Dental anxiety among young adolescent patients in Israel

Aim. To evaluate adolescents’ dental anxiety using self‐reported questionnaires previously given to adults. Sample and method. One hundred and four patients (42 boys, 62 girls) aged 12–18 years who attended their paediatric dentist completed a questionnaire in the waiting room. The survey consisted of three sections: sociodemographic information for the children, a dental anxiety scale (DAS), and a dental fear survey (DFS). Results. The scores of the girls were higher than the boys in every DAS item as well as in the total score. Girls showed higher DFS scores than boys in most items. The most anxiety‐provoking stimuli were feeling and seeing the needle. In the most anxiety provoking stimuli, among the boys who reported higher DFS scores (categories 3, 4, 5), the DAS scores were higher than the scores of the girls. As the stimulus became less anxiety‐provoking, such as sitting in the dental chair, the DAS scores of the girls in these categories were higher than boys. Significantly more girls’ responses were in categories 3, 4 and 5 in the items dealing with the needle and the drill, while no significant difference was observed among the boys and girls regarding sitting in the dental chair. Conclusions. It is concluded that individual personality traits may be the final factor to indicate those who will eventually develop higher dental anxiety, and those who will not. The difference could be also in the conditioning process and learned responses (male and female education) that these individuals have experienced in life.     

Oral health-related quality of life in patients with dental anxiety

OBJECTIVES: To investigate the frequency of impaired oral health-related quality of life (OHRQoL) in patients with dental anxiety. METHODS: OHRQoL was measured with the German version of the 14-item Oral Health Impact Profile (OHIP) developed by Slade and Spencer (1994) in 173 adult patients with dental anxiety [Dental Anxiety Scale (DAS) score 15 or above and Dental Fear Survey (DFS) score 60 or above]. The OHIP summary scores were characterized with an empirical cumulative distribution function and compared with the level of impaired OHRQoL in the general population (n = 2026, age: 16-79 years). In addition, OHIP item prevalences (responses 'fairly often'/'very often') were compared between patients and population subjects. The correlation between DAS, DFS and OHIP scores was calculated using the Pearson correlation coefficient. RESULTS: A median value of 1 and a 90th percentile value of 13 were observed for general population subjects. In contrast, patients with phobic dental anxiety had a median OHIP-14 of 21 and the 90th percentile of 40. All problems mentioned in the OHIP-14 were more prevalent in patients than in population subjects. The most frequently occurring items in patients were 'self-conscious', 'life in general was less satisfying', and 'feeling tense' with prevalences of 50% or greater. In contrast, these items had prevalences of only 1-3% in the general population. A low to moderate relationship between OHRQoL and both dental anxiety measures (DAS and DFS) was observed (r = 0.25/0.26, P < 0.01). CONCLUSIONS: Patients with dental anxiety/fear suffer considerably from impaired OHRQoL and the degree of this impairment is related to the extent of dental anxiety/fear.     

拔牙患者牙科畏惧症的临床调查

目的：研究拔牙患者围拔牙手术期的焦虑状况及其相关因素,为临床防治牙科畏惧症提供指导。方法：采用改良牙科焦虑量表（DAS）对200例拔牙患者进行横断面调查和统计分析。结果：200例拔牙患者中有10.50%的患者DAS评分值≥13,属于严重的牙科焦虑情况,尤其在局部麻醉前焦虑水平最高。牙科畏惧相关因素分析中DAS评分较高因素有：女性、性格偏内向、自我或周围人有不良牙科经历者、疼痛耐受程度低、精神状态差和心情紧张等。结论：拔牙术前的牙科畏惧症有较高发生率,达到10.50%,并且其相关因素较多。患者最为恐惧的因素是拔牙前局麻注射时的疼痛。     

Epidemiologic study of dental fear in school children 8-15 years of age

Authors investigated the dental fear scores (DAS, DFS) of 139 primary school children in Budapest, Hungary (72 females, 67 males, ages between 8-15 years). Sex and age had no effect on the scales. Mean dental fear scores were high (DAS: 10.7 +/- 3.7, DFS: 40.4 +/- 15.3). A strong correlation between DAS and DFS, and somewhat lower correlation between these scales and the general anxiety scales were demonstrated. Children's evaluation of the dental fear of the family and relations strongly correlated with dental fear and moderately with general anxiety. The results indicate that, dental fear is influenced by dental fear of family and relations, and general anxiety, but much less influenced by other demographic variables (i.e. age, sex) in primary-school children.     

