focus on dental residents and even less on the impact of the unique stressors from the COVID-19 pandemic. The objectives of this study were to determine the impact of the COVID-19 pandemic on perceived stress of residents in a military dental residency training program and explore the association among perceived stress and anxiety, depression, sleep quality, and social support. Materials and Methods Dental residents (N = 20) at the Naval Postgraduate Dental School participated in this study. Residents were assessed via self-report measures quarterly from March 2020 through June 2021. The assessment included measures of anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS), fatigue (FSI), and social support (DUKE-SSQ). Results Before the pandemic shutdown, 60% of participants reported high perceived stress. These residents reported an initial decrease in symptoms of anxiety, depression, and fatigue compared to residents reporting low pre-pandemic perceived stress but returned to baseline levels post-shutdown. Additionally, the high stress participants reported lower social support. Conclusions Based on pre-pandemic perceived stress, participants responded differently to the impact of the pandemic shutdown. The low baseline stress participants may have a more robust sense of grit and resilience. These findings suggest that postgraduate dental training programs should integrate coping skills training opportunities, especially for residents reporting high perceived stress before residency.

Dental anxiety poses challenges for providing effective oral healthcare. While therapy dogs have shown promise in various medical and mental health contexts, their use for alleviating dental anxiety in adults remains underexplored. This study aimed to investigate the emotional and physiologic effects of therapy dogs on self-reported dental anxiety. Adults with dental anxiety were randomly assigned to an intervention group (DOG; n = 19) or a standard care group (SC; n = 14). Standard self-report measures were used to assess dental anxiety (Index of Dental Anxiety and Fear [IDAF-4C+]), depression (Patient Health Questionnaire 9), and generalized anxiety (Generalized Anxiety Disorder 7) prior to the intervention. Participants in the DOG group received a 10-minute therapy dog intervention before dental procedures in sessions 1 and 2, while participants in the SC group rested quietly for 10 minutes before their procedure. The SC participants received the 10-minute therapy dog intervention before dental procedures in the third and final session, while patients in the DOG group received no intervention prior to their third procedure. After the dental procedures, patients completed a questionnaire about their satisfaction with the dog therapy (Therapy Satisfaction Scale) and recorded their anxiety and comfort levels on visual analog scales. Continuous electrocardiographic recording measured heart rate variability during the intervention and dental procedure. Prior to the intervention, most participants (90.9%) met the IDAF-4C+ criteria for dental anxiety, with 7 (21.2%) meeting the criteria for dental phobia. The DOG group participants expressed high satisfaction with the therapy dog intervention. No significant differences in heart rate variability were observed between the groups during dental procedures. Therapy dogs can effectively manage dental anxiety in adults with mild to moderate dental anxiety, offering potential benefits for oral healthcare.

ABSTRACTBackgroundPain catastrophising is a maladaptive cognitive response characterised by an exaggerated negative interpretation of pain experiences. It has been associated with greater disability and poorer outcomes in chronic pain, to include several specific oro‐facial pain conditions. The goal of this study was to examine pain catastrophising at a military oro‐facial pain specialty clinic.MethodsThis retrospective chart review (RCR) examined information collected at initial examination from 699 new patients seen between September 2016 and August 2019 at the Orofacial Pain Center at the Naval Postgraduate Dental School (Bethesda, MD). Pain catastrophising, pain characteristics, psychosocial factors and sleep were assessed using standardised scales. Linear regression was used to evaluate associations of patient characteristics and pain intensity with pain catastrophising. Mediation analyses were done to characterise the extent to which the relationship between pain intensity and pain catastrophising may be explained by anxiety, depression and insomnia.ResultsHigher pain intensity, depression, anxiety, insomnia and younger age were each associated with higher pain catastrophising (all p < .05). A primary diagnosis of neuropathic pain was the strongest independent predictor of higher pain catastrophising. The relationship between pain intensity and pain catastrophising was partially mediated by anxiety, depression and insomnia.ConclusionsIn this RCR of a population of oro‐facial pain patients, those diagnosed with neuropathic pain were most likely to display high levels of pain catastrophising, a characteristic which is associated with poor long‐term pain outcomes. This is the first study to show that, independent of other patient characteristics, those suffering from neuropathic pains displayed the highest levels of pain catastrophising. This highlights the importance of also addressing psychosocial factors in the treatment of neuropathic pain conditions, which are commonly treated using a predominantly biomedical approach. Additionally, anxiety, depression and insomnia each partially explains the relationship between pain intensity and pain catastrophising.

