Reliability and validity of the short version of the Dental Anxiety Inventory

The present study focused on a newly developed questionnaire to assess dental anxiety. The short version of the Dental Anxiety Inventory (S-DAI) contains nine items of the Dental Anxiety Inventory (DAI), which was designed to take into account three situations that may evoke dental anxiety, four time elements in which dental anxiety may be provoked, and three reactions. The aim was to assess the validity and reliability of the S-DAI in a sample of highly anxious dental patients applying for treatment at a dental fear clinic in the Netherlands. Three hundred and twenty-one patientslled out several questionnaires assessing dental anxiety (S-DAI, DAS, and a 10-point Likert-scale) and psychological complaints. Total mean score on the S-DAI for women (mean=40.5, s =5.7) was some-what higher than for men (mean=38.8, s =6.9) ( t (306)=2.35; P =0.019). Cronbach's α for the present sample was 0.88. Correlations with other measures of dental anxiety were 0.73 with the DAS ( P < 0.001) and 0.69 ( P < 0.001) with the 10-point scale. The results indicated that the S-DAI has good reliability and construct validity. It was concluded that the S-DAI is easy to administer in general dental practices and dental fear clinics and has satisfactory psychometric qualities.     

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.     

Use of orally administered diazepam in the reduction of dental anxiety

A double-blind randomized clinical trial of the effectiveness of orally administered diazepam in reducing dental anxiety was conducted. Forty-one subjects were assigned to a diazepam or placebo group and tested, using the Dental Fear Survey and State-Trait Anxiety Inventory. Diazepam was effective in reducing anxiety scores but not dental fear scores.     

Stouthard牙科恐惧量表中文版的研制及评价

目的研制Stouthard牙科恐惧量表(Stouthard's dental anxiety inventory,DAI)中文版并对其心理学性质进行检验以评价量表的可行性。方法按照心理测量学中量表的跨文化适应程序对DAI英文版进行翻译、反译、文化调试和试用建立DAI中文版;并使用了DAS牙科焦虑问卷进行验证。使用DAI中文版对940例成人患者进行牙科恐惧调查,检验量表的信度、效度等心理测量学性质,且检测与Corah牙科焦虑量表(Corah's dental anxiety scale,简称DAS)和状态特质焦虑问卷(Stale-Trait Anxiety Inventory,简称STAI)得分之间的关系。结果 DAI中文版重测信度为0.943,内部一致性Cronbach'sα系数为0.956。结构效度KMO=0.961,因子分析共选出5个公因子:害怕医生的处理方式、对就医过程焦虑、一般牙科焦虑、害怕牙医及其评论和恐惧就医过程,其累计贡献率达60.541%。其分布与理论结构假设相符;DAI中文版与DAS和STAI中的特质焦虑量表得分呈显著相关(P<0.01)。结论 DAI中文版具有良好的信度和效度,是符合中国人使用的牙科恐惧量表。     

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.     

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.     

Differential diagnosis of odontophobic patients using the DSM-IV

Categories of extreme anxiety for dental treatment were derived using, DSM-IV psychiatric criteria. A sample of 40 men and 40 women patients with extreme dental anxiety were initially evaluated with Dental Anxiety Scale (DAS), Trait Anxiety Inventory (STAI-T) and Geer Fear Scale (GFS). Patients all had DAS scores ≥15 indicating extreme dental anxiety and were further evaluated with clinical interviews, Denial Fear Survey (DPS), Dental Beliefs Survey (DBS) and Mood Adjective Checklist (MACL). Results showed that 46% of 80 patients complained mainly of powerlessness and embarrassment about dental treatment while also having greater DBS scores than other categories, i.e. social phobia. Another 19% reported conditioned specific phobias (pain, drilling, injection, etc.) most often and lower DBS and GFS scores than other groups; while 35% had broader general anxiety complications, such as multiple phobias and agoraphobia with or without general anxiety symptoms (higher GFS and STAI-T compared to others). Symptoms of general anxiety disorder (GAD) were present in 30 of 80 patients, who had greater STAI-T and GFS and lower MACL scores than non-GAD patients. These results have implications for appropriate treatment strategies.     

Validity of the Children's Dental Fear Picture test (CDFP)

The validity of the Children's Dental Fear Picture test (CDFP) was investigated in 146 Swedish children aged 5–12 yr. The CDFP was compared with dental fear scores on Children's Fear Survey Schedule – Dental Subscale (CFSS-DS), selection criteria for testings (dentally fearful/not dentally fearful), and with level of general fear measured by the Short Form of Children's Fear Survey Schedule (CFSS-SF). Dental fear in the CDFP was closely related to high scores on CFSS-DS and CFSS-SF. The CDFP proved to be a valid instrument to diagnose dental fear in children with values of sensitivity up to 98.5%.     

