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.     

Treatment of dental anxiety disorders. Outcome related to DSM-IV diagnoses

In this study we evaluated treatment effects in 70 consecutively admitted patients in a specialized university clinic for treatment of dental fear. Thirty-three (47%) of the patients fulfilled the diagnostic criteria for Specific Phobia alone (Dental Phobia, DP), 24 (33%) had severe dental anxiety without fulfilling the criteria for phobia (ND), and 13 (19%) fulfilled the criteria for multiple DSM-IV diagnoses (MD). Dental anxiety was measured prior to, immediately after and at follow-up (mean = 19 months) using Corah's Dental Anxiety Scale and Dental Fear Survey. Dental attitudes were measured by Getz' Dental Beliefs Survey. Dental attendance and everyday functioning were measured by self-report. DP patients received significantly more treatment-sessions as compared to the ND group. Despite significant overall reductions in scores on all psychometric instruments from pretreatment to follow up, patients in the MD group reported significantly more severe anxiety at pre- and post-treatment and at follow-up as compared to patients in the ND group. There was no interaction between diagnostic group and assessment occasion (pre treatment, post treatment and follow up) on the self-reported anxiety. Patients reported significant improvements in self-esteem, social relations and everyday functioning, regardless of diagnostic group. Sixty-three percentage of the respondents had been to the dentist within 1 year after completed treatment. Patients treated by dentists who had received supervised training in exposure treatment had significantly more often seen the dentist at follow-up.     

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.     

A test of Berggren's model of dental fear and anxiety

Berggren's (1984) model of dental fear and anxiety predicts that dentally anxious individuals postpone treatment, leading to a deteriorating dental state and subsequently to fear of negative evaluations in relation to their oral condition. The present study aimed to test one of the core assumptions of this model, namely that deterioration of dental health status would mediate the effects of avoidance of dental care on self-reported fear of negative evaluation. Participants were 73 patients (mean age 38.5 yr) meeting the diagnostic and statistical manual of mental disorders - 4th edn - Text Revision (DSM-IV-TR) criteria of dental phobia. Variables in the theoretical model were operationalized with multiple measures. A series of Sobel tests indicated that mediation was present for the relationship between years of avoidance and fear of negative self-evaluation when dental health status was based on the assessment of dentists or patients' opinion of their own dental state, but not when dental health status was operationalized as decayed, missing or filled surfaces (DMFS). Although the findings are supportive of Berggren's model, other causal pathways that contribute to the perpetuation of anxiety and fear still need to be tested. The results suggest that individuals with high levels of dental anxiety would particularly benefit from interventions specifically designed to break their avoidance pattern.     

Dental fear among a young adult Saudian population

AIMS: To assess the prevalence of dental fear and reasons for irregular dental attendance among young adult university students; to describe the gender distribution of the dentally anxious population according to the perceived origins or sources of fear; to identify the time of fear development and preference for anaesthesia or sedation before dental treatment. METHOD: A questionnaire incorporating the Dental Fear Scale (DFS) with items related to sources of dental fear stimuli, together with the preference of anaesthesia or sedation before dental treatment and other characteristics. Approximately 500 questionnaires were distributed among Saudian undergraduate students. RESULTS: 368 questionnaires were completed and presented for statistical analysis. The sight and sensation of anaesthetic needles and the sight, sound and sensation of the drill were rated the most fear-eliciting stimuli. Also, females tended to be more anxious than males. Increased heart rate was the most common reported physiological response to fear resulting from dental treatment. The overall level of fear of dental work among the studied population was found to be about 39%.'Lack of time' and 'no need for treatment' were found to be the main reasons for irregular dental visits. Fear of pain and trauma were the major perceived sources of reported fear reactions and were developed mainly during childhood. About 63% of the subjects preferred to have local anaesthesia before dental treatment to prevent or ameliorate dental fear.     

