Dental beliefs: evaluation of the Swedish version of the revised Dental Beliefs Survey in different patient groups and in a non-clinical student sample

The aim of this study was to evaluate and to test the psychometric properties of a Swedish version of the revised Dental Beliefs Survey (DBS-R) in different patient groups and in a non-clinical sample of students. It was hypothesized that negative dental beliefs, assessed using the DBS-R, would discriminate between fearful and non-fearful study groups. The questionnaire was distributed together with the Dental Anxiety Scale (DAS). The sample included 550 adults who responded to the questionnaires (206 students, 177 general dental patients, 105 periodontal patients and 62 patients at a waiting list for dental-fear treatment). The internal drop-out rate was low. The results confirmed that the DBS-R discriminates well between fearful patients and the other study groups. The DBS-R had a high internal consistency in all the study groups. Furthermore, the DBS-R correlated significantly with age (higher values in younger age groups) and the DAS. Regression analyses showed that the DBS-R subdimensions of 'communication' and 'control'/or 'trust', respectively, were significant predictors for dental fear. The results suggest that the DBS-R is a reliable and valid instrument for use in different Swedish patient- and non-clinical population groups in order to assess attitudes to dentists. However, the underlying factor structure of the DBS-R needs to be further explored and established.     

Dental beliefs, patients' specific attitudes towards dentists and dental hygienists: a comparative study

Abstract:  Interpersonal relationships are important for communication, oral health education and patients' satisfaction with dental care. To assess patients' attitudes towards dental caregivers, a Swedish version of the revised Dental Belief Survey (DBS-R) and a comparable and partly new instrument the Dental Hygienist Belief Survey (DHBS) have been evaluated. The aim of the present study was to investigate if patients' attitudes towards dental hygienists (DH) and dentists (D) differ with regard to the separate items in DBS-R and DHBS. The study was a comparative cross-sectional study with 364 patients (students, general patients and patients with periodontal disease). All patients completed the DBS-R and DHBS surveys. The overall pattern in the results showed that participants in general had a less negative attitude towards DH when compared with that towards D. This was most pronounced among students and least pronounced among patients with periodontal disease. No statistically significant difference could be found in items with regard to feelings of shame and guilt in dental care situations, indicating that these items were rated on a more negative level also for DH. The conclusion is that participants had a less negative attitude towards DH with the exception of situations which may give rise to feelings of shame and guilt, an important finding for future dental hygiene care.     

Evaluation of the Dental Hygienist Beliefs Survey; test-retest assessment in a group of general dental patients

To cite this article: Int J Dent Hygiene 10 , 2012; 30–35
DOI: 10.1111/j.1601‐5037.2011.00521.x
Abrahamsson KH, Andersson P, Krok L, Hakeberg M. Evaluation of the Dental Hygienist Beliefs Survey; test–retest assessment in a group of general dental patients. Abstract: Objective: To evaluate the Dental Hygienist Beliefs Survey (DHBS) and the test–retest reliability of DHBS in a group of general dental patients. Material and methods: The DHBS, which is a questionnaire constructed to assess patients’ specific attitudes towards dental hygienists (DHs), was distributed together with the Dental Anxiety Scale adapted to specifically assess fear of DH treatment (DHAS). It was hypothesized that DHBS would correlate with DHAS and gender. The questionnaires were consecutively distributed to 80 patients at their first visit and after a clinical examination performed by a DH student. Retest assessments of DHBS were conducted approximately two weeks later in conjunction with the next visit at the DH student and before treatment (scaling session). The final study sample included 77 adult general dental patients in treatment at an education clinic for DH students. Results: The results verified a statistically significant correlation between DHBS and DHAS. The DHBS sum of scores showed high internal consistency with Cronbach’s a coefficient of 0.88 and 0.91 at the first and second assessments, respectively, and the test–retest reliability of the DHBS was acceptable with intraclass correlation coefficient of 0.76. No statistically significant association was found between DHBS and gender. Conclusion: The results suggest that the DHBS is a reliable and stable scale to use to assess patients’ specific attitudes towards DHs. Moreover, DH beliefs are associated with fear of DH treatment.     

Revised dental beliefs survey: reliability and validity of a 22-item modified Turkish version

Summary  The aim of this study is to create a Turkish version of the Revised Dental Beliefs Survey (DBS-R) and describe its psychometric properties. The participants were 420 general dental patients. The results of the exploratory factor analysis revealed that the DBS-R consisted of three factors consisting of 22 items. Confirmatory factor analysis results showed that the 22-item three-factor version fit the data better than the original 28-item English language four-factor structure model proposed in Odontol Scand (2004;62:21). The internal reliability of the Turkish version of the DBS-R was Cronbach alpha of 0·88. The correlation between the Turkish version of the DBS-R and the Modified Dental Anxiety Scale (MDAS) was 0·29. Scores on the 22-item version were higher for anxious participants (MDAS ≥ 15) than those determined to be not anxious [59·4 ± 15·5 vs. 51·1 ± 17·2 ( t  = −4·38, P  <   0·0001)]. In conclusion, a 22-item modified version of the DBS-R in Turkish appears reliable and valid.     

