Evaluating a single dental anxiety question in Finnish adults

Objective. To evaluate the psychometric properties (criterion validity, construct validity, sensitivity, and specificity) of a single-item question screening for dental anxiety in a Finnish adult population. Material and methods. A total of 823 subjects, ranging in age from 18 to 87 years, answered a questionnaire comprising sections assessing the respondents’ demographic profile and dental attendance patterns. A single dental anxiety question and the Modified Dental Anxiety Scale (MDAS) were included. The final response rate was 85%. Results. Eight percent of the sample was highly dentally anxious using the MDAS cut-off point of 19 or above. Twelve percent of the respondents rated themselves as “very scared” on the single-item question. The percentage agreement between the single-item question and the MDAS was 93; the Kappa coefficient was 0.63. Specificity of the single question was 0.95 while sensitivity was 0.80 using the MDAS dichotomous classification. The single-item question related to age (p<0.001), gender (p<0.001), and dental attendance (p<0.001), as predicted. Conclusions. The single question has good validity, specificity, and sensitivity and may be used with confidence to assess dental fear in such situations as national health surveys or in routine dental practice where a multi-item dental anxiety questionnaire is not feasible.     

Reliability and validity of the Modified Dental Anxiety Scale (MDAS) in a Turkish population

OBJECTIVES: Fear of dentistry is a common obstacle to obtaining dental care in Turkey. The aim of this study was to assess the reliability, validity and psychometric characteristics of the Turkish translation of the Modified Dental Anxiety Scale (MDAS) and compare it to the Dental Fear Survey (DFS) scores obtained in the same population. METHODS: The Turkish translated version of the MDAS was administered to 115 dental patients; 21 subjects who suffered from dental phobia, requiring general anesthesia for dental procedures, and 94 who did not have dental anxiety, in addition to 442 subjects from the general population. RESULTS: The Turkish translated version of the MDAS was internally consistent and reproducible. The patients with dentist phobia had the highest score. The Turkish MDAS correlated with the DFS (r = 0.80, P < 0.001). The MDAS scale correlated inversely (r = -0.14, P < 0.005) with level of education; however, it did not correlate with economic status. Women scored higher than men on the scale (mean = 12.3, SD = 5.2 vs. mean = 10.9, SD = 4.5, P < 0.005). At a cut-off point > or = 15, sensitivity was 0.80, specificity 0.74, positive predictive value 0.41 and negative predictive value 0.94. CONCLUSION: Although the specificity values were low, the Turkish MDAS demonstrated acceptable sensitivity, positive and negative predictive values. Thus, high reliability and validity of the MDAS supports its cross-cultural validity and indicated that it may be a valuable tool in quantifying fear of dentistry among Turks.     

Further evidence for the reliability and validity of the Modified Dental Anxiety Scale

Aim: To gain further evidence of the psychometric properties of the Modified Dental Anxiety Scale. Setting: Dental admission clinics. Design: Consecutive sampling, cross‐sectional survey. Participants: Patients (n=800) in four cities (Belfast, Northern Ireland; Helsinki, Finland; Jyväskylä, Finland and Dubai, UAE). Methods: Questionnaire booklet handed to patients, attending clinics, for completion following an invitation by the researcher to be included in the study. Measures: Modified Dental Anxiety Scale (MDAS), together with further questions concerning dental attendance and nervousness about dental procedures. Results: Overall 9.3 per cent of patients indicated high dental anxiety. MDAS showed high levels of internal consistency, and good construct validity. The relationship of dental anxiety with age was similar to previous reports and showed lowered anxiety levels in older patients. Conclusion: Data from three countries has supported the psychometric properties of this modified and brief dental anxiety scale.     

