Identifying the mechanisms of latent inhibition to prevent dental fear

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PROJECT SUMMARY Our recent findings as well as others, show pre-exposure to dental stimuli prior to a conditioning event results in latent inhibition (LI). The reverse is also true, lack of pre-exposure is related to greater fear, poorer oral health, increased likelihood of cancellation of dental appointments, decreased likelihood of compliance with the recommended schedule of dental visits, and failure to maintain an ongoing relationship with a dental office. Although findings across studies converge on LI as clinically relevant for the prevention of dental fear, this fact has not been leveraged to develop prevention programs nor have the necessary experimental investigations been undertaken to identify the target mechanisms responsible for LI of dental fear. There are currently no evidence-based prevention strategies for dental fear and existing prevention strategies for related anxiety disorders are typically low-dose versions of diffuse treatment programs without a specified mechanism of action. The purpose of the proposed study is to identify the mechanism(s) underlying the LI of dental fear, allowing for more precise engagement of these target(s), and to examine whether individual differences related to ethnicity that could help account for the disparities observed in oral health and dental fear, are related to the engagement of these targets. We hypothesize that changes in prediction errors and attention that result from pre-exposure account for latent inhibition of conditioned fear and that higher pain sensitivity increases the engagement of these mechanisms. We propose studies that manipulate pre-exposure in a novel virtual reality paradigm, developed and validated by members of our team, to affect the target mechanisms. In addition to assessing attention and prediction errors, we will examine the endpoint of fear, using measures of behavior, subjective emotion, and physiological change. The proposed research is innovative in that it is the first to apply a well-characterized model of learning to the LI of dental fear using an experimental medicine approach; it uses a newer paradigm that allows for the assessment of behavior in the context of clinically-relevant conditions of mixed approach/avoidance motivation, with environmental contingencies that allow for detection of individual differences, including those with the potential to address oral health disparities. Moreover, the approach used includes participants of both sexes across the lifespan, and short and longterm retention tests, noted omissions in the extant literature on human fear conditioning. These studies are relevant to public health because over 40 million Americans suffer from significant dental fear with the potential to negatively impact oral health and downstream health sequalae. The proposed studies are relevant to clinical practice because the lack of precisely defined and measurable targets for prevention of dental fear is a critical barrier to the development of evidence-based, cost-effective prevention strategies with the scalability to effect change in the population. Moreover, the proposed research responds the priorities identified by NIDCR in the 2030 visioning initiative to integrate oral health and overall health, enable precise, personalized care, and, address oral health disparities.