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%.     

Dental fear and pain: effect on patient''s perception of the dentist

A questionnaire was developed including the Dental Anxiety Scale (DAS) and the Dental Beliefs Survey (DBS) as subscales to examine the epidemiology of dental fear and dental beliefs in Germany. The survey was administered before treatment to a sample of 474 dental patients. Of the respondents 56% were female. The mean age was 34.3 yr (SD 12.4 yr). The mean DAS score was 8.6 (SD 3.7). Mean DBS score ranged from 1.73 to 2.75 for single items. The correlation between DAS and DBS scores was highly significant (rs = 0.39, P less than 0.001). Absence or presence of dental pain revealed significant differences for DAS and DBS scores (P less than 0.001). Both tests are valid screening forms for the German linguistic context and easy to implement in daily dental routine.     

Psychometric measures of dental fear

Abstract Four psychometric scales: Corah Dental Anxiety Scale (CDAS), a modified version of the Geer Fear Scale (GFS), the Health Locus of Control Scale (HLCS), and a Mood Adjective Check List (MACL), were studied with regard to their implications for dental fear. Swedish versions given to groups of fearful and non-fearful dental patients as well as non-patients showed satisfactory metric properties. Mean scores obtained were in most cases similar to those reported for original American versions, even though some indications of cultural differences were observed. The scales seem to reflect important aspects of dental fear, and they represent a valuable methodology in research on etiology and treatment of dental fear.     

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.     

Factor structure of the Dental Beliefs Survey in a dental phobic population

The aim of this study was to investigate the factor structure of the 15-item Dental Beliefs Survey (DBS) in a population of dental phobic patients (n=362). Exploratory (EFA) and confirmatory (CFA) factor analyses were used. The EFA indicated three factors: 'communication', 'trust', and 'fear of negative information'. However, the EFA further suggested a general factor with all 15 items. By using the CFA, five factors were found based on the EFA solution and the original DBS dimensions. A general factor, 'social interaction distress in dental treatment', and four more narrow dimensions, 'communication', 'trust', 'fear of negative information' (originally labelled 'belittlement'), and 'lack of control', was the most adequate result with regard to theoretical and statistical properties. However, some items in the factors were partly different from the original version of the DBS. In conclusion, the DBS attempts to measure a complex phenomenon with regard to patients' perceptions and attitudes to dental care. This study has revealed psychometric properties of the DBS in a population of dental phobic patients. The important finding was a general dimension, which suggests the use of DBS as an overall measure of dental beliefs. However, more research is needed in epidemiological and clinical studies with non-phobic individuals.     

Self-reported dental coping strategies among fearful adult patients: preliminary enquiry explorations

This investigation explored strategies to cope with dental treatment used by fearful adult patients undergoing regular dental care and those with phobic avoidance. A newly constructed 20-item questionnaire entitled The Dental Coping Strategy Questionnaire (DCSQ-20) was distributed consecutively to 171 individuals with self- and dentist-reported high dental fear, of whom 77 had dental phobic avoidance and were attending a dental fear clinic and 94 were undergoing regular care at one of three different public dental clinics. The level of dental fear was high in both groups, but significantly higher among avoidant individuals. Several of the DCSQ-20 items showed statistically significant differences between groups. Factor analysis of the DCSQ-20 yielded a four-factor solution explaining 52% of the total variance. The factors were labelled (i) 'self-efficacy statements', (ii) 'self distraction and distancing', (iii) 'catastrophizing', and (iv) 'praying and despair'. The DCSQ-20 displayed sound psychometric properties, and the reliability (Cronbach's alpha) for the factors was between 0.68-0.78. Factors (iii) and (iv) correlated significantly with dental anxiety and were rated significantly higher among individuals with phobic avoidance. In a logistic regression analysis, gender, dental anxiety, and three of the four factors (i, iii, iv) were predictive of regularity vs. phobic avoidance of dental care.     

Assessment of dental fear. A comparison of two psychometric instruments.

To analyze further dental fear and its presentation in dental patients, two psychometric instruments were distributed among 50 patients attending a dental emergency clinic (EMC) and 44 patients applying for treatment at a specialized dental fear clinic (FEC). The Dental Fear Survey (DFS) was compared with the Corah Dental Anxiety Scale (DAS). After separating the EMC patients into high- and low-fear individuals in accordance with DAS scores, analysis showed that DFS values also clearly distinguished between these groups and between the FEC group and EMC groups. The dental fear levels were in correspondence with previous results, and the correlation between the DAS and the DFS was high (r = 0.92). In contrast to the DFS avoidance and arousal dimensions, the difference between the mean item scores on the dental situation dimension was not significantly different between high-fear EMC and FEC individuals. This indicated that the evaluation and appraisal of the dental situation among high-fear EMC and FEC patients may have been corresponding, whereas the behavioral and physiologic effects were different. Thus, in spite of this similar appraisal of the dental situation, FEC patients were interpreted as showing a more phobic behavior, and this was better captured in the DFS than in the DAS.     