Dental anxiety among adults in Turkey

AIM: This aim of this study was to investigate the prevalence of dental anxiety and related factors in a Turkish population. METHODS AND MATERIALS: The Turkish translation of the Dental Fear Scale (DFS) and the Modified Dental Anxiety Scale (MDAS) were administered to 115 dental patients consisting of 21 subjects who had dental phobia and of 94 patients who did not. The scales were also administered to a non-clinical general population (N=183). RESULTS: The Turkish version of the DFS was internally consistent and reproducible. The scale had strong correlations (r=0.80, p<0.001 ) with the MDAS. Female participants scored higher (45.2+/-18.1) on the scale than men (38.2+/-15.7). The DFS had a negative correlation (r=-0.25, p<0.001) with education level. There was a statistically significant difference between dental phobics and the remaining groups on the DFS total score. At a cut-off point 55, the sensitivity of the scale was 0.80, specificity 0.80, positive predictive value 0.48, and negative predictive value 0.95. Thirty-nine subjects (21.3%) in the general population had total scores above this cut-off point. CONCLUSION: Dental fear is common in clinical and non-clinical settings in Turkey. The good psychometric characteristics of the DFS among Turkish participants supports its cross-cultural validity.     

Do dental anxiety questionnaires raise anxiety in dentally anxious adult patients? A two-wave panel study.

OBJECTIVE: To test whether or not dentally anxious patients attending the dentist for an appointment become more anxious when completing a dental anxiety questionnaire. BASIC RESEARCH DESIGN: Patients were initially screened to include only those who were dentally anxious. A pre- and post-test was planned with the completion of the Modified Dental Anxiety Scale (MDAS) questionnaire as the intervention. CLINICAL SETTING: Two dental access centres in the North West of England. PARTICIPANTS: Initially, 583 patients were screened. Of these, 182 (31%) were found to be dentally anxious and were recruited into the study. MAIN OUTCOME MEASURES: State-Trait Anxiety Inventory Scale Short Form. RESULTS: State anxiety did not change with the completion of the MDAS questionnaire in either designated dental phobics (MDAS >or=19) or those classified as non-phobics (MDAS <19). CONCLUSIONS: The MDAS can be used to assess dental anxiety without raising anxiety in patients with or without self-reported dental phobia.     

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for non-attendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (< or = 0.26), but high negative predictive values (> or = 0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point > or = 13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was > or = 15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

Avoidance of dental visits: the predictive validity of three dental anxiety scales

The purpose of this study was to determine the sensitivity, specificity, positive and negative predictive values for Corah's Dental Anxiety Scale (DAS) and two modified versions of it (MDAS; MDAS/4). A questionnaire was mailed to a simple random sample of 1,190 25-year-old residents in the west of Norway in 1997. Half the sample received DAS, the other half MDAS. The response rate after one reminder was 62%. The respondents completed the scales, gave demographic particulars and answered one question about dental visiting habits during the last 5 years plus an open-ended question about reasons for nonattendance. Using the answers to the latter question as validating criterion, it was found that, for all scales, sensitivity decreased while specificity improved when changing from a liberal to a stringent cut-off point. The scales gave low positive predictive values (≤0.26), but high negative predictive values (≥0.98). Since DAS and MDAS/4 gave almost identical findings, the two samples were combined. At a cut-off point ≥13 sensitivity was 0.83, specificity 0.84, positive predictive value 0.18 and negative predictive value 0.99. The corresponding estimates when the cut-off point was ≥15 were 0.67, 0.90, 0.22 and 0.98. It is concluded that, in this test, DAS and the two versions of MDAS gave acceptable, or near acceptable sensitivity, specificity and negative predictive values, but far too low positive predictive values to be useful for prediction at the individual level.     

The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age

Background  

The Modified Dental Anxiety Scale (MDAS) is a brief, self-complete questionnaire consisting of five questions and summed together to produce a total score ranging from 5 to 25. It has reasonable psychometric properties, low instrumental effects and can be integrated into everyday dental practice as a clinical aid and screen for dental anxiety. The objectives were to (i) produce confirmatory evidence of reliability and validity for the MDAS, (ii) provide up-to-date UK representative norms for the general public to enable clinicians to compare their patients' scores, (iii) to determine the nature of the relationship between dental anxiety and age.     

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.     

Psychometric properties of Greek versions of the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS)

Background

A growing body of literature describes the performance of dental fear questionnaires in various countries. We describe the psychometric properties of Greek versions of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Survey (DFS) in adult Greek patients.