Anxiety and depressive disorders and dental fear among adults in Finland

Pohjola V, Mattila AK, Joukamaa M, Lahti S. Anxiety and depressive disorders and dental fear among adults in Finland.
Eur J Oral Sci 2011; 119: 55–60. © 2011 Eur J Oral Sci We studied the association between dental fear and anxiety or depressive disorders, as well as the comorbidity of dental fear with anxiety and depressive disorders, controlling for socio‐demographic characteristics, dental attendance, and dental health. Nationally representative data on Finnish adults, ≥ 30 yr of age (n = 5,953), were gathered through interviews and clinical examination. Dental fear was measured using the question: ‘How afraid are you of visiting a dentist?’ Anxiety and/or depressive disorders were assessed using a standardized structured psychiatric interview according to criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM‐IV).Those with depressive disorders, generalized anxiety disorder or social phobia more commonly reported high dental fear than did those without these disorders. When age, gender, education, dental attendance, and the number of decayed, missing, and restored teeth were considered, those with generalized anxiety disorder were more likely to have high dental fear than were participants with neither anxiety nor depressive disorders. The comorbidity of depressive and anxiety disorders also remained statistically significantly associated with dental fear; those with both depressive and anxiety disorders were more likely to have high dental fear than were those without these disorders. Our findings support the suggestion that some individuals may have a personality that is vulnerable to dental fear.     

Dental Fear in Children With a Cleft Lip and/or Cleft Palate

Objective : To assess the level of dental fear in children with a cleft lip and/or palate, to compare this level with that of a normative group testing the hypothesis that children with a cleft lip and/or palate have a higher level of dental anxiety than children from the general population, and to assess the relation between dental fear and coping. Design : Cross-sectional study. Setting : VU Medical Centre University Amsterdam. Patients : A total of 110 children (4 to 12?years old, 50 girls) with a cleft lip and/or palate. Interventions : Dental fear in the study group was compared with a normative group of Dutch children. Main Outcome Measures : Dental fear was investigated using the parental version of the dental subscale of the Children's Fear Survey Schedule for children aged 4 and 5?years old (n = 36). Also the Inventory of Stressful Situations was completed. Children aged 6 to 12?years old also completed the Dental Cope Questionnaire. Results : Young children with a cleft lip and/or palate experience more dental fear compared with children in a normative control group (Children's Fear Survey Schedule dental subscale scores: 30.3 ± 14.6 compared with 24.6 ± 8.6, p < .01). A weak correlation was found between the child's dental anxiety (Children's Fear Survey Schedule dental subscale) and his or her coping behavior (Dental Coping Questionnaire) (r = .196 p < .05). A clear correlation exists between the total Inventory of Stressful Situations and total Children's Fear Survey Schedule scores of the youngest age group (r = .507 p < .01). Conclusions : Findings support the hypothesis that dental anxiety is related to a higher level of exposure to medical interventions at a young age.     

Predicting anxiety during dental treatment using patients'self-reports: less is more

BACKGROUND: Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment. METHODS: One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales. RESULTS: Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment. CONCLUSIONS: Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.     

Validation of a Chinese version of the dental anxiety inventory

OBJECTIVES: To translate the English version of Dental Anxiety Inventory (DAxI) and its short-form (SDAxI) and to validate their use in Hong Kong Chinese. METHODS: The DAxI and SDAxI were translated into Chinese. A total of 500 adults (18-64 years) were interviewed, the Chinese DAxI, Symptom Checklist 90 (SCL-90), Depression Anxiety Stress Scales (DASS) and State-Trait Anxiety Inventory (STAI) were completed. Based on their initial DAxI scores, 135 interviewees were invited to attend a dental examination 1 month later. Then, the subjects completed the DAxI again, together with Beck Anxiety Inventory (BAI) which measured the state anxiety level of the participants. Two months after the initial interview, all 500 subjects were asked to complete the DAxI again. Another 300 adults were recruited and interviewed for the SDAxI validation. RESULTS: Cronbach's alpha of the Chinese DAxI and SDAxI were 0.77 and 0.80 and the test-retest correlation coefficients were 0.90 and 0.84, respectively. High correlation between BAI and DAxI scores and its stability over time supported construct validity of the Chinese DAxI. Small positive correlations between the DAxI and other subscales of the SCL-90, DASS and STAI supported discriminant validity of the instrument. The SDAxI demonstrated comparable validity and reliability with DAxI. CONCLUSION: The translated Chinese DAxI demonstrated good validity and reliability. It is available for use in dental anxiety research in adult Chinese. In situations where a short-form is desirable, the Chinese SDAxI is a simple, valid, reliable and interpretable scale for measuring dental anxiety in both research and dental practice.     

