Towards a better understanding of dental anxiety and fear: cognitions vs. experiences

Armfield JM. Towards a better understanding of dental anxiety and fear: cognitions vs. experiences. Eur J Oral Sci 2010; 118: 259–264. © 2010 The Author. Journal compilation © 2010 Eur J Oral Sci Traumatic dental experiences are associated with dental anxiety and fear. However, many people with no dental fear have had negative dental experiences, and some people with considerable fear fail to recall any traumatic incidents. This study aimed to determine whether dental fear was better explained by experiences or by cognitive perceptions of going to the dentist as being uncontrollable, unpredictable, dangerous, and disgusting. A random sample of 1,084 Australian adults (response rate = 71.7%) completed a mailed questionnaire with measures of dental fear, perceptions of going to the dentist, and dental experiences. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness had strong bivariate associations with scores on the Index of Dental Anxiety and Fear (IDAF‐4C). Vulnerability‐related perceptions accounted for 46.3% of the variance in IDAF‐4C scores beyond that accounted for by demographic variables and five possible dental experiences comprising intense pain, considerable discomfort, gagging, fainting, and having a personal problem with the dentist. In contrast, dental experiences accounted for < 1% of the variance in IDAF‐4C scores beyond that accounted for by the four cognitive perceptions. Perceptions of uncontrollability, unpredictability, dangerousness, and disgustingness were superior predictors of dental fear compared with negative dental experiences.     

Alcohol use disorder,smoking and dental fear among adults in Finland

Abstract

Objective. This study investigated the association between dental fear and alcohol use disorder and smoking controlling for age, gender and attained level of education as well as anxiety and depressive disorders. Materials and methods. Nationally representative data on Finnish adults, 30 + years old (n = 5953), were gathered in interviews. Dental fear was measured in an interview using the question: ‘How afraid are you of visiting a dentist?’ The alternatives for replying were: ‘Not at all’, ‘Somewhat’ and ‘Very’. Alcohol use, anxiety and depressive disorders were assessed with a standardized structured psychiatric interview based on DSM-IV criteria. The question on regularity of smoking gave three reply alternatives: smoking ‘Daily’, ‘Occasionally’ or ‘Not at all’. Results. When socio-demographics and anxiety and depressive disorders were controlled for, those with lifetime alcohol use disorder were more likely to have high dental fear than were those without this disorder. When smoking was added to the model, those who smoked regularly were more likely to have high dental fear than those who smoked occasionally or not at all. In this model, alcohol use disorder was not statistically significantly associated with dental fear. Conclusions. The results of this study support the suggestion that some individuals may have personality traits that make them vulnerable to substance use disorders and dental fear.     

Psychological disorders and dental anxiety in a young adult population

OBJECTIVES: It has been suggested that some individuals who are fearful or anxious about dental treatment have a constitutional vulnerability to anxiety disorders as evidenced by the presence of multiple fears, generalized anxiety or panic disorders. This paper compares the prevalence of psychological disorders among dentally anxious and non-anxious groups drawn from the general population. METHODS: Data were obtained as part of a birth cohort study when study members were aged 18 years. They were assessed using the Dental Anxiety Scale (DAS) and the Diagnostic Interview Schedule (DIS). The disorders diagnosed by the DIS were major depressive episode, dysthymia, generalized anxiety disorder, panic disorder, agoraphobia, social phobia, simple phobia, obsessive compulsive disorder, conduct disorder, cannabis and alcohol dependence. RESULTS: Overall, 12.5% of study members had DAS scores of 13 or more and were considered to be dentally anxious. Those who were dentally anxious were more likely than the non-anxious to be diagnosed with one or more psychological disorders (55.0% vs. 42.3%). However, those with DAS scores of 13 or 14 (moderately dentally anxious) were broadly similar to the non-anxious in terms of their psychological profile. This excess prevalence of psychological disorder was largely accounted for by high rates of disorder among those with DAS scores of 15 or more (highly dentally anxious). The highly anxious were more likely than the non-anxious to have a diagnosis of conduct disorder, agoraphobia, social phobia, simple phobia or alcohol dependence. Odds ratios ranged from 2.8 to 5.0 after controlling for the effects of gender. The data also suggested that dentally anxious individuals with psychological disorders were more likely to maintain their anxiety over time. CONCLUSIONS: In this population of young adults, high rates of psychological disorder were characteristic of those with high levels of dental anxiety. Psychological disorder was related to the maintenance of dental anxiety over time.     

Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems

Gustafsson A, Broberg AG, Bodin L, Berggren U, Arnrup K. Possible predictors of discontinuation of specialized dental treatment among children and adolescents with dental behaviour management problems. Eur J Oral Sci 2010; 118: 270–277. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci This study aimed to identify potential predictors of non‐attendance among children and adolescents with dental behaviour management problems (DBMP). A group of 179 patients, 7.5–19 yr of age, was grouped into 56 ‘non‐attenders’ (discontinued treatment, missed appointments, or ≥ 20% cancellations) and 123 ‘attenders’. In addition to data from an introductory interview and dental recordings, baseline data from psychometric measures of fear and other personal and parental characteristics were included in logistic regression analyses and tree‐based modelling. The non‐attenders had higher scores on impulsivity and sociability and lower socio‐economic status (SES) than the attenders, and they lived more often in single‐parent families. Logistic regression analyses and tree‐based modelling point to SES and parental anxiety as important predictors for non‐attendance within this group of children and adolescents. To predict, and possibly to prevent, non‐attendance among children and adolescents referred for specialized dental care because of DBMP, we must consider their lives and family situations as well as their personal characteristics and oral health status. Further research should focus on whether the observed associations between non‐attendance and factors such as personal characteristics, family and psychosocial factors, and previous dental experiences, also hold for those who remain in regular dental care.     

Cognitive vulnerability and the aetiology and maintenance of dental anxiety

Edmunds R, Buchanan H. Cognitive vulnerability and the aetiology and maintenance of dental anxiety. Community Dent Oral Epidemiol 2012; 40: 17–25. © 2011 John Wiley & Sons A/S Abstract – Objectives: Dental anxiety prevalence has not changed markedly in the last 30 years, in spite of more modern and less painful technology. The objective of this study was to explore the four components (dangerousness, uncontrollability, unpredictability and disgustingness) of the Cognitive Vulnerability Model (CVM) in relation to the acquisition and maintenance of dental anxiety/phobia. Methods: Three hundred and seventy‐five participants were recruited through two dental anxiety online support groups. They completed an online questionnaire which included: a formal dental anxiety measure; open‐ended questions regarding the perceived origins of their dental anxiety, and questions specifically assessing the CVM components in the acquisition and maintenance of their fear. Results: Perceptions of the dental context as uncontrollable and unpredictable were considered important in fear acquisition, however ‘dangerousness’ was not as fully established and ‘disgustingness’ was not considered salient by participants. Three of the key components of the CVM (controllability, dangerousness and disgustingness) predicted current dental anxiety scores explaining 54% of the variance. Unpredictability was not found to have a significant independent relationship with dental anxiety. Conclusions: These findings show general support for the CVM as an explanatory model for maintaining dental anxiety, though its role as a model for fear acquisition is still not fully established.     

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder

Objectives. The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder. Methods. Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed. Results. At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month. Conclusions. Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.     

Individual oral symptoms in burning mouth syndrome may be associated differentially with depression and anxiety

Background Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms. Objective In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms. Methods Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule–Revised). Results Taste change (p?=?0.007), fear of serious illness (p?=?0.011), metallic taste (p?=?0.018) and sensation of a film on the gums (p?=?0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient?=?0.497, 95% CI?=?0.149–0.845; p?=?0.006) and sensation of film on gums (coefficient?=?0.625, 95% CI?=?0.148–1.103; p?=?0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient?=?0.269, 95% CI?=?0.077–0.461; p?=?0.007), bad breath (coefficient?=?0.273, 95% CI?=?0.065–0.482; p?=?0.012) and fear of serious illness (coefficient?=?0.242, 95% CI?=?0.036–0.448; p?=?0.023) were associated with higher anxiety scores. Conclusion Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.     

Can parents and children evaluate each other’s dental fear?

Luoto A, Tolvanen M, Rantavuori K, Pohjola V, Lahti S. Can parents and children evaluate each other’s dental fear? Eur J Oral Sci 2010; 118: 254–258. © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci The aim of this study was to determine whether parents and their 11–16‐yr‐old children can evaluate each other’s dental fear. At baseline the participants were 11–12‐yr‐old children from the Finnish Cities of Pori (n = 1,691) and Rauma (n = 807), and one of their parents. The children and their parents were asked if they or their family members were afraid of dental care. Fears were assessed using single 5‐point Likert‐scale questions that included a ‘do not know’ option. Children and parents answered the questionnaire independently of each other. Background variables were the child’s and their parent’s gender. Parents’ and children’s knowledge of each other’s dental fear was evaluated with kappa statistics and with sensitivity and specificity statistics using dichotomized fear variables. All kappa values were < 0.42. When dental fear among children and parents was evaluated, all sensitivities varied between 0.10 and 0.39, and all specificities varied between 0.93 and 0.99. Evaluating dental fear among fearful children and parents, the sensitivities varied between 0.17 and 0.50 and the specificities varied between 0.85 and 0.94, respectively. Parents and children could not recognize each other’s dental fear. Therefore, parents and children cannot be used as reliable proxies for determining each other’s dental fear.     