Methods

Greek versions of the MDAS and DFS were administered to two samples of adult dental patients. In the first sample, 195 patients attending one of three private practice dental offices in a large city in Greece completed the questionnaires in the waiting room before dental treatment. After treatment, their dentists (who did not know how the patients had answered the questionnaire) rated their anxiety during dental treatment. In the second sample, 41 patients attending a Greek university dental school clinic completed the questionnaire twice at two separate visits, in order to provide test-retest data. Cronbach's alpha was used to compute the internal consistencies, while Spearman's rho was used to compute the test-retest reliabilities. Construct validity was assessed by correlating the responses to the MDAS and DFS by Spearman's rho. Spearman's rho was also used to examine the criterion validities, by comparing the questionnaire responses with the dentists' ratings of anxiety.

Results

The internal consistencies for the MDAS were 0.90 and 0.92 in the two samples; for the DFS, the internal consistencies were 0.96 in both samples. The test-retest reliabilities were 0.94 for the MDAS and 0.95 for the DFS. The correlation between the two questionnaires was 0.89. The patients' responses to both questionnaires were significantly related to the dentists' ratings of their anxiety during dental treatment (both p values <0.001).

Conclusion

The results indicate that the Greek versions of the MDAS and DFS have good internal consistencies and test-retest reliabilities, as well as good construct and criterion validities. The psychometric properties of the Greek versions of these questionnaires appear to be similar to those previously reported in other countries.     

Assessment of general pre and postoperative anxiety in patients undergoing tooth extraction: a prospective study

Our aim was to analyse the amount of anxiety and fear felt before, immediately after, and one week after, dental extraction. We studied 70 patients (35 men and 35 women (mean (SD) age 43 (±10) years), who were listed for dental extraction under local anaesthesia in a private clinic that specialised in oral surgery. Patients were evaluated on 3 consecutive occasions: immediately preoperatively, immediately postoperatively, and 7 days later. Each patient's anxiety was measured using Spielberger's State-Trait Anxiety Inventory (Spanish version), the Modified Corah Dental Anxiety Scale (MDAS) and the Dental Fear Survey. There were significant differences in the STAI-Trait scale between before and 7 days after extraction (p = 0.04), and in the MDAS between before and immediately after extraction (p = 0.02), and between immediately after and 7 days after extraction (p = <0.001). The DFS also differed between before and immediately after extraction (p = 0.002), and between immediately and 7 days after extraction (p < 0.001). Dental anxiety immediately after tooth extraction may be influenced by operative techniques (type of anaesthesia, duration of operation, or position of tooth extracted), but anxiety at 7 days after extraction is not.     

微种植体支抗植入患者牙科焦虑的调查分析

目的研究微种植体支抗（MIA）植入患者牙科焦虑症的影响因素及术前焦虑程度高对术后疼痛的影响。 方法采用改良牙科焦虑量表（MDAS）和视觉模拟量表（VAS）对2016年8月至2018年5月在佛山市口腔医院进行MIA植入的患者进行焦虑情况及术后疼痛程度的调查，共发出问卷553份，回收有效问卷509份，有效率为92.04%。采用成组设计t检验分别统计不同性别、年龄、文化程度、婚姻状况及收入水平间MDAS值差异是否显著，并采用两因素重复测量方差分析评估不同焦虑程度术后疼痛程度VAS评分差异是否显著。 结果接受MIA植入的患者术前MDAS平均值为（11.24 ± 3.05）分，其中，大于11分占58.9%。男性患者的MDAS值为（9.85 ± 2.12）分，女性患者的MDAS值为（12.41 ± 2.56）分，差异有统计学意义（t = -12.18，P<0.001）；12 ~ 18岁患者的MDAS值为（13.27 ± 3.12）分，18岁以上患者的MDAS值为（10.53 ± 2.36）分，差异有统计学意义（t = 10.51，P<0.001）；未婚患者的MDAS值为（11.06 ± 2.96）分，已婚患者的MDAS值为（11.63 ± 2.75）分，差异有统计学意义（t = -2.07，P = 0.039）；文化程度为专科及以下患者的MDAS值为（11.95 ± 2.37）分，文化程度为本科及以上患者的MDAS值为（10.46 ± 3.01）分，差异有统计学意义（t = 6.23，P<0.001）；收入低于2万/月的患者的MDAS值为（11.13 ± 2.14）分，收入2万/月及以上患者的MDAS值为（11.58 ± 3.02）分，差异无统计学意义（t = -1.82，P = 0.068）。低焦虑组患者及高焦虑组患者在术后2、6、24和48 h的VAS值差异均有统计学意义（P<0.001）。 结论MIA植入患者牙科焦虑症患病率较高，与性别、年龄、文化程度及婚姻状况有密切关系，术前焦虑程度高患者术后疼痛的强度高。     