Background Dentistry assumed the primary role for treating patients with pain in the region of the temporomandibular joint (TMJ) based upon an article published in 1934 by Dr. James Costen, an otolaryngologist. After presenting eleven anecdotal case reports, Costen theorized that “abnormal pressure” on the TMJ due to occlusal deficiencies from ill-fitting dentures was a frequent cause of periauricular pain and headache. Despite its limitations, the Costen paper was widely accepted and prompted the dental and medical professions to apply traditional dental principles to the diagnosis and management of periauricular pain and headache.

Orofacial disorders include a classification of disorders that affect the orofacial structures causing pain and dysfunction. They include masticatory and cervical neuromuscular pain disorders, temporomandibular joint disorders, benign headache disorders, neuropathic and neurovascular orofacial pain disorders, burning mouth pain, chronic regional pain syndrome, atypical dental and facial pain, orofacial cancer and AIDS pain, orofacial sleep disorders, and oromotor dysfunction conditions such as dyskinesias and dystonias. Because the orofacial structures have more density of innervation and vascularity of tissues than other areas of the body, the prevalence of these disorders is high at over 40% of the general population. A survey of practice patterns for the diagnosis and treatment of patients with orofacial disorders was sent to a defined population of general dentists and dental specialists who are members of the Minnesota Dental Association (MDA). Of the 1200 surveys mailed to the MDA members, 426 (35.5%) were returned by 329 general dentists and 97 dental specialists. The results demonstrated that on the average, 95% of the general dentists and dental specialists choose to refer these patients to an orofacial care dentists who specializes in managing these conditions. Yet, there very few dentists who focus their practices in these fields of Dentistry creating a large access to care problem. The need to expand training of more orofacial care specialists are needed to meet this need. INTRODUCTION Orofacial Pain is the discipline of dentistry that focuses on the assessment, diagnosis and treatment of patients with chronic orofacial pain disorders. These conditions include masticatory and cervical neuromuscular pain disorders, temporomandibular joint disorders, benign headache disorders, neuropathic and neurovascular orofacial pain disorders, burning mouth pain, chronic regional pain syndrome, atypical dental and facial pain, orofacial cancer and AIDS pain, orofacial sleep disorders, and oromotor dysfunction conditions such as dyskinesias and dystonias. Changes in the U. S. population demographics and an increasing awareness of these disorders by the public have contributed to a rapidly expanding demand for orofacial pain services (1). The dental profession has a great responsibility to meet this demand in terms of differentiating orofacial pain by type and mechanism, performing a proper clinical assessment, and developing appropriate treatment plans for these patients (2). The professional training received by most dentists has been traditionally oriented toward treating caries and periodontal disease, rather than to meet such new challenges (1, 3). However, OFP shows a similar prevalence to that of caries and periodontal disease in the U.S. adult population. For example, the NHANES III survey found 40.5 % of the U.S. population, aged 18 to 74, had at least one tooth or tooth space meeting criteria defined as compromised structural integrity, dysfunction or disease (nonperiodontal) that may benefit from treatment (4). Similarly, 30% of the population, aged 13-65, was determined to have a gingival pocket depth ≥ 4 mm, and 4% had a pocket ≥ 6 mm in depth (5). A 1989 national orofacial pain survey of 45,711 households found that 22% of adults had suffered some type of orofacial pain during the previous six months (6). A 1986 survey of the city of Toronto found 40% of respondents had experienced dental or facial pain during the previous four weeks (7). Temporomandibular disorders (TMD), which constitute just one of the orofacial pain disorders, are present in about 5-6% of the adult population at a severity that would benefit from treatment (1, 6, 8, 9). When all facial pain disorders are considered, a conservative estimate for OFP treatment needs in the adult population would be at least 7% (6, 10). In the U.S. civilian non-institutionalized population 18

Paced breathing has shown efficacy in fibromyalgia (FM), but the mechanisms associated with symptom change are largely unknown. We investigated whether changes in respiratory rate (RR) alone resulted in autonomic changes during normal, paced, and mechanically assisted breathing in untrained FM patients and controls. Participants included 20 FM patients and 14 controls matched for age and body mass index. During a single visit, participants completed three 15-minute breathing sessions: 1) normal breathing, 2) slow-paced breathing, and 3) mechanically assisted breathing (continuous positive airway pressure) while supine. Continuous blood pressure and electrocardiogram were recorded, and measures of heart rate variability (HRV) and spontaneous baroreceptor sensitivity (sBRS) were calculated. During normal breathing, FM patients had higher heart rate (HR), but lower HRV and sBRS variables compared to controls with no difference in RR. Compared to the paced breathing condition, FM patients had significantly lower HR with higher HRV and sBRS variables during mechanically assisted breathing, despite no significant change in RR. Mechanically assisted breathing provided greater benefits in autonomic function than paced breathing in untrained FM patients. Future research will be needed to elucidate the central pathways involved in these autonomic changes and whether training in paced breathing can eventually replicate the results seen in mechanically assisted patients.

