Fear of Pain Mediates the Association between MC1R Genotype and Dental Fear

Abstract

Fear of pain is experienced in acute and chronic pain populations, as well as in the general population, and it affects numerous aspects of the orofacial pain experience, including pain intensity, pain-related disability, and pain behavior (e.g., avoidance). A related but separate construct—dental fear—is also experienced in the general population, and it influences dental treatment–seeking behavior and oral and systemic health. Minimal work has addressed the role of genetics in the etiologies of fear of pain and dental fear. Limited available data suggest that variants of the melanocortin 1 receptor ( MC1R) gene may predict greater levels of dental fear. The MC1R gene also may be etiologically important for fear of pain. This study aimed to replicate the finding that MC1R variant status predicts dental fear and to determine, for the first time, whether MC1R variant status predicts fear of pain. Participants were 817 Caucasian participants (62.5% female; mean ± SD age: 34.7 ± 8.7 y) taking part in a cross-sectional project that identified determinants of oral diseases at the community, family, and individual levels. Participants were genotyped for single-nucleotide polymorphisms on MC1R and completed self-report measures of fear of pain and dental fear. Presence of MC1R variant alleles predicted higher levels of dental fear and fear of pain. Importantly, fear of pain mediated the relation between MC1R variant status and dental fear ( B = 1.60, 95% confidence interval: 0.281 to 3.056). MC1R variants may influence orofacial pain perception and, in turn, predispose individuals to develop fears about pain. Such fears influence the pain experience and associated pain behaviors, as well as fears about dental treatment. This study provides support for genetic contributions to the development/maintenance of fear of pain and dental fear, and it offers directions for future research to identify potential targets for intervention in the treatment of fear of pain and dental fear.

Fear of Pain Questionnaire‐9: Brief assessment of pain‐related fear and anxiety

“…Convergent validity also was evaluated comparing FPQ‐9 responses to those of the PASS and the DFS. The DFS was chosen for analysis of convergent validity given that fear of pain has been shown to be a primary component (McNeil and Berryman, ) and strong predictor (Randall et al., ) of dental care‐related fear, and because dental care‐related fear is prevalent, with wide variability, among the general population (Milgrom et al., ). Moreover, the DFS can simultaneously be used for the analysis of convergent and divergent validity across FPQ‐9 subscales, given that the FPQ‐9 has a subscale assessing fear of Medical/Dental Pain (with expected large associations with DFS scores) and two subscales that are not specifically related to Medical/Dental Pain (each with expected smaller associations with DFS scores).…”

A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model

“…Genetics also have been associated with predisposing psychological factors in oral health. That is, some have demonstrated a predisposition toward pain sensitivity (e.g., MC1R gene) and its relation to poorer oral health (Randall et al, 2016, 2017a,b). Other long-standing factors such as SES, region, or access to dental insurance have been implicated in the utilization of dental services, which can influence oral health status (Chen et al, 2019).…”

Extraction of Maxillary Teeth Without a Palatal Injection: A Randomized Control Trial

“…Fear and behaviors linked to anxiety have been known as a significant impediment to dental involvement (1) . The main explanation for many dental operations is outstanding local anesthesia.…”