心理行为干预对成人正畸治疗患者牙科焦虑和社交焦虑的作用

目的 了解成人正畸治疗患者牙科畏惧症、牙科焦虑、社交焦虑的发病情况和心理行为干预的作用,为成人正畸患者进行心理行为干预提供科学依据.方法 选择于山东省济宁市第一人民医院口腔正畸科就诊,符合直丝弓矫治适应证的牙(牙合)畸形成人患者226例,随机分为心理干预组和对照组,对照组接受一般正畸知识教育,心理行为干预组在正畸治疗前和每次正畸检查治疗操作中进行焦虑紧张情绪干预、心理行为干预"家庭作业"安排、认知教育以及社交焦虑问题干预.首次正畸治疗时和治疗1月、1年时分别进行改良柯氏牙科焦虑量表、交往焦虑量表评定.结果 首次正畸治疗时,改良柯氏牙科焦虑量表评分:干预组10.24±3.67,对照组12.43±3.75;发生焦虑人数的比例:干预组10.5%,对照组26.8%.正畸治疗1月,Liebowitz社交焦虑量表评分:干预组36.71±10.42,对照组58.23±9.74;社交焦虑发生人数的比例:干预组21.0%,对照组33.0%:正畸治疗1年,社交焦虑量表评分:干预组24.73±10.62,对照组35.42±12.83;社交焦虑发生的比例:干预组2.6%,对照组12.5%.组间两两比较均有统计学意义.结论 成人正畸患者牙科焦虑、社交焦虑的发生率较高,心理行为干预对其有良好的干预效果.     

Psychological trauma exposure and trauma symptoms among individuals with high and low levels of dental anxiety

This questionnaire-based study investigated the traumatic background and trauma-related symptomatology among 141 treatment-seeking individuals with high levels of dental anxiety and among a low-anxious reference group consisting of 99 regular dental patients. The highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%). Horrific experiences in the dental setting were the most common traumatic events reported. Of the highly anxious individuals, 46.1% indicated suffering from one or more of the post-traumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, loss of interest, and insomnia), while in the reference group this percentage was 6%. Severity of dental anxiety was significantly associated with number of screening criteria for specific phobia and the extent to which the anxious subjects displayed symptoms of post-traumatic stress. Two variables were uniquely predictive for positive diagnostic screens for dental phobia and PTSD: having experienced a horrific dental treatment and having been a victim of a violent crime. In conclusion, post-traumatic symptoms are common accompaniments of severe forms of dental anxiety and are experienced even when dental treatment is not imminent.     

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.     

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.     

Symptom provocation in dental anxiety using cross-phobic video stimulation

Although video stimulation has been successfully employed in dental phobia, conclusions regarding the specificity of reactions are limited. A novel, video-based paradigm using cross-phobic video stimulation was validated based on subjective and autonomic responses. Forty subjects were stratified according to dental anxiety as measured by the Dental Fear Survey (DFS) using a median-split procedure (high-DFS and low-DFS groups). Anxiety stimuli comprised dental-anxiety scenes and non-dental-anxiety control scenes (snake stimuli). Neutral scenes were tailored to each anxiety stimulus. Dental, but not snake, stimuli were rated as more anxiety provoking only in the high-DFS group. Elevated skin-conductance amplitudes were observed in the high-DFS group for dental anxiety vs. neutral videos, but not for snake anxiety vs. neutral videos. State and trait anxiety and autonomic reactivity were correlated according to expectations. Using cross-phobic video stimulation, it was demonstrated that phobogenic reactions in dental anxiety are specific to the respective stimulus material and do not generalize to other non-dental-anxiety control conditions. The validation of the paradigm may support and stimulate future research on the characterization of dental anxiety on different response systems, including its underlying neural substrates.     

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 anxiety in young adult Danes under alternative dental care programs

Abstract – The purpose of the present report is to establish to what extent dental anxiety is expressed by young adults with a long history of regular dental care, to analyze whether expressions of dental anxiety vary during young adulthood in response to different dental care delivery programs, and to study which factors might account for existing expressions of dental anxiety. The study comprised 697 persons who participated in a longitudinal study on alternative dental care programs, running from the youngsters' 16th to their 19th yr. At the end, Corah Dental Anxiety Scale (DAS) was applied through self-completed questionnaires. Overall DAS-mean was 7.26; women expressed more anxiety than men (7.73; 6.78). Significant association between anxiety expressed at the end and at the start of the study indicated that dental anxiety was probably present at an early age. No association was found with utilization of dental services, A multiple regression analysis indicated early expressed dental anxiety and negative self assessment of dental health as important predictors for dental anxiety, while sex, negative assessment of gingival health, and dental program were of less importance, altogether explaining 22% of the DAS score variation. The risk group concept currently employed by the Public Child Dental Health Services might be extended to include expressions of dental anxiety.     