Translation and psychometric properties of the Swedish version of the Index of Dental Anxiety and Fear (IDAF‐4C+)

Dental anxiety (DA) is a common condition, with significant medical, psychological, and social consequences. High‐quality psychometric tools for the assessment of dental anxiety are necessary for clinical and research purposes. The aim of this study was to adapt the Index of Dental Anxiety and Fear (IDAF‐4C⁺) to the Swedish language and to explore the psychometric properties of the translated version. The study included a clinical sample (n = 414; 17–91 yr of age) and a non‐clinical sample (n = 51; 19–47 yr of age). The scales used were the IDAF‐4C⁺, the Single‐Question Assessment of Dental Anxiety (SQDA), the Dental Fear Survey (DFS), and the Internal Health Locus of Control (IHLOC). The Swedish IDAF anxiety module showed a clear, one‐dimensional structure, good internal consistency (Cronbach's alpha = 0.95), and adequate validity, as evidenced by strong correlations with the other DA measures (SQDA and DFS) and weak correlations with the IHLOC. In addition, the IDAF phobia module and the IDAF stimulus module were strongly correlated with the other DA measures. To conclude, the study shows promising findings for the reliability and validity of the Swedish translation of the IDAF‐4C⁺, as a useful measure of dental anxiety in research and clinical practice.     

Reliability and validity of the Dutch version of the Social Attributes of Dental Anxiety Scale

The aim of the present study was to assess the reliability and (factorial) validity of the Dutch version of the Social Attributes of Dental Anxiety Scale (SADAS). A factor analysis using the English version of the SADAS revealed two separate scales. The first eight items involved unwanted psychological upsets when patients encounter dental care directly; the four remaining items were about social inhibitions or restrictions due to the perceived state of oral health. Psychometric properties of the Dutch version were assessed using a sample of 170 highly anxious dental patients of a dental fear clinic in Amsterdam, The Netherlands. The Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI) were used as measures of dental anxiety. Factor analysis revealed that four factors explained 72.8% of the variance, and two forcedly extracted factors explained 53.4% of the variance. Correlations indicated that the SADAS does measure a different concept than dental anxiety. In addition, t-tests indicated that the SADAS was able to discriminate between a group of non-anxious individuals and the present group of patients. In conclusion, the SADAS is a promising new questionnaire with moderate factorial, but with more than sufficient reliability, as well as construct and discriminant validity.     

Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study

OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.     

Australian population norms for the Index of Dental Anxiety and Fear (IDAF-4C)

Background: The Index of Dental Anxiety and Fear (IDAF‐4C) is a theoretically derived test developed to allow clinicians and researchers to measure a person’s level of dental fear. Population norms have not previously been made available for the IDAF‐4C. The aim of this study was to provide Australian norms for the IDAF‐4C using percentile ranks and to examine associations between scores and individual‐level characteristics, dental avoidance and fear of pain. Methods: A stratified random sample of 1511 Australian adults yielded complete questionnaire data for 1063 individuals (70.4%). Percentile ranks were calculated for IDAF‐4C full scale scores stratified by age and gender. Results: IDAF‐4C mean scores varied significantly by age, gender, income, and speaking a language other than English at home. Tables to convert raw scores to percentiles showed that full scale scores varied by age and gender. Scores on the IDAF‐4C had strong and significant associations with avoidance of the dentist due to fear, average dental visiting frequency and anxiety about pain when going to the dentist. Conclusions: Population norms allow clinicians or researchers to compare results for an individual or subgroup to the Australian population. It is recommended that a dental fear scale be used to screen all dental patients for dental fear to enable a more tailored and effective dental treatment experience.     

Dental anxiety before removal of a third molar and association with general trait anxiety.

PURPOSE: The aim of the present study was to evaluate dental anxiety in patients consulting for third molar removal, and to assess possible relationships with general trait anxiety. MATERIALS AND METHODS: Dental anxiety was measured using Corah's Anxiety Scale (DAS), the Dental Fear Survey (DFS), and the state anxiety scale of the State-Trait Anxiety Inventory (STAI). Trait anxiety was measured with the trait anxiety scale of the STAI. RESULTS: Trait anxiety showed significant positive correlations with both DAS score and DFS score. The 3 measures of dental anxiety all showed significant positive correlations with each other. The difference between men and women was only statistically significant in the case of trait anxiety. CONCLUSION: These results suggest that trait anxiety may be a useful predictor of a patient's predisposition to dental anxiety.     

Cognitive ability and dental fear and anxiety

Dental fear and anxiety (DFA), as well as dental behavior management problems, are common in children and adolescents. Several psychological factors in the child, and parental DFA, have been studied and found to correlate to the child's DFA. The aim of this study was to investigate the relationship between cognitive ability and DFA in a population‐based group of children with identified behavior and learning problems. In conjunction with a dental examination at 11 yr of age, 70 children were assessed with regard to DFA using the Children's Fear Survey Schedule Dental Subscale (CFSS‐DS), and their cognitive ability was assessed using the Wechsler Intelligence Scale for Children. In addition, parental DFA was measured using the Corah Dental Anxiety Scale. The results revealed that DFA was significantly correlated to verbal intelligence quotient (IQ) but not to any other cognitive index. A significant correlation was found between parental DFA and child DFA. The results indicate that the child's verbal capacity may be one factor of importance in explaining dental fear in children.     

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.