Epidemiological study of dental fear scores in several Hungarian sub-populations

Authors investigated the dental fear scores (DAS, DFS) and anxieties of 362 persons from several sub-populations living in Budapest. The subjects were: 253 females, 109 males, aged 14 to 73. Dental fear scores were rather high (DAS: 11.0 +/- 3.6; DFS: 42.0 +/- 16.0). Age influenced the dental fear scales (DAS and DFS) only; sex, and marital status influenced both dental fear scales and general anxiety scales (one-way ANOVA). A strong correlation between DAS and DFS, and somewhat lower correlation between these scales and the general anxiety scales were also demonstrated.     

Some background data about the high dental anxiety of the Hungarian population

100 dental patients waiting for hypnotic dental treatment (n = 100, 58 female, 42 male, mean age: 36.4 +/- 10.6 yr.) was investigated about their perceived origins of dental anxiety. Dental anxiety levels (DAS, DFS) and general anxiety were measured as well. Mean dental anxiety scores were high (DAS: 12.5 +/- 3.3; DFS: 47.9 +/- 17.3). The most frequent reason of high dental anxiety was previous painful dental treatment (20.0%), dislike of dentist's behaviour (15.0%), treatment error (5.0%), and "other reasons" (4.0%). A large amount of the patients (48.0%) did not know what to expect, and 8.0% indicate no fear related to dentistry. Previous painful dental treatment induced the highest dental anxiety (DAS: 15.1 +/- 3.1; DFS: 58.1 +/- 20.3), followed by the "other reasons" (DAS: 14.0 +/- 0.8; DFS: 50.5 +/- 13.5), treatment error (DAS: 13.0 +/- 3.7; DFS: 49.0 +/- 16.1), and dislike of dentist's behaviour (DAS: 11.4 +/- 2.8; DFS: 45.0 +/- 12.5). Increased general anxiety was found in the groups indicated previous painful dental treatment, "other reasons", and no expectation.     

Incidence of dental anxiety in young adults in relation to dental treatment experience

OBJECTIVES: To document the incidence of dental anxiety among individuals aged 18 years at baseline and 26 years at follow-up, and to determine if dental treatment experience continues to play a significant etiological role with respect to the onset of dental anxiety in young adults. METHODS: Dental anxiety scale (DAS; Corah, 1969) scores at ages 15, 18 and 26 were obtained for Study members in the Dunedin Multidisciplinary Health and Development Study. Dental examinations were conducted, and sociodemographic and dental service-use data were collected using a self-report questionnaire. Using a case definition of a DAS score of 13 or more, age 18-26 incident cases were identified and their dental treatment experience and service-use characteristics compared with the remainder. RESULTS: DAS scores at 18 and 26 were available for 792 (80.8%) of the 980 26-year-old Study members. An increase in dental anxiety prevalence was observed over the eight-year period, with an annualized incidence of 2.1%. Fewer incident cases had visited a dentist in the previous eight years, and there were no differences between incident cases and others in their eight-year DFS, FS or tooth-loss increments. A subgroup of "recurrent" cases was identified who were dentally anxious at 15 and 26 but not at 18, and their eight-year incidence of tooth loss due to caries was substantially higher than non-cases. CONCLUSIONS: Aversive conditioning experiences appear to be unrelated to the adult onset of dental anxiety, and it may be that particular temperamental or psychological traits are associated with the condition.     

Dental fear and anxiety in an older adult population

A random sample of 580 people aged between 50 and 89 yr completed a questionnaire containing two measures of dental fear and anxiety. One of these was Corah's Dental Anxiety Scale (DAS) and the other a scale derived from the Structured Interview for Assessing Dental Fear (SIADF). The mean score on the DAS was 7.8, and 8.4% of subjects were classified as dentally anxious. There were no differences in mean DAS scores by sex but significant differences by age, with younger individuals having higher scores (P less than 0.0001). The edentulous had significantly higher scores than the dentate (P less than 0.001). Scores on the SIADF scale were higher among younger individuals (P less than 0.0001), the edentulous (P less than 0.01) and women (P less than 0.05). Older adults who were dentally anxious were less likely to report a regular source of dental care and a dental visit in the previous year and more likely to report having avoided or delayed dental treatment. Possible explanations of higher dental anxiety scores among younger persons and the edentulous are reviewed.     