Psychometric properties of the modified dental anxiety scale: an independent replication

AIM: To estimate the internal consistency, test-retest reliability, discriminant and concurrent validity of the Modified Dental Anxiety Scale (MDAS). METHOD: Survey of a cohort of 135 dental patients in three equal groups (non-anxious; treated anxious; highly anxious). The average age of the total sample was 39.2 years (SD = 13.21), 101 patients (75%) were female. All patients were asked to complete the MDAS, together with the brief form (six items) of the Speilberger Trait Anxiety Inventory (STAI). Thirty-three participants completed the MDAS on a second occasion 2-3 months after the first testing session. FINDINGS: The MDAS is highly internally consistent (Cronbach alpha = 0.93) and shows good reliability over time (Intra-class correlation coefficient = 0.93). The MDAS was found to discriminate between the three groups of participants defined by self-reported anxiety level, and correlates highly with the Speilberger Trait Anxiety Inventory. CONCLUSIONS: The MDAS is a highly consistent and reliable measure which has good discriminant and concurrent validity.     

138例牙科种植术前患者焦虑水平与STAI量表相关性分析

目的: 探讨种植患者术前焦虑症状况与状态-特质焦虑量表（state-trait anxiety inventory,STAI）的相关性。方法: 选择2018年5月—2021年5月间上海市浦东新区人民医院口腔科收治的138例种植修复患者作为研究对象,采用改良版Croa牙科焦虑量表（modified dental anxiety scale,MDAS）、牙科恐惧量表（dental fear scale,DFS）及STAI问卷对患者进行横断面调查,分析种植患者焦虑状况及影响因素。采用SPSS 22.0软件包对数据进行统计学分析。结果: 患者MDAS得分超过12分占59.42%（82/138）,其中性别、收入、口腔健康自评状况、是否为初次就诊及既往种植史等项目差异具有统计学意义（P<0.05）;患者MDAS评分及DFS评分与S-AI量表呈正相关（P<0.05）,与T-AI不相关。结论: 口腔种植术前患者易焦虑,焦虑症水平影响因素较多,与S-AI呈正相关,牙科医师需重视口腔种植术前患者焦虑状态。     

Dental Hygiene Fear Survey: reliability and validity of the Turkish version

The aims of the present study were to 1) investigate patient anxiety as it relates to dental hygiene procedures and 2) conduct validity and reliability testing of the Turkish version of the Dental Hygiene Fear Survey (DHFS) to test its psychometric properties in the Turkish culture. The study consisted of 200 periodontal patients. The patients completed the DHFS, the Modified Dental Anxiety Scale (MDAS), and a questionnaire designed to elicit sociodemographic and clinical characteristics. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the DHFS with measures found in the literature that correlate with dental fear and anxiety. Construct validity was determined using exploratory factor analysis with a direct oblimin (oblique) rotation, which revealed a model with three factors accounting for 62.8 of the variance when item 11, which has the lowest item total correlation, was omitted. The Cronbach alpha coefficients of the subscales in the fifteen-item scale (generalized anxiety, dental hygiene specific anxiety, and catastrophe) were 0.83, 0.86, and 0.79, respectively. The overall reliability of the DHFS was 0.91. Significant negative correlations were found between total DHFS scores and age (p<0.05). Females reported dental hygiene fear more frequently than did males. The DHFS demonstrated good psychometric properties in spite of being translated into another language and used in a culture different from the one where it was originally developed. The Turkish version of the DHFS is a valid and reliable instrument and may be included in assessments designed to measure fear related to dental hygiene treatment procedures.     