A comparison of three continuous scales used to determine the prevalence of clinically significant dental fear

Armfield JM. A comparison of three continuous scales used to determine the prevalence of clinically significant dental fear. Community Dent Oral Epidemiol 2011; 39: 554–563. © 2011 John Wiley & Sons A/S Abstract – Objective: To assess the level of agreement and concordance of three different dental anxiety and fear scales and determine whether using commensurate cut‐points reduces discrepancies in the estimated prevalence of high dental fear. Methods: A representative sample of the Australian adult population completed a computer‐assisted telephone interview (CATI) with additional data obtained on a random sample of 25% of those completing the CATI. Participants completed three measures of dental anxiety and fear: the Dental Anxiety Scale, the Index of Dental Anxiety and Fear, and a single‐item question. Cut‐points were determined to equivalize the range of possible score responses defining a case of high dental fear for each scale. Results: A total of 1084 people completed the CATI and returned a questionnaire (response rate = 71.4%). Prevalence estimates ranged from 7.3% to 28.4% depending upon both the scale and cut‐point used. The overall percent agreement between the scales was high, but the overlap between the scales in those people determined to have high dental fear was considerably lower. Using different cut‐points to define a case significantly altered the sensitivity and specificity of the scale in predicting dental avoidance, problem‐oriented visiting and fear of lack of control. Conclusions: Equivalizing scale cut‐points does reduce variation in prevalence estimates of high dental fear across scales, but variation remains because of differences in the nature of, and content covered by, each scale. Dichotomizing scores on continuous scales to obtain prevalence estimates of high dental fear should be appropriately justified, correctly interpreted and supplemented by results describing the distribution of scores.     

Oral health‐care utilization in adults with disabilities in Belgium

Leroy R, Declerck D. Oral health‐care utilization in adults with disabilities in Belgium.
Eur J Oral Sci 2013; 121: 36–42. © 2012 Eur J Oral Sci Reports on oral health‐service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health‐care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health‐care utilization and socio‐demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental‐attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral‐treatment needs.     

Evaluating the validity of the Index of Dental Anxiety and Fear (IDAF-4C+) in adults with severe dental anxiety

Dental anxiety is a common condition with severe consequences for oral health and health-related quality of life. The aim of this study was to evaluate the recently developed self-report scale Index of Dental Anxiety and Fear (IDAF-4C⁺) in adults with severe dental anxiety. A sample of 147 adults (age 20–71 yr) with severe dental anxiety completed a questionnaire including the IDAF-4C⁺ and three other dental anxiety scales. In a clinically assessed subgroup (n = 93), 95% had an International classification of diseases and related health problems 10th version (ICD-10) diagnosis of specific phobia for dentistry. Agreement between the scales was analysed using Spearman’s correlation, the Kappa measure of agreement and the intraclass correlation coefficient. The agreement of dental phobia according to the IDAF-4C⁺ phobia module and the ICD-10 was very low (ĸ = 0.02). The anxiety and fear module of the IDAF-4C⁺ showed acceptable agreement with the other scales (r_s 0.69–0.75; ICC 0.90, 95% CI 0.87–0.93). We conclude that the IDAF-4C⁺ offers more information to clinicians and researchers than the older dental anxiety scales, but the phobia module needs further development.     

The relationship between dental anxiety and dental decay experience in antenatal mothers

Esa R, Savithri V, Humphris G, Freeman R. The relationship between dental anxiety and dental decay experience in antenatal mothers. Eur J Oral Sci 2010; 118: 59–65 . © 2010 The Authors. Journal compilation © 2010 Eur J Oral Sci
The aim of this study was to investigate the relationship between dental anxiety and dental decay experience among antenatal mothers attending Maternal and Child Health clinics in Malaysia. A cross-sectional study was conducted on a consecutive sample of 407 antenatal mothers in Seremban, Malaysia. The questionnaire consisted of participants' demographic profile and the Dental Fear Survey. The D_3cvMFS was employed as the outcome measure and was assessed by a single examiner (intraclass correlation = 0.98). A structural equation model was designed to inspect the relationship between dental anxiety and dental decay experience. The mean Dental Fear Survey score for all participants was 35.1 [95% confidence interval (34.0, 36.3)]. The mean D_3cvMFS score was 10.8 [95% confidence interval (9.5, 12.1)]. Participants from low socio-economic status groups had significantly higher D_3cvMFS counts than those from high socio-economic status groups. The path model with dental anxiety and socio-economic status as predictors of D_3cvMFS showed satisfactory fit. The correlation between dental anxiety and dental decay experience was 0.30 (standardized estimate), indicating a positive association. Socio-economic status was also statistically significantly associated with the D_3cvMFS count (β = 0.19). This study presented robust evidence for the significant relationship between dental anxiety and dental decay experience in antenatal mothers.     