Dental fear scores of 12-19-year-old school children of the Hungarian minority in Transylvania

In this study 549 school children of the Hungarian minority in Transylvania were investigated (n=549, 342 female, 207 male, age between: 12-19 years). Mean dental fear scores were high: DAS: 12.6 +/- 3.3, DFS: 50.6 +/- 25.1. Girls scored significantly higher (p< or =0.01) in both scales. Scores increased between age of 12 and 16 confluently in both scales (DAS, DFS; p< or =0.05). There was a strong Pearson's correlation between DAS and DFS scales: (r= 0.70; p< or =0.01), and a somewhat lower correlation between these scales and the general anxiety scores. Mean DBS score (n = 203 only) was: 44.9 +/- 10.2.     

Dental fear and anxiety scores of a Hungarian population living in the Hungarian-Slovakian border region. A pilot study

The aim of the authors was to investigate whether living as a minority has an influence on the dental fear and anxiety values. In this study 201 volunteers (n = 201, inside border Hungarians 144, outside border Hungarians 57, male 90, female 111; age 8 to 83 years, mean 44 +/- 16 yrs.) were investigated. Our methods included collection of demographic data (gender, age, marital status, profession), and administration of the Hungarian versions of dental fear and anxiety related scales namely: DAS, DAQ, DASQ, DFS, DBS, STAI-S, STAI-T and Expectation Scale. Mean values of the scales were: DAS: 10,34 +/- 3,54; DAQ: 2,3 +/- 1,15; DASQ: 12,58 +/- 4,55; DFS: 40,37 +/- 15,67; DBS: 32,89 +/- 12,94; Expectation Scale: 2,87 +/- 3,56, STAI-S: 39,51 +/- 10,68; STAI-T 41,65 +/- 9,08. The mean scores of all the scales were higher in the case of Hungarians living inside the borders of Hungary. The differences were significant in the case of DAS, DAQ, DASQ and DFS scales (p < 0,05). Data of our study indicate that living as a minority not necessarily leads to the increase of dental fear and anxiety.     

牙科畏惧症患者的异常心理分析

目的：探讨不同年龄段牙科畏惧症患者的抑郁、焦虑状态、对人性的信心以及自信。方法：选取329名牙痛患者，填写抑郁自评量表（SDS），焦虑自评量表（SAS），信赖他人量表（FPA），状态-特质焦虑问卷（STAI），得到各评分值，用牙科畏惧（DF）量表筛选出畏惧症患者，将无畏惧症者作为正常对照组与畏惧症患者进行比较，并根据年龄段分组，进行统计学分析。结果：牙科畏惧症患者与正常对照组的抑郁自评量表评分经统计学处理有显著性差异。男女患者在牙科畏惧症评分上有显著性差异，女性的畏惧程度较男性要严重。青年组和中年组畏惧症患者的抑郁自评量表与正常对照组比较有统计学差异。青年组的状态焦虑评分有统计学意义。结论：牙科畏惧症患者具有异常的心理状态。     

Reliability and clinical usefulness of psychometric measures in a self-referred population of odontophobics

Questionnaire responses of 155 self-referred subjects with extreme dental fear were used to evaluate the reliability and clinical usefulness of some psychometric tests used in diagnosis and treatment. The Corah Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory (STAI), and a general Geer Fear Scale (GFS) were filled out by all subjects, while 80 patients with highest dental fear scores were also tested before and after dental fear treatment with the following scales; a Getz Dental Belief Survey (DBS), Dental Fear Survey (DFS), and a Mood Adjective Checklist (MACL). Cronbach's alpha measured internal consistency reliability. SPSS data analyses calculated item-remainder and test-retest correlations. Clinical usefulness of scales was judged by Spearman correlations of initial scores and test score changes after dental fear treatment. All total test scores showed high internal consistency and test-retest reliability. DFS was judged the preferred clinical measure of threatening perceptions of pain or unpleasantness specific to dental procedures. DBS and STAI-State measured confidence in relating with the dentist and situational fear associated with that relationship. GFS, STAI-Trait, and MACL discriminated levels of general fearfulness, anxiety and mood fluctuations that can impact on dental fear.     