Reducing patients' state anxiety in general dental practice: a randomized controlled trial

Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients' state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger's state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P < 0.0001). Providing the dentist with information of the high level of a patient's dental anxiety prior to treatment, and involving the patient in this, reduced the patient's state anxiety.     

The effects of lavender scent on dental patient anxiety levels: a cluster randomised-controlled trial

Kritsidima M, Newton T, Asimakopoulou K. The effects of lavender scent on dental patient anxiety levels: a cluster randomized-controlled trial. Community Dent Oral Epidemiol 2010; 38: 83–87. © 2009 John Wiley & Sons A/S   Abstract – 
Objectives:  To review the effect of lavender scent on anticipatory anxiety in dental participants.
Methods:  In a cluster randomized-controlled trial, patients' ( N  = 340) anxiety was assessed while waiting for a scheduled dental appointment, either under the odor of lavender or with no odor. Current anxiety, assessed by the brief State Trait Anxiety Indicator (STAI-6), and generalized dental anxiety, assessed by the Modified Dental Anxiety Scale (MDAS) were examined.
Results:  Analyses of variance ( anova s) showed that although both groups showed similar, moderate levels of generalized dental anxiety (MDAS F _(1,338) = 2.17, P  > 0.05) the lavender group reported significantly lower current anxiety (STAI: F _(1,338) = 74.69, P  < 0.001) than the control group.
Conclusions:  Although anxiety about future dental visits seems to be unaffected, lavender scent reduces state anxiety in dental patients.     

Emergency dental clinic patients in South Devon, their anxiety levels, expressed demand for treatment under sedation and suitability for management under sedation.

OBJECTIVE: To assess the anxiety levels of patients attending two salaried dental service emergency clinics, their expressed demand for treatment under sedation, and their medical suitability for dental sedation. DESIGN: A questionnaire survey, incorporating the Modified Dental Anxiety Scale (MDAS) and assessment of American Society of Anesthesiologists' (ASA) physical status classification, of all adult patients attending two emergency dental clinics in Torquay and Newton Abbot. RESULTS: 513 patients returned questionnaires. Only five declined to take part in the study. The mean MDAS for patients attending the two emergency dental clinics was 14.09 (SD 6.04) and 41.9% of patients were classified as dentally anxious (MDAS >15). A preference for treatment under sedation was expressed by 56.3%, of all patients, of whom 50.5% were classified as ASA 1 (without health problems) and would have been suitable for sedation in primary dental care. CONCLUSIONS: The reported dental anxiety levels of patients attending the two emergency dental clinics were found to be much higher than those found by previous studies in general dental practice and at dental school emergency clinics. There was a high expressed demand for treatment under sedation. Further studies are needed to assess the levels of dental anxiety seen at other dental emergency clinics and a health needs assessment to determine need as opposed to expressed demand.     

正畸治疗前焦虑、抑郁水平与完美主义倾向的相关性

目的 探讨正畸患者治疗前的焦虑、抑郁水平和完美主义倾向之间的关系。方法 采用修改版Corah牙科焦虑量表（MDAS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、中文版《Frost多维度完美主义心理量表》（CFMPS）对170例口腔正畸初诊患者进行测试,采用SPSS16.0软件包对数据进行独立样本t检验、相关分析和多元逐步回归分析。结果 明显患有牙科焦虑症（MDAS得分≥11）的患者42例,占24.71%,在SAS、SDS得分上均显著高于无明显牙科焦虑症组（MDAS得分<11）（P<0.01）;在CFMPS的担心错误（CM）、个人标准（PS）、行动的疑虑（DA）和条理性（OR）4个维度上与无明显牙科焦虑症组存在显著差异（P<0.05）。牙科焦虑症患者在CM、PS、DA与SAS和SDS得分之间均呈显著正相关（P<0.01）;OR与SDS得分呈显著负相关（P<0.05）;回归分析显示,CFMPS的CM、OR维度得分以及年龄对SAS和SDS得分均具有较强的预测作用。结论 正畸治疗前牙科焦虑症患者的焦虑和抑郁水平较高,且与其完美主义倾向之间具有显著相关性。针对牙科焦虑症的早期干预,应结合患者的年龄和不同完美主义个性特征而区别对待。