Dental caries and changes in dental anxiety in late adolescence

Little is known about changes in dental anxiety with ageing and their association with changes in oral health. This study examined the relationship between changes in dental caries experience and dental anxiety from 15 to 18 years of age among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated using the Corah Dental Anxiety Scale (DAS), and individuals with a DAS score of 13 + were identied as being dentally anxious. Dental examinations were performed on 649 individuals at ages 15 and 18, and a DMFS score was computed for each. Caries prevalence among those who were dentally anxious at both 15 and 18 years was signicantly higher than for those who were not at either age. Regression analysis revealed that dental anxiety predicted caries incidence between ages 15 and 18 years. Dental anxiety is likely to be a signicant predictor of dental caries experience, and may be a risk factor for dental caries incidence.     

Trajectories of dental anxiety in a birth cohort

Abstract – Objective: To examine predictors of dental anxiety trajectories in a longitudinal study of New Zealanders. Methods:  Prospective study of a complete birth cohort born in 1972/73 in Dunedin, New Zealand, with dental anxiety scale (DAS) scores and dental utilization determined at ages 15, 18, 26 and 32 years. Personality traits were assessed at a superfactor and (more fine‐grained) subscale level via the Multidimensional Personality Questionnaire at age 18 years. Group‐based trajectory analysis was used to identify dental anxiety trajectories. Results:  DAS scores from at least three assessments were available for 828 participants. Six dental anxiety trajectories were observed: stable nonanxious low (39.6%); stable nonanxious medium (37.9%); recovery (1.6%); adult‐onset anxious (7.7%); stable anxious (7.2%) and adolescent‐onset anxious (5.9%). Multivariate analysis showed that males and those with higher DMFS at age 15 years were more likely to be in the stable nonanxious low trajectory group. Membership of the stable nonanxious medium group was predicted by the dental caries experience at age 15 years. Participants who had lost one or more teeth between ages 26 and 32 years had almost twice the relative risk for membership of the adult‐onset anxious group. Personality traits predicted group membership. Specifically, high scorers (via median split) on the ‘stress reaction’ subscale had over twice the risk of being in the stable anxious group; low scorers on the traditionalism subscale were more likely to be members of the recovery trajectory group; and high scorers on the ‘social closeness’ subscale had half the risk of being in the stable anxious group. Dental caries experience at age 5 years was also a predictor for the stable anxious group. Membership of the late‐adolescent‐onset anxious group was predicted by higher dental caries experience by age 15 years, but none of the other predictors was significant. Conclusion:  Six discrete trajectories of dental anxiety have been observed. Some trajectories (totalling more than 90% of the cohort) had clear associations with external influences, but others were more strongly associated with characteristics such as personality traits. A mix of both influences was observed with only the stable anxious dental anxiety trajectory.     

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.     

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.     

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

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

牙科畏惧症患者的异常心理分析

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

Dental anxiety, optimism–pessimism, and dental experience from childhood to adolescence

Abstract 94 adolescents, 58% of the original study group, participated in a 5-yr follow-up questionnaire study to assess the predictive power of self-reported dental anxiety, optimism–pessimism dimension, and previous dental experience on dental anxiety level over the 5-yr period. The mean values on Corah's Dental Anxiety Scale (DAS) and Dental Anxiety Question (DAQ) had increased for the girls and remained stable for the boys. The predictive power of DAS and DAQ on anxiety levels as measured by these same scales 5 yr later was weak to moderate, although statistically significant. The optimism–pessimism dimension and dental treatment experiences did not have any effect on dental anxiety changes from childhood to adolescence. DAS had an independent, weak, but statistically significant negative effect on optimistic disposition over the period. The internal reliability of DAS was high and highly similar results using DAS and DAQ were found. Except for significantly more dental experience in the drop-out group (n= 69) than in the current study group in the first study, there were no satistically significant differences in mean scores between the groups with respect to self-reported and clinical dental anxiety, and optimism. Methodological complications are discussed.     

Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood

Most studies examining the origins of dental fear and anxiety have relied on cross-sectional data. These are subject to several problems, such as recall and uncertainty concerning temporal relationships. This paper uses longitudinal data from the Dunedin Multidisciplinary Health and Development Study to assess risk factors for the development of dental anxiety in persons between the ages of 18 and 26 years. It was hypothesized that psychological factors would be as important as conditioning experiences in the genesis of dental anxiety over this period. The eight-year incidence of dental anxiety was 16.5%. Five variables entered models predicting onset: multiple fears, symptoms of substance dependence, previous experience of invasive dental treatment, dental visiting pattern, and the extraction of one or more teeth. Separate analyses for those avoiding and those using dental services resulted in different explanatory models. These results indicated that both psychological and conditioning variables contributed to the development of dental anxiety in this population of young adults.     

深圳市成人牙科畏惧症患者的口腔健康相关生活质量研究

目的：研究牙科畏惧症（DF）患者的口腔健康相关生活质量。方法：选择在深圳市第五人民医院口腔科门诊就诊的358名18～75岁初诊患者,应用口腔焦虑量表（CDAS）和口腔健康影响程度量表（OHIP-14中文版）、人口统计学一般项目表进行调查。结果：DF患者的OHIP-14的分值中位数为21.25,明显高于一般就诊患者（中位数11.20）。且在生理性疼痛、心理不适和心理障碍等领域影响最大。CDAS与OHIP-14分值间的相关系数为0.255。结论：在牙科畏惧症患者中,牙科畏惧程度与口腔健康影响程度之间存在相关性,焦虑程度越高的患者口腔健康相关生活质量越差。对牙科畏惧症患者进行有效的心理干预可以提高其相关生活质量。     

Dental anxiety among Israeli dental students: a 4-year longitudinal study

The aims of the present study were (a) to evaluate students' estimation of their parents' dental anxiety; (b) to measure students' dental anxiety and to study their ranking of the most fear provoking stimuli in the dental situation during their pre-clinical and clinical years; (c) to investigate gender differences among students with regard to dental anxiety. 30 3rd-year students (15 male and 15 female) who completed a 4-section questionnaire which requested sociodemographic information, evaluation of parents' dental anxiety, dental anxiety scale (DAS) and dental fear scale (DFS), completed the DAS and DFS in their 5th and 6th years. Both male and female students estimated their mothers' dental anxiety as significantly higher than their fathers'. Female students ranked their parents higher than males. DAS scores were significantly higher among female students than among males in the 3rd year. However, DAS scores were reduced from the 3rd to the 6th year among the total class and significantly among females, while males' levels of anxiety remained within close range throughout the years. The dental anxiety scores of all students who experienced a dental procedure in the past were higher than the scores of the students who did not. The most fearful stimulus was 'feeling the needle'. Our findings may suggest that the change in the reported dental anxiety of the students during the years of dental studies in the present study may be explained by the increased professional education and clinical experience that the students acquire throughout their studies in the dental school. Being exposed to basic trivial dental procedures (such as local anaesthetic injection) may help students either to be habituated or to use rational coping strategies when dealing with personal dental experience.     

Dental anxiety among patients undergoing various dental treatments in a Nigerian teaching hospital

The aim of the present study is to evaluate the levels of dental anxiety among patients undergoing various dental treatments and to compare the anxiety levels with those of similar studies conducted with subjects from different socio-cultural backgrounds. Dental anxiety was evaluated by the administration of a questionnaire based on the Corah's Dental Anxiety Scale (DAS). Student t-test and analysis of variance (ANOVA) with Bonferoni correction was employed to compare the mean DAS scores. Females recorded higher total DAS scores than males (7.49 +/- 2.96 and 7.16 +/- 3.44, respectively). Patients in the 24-34 year age group showed the highest total DAS scores (8.25 +/- 3.20) followed by the <24 year age group. The total DAS scores for age groups 35-39 and >50 years differ significantly from those of age groups <24 and 24-34 years. The highest DAS score was recorded for root canal therapy (9.30 +/- 2.84) followed by extraction. The level of dental anxiety among this study population is lower than those reported elsewhere. The observed avoidance of dental treatment among Nigerians, despite the seemingly low mean DAS scores, may be related to dental anxiety. The authors are, however, of the opinion poor dental awareness may be a contributory factor.     