大学生牙科焦虑症及对选择种植修复选择的影响分析

目的了解大学生的牙科焦虑症情况和牙科焦虑症对种植修复选择的影响。方法用改良牙科焦虑量表对126名大学生进行问卷调查。根据性别分析牙科焦虑症情况,并按问卷得分将研究对象分成两组:牙科焦虑症患者和非牙科焦虑症患者。对两组的种植修复的选择情况进行分析,并按组统计不选择种植修复的原因。结果大学生中女性牙科焦虑症发病率较男性高。牙科焦虑症患者对种植修复选择相对较少。不选择种植修复的原因以害怕手术和害怕疼痛为主。结论提高对种植牙的认识,减轻对种植牙的焦虑,可以让更多人选择种植。     

Cross validation of a Brazilian version of the Dental Fear Survey

Abstract – The Dental Fear Survey (DFS), a paper and pencil instrument for assessing dental fear and avoidance, has been widely used and validated in fear studies in the US. However, before such instruments are used in countries and cultures dissimilar to the one in which it was developed, they should be cross-validated in that culture. The present study is an examination of the DFS response characteristics in a group of 374 Brazilian university students. Factor analysis of the DFS revealed three factors essentially identical to those found among university students in the US and in Singapore, as well as among US adult dental patients. Higher DFS scores were significantly associated longer intervals since last dental visit. These results are taken as evidence that the DFS performs in this Brazilian sample very much as it does in other samples; and is thus, a valid indicator of dental fear at least among Brazilian university students.     

Background data about the dental fear scores of Hungarian secondary school students

Free association (coupling) of 139 Hungarian secondary school students (90 females, 49 males, age between 14-18 yr.) about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: simple and traumatising dental treatments, etc.) were coupled by the participants in 36,7% of the cases. Functions and importance of the teeth and oral hygiene were described in 7,2% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 16,5% of the cases. No answer was found in 39,6% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Age had no influence on the sense of the association (coupling).     

Assessment of dental fear. A comparison of two psychometric instruments.

To analyze further dental fear and its presentation in dental patients, two psychometric instruments were distributed among 50 patients attending a dental emergency clinic (EMC) and 44 patients applying for treatment at a specialized dental fear clinic (FEC). The Dental Fear Survey (DFS) was compared with the Corah Dental Anxiety Scale (DAS). After separating the EMC patients into high- and low-fear individuals in accordance with DAS scores, analysis showed that DFS values also clearly distinguished between these groups and between the FEC group and EMC groups. The dental fear levels were in correspondence with previous results, and the correlation between the DAS and the DFS was high (r = 0.92). In contrast to the DFS avoidance and arousal dimensions, the difference between the mean item scores on the dental situation dimension was not significantly different between high-fear EMC and FEC individuals. This indicated that the evaluation and appraisal of the dental situation among high-fear EMC and FEC patients may have been corresponding, whereas the behavioral and physiologic effects were different. Thus, in spite of this similar appraisal of the dental situation, FEC patients were interpreted as showing a more phobic behavior, and this was better captured in the DFS than in the DAS.     

Clinical measurement of dental anxiety

Abstract The mean scores on five dental anxiety measurements of 60 patients suffering from extreme dental anxiety are compared with those of an equal-sized, matched group of regular dental attenders free from dental anxiety. Four of the measurements, especially Corah's DAS, appear to be suitable for distinguishing persons suffering from extreme dental anxiety. Also, persons with extreme dental anxiety appear to express their fear openly.     

Background data about the high dental fear scores of Hungarian 8-15-year-old primary school children

Free associations (coupling) of 139 Hungarian primary school children about their teeth was collected. Dental fear (DAS, DFS) and general anxiety scores were measured. Typical dental events (i.e.: loss of deciduous teeth, simple and traumatising dental treatments, tooth fractures) were coupled by the participants in 41.0% of the cases. Functions and importance of the teeth and oral hygiene were described in 20.1% of the cases. Simple, grotesque, or magical stories and tales about teeth were found in 8.6% of the cases. No answer was given in 30.2% of the cases. Highest dental fear and general anxiety scores were found in the group coupled traumatising dental treatment. Traumatising loss of deciduous teeth was caused by the dentist or by the father of the child, and was associated with higher dental fear and general anxiety comparing to simple loss of deciduous teeth. Higher dental fear and general anxiety scores were found in the group coupled functions and importance of the teeth comparing to the group coupled simple, grotesque, or magical stories and tales, or the group giving no answer.     

Attendance pattern of anxiety-treated dental patients: a pilot study

Ex-patients of a dental fear clinic were found to have significantly reduced, yet still high, dental anxiety scores in comparison with the pre-intervention scores. In spite of the intervention about one quarter of the ex-patients did not visit a dentist regularly. A positive relationship was found between dental anxiety, measured with Corah's DAS, and "dislike of drilling". A short duration of (self-reported) psychophysiologic anxiety reactions appeared to be associated with the intention to ask for treatment, e.g. if a cavity were present. However, regular dental attendance was not correlated with dental anxiety scores.