Dental fear and subjective oral impacts among adults in Finland

We aimed to study the association between subjective oral impacts and dental fear adjusted for age, gender, level of education, and dental attendance, and to evaluate whether this association was modified by the number of remaining teeth. Nationally representative data on Finnish adults, 30+ yr of age (n = 5,987), were gathered through interviews, clinical examination, and questionnaires. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ and subjective oral impacts were measured using the 14‐item Oral Health Impact Profile (OHIP‐14) questionnaire. The outcome variables were the percentage of people reporting one or more OHIP‐14 items fairly often or very often, and the ‘extent’ and ‘severity’. Those with high dental fear reported higher levels of prevalence, ‘extent’, and ‘severity’ of subjective oral impacts than did those with low dental fear or no fear. The association between dental fear and subjective oral impacts was not significantly modified by the number of remaining teeth. The greatest differences between those with high dental fear and low dental fear were found in psychological, social, and handicap dimensions, but not in functional or physical dimensions of the OHIP‐14. Treating dental fear could have positive effects on subjective oral impacts by reducing psychological and social stress and by improving regular dental attendance and oral health.     

Are Oral Health Status and Care Associated with Anxiety and Depression? A Study of Portuguese Health Science Students

The relationship between oral health and anxiety/depression were assessed in a cross-sectional study conducted in 388 Portuguese students from the Health Sciences (age: 21 +/- 3 years, 75% women). Oral health included prevalence of reported tooth pain/gum bleeding, dentist attendance, and dentifrice and dental floss use. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale. Subjects with anxiety or depression had a higher frequency of perceived gum bleeding and reported a higher dentist attendance than normal subjects. On multivariate analysis, anxiety was significantly and independently related to perceived toothache (OR = 2.90, 95% CI: 1.25-6.72) and dentist attendance (OR = 2.15, 95% CI: 1.18 - 3.91) whereas depression was associated with perceived gum bleeding (OR = 4.96, 95% CI: 1.68 - 14.59), and no differences were found regarding teeth brushing or dental flossing. The author concludes that anxiety and depression are related to perceived toothache and gum bleeding, but this association cannot be explained by decreased dental care.     

Changes in dental fear and its relations to anxiety and depression in the FinnBrain Birth Cohort Study

This study aimed to: (i) evaluate short-term changes in dental fear during a 9-month period among women and men, and (ii) evaluate whether the course and magnitude of changes in dental fear were associated with changes in depression and anxiety. The longitudinal data of the FinnBrain Birth Cohort Study were used. Out of 3808 women and 2623 men, 1984 women and 1082 men filled in the Modified Dental Anxiety Scale (MDAS) at gestational weeks 14 and 34, and 3 months after childbirth. Other questionnaires used were the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Symptom Checklist-90. All scales were analyzed as sum scores. The MDAS was also trichotomized to assess the stability of dental fear. Statistical significances of the changes in dental fear, depression, and general anxiety were evaluated using repeated-measures Friedman tests. Correlation coefficients were used to describe the associations between measures (Spearman) and their changes (Pearson). Dental fear more often increased than decreased, but for the majority it was stable. On average, dental fear, depression, and anxiety symptoms correlated throughout the study. The correlations tended to be stronger with depressive symptoms. However, the relationships between changes in dental fear, depression, and anxiety were not systematic.     