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.     

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.     

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.     

Oral-health-related quality of life among children with and without dental fear

Objectives.  This study aims to determine whether the oral-health-related quality of life (ORHQoL) and its dimensions differed among children with and without dental fear when different characteristics of fear were measured.
Material and methods.  The participants were 11- to 14-year-old Finnish child volunteers from the Oulu University Hospital cleft lip and/or palate (CLP) treatment register ( n  = 51) and schoolchildren ( n  = 82). Dental fear was measured with 'Treatment of dental decay' and 'Attending dentist' dimensions of the modified Children's Fear Survey Schedule–Dental Subscale and a single question. ORHQoL was measured with CPQ_11–14. Background variables were gender and the dental care experienced.
Results.  The response rates were 87% and 51% in the schoolchildren's and CLP groups, respectively. Those who were afraid of 'Treatment of dental decay' had higher mean CPQ_11–14 total scores (33.2) and higher scores for social (8.8) and emotional well-being (9.0) than those who were not fearful (24.0, 6.2, and 5.8, respectively, P  < 0.05), indicating poorer ORHQoL. Among those with experience of orthodontics, the association between dental fear and social and emotional well-being was weaker than among those with no experience of orthodontics.
Conclusion.  Dental fear may have a negative effect on a child's ORHQoL, especially on social and emotional well-being. Positive minor treatment experiences might weaken this effect.     

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.     

Childhood dental fear in the Netherlands: prevalence and normative data

OBJECTIVE: This study aimed to present normative data on dental fear for the Dutch child population, by identifying not only highly fearful children but also children at risk for developing this high dental fear. METHODS: Fear distribution of samples of high and low fearful children was studied, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Total fear scores were calculated for both samples, for different age levels and for boys and girls separately. To establish cut-off scores, mean CFSS-DS scores were associated with dentists' clinical fear ratings and, in addition, were transformed into stanines. RESULTS: Scores between 32 and 38 were found to represent a borderline area for dental fear, and scores of 39 and higher to represent high dental fear. CONCLUSION: The results have shown 6% of the Dutch child population to be highly fearful, while another 8% may be at risk to develop high dental fear. By providing extra attention for these children, the development of high dental fear or phobia may be prevented.     

Factors related to satisfaction with dental care among 23-year olds in Norway

OBJECTIVES: The aims of the present study were to explore (i) the prevalence and distribution of satisfaction with dental care among 23-year olds in Norway; and (ii) possible factors associated with the same variable. METHODS: A random sample of adolescents (n=968) surveyed at age 18 were resurveyed by post at the age of 23. The questionnaire included the psychometric instruments Dental Satisfaction Questionnaire (DSQ), Dental Fear Survey (DFS), Dental Beliefs Survey (DBS), and the (WHO) Five Scale Psychological General Well-Being Schedule. RESULTS: The response rate was 69%. Of this group, 15% of the subjects were very satisfied, and another 15% were very dissatisfied with dental care. The following variables explained 58% of the variance of satisfaction with dental care at age 23: positive beliefs of the dentist (DBS), low dental anxiety, perception of having a dentist to go to, last treatment session not painful/unpleasant, and gender (male). Being very satisfied with dental care was associated with high DMFT at age 16 and few previous experiences of pain. Being very dissatisfied at age 23 was associated with low general well-being, previous experiences of pain and dislike of the dentist (both reported at age 18). Last dental treatment session was reported as very painful or unpleasant by 6.7% of the group. CONCLUSIONS: Beliefs of the dentist and pain control seems to be important aspects in young adults' evaluation of dental care.     

Psychometric properties of the Revised Dental Beliefs Survey

OBJECTIVES: The objectives of this pair of studies were to examine the internal reliability, test-retest reliability, and construct validity of the Revised Dental Beliefs Survey. METHODS: A total of 108 college students completed two questionnaires containing the Revised Dental Beliefs Survey, as well as the Revised Iowa Dental Control Index, and Desirability of Control scales. As part of another experiment, 141 study participants with dental injection phobia completed the Revised Dental Beliefs Survey and the Dental Anxiety Scale. RESULTS: Both the internal and test-retest reliabilities of the Revised Dental Beliefs Survey were high. The measure demonstrated good convergent and discriminant validities. CONCLUSION: The Revised Dental Beliefs Survey is well-suited for use with clinical and nonclinical populations, in which a stable and valid measure of perceptions of the dental situation is desired.