Prevalence of dental anxiety in an adult population in a major urban area in Sweden

The aims of the study were to describe the level of dental anxiety in a representative sample of an adult population, to evaluate different demographic variables in relation to dental anxiety, and to compare two measurement scales of dental anxiety. A random sample of residents (n = 830) of the city of Gothenburg (population 432,000) was selected for a telephone survey. The survey comprised different questions concerning demographic variables, dental care habits, and the level of dental anxiety. The methods of measurement of dental anxiety were a 10-point dental Fear Scale (FS) and the Corah Dental Anxiety Scale (DAS). A total of 620 interviews were completed giving a response rate of 74.7%. 41.4% of the respondents were males, 58.6% females. Females were significantly more likely to report a high dental anxiety compared with males. The prevalence of high dental anxiety in the sample as measured by the FS and DAS was 6.7% and 5.4% respectively. The correlation between the FS and DAS was 0.81. The distribution of high dental anxiety and age showed a clearly and significantly higher portion of dental anxiety in the age group 20-39 yr compared to both younger and older groups. The effect of dental anxiety on regularity of dental visits revealed a significant difference as measured by the FS. No significant correlation was found between dental anxiety and educational level or income. A majority of the respondents (82-95%) expressed a desire for establishment of a special dental fear treatment clinic without need for referral.     

Dental anxiety and regularity of dental attendance in younger adults

Dental anxiety constitutes a major problem for patients and dental care providers alike. The aim of this study was to examine the relationship between dental anxiety and regularity of dental attendance among young adults. A random sample of 15 course directors (1:50) was asked to participate in the study. Of these, only 10 course-directors agreed to handout the 500 questionnaires. All undergraduate students who participated in this study were asked to complete a questionnaire modified from Dental Fear Survey (DFS) questionnaire and 368 (73.6%) filled forms were returned for statistical analysis. The results showed that only 20.9% were regular dental attendee while the majority (79.1%) were irregular attendee. The reasons given for irregular attendance were 'lack of time' (36%), 'treatment not needed' (34.1%), 'fear from dentist' (13.3%) and 'cost' (16.6%). The sight and sensation of the injection and sight, sound, and sensation of the drill were the most common fear-eliciting stimuli. Increased heart rate was the commonest reported physiological response. Females had higher mean ratings, therefore tended to be more anxious than males. Dental anxiety represented by the mean responses to the items, was found to be higher in irregular dental attendee than regular attendee. In conclusion, this suggests that dental anxiety may affect the seeking of dental care, therefore to be taken into account when training dental care providers.     

Factors affecting dental anxiety and beliefs in an Indian population

Summary  The purpose of this study was to describe the possible factors that may affect dental anxiety and beliefs and to validate and test the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and a Modified Dental Beliefs Scale (MDBS) among the patients attending a university dental clinic in India. A cross-sectional study design was used. A total of 482 general dental patients attending a university dental clinic returned completed forms of the Indian translations of the MDAS and MDBS. General information about the age, sex, occupation and educational qualifications of the respondents as well as information about past dental experiences was also collected. All the statistical analysis was carried out by the spss (version 10) statistical software package. The Indian translations of the MDAS and the MDBS were found to be internally reliable with a Cronbach's alpha of 0·78 and 0·85, respectively. Validity was demonstrated by a statistically significant correlation between the MDAS and the MDBS scores with the correlation coefficient of 0·47. Age was also inversely related to dental anxiety. Anxiety scores were higher among the less educated patients. Those who had a prior unpleasant dental experience showed higher dental anxiety and more negative dental beliefs. The data obtained in this study provided strong evidence for the psychometric properties of the Indian version of the MDAS and the MDBS.     

根管治疗患者牙科恐惧症的调查分析

目的探讨减轻根管治疗中牙科恐惧（DA）的方法。方法将360名牙髓炎患者分为三组,每组120名。A组患者为口头与书面告知根管治疗内容,B组患者书面告知同时进行心理沟通,C组患者进行书面告知、心理沟通并辅以必兰局部麻醉。采用改良牙科焦虑量表（MDAS）测量三组患者不同治疗时期DA水平的变化,并用视觉模拟量表（VAS）评估三组患者对根管预备的恐惧程度,对根管治疗前后测量数据进行统计学分析。结果随着就诊次数的增加,三组患者的DA值均逐渐下降,其中以C组下降最为明显,其次为B组。同一组内治疗前后DA值均有显著性差异（P<0.01）。三组患者根管预备前的DA值及VAS评估结果也具有显著性差异（P<0.05）。结论心理沟通与麻醉同时应用可显著降低根管治疗中的牙科恐惧。