The association between dental anxiety and oral health-related quality of life in Britain

OBJECTIVE: The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self-reported) factors. METHODS: The basic research design included a cross-sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health-related quality of life instrument (OHQoL-UK (W)). Results: DAS was correlated with OHQoL-UK (W) scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self-reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS > or = 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL-UK (W) score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65). CONCLUSION: Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health-related quality of life in Britain.     

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.     

Dental anxiety among patients prior to different dental treatments

The purpose of the present study was to evaluate dental anxiety among patients anticipating various dental treatments. One hundred and eighty patients who were scheduled for specific dental treatments at the School of Dental Medicine, the Hebrew University--Hadassah, Jerusalem, Israel participated in the study. Patients were anticipating one of the following dental procedures: scaling, filling, root canal therapy, preparation for crown, periodontal surgery or extraction. For each of the six dental treatments, 30 patients were selected at random. Dental Anxiety Scale (DAS) questionnaires were completed by the patients while waiting for their treatments. The results indicated that extraction caused the highest score, followed by scaling (though not significantly). Patients in the 35 to 49 year age group showed the highest total DAS scores. Women demonstrated higher total DAS scores than men. The relative influence of gender, type of treatment and age on the anxiety scores is demonstrated by using logistic regression, which revealed gender to have the strongest impact on the DAS scores, followed by the type of treatment and age.     

拔牙患者牙科畏惧症的临床调查

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

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

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

Temperament and character personality dimensions in patients with dental anxiety

The aim of the present study was to investigate character and temperament dimensions of personality in six men and 31 women (aged 20-57 yr) with severe dental anxiety, and to evaluate whether these dimensions were associated with the level of dental anxiety. The Dental Anxiety Scale (DAS) and the Temperament and Character Inventory (TCI) were used. High ratings in novelty seeking and female gender predicted high DAS scores. Compared with controls, the patients scored significantly higher on the temperament dimension, novelty seeking. For character dimensions, the patients scored lower on cooperativeness and higher on self-transcendence than controls. Our results indicated that patients with dental anxiety are neurotic extravert (i.e. novelty seekers who experience brief dissociative periods and magical thinking). Furthermore, the combination of the inherited temperament dimension novelty seeking and the social learned character dimension cooperativeness and self-transcendence seem to form a vulnerable personality to develop dental anxiety.     

Dental anxiety and oral health outcomes among rural older adults

Objectives: The objective of this study is to determine the degree to which rural older adults are able to complete a measure of dental anxiety and to assess the prevalence, as well as the demographic and oral health characteristics, of individuals reporting high dental anxiety. Methods: A population‐based sample of 635 African American, American Indian and White older adults (age ≥60 years) completed an in‐home survey, and 362 dentate participants completed an oral examination. Dental anxiety was measured using the four‐item Corah's Dental Anxiety Scale (DAS). Gender, ethnicity, age, education, and oral health outcomes were compared between those who completed all four DAS questions (completers) and those who did not (noncompleters) as well as, among completers, those with high versus low DAS scores. Results: There were 94 (14.8%) noncompleters. Noncompletion was associated with older age, lower education, being edentulous, and having gingival recession. 12.4% of DAS completers had high DAS scores, which was more common among those aged 60‐70 years, women, and those with oral pain and sore or bleeding gums. In logistic regression analysis, only sore and bleeding gums had a significant association with a high DAS score (odds ratio = 2.40, 95% confidence interval 1.09‐5.26). Conclusions: About one in eight rural older adults have high dental anxiety, which is associated with poor oral health outcomes. Identifying new approaches to measure dental anxiety among a population with limited interaction with dental care providers is needed.     

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.