SHEEP production remains dependent upon the use of effective broad-spectrum anthelmintics to control the production limiting effects of gastrointestinal nematodes (GINs) and negative health and welfare impacts associated with parasitic gastroenteritis (PGE). All major sheep-producing countries have reported resistance to the three ‘older’ groups of broad-spectrum anthelmintics; the 1-BZ, 2-LV and 3-ML groups (Kaplan and Vidyashankar 2012, Rose and others 2015). Of concern are recent reports of the rapid development of multigeneric resistance to monepantel, a novel anthelmintic of the 4-AD group (Scott and others 2013, Mederos and others 2014, Van den Brom and others 2015). Anthelmintic resistance (AR), the heritable ability of GINs to tolerate a normally effective dose of an anthelmintic (Abbott and others 2013), has been responsible for outright failure of anthelmintics to control PGE (Sargison and others 2005, Wilson and Sargison 2007, Scott and others 2013, Mederos and others 2014, Van den Brom and others 2015). When involving multiple anthelmintic groups, resistance has reportedly led to the closure of flocks in the UK (Sargison and others 2005, Blake and Coles 2007). Suboptimal production, a consequence of early AR, has often remained unrecognised in flocks until laboratory-based or faecal egg count reduction tests (FECRTs) have revealed a lack of anthelmintic efficacy. Surveys in the UK have revealed an upward trend over time in the proportion of flocks with AR (Cawthorne and Cheong 1984, Hong and others 1992, 1996, Bartley and others 2003, Taylor and others 2009, Mitchell and others 2010, Jones and others 2012, Stubbings 2012, Thomas and others 2015). Results of a survey of faecal egg count reduction efficacy (FECR%) of …

Objectives: This study compared persistent breast pain among women who received breast-conserving surgery for breast cancer and women without a history of breast cancer. Methods: Breast cancer survivors (n=200) were recruited at their first postsurgical surveillance mammogram (6 to 15 mo postsurgery). Women without a breast cancer history (n=150) were recruited at the time of a routine screening mammogram. All women completed measures of breast pain, pain interference with daily activities and intimacy, worry about breast pain, anxiety symptoms, and depression symptoms. Demographic and medical information were also collected. Results: Persistent breast pain (duration ≥6 mo) was reported by 46.5% of breast cancer survivors and 12.7% of women without a breast cancer history (P<0.05). Breast cancer survivors also had significantly higher rates of clinically significant persistent breast pain (pain intensity score ≥3/10), as well as higher average breast pain intensity and unpleasantness scores. Breast cancer survivors with persistent breast pain had significantly higher levels of depressive symptoms, as well as pain worry and interference, compared with survivors without persistent breast pain or women without a breast cancer history. Anxiety symptoms were significantly higher in breast cancer survivors with persistent breast pain compared with women without a breast cancer history. Discussion: Results indicate that persistent breast pain negatively impacts women with a history of breast-conserving cancer surgery compared with women without that history. Strategies to ameliorate persistent breast pain and to improve adjustment among women with persistent breast pain should be explored for incorporation into standard care for breast cancer survivors.

Objective. Patients with complaints of orofacial pain (OFP) often have other body pain, yet many do not report these to their providers. Uncontrolled pain at any location may impact the successful management of an OFP complaint. The objective of this study was to determine the number of pain regions throughout the body, and the underreporting of pain, in patients who presented to a tertiary military OFP clinic.Design. A retrospective chart review was conducted on 423 consecutive new patients. Patients were given three assessment opportunities to report their pain on a whole-body pain map: 1) prior to evaluation (Pt1), 2) following an explanatory statement by their provider on the relationship between pain and prognosis (Pt2), and 3) during directed pain inquiry of specific body regions (Pro). The pain map was divided into nine anatomical regions that were assessed for the presence of pain after Pt1, Pt2, and Pro.Results. Initially, 60.5% of patients did not report all pain locations (Pt1). Following the explanatory statement (Pt2), 30.5% still did not report all pain. Following the completion of all assessment methods, the most commonly reported number of pain regions was five (17.0%), and 91.5% of patients reported multiple pain regions.Conclusions. Most patients had multiple pain complaints outside the chief complaint, yet the majority did not report these until multiple forms of assessment were utilized. These data encourage the use of a pain map, a verbal pain explanation, and directed pain questioning to more accurately capture pain location and facilitate multidisciplinary care.