Dental fear and alexithymia among adults in Finland

population sample, controlling for age, gender, education and marital status as well as depressive and anxiety disorders. An additional aim was to evaluate whether gender modified this association. MATERIAL AND METHODS. The two-stage stratified cluster sample (n = 8028) represented the Finnish population aged 30 years and older. Participants (n = 5241) answered the question 'How afraid are you of visiting a dentist?' They also filled out the 20-Item Toronto Alexithymia Scale (TAS-20), which included three sub-scales, i.e. difficulties in identifying feelings (DIF), difficulties in describing feelings (DDF) and externally oriented thinking (EOT). Anxiety and depressive disorders were assessed with a standardized structured psychiatric interview according to DSM-IV criteria. To evaluate the association between dental fear and alexithymia, multiple logistic regression analyses were performed, adjusting simultaneously for the effects of possible confounding variables. RESULTS. Gender modified the association between dental fear and alexithymia. Among women, those reporting higher scores for TAS-20, DIF and EOT sub-scale scores were more likely to have high dental fear than were those reporting lower scores. Among men no such association was observed. Those participants who reported high DDF sub-scale scores were more likely to have high dental fear than were those reporting lower scores. CONCLUSIONS. Alexithymics are more likely to have high dental fear than non-alexithymics are. The findings support the suggestion that some people with dental fear may have internal personality vulnerability to anxiety disorders.     

The complexity of dental anxiety and its association with oral health-related quality of life: An exploratory study

This study aimed to explore the factors associated with oral health-related quality of life (OHRQoL) in a sample with high dental anxiety. Data were obtained from 107 patients attending a therapeutic treatment program for people who have experienced abuse and for those with dental phobia in Norway. Patients completed questionnaires, including the Index of Dental Anxiety and Fear, the Anxiety subscale of the Hospital Anxiety and Depression Scale, and the Oral Impacts on Daily Performance scale, measuring OHRQoL prior to treatment. The various measurement instruments were evaluated psychometrically, and the variables associated with OHRQoL were explored using hierarchical multiple regression. Symptoms of dental anxiety and general anxiety were high, while OHRQoL was poor. Dental anxiety, higher age, higher number of years since the last dental treatment, and higher general anxiety were discernibly associated with lower OHRQoL. The strongest association was found between general anxiety and OHRQoL. In conclusion, several factors were associated with OHRQoL in a sample with high dental anxiety, suggesting a complex picture of dental anxiety. When treating patients with high dental anxiety, dental practitioners should be aware that there may be factors complicating the therapeutic setting, such as general anxiety.     

Association of dental anxiety to personality traits in a general population sample of Finnish university students

Abstract

Objective. To estimate the association between personality and dental anxiety among Finnish University students. Materials and methods. A total of 880 university students in Finland returned the questionnaires addressing dental anxiety by using the Modified Dental Anxiety Scale (MDAS) questionnaire. In addition, the personality of traits (neuroticism, extraversion, agreeableness, conscientiousness and openness to experience) were noted. Personality traits of students were compared with the level (high, mild or none) of dental anxiety derived from the MDAS questionnaire. The relative odds of dental anxiety associated with the level of dental anxiety were estimated by logistic regression, Chi-Square tests and one-way analysis of variance (ANOVA). Results. Median age of the respondents was 22 years. Of the respondents, 99 (11.3%) were classified as dentally anxious patients (90, 12.2% of females; 9, 6.6% of males)). Neuroticism was the only personality trait that was significantly associated with dental fear (p < 0.001). A tendency, although not significant, was seen between high dental fear and lower extraversion and agreeableness. Conclusions. Of the five different personality traits, neuroticism was a significant risk factor for developing dental anxiety, and this should be recognized in clinical practice.     

Dental anxiety in a representative sample of residents of a large German city

In a demographic survey, 300 residents of a German city were questioned to determine the prevalence of dental anxiety. The correlation between the amount of dental anxiety and the age, sex, and education of the subjects was examined and the reasons for avoiding dentist’s appointments, the duration of this avoidance, and what the subjects desire from future dental treatment. The Hierarchical Anxiety Questionnaire (HAQ) was used to measure the amount of dental anxiety. The average level of anxiety was 28.8±10.1 according to the HAQ. Young people were more afraid than older people (p=0.007), and women were more anxious than men (p=0.004). Of the women, 72% go to the dentist regularly, but only 60% of the men do (p=0.020). A painful experience while receiving dental treatment was given by 67% as the main reason for their dental anxiety, followed by a fear of needles (35%). The people wished for the most accurate information available about the dental treatment they receive (69%), followed by a compassionate dentist (62%), and treatment that is free of pain (62%). Of the people, 11% [95% CI: (7.5%; 14.5%)] suffer from dental phobia. All dental phobics were able to state the cause of their fear and more urgently wished for help from the dentist in overcoming their anxiety than the non-phobics (p=0.030). To satisfy the needs of the phobic patients, it appears necessary to screen the phobics out of the group of all patients and then offer them adequate therapy, or refer these patients to specialised treatment centres.