We sought to examine the existential challenges that cancer survivors may experience as they strive to make meaning, regain their self-identity, cope with fear of recurrence, and experience feelings of grief and guilt. Lymphoma survivors ( n = 429) completed the 2010 LIVESTRONG survey and provided responses about meaning, cancer worry, security, identity, grief, guilt, and perceived functional impairment due to these concerns. Most survivors (73%−86%) endorsed existential concerns, with 30–39 percent reporting related perceived functional impairment. Concerns were associated with being female, younger, unmarried, and having undergone stem cell transplantation. Lymphoma survivors experience existential challenges that impact their life even years after diagnosis.

e20577 Background: Accumulating evidence indicates that adverse childhood experiences (ACEs) substantially increase the risk of negative health behaviors and outcomes later in life. Multiple studies have documented that ACEs are associated with increased rates of cigarette smoking, but just one prospective study, with only 64 cases, reported an increased risk of lung cancer. Methods: The present study explored childhood ( < 12y) parental death, one of the most profoundly stressful ACEs, as a risk factor for adult cigarette smoking and lung cancer in the Shanghai Cohort Study, a population-based prospective cohort of 18,244 men aged 45-64 years in Shanghai, China, enrolled during 1986-1989. Information on parental death, smoking history, and other lifestyle factors were collected by trained nurse interviewers at baseline. Cancer incidence among cohort participants has been identified through annual in-person interviews and linkage analyses with databases of the Shanghai Cancer Registry and death index. After accrual of 348,249 person-years with up to 25 years of follow-up, 906 lung cancer cases have been identified. Hazard ratio (HR) and the corresponding 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression method adjusted for potential confounders. Results: Individuals who experienced childhood parental death had higher smoking rates with more cigarettes/day and years of smoking. Childhood parental death remained significantly associated with increased risk of lung cancer after adjustment for smoking and other potential confounders. The adjusted-HRs (95% CIs) for the death of father, mother, or both parents were 1.02 (0.85-1.23), 1.20 (0.95-1.52) and 1.44 (1.07-1.94), respectively, compared with those who did not experience childhood parental death (P for trend = 0.01). Conclusions: These findings suggest a long lasting adverse impact of parental death in childhood on the risk of developing lung cancer. The biological mechanisms responsible for the increased risk beyond smoking are not yet known, but ACEs have been shown to have profound effects on biological stress responses, which could contribute to increased oxidative DNA damage, a known risk factor for lung cancer.

PURPOSE:With cancer survivors now numbering over 13 million in the United States, and expected to continue to increase, it is important to consider the needs of this growing population. In the literature, one of the most common complaints by cancer survivors is perceived cognitive dysfunction. Since the preponderance of the research has focused on breast cancer survivors, the purpose of the present study was to explore the prevalence and correlates of perceived cognitive dysfunction in a large sample of cancer survivors with representation across a wide range of different types of cancer.METHODS:A sample of 3108 post-treatment cancer survivors completed the 2010 LIVESTRONG survey as part of a larger study of cancer survivorship. Respondents completed standardized questions regarding current and past perceived cognitive dysfunction, as well as depressive symptoms, and demographic and medical variables.RESULTS:Current perceived cognitive dysfunction was reported by nearly half of respondents (45.7%), across a wide range of cancer types, with the highest prevalence among survivors of central nervous system cancers. Receiving chemotherapy and current report of depressive symptoms were both strongly associated with current perceived cognitive dysfunction.CONCLUSION:These findings contribute to a growing appreciation of the high prevalence of perceived cognitive dysfunction in survivors of a wide range of cancer types and the potential interactive effect of concurrent symptoms of depression. These findings highlight a need to develop more effective means of preventing or reducing cognitive dysfunction in cancer survivors.IMPLICATIONS FOR CANCER SURVIVORS:Perceived cognitive dysfunction was reported in a wide range of cancer survivors. The potential interactive effect of symptoms of depression suggests the need to develop interventions targeting both cognitive dysfunction and depression to achieve improvements in cognitive functioning.